Chapter 16

Lecture 12 Chapter 16 - Mental Health Services: Legal and Ethical Issues The Concept of Mental Illness in Civil Commitment Proceedings (p. 560-565) ARTHUR •Family could not admit him into the hospital – he could only admit himself – which was not likely, given his belief that nothing was wrong with him – buthey had no power to admit him involuntarily unless he was in danger of doing harm to himself or others •What is important here is to see how the mental health system responded ob/c Arthur had not hurt anyone or himself, he had to seek help on his own before the hospital would assist him CIVIL COMMITMENT •Each province and territory has CIVIL COMMITMENT LAWS: o Legal proceedings that determine a person has a mental disorder and may be hospitalized involuntarily •Most provincial legislations permits commitment when the following three conditions have been met: 1.the person has a “mental disorder” 2.the person is dangerous to himself or herself or others, and 3. the person is in need of treatment •a person in need of help can always voluntarily request admission to a mental health facility; after an evaluation by a mental health professional, he or she may be accepted for treatment… •however, when an individual does not voluntarily seek help, but others feel that treatment or protection is necessary, the process of CC may be initiated Defining Mental Illness •Is a legal concept referring to severe thought or behavioural disturbances that negatively affect an individual’s health/safety •Mental illness is NOT synonymous with a psychological disorder •Definitions of mental illness vary by province - Saskatchewan uses ‘Functional Definition’ = the effect of illness of thoughts and behaviour •Vs. Ontario instead defines MD more traditionally as a “disease or disability of the mind” Dangerousness to Self or Others: central to commitment proceedings • Assessing whether someone is a danger to himself, herself, or others is a critical determinant of the civil commitment process •assessing dangerousness: the role of mental health professionals oHistory, alcohol abuse, etc •hallucinations, delusions, personally disorder raise risk for violence •not able to make specific predictions about violence and mental illness o some reviews agree whiles others show no unusual association between mental illness and violence •90% of mentally ill have no history of violence •how do you determine whether a person is dangerous to other? How accurate are mental health professionals at predicting who will and who will not be violent? oAnswers directly affect the process of civil commitment as well the protection of society Self-harm - those who: •Since risk for self-harm is one of the common criteria used for decisions about civil commitment, one might ask whether psychologists can accurately predict risk for suicidal behaviours… several variables predict…found those who: oreport suicidal thoughts while in hospital oshowed verbal/physical aggression ohave a history of self-harm ohad engaged in a suicide attempt within two weeks before being committed o** all were more likely to harm themselves in hospital Two trends have influenced the number of people in Canada who are involuntarily committed each year: (1)the increase in the # of people who are homeless (2)DEINSTITUTIONALIZATION, the movement of people with severe mental illness out of institutions Problems with the Process of Civil Commitment (p.560-565) Early Supreme Court Rulings: Restrictions on Involuntary Commitment •A non-dangerous person cannot be committed •need for treatment alone is not enough •having a grave disability is insufficient Consequences of Supreme Court Rulings •Criminalization of the mentally ill •Deinstitutionalization oDownsize/close several large psychiatric hospitals and create a network of community health services oIs one factor that many believe has contributed to increasing rates of homelessness in Canada oD had two goals: 1.to downsize or even close the large provincial and territorial mental hospitals (accomplished) 2.to create a network of community health services in which the released individuals would be treated (not accomplished) •Transinstitutionalization - movement of mentally ill to nursing homes, jails, and group residences Subsequent Modification to Civil Commitment Procedures (p. 560-565) Civil Commitment Criteria Were Broadened •Involuntary commitment for dangerous and non-dangerous persons •Involuntary commitment for persons in need of treatment Criminal Commitment (p.565) Nature of Criminal Commitment Is the process by which people are held because 1. They have been accused of committing a crime and are detained in a mental health facility until they can be assessed as fit or unfit to participate in legal proceedings against them oDetainment in a mental health facility for evaluation of fitness to stand trial 2. they have been found not criminally responsible on account of a mental disorder The Insanity Defense (p.565-566) Nature of the Insanity Defense Plea •Not all people are punished for criminal behaviour – b/c the law recognizes that, under certain circumstances, people are not responsible for their behaviour and it would be unfair and perhaps ineffective to punish them oLegal statement by the accused of not guilty because of insanity at a time of crime • Defendant gross to a treatment facility rather than a prison •diagnosis of a disorder is not the same as insanity •Battered wife syndrome: a valid form of the self-defense because an accused may reasonably believe that her life is in danger even though it may not be imminent oWife was more likely to be guilty of murder if spouse was asleep than if the death occurred during a fight (imminent threat) Definitions of Insanity •M’Naughten rule – people are not responsible for their criminal behaviour if they do not know what they are doing or if they don’t know that what they are doing is wrong – 1984 (Canadian Law) oMost common Insanity defense standard - originated with this ruling - not know what they’re doing of that it is wrong Durham rule - More inclusive, involving mental defense or defect - has been discarded •American Law oModified this law b/c many critics feel that simply relying on an accused person’s knowledge of right or wrong is too limiting and a broader definition is needed •Canada – originally under the 1985 Canadian Criminal Code, a person found guilty by reason of insanity (NGRI) would automatically be detained in a psychiatric hospital until the mental disorder improved sufficiently to justify the patient’s release o PURPOSE was to protect the public and allow the patient to recover from his or her mental disorder oIn 1991 – the name of the defence was changed from not guilty by reason of insanity (NGRI) to not criminally responsible on account of mental disorder (NCRMD) oThree main differences between the names: 1.the term “insanity” has been replaced by “mental disorder” 2.the defendant is now considered “not criminally responsible” as opposed to “not guilty” 3.the meaning “wrong” has changed from NGRI to NCRMD – judgments can be made if the person is incapable of knowing that his or her actions were either legally or morally wrong Consequences of the Insanity Defense Facts about the insanity defense • used in less than 1% of criminal cases •Persons judged “not guilty by reason of insanity” (NGRI) spend more time in mental hospitals than they would have spent in jail Changes Regarding the Insanity Defese • Insanity Defense Reform Act - Movement back to M’Naughten - like standards •‘NGRI’ changed to “not criminally responsible on account of mental disorder” o Represents an effort by the legal system to focus on the needs of people with mental illness who also break the law by providing mental health treatment instead of punishment* odefense can raise the issue any time persecution only have