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Chapter 16 Mental Health Services.docx

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Queen's University
PSYC 235
Christopher Bowie

Chapter 16 Mental Health Services: Legal and Ethical Issues Civil Commitment: laws under the provincial/territorial Mental Health Acts that detail when a person can be legally detained in a psychiatric institution (even if against their own will) 1. Person has a mental disorder 2. Person is dangerous to him/herself or others (required) 3. In need of treatment Definition of mental illness differs across jurisdictions (how they define safety and protection) EX: British Colombia VS Ontario  Some argue that the liberal definitions of dangerousness are actually in the patient’s best interest (more likely to be admitted) - Prognosis will be worse for lost treatment time as well as the likelihood of legal issues  Liberal definitions can result in the compromise of a patient’s self-sufficiency  Right to refuse treatment, informed of reasons for hospital detention, apply to a review panel granting discharge & specified right to legal counsel is also varied through jurisdictions Conditions for civil commitment 1. Police power: government takes responsibility for protecting the pubic safety, health and welfare and can create laws & regulations to ensure this protection (public interest) 2. Parens patriae (state of parent) power: when citizens are not likely to at in their own best interest. (Patient interest) Deinstitutionalization & Homelessness : influenced by the number of people involuntarily committed each year  14 000 live in shelters aged 35-64 (47%) and 15-34 (33%) rest are minors  ¾ had some kind of mental health issue (Queen’s study)  As well as mental health, homelessness is also due to economic factors such as increased unemployment & shortage of low income housing Deinstitutionalization (closing of many psych hospitals and/or moving them out) 1. Downsize/close the large provincial hospitals (accomplished) 2. To create a network of community mental health services in which the released individuals could be treated (Not accomplished)  Trans-institutionalization: movement of people with severe illness from large hospitals to nursing homes/other group residences (including jails, prisons) that offer marginal service -Considered a failure because quality of care has decreased significantly Mental illness as a concept in civil commitment proceedings 1. Legal concept referring to severe thought or behavioral disturbances 2. Not synonymous with mental disorders defined by DSM 3. Intellectual disability & substance-related disorders are excluded Criminal Commitment : process in which people are held because: 1. Accused of committing a crime & are detained in a mental health facility until they reassessed as fit or unfit to participate in legal proceedings against them 2. Found not criminally responsible on account of a mental disorder Insanity Defense: renamed the not criminally responsible due to mental disorder NCRMD) defense  Less that 1 in 100 defendants in felony cases plea insanity and only 26% result in acquittal  In Canada many suffer from psychotic disorders (IE: schizophrenia) M’ Naghten Rule (1843): people are not responsible for criminal behaviour if they do not know what they are doing is wrong or if they don’t know that what they are doing is wrong Durham Rule (1954): accused is not responsible if they unlawful act was a product of a mental disease or defect American Law Institute (1962): modify M’ Naghten rules because a person might know it is wrong but cannot stop the compulsion a. Not responsible for criminal conduct if at the time of even was a result of a mental disease or defect he lack substantial capacity either to appreciate the criminality wrongfulness of his conduct or to conform his conduct to the requirements of the law b. “Mental disease or defect” do not include an abnormality manifested only by repeated criminal or otherwise antisocial conduct 1985 Canadian Criminal Code: a person found not guilty by reason of insanity (NGRI) would be automatically detained in a psych hospital until the mental disorder improved sufficiently to justify the patient’s release. -> Purpose to protect public and allow the patient to recover from disorder  Concerns of if they were receiving sufficient treatment in these facilities  Detention periods longer than the prison sentence they would have got ->This indeterminate detention infringed on the rights of the accused Difference between NGRI and NCRMD defense a. Term “insanity” has been replaced by “mental disorder” b. Defendant is now considered “not criminally responsible” not “not guilty” c. T
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