Chapter Sixteen

1. Chapter Sixteen Law and Ethics in Abnormal Psychology

2. Law and Ethics in Abnormal Psychology • Psychologists: • Play a role in determining defendants’ state of mind in criminal actions • Participate in legal decisions and legal actions • Offer expert opinions on child custody, organic brain functioning, traumatic injury, suicide, deprogramming activities • American Psychological Association taken role of amicus curiae (friend of the court)

3. Criminal Commitment • Incarceration of an individual for having committed a crime • Criminal law recognizes that some people lack the ability to discern the ramifications of their actions because they are mentally disturbed • Although they may be guilty of a crime, their mental state at the time of the offense exempts them from legal responsibility

4. Criminal Commitment (cont’d.) Figure 16-1 Legal Standards That Address the Mental State of Defendant

5. The Insanity Defense • Legal argument used by defendants who admit they committed a crime but plead not guilty because they were mentally disturbed at the time of the crime • “Faking it?” • Most defendant who plead NGRI have long history of mental illness • Those who fake it are seldom successful

6. Insanity Defense: Legal Precedents • M’Naghten Rule (the “right-wrong test”): • A person can be acquitted of a crime if at the time of the act : • The defendant had such defective reasoning that they did not know what they were doing (nature of the act) • The defendant was unable to comprehend that the act was wrong (quality of the act) • Criticism: • Exclusively cognitive test - does not consider volition, emotion, or other mental activity.

7. Insanity Defense: Legal Precedents (cont’d.) • Irresistible impulse test: • Defendant is not criminally responsible if he or she lacked the will power to control his or her behavior • Criticism: • What constitutes irresistible impulse as opposed to an unresisted impulse? • Durham standard (the products test): • Accused is not responsible if the unlawful act was the product of mental disease or defect • broadened the M'Naghten rule with the so-called products test • Criticism: Almost anything can cause anything

8. Insanity Defense: Legal Precedents (cont’d.) • American Law Institute (ALI) model penal code: • Mental disease or defect impairs capacity to appreciate the criminality of conduct or to conform the conduct to the requirements of law • “Mental disease or defect” does not include abnormality manifested by repeated criminal or otherwise antisocial conduct

9. Insanity Defense: Legal Precedents (cont’d.) • Some jurisdictions incorporate “diminished capacity” into ALI standard: • As a result of mental disease or defect, a person may lack specific intent to commit offense • Although diminished capacity has been used primarily to guide the sentencing and disposition of the defendant, it is now introduced in the trial phase as well.

10. Insanity Defense: Legal Precedents (cont’d.) • Insanity Defense Reform Act of 1984 based the definition of insanity totally on the individual's ability to understand what he or she did. • Resulted from outcry following John Hinckley, Jr.’s John Hinckley, Jr. (center), was charged with the attempted murder of President Ronald Reagan. The Hinckley verdict also led to alternative pleas such as: • Guilty, but mentally ill: • Attempt to separate mental illness from insanity and to hold people responsible for their acts • Jurors may convict individuals and hold them responsible for their crimes, but also ensure they are treated for their mental illness

11. Competency to Stand Trial • Defendant has a factual and rational understanding of the proceedings and can rationally consult with counsel in presenting his or her own defense • Refers to defendant’s mental state at time of psychiatric examination • Jackson v. Indiana • Due Process: legal checks and balances guaranteed to everyone

12. Civil Commitment • Parens patriae: • The government has the authority to commit disturbed persons for their own best interest • Civil commitment: • Involuntary confinement of a person judged to be a danger to self or others, even though the person has not committed a crime • May be viewed as protective confinement

13. Civil Commitment (cont’d.) • Potentially negative consequences: • Lifelong social stigma, major interruption and loss of control of one’s life, being dependent on others, loss of self-esteem and self concept • Possible loss or restriction of civil liberties

