Mental Health Services Lecture and textbook notes (ch. 16) which details legal and ethical issues, ethical treatment and clinical practice guidelines.

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16 Oct 2011

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Mental Health Services: Legal and Ethical Issues
2:31 PM
Ethical dilemmas faced: abuse, inadequate treatment, etc
Is a psychologist obligated to report assisted suicide, rape, murder, abuse etc?
Who is privy to information?
What about committing someone against their will?
Civil Commitment
Civil commitment laws: legal proceedings that determine a person has a mental disorder and may
be hospitalised, even involuntarily
o Each province and territory has its own civil commitment laws
Criteria for civil commitment
o Most provincial legislation permits commitment when the following three criteria have been
met: person has a mental disorder; person is dangerous to himself/herself or others; the
person is in need of treatment
o All Canadian jurisdictions require the second, but not all require the first and third
o Definition of mental illness differs across Canada
o Argued that more liberal definitions of dangerous are better for the patient, otherwise they
have to demonstrate being dangerous, likely resulting in legal issues
o Government justifies its right to act against the wishes of an individual under two types of
authority: police power and 'parens patriae' power (state as the parent).
Under police power: government takes responsibility for protecting public health, safety
and welfare
Provinces and territories apply second rationale in circumstances in which citizens are
not likely to act in their own best interest
o Person in need can always voluntarily request admission to a mental health facility; may be
accepted for treatment after evaluation
o Civil commitment process initiated when others feel treatment or protection is necessary for
an individual not voluntarily seeking help. Usually one or two physicians or psychiatrists must
conduct an assessment and agree that the person meets criteria for commitment
o Those deemed suitable for commitment have alternatives like compulsory community
Main goal is to prevent relapse and provide care.
Not permitted in Canada unless there has already been previous inpatient treatment
o Civil commitment process
o Person fails to seek help, but others feel that help is needed
o Petition is made to a judge on behalf of the person
o Individual in question must be notified of the civil commitment process
o Normal legal proceedings in most cases
o Determination is made by a judge regarding whether to commit the person
Defining Mental Illness
o Mental illness: term formerly used to mean psychological disorder but less preferred because
it implies that the cause of the disorder can be found in a medical disease process
o Definition differs by jurisdiction
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o Functional definition: specifies the effect of the illness on the patient's thoughts and
o Mental illness not synonymous with psychological disorder
o Dangerousness: tendency to violence that, contrary to popular opinion, is not more likely
among mental patients
o Link between violence and certain forms of mental illness, not all - specifically psychotic
o Symptoms of delusion and hallucination strongly related to risk for violence
o HCR-20: model for predicting violent behaviour
o Suicide Risk Assessment Scale validated to determine suicide risk in prisoners
Deinstitutionalisation and Homelessness
o Two trend influence number of people involuntarily committed in Canada each year: increase
in number of people who are homeless and deinstitutionalisation: systematic removal of
people with severe mental illness or mental retardation from institutions like psychiatric
hospitals. Largely considered a failure
o First nations people, refugees and ethnic minorities overrepresented in the homeless
population of Canada
o Deinstitutionalisation had two goals: downsize or close provincial and territorial mental
hospitals; and create a network of community mental health services in which the released
individuals could be treated
o Transinstitutionalisation: movement of people with severe mental illness from large
psychiatric hospitals to smaller group residences
Criminal Commitment
Battered woman syndrome: state of learned helplessness or post traumatic stress that results from
chronic abuse within a relationship such that a woman feels unable to leave.
o Supreme Court of Canada has acknowledged that in certain extreme cases of battered woman
syndrome, the accused may be under reasonable apprehension of death even though she was
not in danger of immediate harm at the moment that force is used to protect herself
o Jury verdicts biased on: whether the defendant killed her spouse during a fight or not; and
whether testimony on battered woman syndrome or social context of the battered woman
was provided
Criminal commitment: legal procedure by which a person who is found not criminally responsible
on account of a mental disorder must be confined in a psychiatric hospital
Insanity defence
o M'Naughten rule - insanity defence originated with this ruling. Implied that the person can't
be aware of what they're doing or the fact that its wrong
o Durham rule - more inclusive, involving mental disease or defect. Unable to control behaviour
o ALI Standard - knowledge of right vs. wrong, self control and diminished capacity
o Legal statement by the accused of not guilty because of insanity at time of crime
o Results in defendant going to treatment facility rather than a prison
o Diagnosis of a disorder not the same as insanity
o Public often hold negative perceptions about the 'not criminally responsible on account of
mental disorder' (NCRMD) defence
o To be not criminally responsible on account of a mental disorder in Canada
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