Legal & Ethical Issues in Psychopathology

1. Legal & Ethical Issues in Psychopathology

2. Legal Issues: Civil Commitment Criminal Commitment Duty to Warn Ethical Issues (in Treatment): Confidentiality Competence Dual Relationships Current Legal/Ethical Issues

3. Legal Issues

4. Legal Issues • Rights of patients vs. rights of public • Few laws govern therapy • Required to be competent • To have a license • Can use collection agencies if clients fail to pay • Several unique legal issues with therapy • Complex questions • Burden therapist, state, others

5. Civil Commitment • Most hospitalizations are voluntary • Voluntary is in best interest b/c can check out • In some cases, patients are involuntarily hospitalized • Danger to oneself (suicidality) • Danger to others (homocidality) • Majority of commitments are male schizophrenics

6. Civil Commitment • Judge hears case & decides • Hearing is requested by police, mental health provider • Civil commitment must legally be lifted when patient is no longer dangerous • Requirements protect patients - historically, anyone could have someone committed • But, goals are re: danger, not helping

7. The Right to Treatment • Established 1972 by Wyatt v. Stickney • Rationale for commitment = treatment • Thus, if hospital is unwilling or unable to provide, patient can petition for commitment overruled • Why suspend a patient’s rights unless there is a benefit? • First attempt to have minimum criteria for mental health treatment

8. The Right to Treatment • Staffing levels, # of bathrooms, size of facility, variables that impact quality of life • Rulings required states to provide facilities that met minimal requirements • State provides most treatment for the severely and chronically mentally ill

9. The Insanity Defense • Based up on premise that people cannot be held responsible for crimes if they were unaware of the nature of their actions or were unable to control their actions • We have free will to commit or not commit crime • Legal insanity is a very narrow definition • Psychological insanity: products of antecedents (a disorder is not something we choose)

10. Insanity Defense Reform Act (1984) • Made it more difficult to prove insanity • Unable to appreciate wrongfulness as result of severe mental illness • Defense now has burden of proof • Previously, prosecution had to prove sanity • Reduced advantages of pleading insanity • Fixed minimum periods of incarceration • Eliminated automatic release following reduction of danger

11. Guilty But Mentally Ill • Individual will be incarcerated, but acknowledges presence of mental illness • Suggests that treatment is needed during incarceration

12. Public Opinions of Insanity Pleas • 90% of the public believes that: • The insanity defense is used too much • Lots of guilty people get to go free • Public estimates of how many felony cases involve insanity pleas: 33% • Actual number: <1% • Public estimates of success: 50% • Actual number: 25%

13. Public Opinions of Insanity Pleas • Public estimate of how many “insane” people are released: 50% • Actual number: 15% (minor offenses that do not result in incarceration anyway) • Public also tends to believe successful insanity pleas = short time in hospital • They actually spend 50% longer in hospital then they would have in prison if guilty

14. Competency to Stand Trial • Is the person capable of understanding the charges and helping attorney to prepare the case? • This is independent from sanity at the time of crime • Trial is postponed; defendant is held for treatment • Protects public from possible danger

15. The Right to Refuse Treatment • Can usually refuse treatment if desired • Unless refusal is based on psychosis or delusions • Before all commitments, independent evaluation is required (not connected to the hospital)

16. Therapist’s Duty to Warn • Tarasoff v. Regents of the U. of CA (1974, 1976) • Therapists have a legal responsibility to warn potential victims when they may be at risk from a client • 1969 Tatiana Tarasoff is murdered by a grad student who suggested, in therapy, that he was going to kill her • Therapist informed police, who told grad student they were aware of his threats • Grad student assured police he had no intentions of murder

17. Therapist’s Duty to Warn • Therapists are required to warn/protect potential victims • By telling the police • By committing the client • By informing the potential victim • Involves breaking a client’s confidentiality

18. Ethical Issues

19. Ethical Issues in Treatment • Competence • Integrity • Professional & Scientific Responsibility • Respect for People’s Rights & Dignity • Concern for Others’ Welfare • Social Responsibility

20. Confidentiality • Therapy is a protected relationship - information is not shared without explicit permission • Exceptions: • Knowledge of child abuse • Threats to others (Tarasoff) • Threat to self • Can consult with other therapists openly

21. Competence • Maintain the highest standards of competence • Recognize & respect the limits of competence • Provide only those services we are qualified to provide • Competence is a combination of: education, training, experience

22. Competence • E.g. Conducting a neuropsyc assessment without training • Be familiar with culture, gender, other differences & how those differences will effect one’s work • Remain current in the field on research and professional information

23. Record Keeping • Maintain records of client contact to facilitate & document treatment • Provide a basis for decisions • Covers the therapist in case of legal action • E.g. decisions regarding suicidality • Records are often requested by insurance companies to determine if more services are needed

24. Who is the Client? (Esp. Children) • Psychologists may work with more than one person • Especially with children, who have parents & teachers, and other providers • Ethics do not offer a clear line in this case • Avoid multiple roles • Clarify roles if they are ambiguous • Often ask parents for child’s confidentiality

25. What if No Treatment Exists? • Experimentation is required to further the field • Clients should be informed of experimentation • Clients also should be informed of other options that are established • Often try experimental tx if an EST has been tried and failed (in clinical work) • Design based on available science

26. Dual Relationships • When therapist/client relationship exists at the same time as another • E.g. friend/friend or boss/employee • Should therapists treat their friends? • Should therapists treat/listen to their students?

27. Some Practical Issues - Science vs. Pseudoscience

28. The Widening Gap • Between academic psychology & popular psychology • Between research and general public knowledge

29. Characteristics of Pseudoscience • Overuse of ad hoc hypotheses to escape refutation • Emphasis on confirmation, not refutation • Absence of self-correction • Reversed burden of proof • Overreliance on anecdotal evidence • Use of obscurantist language • Absence of “connectivity” with other disciplines

30. Pseudoscience in Psychopathology • Explosion of unvalidated tx for trauma • Use of demonstrably ineffective tx for autism • Continued use of inadequate assessments • Widespread use of herbal tx w/o testing • Subliminal self-help tapes • Explosion of self-help books and programs • Suggestive techniques for memory recovery

31. Why Should We Care? • Why should we monitor the general public? Can’t they use whatever they want to buy? • Techniques may be harmful to the public • Consumers waste time & $ they could use in therapy • Damage to our reputation & integrity • Our ethical guidelines of social responsibility

32. What Should Psychologists Do? • Actively study & “debunk” pseudoscience • Evaluate self-help materials • Standardize training programs • Popularize our findings & methods to the general public, convey our scientific excitement to outsiders & show the successful applications of it • The general public is often unaware of what is proven, and what is not