Psychology 2030A/B Chapter Notes - Chapter 16: Insanity Defense, Mental Health Professional, Involuntary Commitment
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18 Nov 2011
School
Department
Course
Professor
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 – but they 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:
oLegal 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
osome 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