14. Civil Commitment (cont’d.) Figure 16-2 Factors in the Civil Commitment of a Nonconsenting Person

15. Criteria for Commitment • Criteria: • Clear and imminent danger to self or others • Inability to care for oneself or lack of social network to provide such care • Most civil commitments are based primarily on this criterion. • Inability to make responsible decisions about appropriate treatment or hospitalization • Unmanageable state of fright or panic • Dangerousness: • Potential to harm oneself or others

16. Criteria for Commitment (cont’d.) • Increasingly, the courts have tightened up civil commitment procedures and have begun to rely more on a determination of whether the person presents a danger to the self or others. • Assessing dangerousness: • The rarer something is, the more difficult it is to predict • Violence seems to be a function of both context and a person’s characteristics • The best predictor of dangerousness is probably past criminal conduct or a history of violence or aggression. Such a record, however, is often ruled irrelevant or inadmissible. • The definition of dangerousness is unclear

17. Procedures in Civil Commitment • Rationale for instituting procedures: • Prevents harm to person or others • Provides appropriate treatment and care • Ensures due process of law • In most cases individual is persuaded to agree to voluntary commitment • Involuntary commitment is used when the individual does not consent to hospitalization

18. Procedures in Civil Commitment (cont’d.) • Formal civil commitment: • The court is petitioned to examine the person • Judge appoints two professionals to examine the person • In a formal hearing, the examiners and others testify about the person’s mental state and potential dangerousness • If treatment is recommended, finite period of time must be determined • 6 months to 1 year are common. Some states, however, have indefinite durations subject to periodic review and assessment.

19. Procedures in Civil Commitment (cont’d.) • Protection against involuntary commitment • A mentally ill person may be confined without a jury trial and without having committed a crime, based on what might happen • Treatment or punishment? • incarceration—both criminal and civil—cannot occur on the basis of potential danger alone • Opponents argue: • Civil commitment is for the benefit of those initiating commitment, not for the individual

20. Serial Killers • Compulsion to kill has been associated with “morbid prognostic signs”: • breaking and entering for nonmonetary purposes • unprovoked assaults and mistreatment of women • a fetish for female undergarments and destruction of them • hatred, contempt, or fear of women • violence against animals, especially cats • sexual identity confusion • a “violent and primitive fantasy life and • sexual inhibitions and preoccupation with rigid standards of morality

21. Rights of Mental Patients • Some courts have ruled that commitment for any purpose constitutes a major deprivation of liberty that requires due process protection • Dixon v. Weinberger (1975) • Least restrictive environment: • Right to least restrictive alternative to freedom that is appropriate to a person’s condition

22. Right to Treatment • Mental patients who are involuntarily committed have a right to receive therapy that would improve their emotional state • Rouse v. Cameron (1966) • Right to treatment is constitutional right; failure to provide treatment not justified by lack of resources • O’Connor v. Donaldson (1975) • State cannot constitutionally confine nondangerous person who can care for self • Wyatt v. Stickney (1972) • specified staff–patient ratios, therapeutic environmental conditions, and professional consensus about appropriate treatment. • The court also made it clear that mental patients could not be forced to work

23. Right to Refuse Treatment • Many forms of treatment may have long-term side effects and forced treatment may nullify potentially beneficial effects • Sell v. United States: • Strict limits on ability of government to forcibly medicate mentally ill defendants to make the competent to stand trial • Such actions must be in “Best interest of defendant” • Least intrusive forms of treatment • May involve mainstreaming

24. Deinstitutionalization • Shift responsibility for care of mental patients from large central institutions to agencies within local communities: • Large institutions mainly provided mainly custodial care • Patient rights and mainstreaming (integrating mental patients as soon as possible back into the community) • Insufficient funds for state hospitals • It appears that millions of mentally ill individuals have become homeless

25. Deinstitutionalization (cont’d.) • Critics: • States have relinquished responsibility • Mentally ill are not receiving treatment • Low quality care in residences, and many are homeless • Community’s lack of preparation and resources to care for mentally ill

