Textbook Notes (369,154)
Canada (162,425)
Psychology (1,025)
PSYCH 257 (72)
Chapter 16

Chapter 16 Text Notes.docx

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Allison Kelly

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PSYCH 257: March 14, 2013 Chapter 16: Mental Health Services: Legal and Ethical Issues Civil Commitment - Civil commitment laws: legal proceedings that determine a person has mental disorder and may be hospitalized, even involuntarily o Varies between each province and territory o The rights of the people are pitted against the responsibility of the government to care for its citizens CRITERIA FOR CIVIL COMMITMENT - Most provincial legislation permits commitment when the following 3 conditions are met: 1. Person has a “mental disorder” 2. Person is dangerous to himself/herself or others 3. Person is need of treatment o All jurisdictions require the #2 to be met; some also require #1 and #3 o The definition of “mental illness”, “safety”, and “protection is defined differently in different jurisdictions (eg. Ontario defines the terms more broadly than BC) - Canadian jurisdictions also differ on other issues: whether the patient has the right to refuse treatment, the right to be informed of the reason for hospital detention, the right to apply for a review panel for a discharge, specified right to legal counsel, and how long a person can be detained - Government justifies its right to act against the wishes of an individual under two types of authority: police power and parens patriae (“state as the parent”) power o Police power is the government protecting the public health, safety, and welfare; criminal offenders are held in custody if they are a threat to society o Parens patriae is when citizens are not likely to act in their best interest; when individuals might be harmed if they are unable to secure the basic necessities of life or do not recognize their need for treatment - Person in need of help can voluntarily request admission to a mental health facility, get evaluated by a mental health professional, and be accepted for treatment - When the person does not voluntarily seek help, then one or two physicians or psychiatrists will conduct an assessment to agree that the person meets the criteria for commitment outlined in the jurisdiction’s legislation - Compulsory commitment treatments (CCT) is another option for people deemed suitable for commitment o Main goals are to prevent relapse and provide care in a less restrictive environment o Criteria in Canada is the patient must have previous inpatient treatment and some risk of increased mental deterioration, or pose possible harm to himself/herself or others DEFINING MENTAL ILLNESS Mental illness: term formerly used to mean psychological disorder but less preferred because it implies that the causes of the disorder can be found in a medical disease process - Each jurisdiction has its own interpretation - A functional definition of mental illness would specify the effects of the illness on the patient’s thoughts and behaviours - Mental illness is not synonymous with psychological disorder; receiving a DSM diagnosis does not necessarily mean that person fits the legal definition of someone having a mental illness DANGEROUSNESS: whether someone is a danger to himself, herself, or others - There is a widespread belief that mental illnesses causes a person to be violent → slightly true o Specific symptoms (eg. hallucinations, delusions, or having a comorbid personality) appears to be associated with people at increased risk of violence - Suicide Risk Assessment Scale (SRAS) performed better in predicting suicide risk in two samples of inmates DEINSTITUTIONALIZATION AND HOMELESSNESS 2 trends have influenced the number of people involuntarily committed each year 1. The increase in the number of people who are homeless o 75% of the homeless have some kind of mental health issue, 33% displayed significant mental health problems, 33% had lifetime alcohol abuse o Face of a homeless person has changed from an older male to younger people, women, and families living on the streets o First Nations, refugees, and ethnic minorities are overrepresented among the Canadian homeless rise in homelessness is due to economic factors (increased unemployment and a shortage of low-income housing) 2. Deinstitutionalization: systematic removal of people with severe mental illness or intellectual disability from institutions o Has 2 goals: to downsize or close the large provincial and territorial mental hospitals and to create a network of community mental health services in which the release individuals could be treated o The 2 goal was not met and transinstitutionalization happened instead o Transinstitutionalization: movement of people with severe mental illness from large psychiatric hospitals to smaller group residences providing only marginal services o Deinstitutionalization is argued whether or not it leads to homelessness or patient abandonment in the community Criminal Commitment - Battered woman syndrome: refers to the state of learned helplessness or post-traumatic stress resulting from chronic abuse within a relationship such that a woman feels unable to leave - Expansion of self-defence legal defence involving the battered woman syndrome in which threat can be imminent or non-imminent - Defendant were found to be more guilty if they killed during a non-imminent threat with no expert testimony - Criminal commitment: legal procedure by … 1 o which a person who is found not criminally responsible on account of a mental disorder must be confined in a psychiatric hospital or 2 o have been accused of a crime and are detained in a mental health facility until they are assessed to be fit or unfit to participate in the legal proceedings THE INSANITY DEFENCE - Under certain circumstances, people are not responsible for their behaviour and it would be unfair/ ineffective to punish them - The M’Naghtan Rule: people are not responsible for their criminal behaviour if they do not know that what they are doing is wrong th th o The most common insanity defence standard during the 19 and 20 century o Critics say that relying on an accused person’s knowledge of right or wrong is too limiting and a broader definition is needed - Person found not guilty by reasons of insanity (NGRI)would be automatically detained in a hospital until the mental disorder improved sufficiently to justify the patient’s release o The detention was often longer than the prison sentence the person would have served if convicted - NGRI was changed to not criminally responsible on account of mental disorder (NCRMD) o NCRMD judgements can be made if the person is incapable of knowing his or her actions were either legal or morally wrong o Recognizes that the defendant did commit the crime REACTIONS TO THE INSANITY DEFENCE - Many people feel criminals who use the NCRMD defence “got off too easily” - NGRI was used relatively infrequently; the use of NCRMD is increasing but is still uncommon - Forensic comm
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