Chapter 16

Report
Abnormal Psychology, Twelfth Edition
by
Ann M. Kring,
Sheri L. Johnson,
Gerald C. Davison,
& John M. Neale
© 2012 John Wiley & Sons, Inc. All rights reserved.
1
 Chapter
16: Legal and Ethical Issues
I. Criminal Commitment
II. Toward Greater Protection of the Rights of
People with Mental Illness
III. Ethical Dilemmas in Therapy and Research
Copyright © 2012 John Wiley & Sons, Inc. All rights reserved.
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 People
with mental illness who are alleged to
have broken the law are subject to criminal
commitment
• A procedure that confines a person to a mental hospital
either for:
 Determination of competency
 After acquittal by reason of insanity
 mens rea
• Guilty mind
 “No crime without an evil intent”
 Concept of insanity
• A disordered mind can’t be a guilty mind
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 Insanity a legal term
• Not a psychiatric or psychological concept
 Based on mental state of the accused
time the crime was committed
 Insanity defense
at the
• Defendant not responsible for an illegal act if it is
attributable to mental illness or not knowing right
from wrong
• Pleaded in fewer than 1% of cases
• Rarely successful
 Requires
judgments by lawyers, judges,
jurors, and clinicians
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 Irresistible
impulse (1834)
 The M’Naghten rule (1843)
 American Law Institute Guidelines (1962)
 Insanity Defense Reform Act (mid-1980s)
 Guilty but mentally ill
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
Not guilty by reason of insanity (NGRI)
• No dispute over guilt
• Accused not responsible for the crime because of mental illness
• Indefinite commitment to a forensic hospital
 Only released when no longer mentally ill
• John Hinckley

Guilty but mentally ill (GBMI)
• Found guilty and responsible for the crime
• Mental illness plays a role in sentencing
 Can be committed for treatment until no longer mentally ill
 Then sent to prison to serve remainder of sentence
 Most are incarcerated and may or may not receive any psychiatric care
• Jeffrey Dahmer
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© 2012 John Wiley & Sons, Inc. All rights reserved.
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 Accused
must be able to participate in his or
her defense
• 1960 US Supreme Court decision
 “…ability to consult with his lawyer with reasonable
degree of rational understanding…”
 “…has a rational as well as a factual understanding of the
proceedings against him”
• Courts do not want a person to be brought to trial in
absentia
 Determination
of competency made before
individual is tried
• Prosecutor, judge, or defense attorney can raise issue
© 2012 John Wiley & Sons, Inc. All rights reserved.
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 Synthetic
sanity
• If medication can produce rationality, trial can be
held
 Even if discontinuation of the drug would again render
the defendant incompetent
 Forced
medication to restore competency
can be used only in very limited
circumstances
© 2012 John Wiley & Sons, Inc. All rights reserved.
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 US
Supreme Court
• Unconstitutional to execute individuals who are
insane or have an intellectual developmental
disorder
 Execution would constitute cruel and unusual
punishment
• However, definition of mental retardation varies
from state to state
© 2012 John Wiley & Sons, Inc. All rights reserved.
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 Parens Patriae: “Power of the state”
• Duty of government to limit freedoms for people’s protection
 An individual can be committed to a psychiatric
hospital against his wishes if
• Person is mentally ill, and
• Danger to self or others
 Commitment should end when person is no longer dangerous
 Formal
commitment
• Requires a court order
 Informal
emergency commitment
• Initially no court involvement is needed
 2PC: Two physician certificate
 Further detainment requires formal judicial commitment
© 2012 John Wiley & Sons, Inc. All rights reserved.
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 When
substance abuse is not a factor,
mentally ill are no more likely to commit
violent crimes than the average person
• Only 3% of violent crimes linked to mentally ill
• If violent, target is usually family or friends, not
strangers
• Stranger homicide by people with mental illness is
extremely rare
© 2012 John Wiley & Sons, Inc. All rights reserved.
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 Factors
that influence accuracy of violence
prediction:
• Repeated violent acts in the past
• Individual returns to same environment in which
past violent acts were committed and individual’s
personality has not changed
• Person is on the brink of committing a violent act
• Medication noncompliance
© 2012 John Wiley & Sons, Inc. All rights reserved.
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 Courts
try to balance patient rights and the
right of the public to be protected
 Supreme Court ruled that evidence for
commitment must be clear and convincing
 Danger must be imminent
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 Least restrictive alternative
• Required to be provided when treating mentally ill
 Right to treatment
• State required to provide treatment after civil
commitment
 Right to refuse treatment
• Unless person is a danger to self or others
© 2012 John Wiley & Sons, Inc. All rights reserved.
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 Deinstitutionalization
• In the 1960s, many states released patients from state
psychiatric hospitals; community treatment preferred
• Many cities lack sufficient community mental health
facilities
 Transinstitutionalization
• Many mentally ill end up in nursing homes, hospitals
and prisons
 Justice department survey found that 16.2% of prison population
is mentally ill
• Police officers increasingly called on to work with
mentally ill
 New laws provide funding for special training
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 Research
• Ethical restraints to avoid unnecessary harm, risk,
humiliation, and invasion of privacy to participants
• Institutional Review Board (IRB) approval necessary
• Researchers must receive training in research ethics
 Researchers
must ensure that mentally ill
participants understand risks of research before
participating
• Informed consent
 Sufficient information must be provided to allow an individual to
make an informed decision to participate
• Freedom to withdraw at any time for any reason
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 Therapy
• Confidentiality
• Privileged communication
 Patient “holds the privilege”
 Both
can be broken if:
• Patient has filed a malpractice suit against a therapist
• Patient is under age 16 and a crime or abuse victim
• Patient is trying to avoid arrest for a crime committed
or planned
• Patient is a danger to self or others
 Tarasoff decision
© 2012 John Wiley & Sons, Inc. All rights reserved.
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Copyright 2012 by John Wiley & Sons, Inc. All
rights reserved. No part of the material protected
by this copyright may be reproduced or utilized in
any form or by any means, electronic or
mechanical, including photocopying, recording
or by any information storage and retrieval
system, without written permission of the
copyright owner.
© 2012 John Wiley & Sons, Inc. All rights reserved.
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