Chapter 14 - Mental Health Services

Civil Commitment
Psychopathology: An • Civil commitment laws* (terms with an asterisk are key terms) detail
Integrative Approach, when a person can be legally declared to have a mental illness and be
placed in a hospital for treatment
9th Edition • Involves legal definition of mental illness
• Civil commitment laws in the United States date back to the late
Chapter 16: Mental Health 19th century
Services: Legal and Ethical • Laws vary by state
Issues
Barlow & Durand, Psychopathology: An Integrative Approach, 9th Edition. © 2023 Cengage. All Rights Reserved. May not be Barlow & Durand, Psychopathology: An Integrative Approach, 9th Edition. © 2023 Cengage. All Rights Reserved. May not be
scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 1 scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 2
Civil Commitment: Criteria, and Oversight The Civil Commitment Process

Authority
• General criteria • Initial stages
• Person has a mental illness* and needs treatment • Person fails to seek help
• Person is dangerous to self or others, or • Others feel that help is needed
• Person is gravely disabled • Petition is made to a judge on the behalf of the person
• Inability to care for self • Individual must be notified of the commitment process
• Governmental authority over civil commitment • Subsequent stages
• Police power – health, welfare, and safety of society • Involve normal legal proceedings in most cases
• Parens patriae – state acts a surrogate parent (a person receives • Determination is made by a judge
care to prevent them from being in danger) • Decision informed by expert opinions
Mental Illness as a Legal Concept Dangerousness to Self or Others
• Typically defined as severe emotional or thought disturbances that • Central to commitment proceedings
impact health and safety • Violence and mental illness
• Definitions vary by state • Misconception that people with mental illness are much more likely to be
dangerous – perpetuated by sensational media portrayals
• Often exclude: • Substance use disorder and recent victimization increase likelihood of
• Cognitive disability violence
• People with mental illness are more likely to be victims of violent crimes
• Substance-related disorders than those without
• Definition is not synonymous with having a psychological diagnosis • Assessment tools are best at identifying persons at low risk of being violent,
• Benefit: Flexibility not good at long term prediction
• Ultimately, professionals cannot predict whether any given individual will
• Disadvantage: Vulnerable to bias become violent
©2019 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 1
Breakout Group Activity Changes Affecting Civil Commitment
• Break into pairs or small groups of students. • Supreme Court has placed restrictions on involuntary commitment
• Psychologists and other mental health professionals are better at • A non-dangerous person cannot be involuntarily commitment
identifying who is at low probability of behaving violently than who is at • Consequences of Supreme Court rulings
high probability of behaving violently, especially when relying solely on • Criminalization of the mentally ill
clinical judgment. Even formal assessment tools have significant
• Deinstitutionalization*: Movement of people with mental illness out
psychometric problems, including discouragingly high rates of false
of institutions
positives and false negatives. The net result is that identifying
dangerousness is challenging. • Problem: Led large numbers of ill people to become homeless
• Suppose you were trying to develop a scale to predict who might be • Transinstitutionalization*: In practice, people with mental illness
dangerous. What would you include? Why? Remember to be specific. have been moved out of large mental hospitals to other institutions,
including prisons and nursing homes
• Discuss your
Barlow &thoughts in the
Durand, Psychopathology: group
An Integrative and
Approach, with
9th Edition. the
© 2023 class.
Cengage. All Rights Reserved. May not be Barlow & Durand, Psychopathology: An Integrative Approach, 9th Edition. © 2023 Cengage. All Rights Reserved. May not be
Discussion Activity 2 Criminal Commitment
In many jurisdictions, the largest facility housing mentally ill individuals • Nature of criminal commitment*
is a correctional facility – often a county or regional jail or a state prison.
• Accused of committing a crime
This is part of the problem on the transinstitutionalization of the
mentally ill. • Detained in mental health facility
• Review The AVID (Amplifying Voices of Inmates with Disabilities) Jail • Evaluation determines fitness to stand trial
Project’s documentary “Inmates with Mental Illness Tell Their Stories”
on the Rooted in Rights channel on YouTube. • Can be found guilty, not guilty, or not guilty by reason of insanity
• What kinds of stories do the people tell about their experiences? Have
they received appropriate treatment? Any treatment? How are they
treated by other inmates? By corrections staff? By medical staff?
• How do you think these issues should be addressed?
The Insanity Defense Discussion Activity 3
• Nature of the insanity defense plea Although the underlying principals are similar, mental health laws,
• Accused not guilty because of insanity at time of crime including the laws covering civil commitment, vary greatly from state to
state in the United States.
• Diagnosis of a disorder is not the same as insanity
• Get a copy of the laws regarding the insanity defense in your state.
• Frequently portrayed in popular media but actually very rare
• Review the laws for your state.
• Definitions of insanity
• M’Naghten rule: Inability to distinguish right from wrong • Is the insanity defense even possible in your state?
• Durham rule: Crime was the product of a mental illness • What standards are used? In which of the historical approaches are
they rooted?
• American Law Institute standard: Knowledge of right vs. wrong; self-
control; diminished capacity* • How could the laws be improved?
Facts about the Insanity Defense Poll Activity
• Public outrage • What percentage of felony indictments result in an insanity plea?