26. Deinstitutionalization (cont’d.) • Solution: • Probably provisions for more and better community-based treatment facilities and alternatives • Programs providing permanent housing, special care, and concerned community treatment can reduce homelessness and improve well-being • Few of these programs

27. The Therapist-Client Relationship • Confidentiality: • Ethical standard (obligation of therapist) that protects clients from disclosure of information without their consent • Privileged communication: • Therapist’s legal obligation to protect a client’s privacy and to prevent the disclosure of confidential communications without a client’s permission • Client is the holder of the privilege

28. The Therapist-Client Relationship (cont’d.) • Privileged communication exemptions: • Civil or criminal commitment or competency to stand trial • Mental condition is introduced as a claim or defense in a civil action • Client is younger than 16 or is a dependent elderly person who was the victim of a crime • Client presents danger to self or others

29. The Duty to Warn • Based on Tarasoff v. University of California Regents 1976): • Obligates mental health professionals to break confidentiality when clients pose clear and imminent danger to other person • Must warn intended victim • protective privilege ends where public peril begins.

30. The Duty to Warn (cont’d.) • Therapists may be liable when they: • Fail to diagnose/predict dangerousness • Fail to warn potential victims • Fail to commit dangerous individuals • Prematurely discharge dangerous clients from a hospital

31. The Duty to Warn (cont’d.) • Criticisms of duty to warn principle: • Therapist becomes double agent • Therapist have ethical and legal obligation to their clients, but also have legal obligation to society • Hostile clients are less likely to act out or become violent when they vent their thoughts

32. The Duty to Warn (cont’d.) • Past crimes and the requirement to inform: • Law is unclear • Prevailing consensus is that mental health professionals are not legally mandated to breach confidentiality in these cases

33. The Duty to Warn (cont’d.) • The “family educational rights and privacy act” prevents colleges and universities from disclosing personal information about students, even to their parents • Colleges treat students as adults, so telling parents would infantilize students • Students may be less inclined to share information if they knew rights were not confidential

34. Sexual Relationships with Clients • Professional malpractice lawsuit can be brought under certain conditions: • The plaintiff must have been involved in a professional therapeutic relationship • Negligent care of client • Demonstrable harm must have occurred • Cause-effect relationship between the negligence and harm

35. Sexual Relationships with Clients (cont’d.) • Many reasons to separate therapist’s personal and professional lives: • Therapists need to be objective and removed from client to be therapeutic • Therapist in a relationship with client: • May be less confrontational • May fulfill his/her needs at the expense of the client • May exploit the client

36. Sexual Relationships with Clients (cont’d.) • Sexual misconduct is one of the most serious ethical violations • Is explicitly condemned and forbidden by American Psychological Association (APA) • 1 to 17 percent of professionals have had some form of sexual contact with their clients. • actual incidence may be much higher majority are between a male therapist and a female client • the reverse has also been reported, as have acts in which the therapist and patient are of the same sex

37. Cultural Competence and the Mental Health Profession • Prevailing concepts of mental health and mental disorders are culture-bound • Theories of therapy are based on values specific to middle-class, white, individualistic, ethnocentric population • Concerns that services offered to culturally different clients are frequently antagonistic or inappropriate to life experiences

38. Cultural Competence in Mental Health Profession (cont’d.) • APA ethical principles: • Need adequate training and expertise in multicultural psychology • “Guidelines on multicultural education, training, research, practice, and organizational change for psychologists:” • Service providers need to become aware of how own culture, life experiences, attitudes, values, and biases has influenced them • Importance of cultural and environmental factors in diagnosis and treatment

39. Cultural Competence in Mental Health Profession (cont’d.) • Cultural competence requires therapists to attain three goals: • To become aware of and deal with biases, stereotypes, and assumptions • To become aware of the culturally different client’s values and worldview • To develop appropriate intervention strategies that take into account the social, cultural, historical, and environmental influences on culturally different clients