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Ch. 16 - Mental Health Services: Legal and Ethical Issues
- ethics and legal concepts change across time
-civil commitment law: provincial/territorial laws that detail when a person can be
legally detained in a psychiatric institution. These laws put the human rights
before the responsibility of the government to care for its citizens
Criteria for Civil Commitment
- Most laws permit institutionalization if the following 3 conditions are met:
oThe person has a mental disorder
oThe person is dangerous to himself or others
oThe person is in need of treatment
oNote: interpretations on what “dangerous” means are different in different
provinces. The level of “danger” required varies
- Government may institutionalize someone under 2 types of authority:
oPolice power: protecting public health, safety and welfare
oParens patriae power: protecting the individual if he is unable to secure the
basic necessities of life. Acting in best interest of individual
oInstitutionalization does not necessarily mean commitment to a hospital.
Could mean compulsory community treatments (CCT), but these are only
permitted if patient has already had some kind of treatment
Defining Mental Illness
- mental illness is not synonymous with a psychological disorder
-Mental illness: severe emotional or thought disturbances that negatively affect an
individual’s health and safety.
-Includes disorders/states that impair judgment, capacity to recognize reality,
ability to associate with others, and ability to meet the ordinary demands of life
- hallucinations, delusions, and comorbid personality disorders increase risk of
violence in mentally ill individuals
- HCR-20 a violence risk assessment model
- Suicide Risk Assessment Scale (SRAS) for inmates
Deinstitutionalization and Homelessness
- closing of many large psychiatric hospitals has led to increased homelessness
- when can psychological states be used to exempt people from criminal acts?