• After John Hinckley Jr. found not guilty by reason of insanity, 75% of
states moved to abolish or change the insanity defense • What percentage of insanity pleas result in an acquittal?
• Public views insanity defense as a legal loophole • What percentage of insanity acquittees are sent to a mental hospital?
• Facts about the insanity defense
• Used in less than 1% of criminal cases • What percentage of insanity acquittees are freed?
• Spend more time in mental hospitals than in jail
• Changes regarding the insanity defense
• Insanity defense reform act
• Guilty but mentally ill (GBMI)
• Allows for treatment and punishment
Poll Activity Debrief Therapeutic Jurisprudence
• Overview
ITEM PUBLIC PERCEPTION ACTUAL OCCURRENCE
What percentage of felony indictments 37.0% 0.9% • Using knowledge of behavior change to help those in trouble with
result in an insanity plea? the law
What percentage of insanity pleas result in 44.0% 26.0%
an acquittal? • “Problem solving” courts
What percentage of insanity acquittees are 50.6% 84.7% • Address unique needs of people with specific problems
sent to a mental hospital?
• Examples include drug treatment courts, domestic violence courts,
What percentage of insanity acquittees are 25.6% 15.3%
freed? and mental health courts
Determination of Competence to Stand Duty to Warn

Trial
• Requirements for competence* • Tarasoff v. Regents of the University of California
• Understanding of legal charges • Must warn individual in danger
• Ability to assist in one’s own defense • Thompson v. County of Alameda
• Essential for trial or legal processes • Threats must be specific
• Burden of proof is on the defense • When in doubt, consult with colleague
• Consequences of a determination of incompetence
• Loss of decision-making authority
• Results in commitment, but with limitations
Mental Health Professionals as Expert Patients’ Rights: An Overview
Witnesses
• Psychologists’ role as expert witness* • The right to treatment
• Person with specialized knowledge and expertise • Cannot be involuntarily committed without treatment
• Assist in competency determinations • Treatment – reduce symptoms and humane care
• Assist in making reliable DSM diagnoses • The right to the least restrictive alternative
• Treatment within the least confining and limiting setting
• Advise the court regarding psychological assessment and diagnosis.
• The right to refuse treatment
• Assess malingering (i.e., faking symptoms)
• Often in cases involving medical or drug treatment
• Persons cannot be forced to become competent for trial (e.g., by
taking medications)
Research Participant Rights: An Overview Evidence-Based and Clinical Practice

Guidelines and Standards
• The right to be informed about the research • Increased cost of health care leads governments to study effectiveness of
treatment
• Involves informed consent, not simply consent alone • Past 15 years—Evidence Based Practice (EBP) formally identified as systematic
• The right to privacy method of delivering clinical care
• Agency for Healthcare Research and Quality
• Right to be treated with respect and dignity • Efficient and cost-effective mental health services
• Right to be protected from physical and mental harm • Dissemination of relevant state-of-the-art information
• Clinical efficacy axis* involves thorough consideration of scientific
• Right to choose or to refuse to participate in research evidence to determine whether intervention is effective compared to
• Right to anonymity in report of study findings alternative treatment
• Clinical utility axis* is concerned with the effectiveness of the intervention
• Right to safeguarding of records in the practice setting

Chapter 14 - Mental Health Services

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Chapter 14 - Mental Health Services

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Civil Commitment

Civil Commitment: Criteria, and Oversight The Civil Commitment Process

Mental Illness as a Legal Concept Dangerousness to Self or Others

Discussion Activity 2 Criminal Commitment

The Insanity Defense Discussion Activity 3

• Public outrage • What percentage of felony indictments result in an insanity plea?

Poll Activity Debrief Therapeutic Jurisprudence

Determination of Competence to Stand Duty to Warn

Research Participant Rights: An Overview Evidence-Based and Clinical Practice

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