LEGAL AND

ETHICAL ISSUES IN
ABNORMAL
PSYCHOLOGY
 Table of contents
Perspectives on
01 Mental Health 03 Criminal
Commitment
Law

Civil Patients’ Rights

02 Commitment 04 and Clinical
Practice
Guidelines
 01
Perspectives on
Mental Health
Law
 ARTHUR• • • A Family’s Dilemma
As you remember, Arthur was brought to our Arthur could admit himself—which was
clinic by family members because he was not likely, given his belief that nothing
speaking and acting strangely. He talked was wrong with him—but they had no
incessantly about his “secret plan” to save all power to admit him involuntarily unless
the starving children in the world. His he was in danger of doing harm to
family’s concern intensified when Arthur himself or others. Even if they sincerely
said he was planning to break into the
believed some harm might be
German embassy and present his plan to the
German ambassador. Alarmed by his
forthcoming, this wasn’t sufficient
increasingly inappropriate behavior and reason to admit him involuntarily. The
fearing he would be hurt, the family was family coped with this emergency as
astounded to learn they could not force him best they could for several weeks until
into a psychiatric hospital. the worst of Arthur’s behaviors began
to diminish.
As public opinion about people
with mental illness changes, so do
the relevant laws, and legal and
ethical issues affect both research
and practice
02 Civil
Commitment
a state-initiated
procedure that forces
involuntary treatment on
people who are judged to
have a mental illness
 Background
Liberal Era Neoconservative Era
1960 to 1980 1980 to present

rights of people with mental rights of people with

illness dominated mental illness have been
limited to provide greater
protection to society
 CRITERIA FOR CIVIL
COMMITMENT
1. 2. 3.
The person has a The person is Grave
“mental dangerous to Disability
illness” and is himself or herself
in need of or others
treatment
 Two types of authority
1. Police Power
2. Parens Patriae (State or Country as the Parent)

Another route to civil commitment is being

adopted by some states: court-ordered assisted
outpatient treatment (AOT)
PROCEDURAL The Supreme Court and Civil Commitment
If nondangerous people with mental illness
CHANGES can survive in the community with the help of
AFFECTING others, they should not be detained against
their will
CIVIL
Criminalization
COMMITMENT This “criminalization” of the mentally ill was
of great concern because the criminal justice
system was not prepared to care for these
individuals.
 Deinstitutionalization and Homelessness
PROCEDURAL they restrict detaining individuals who has
CHANGES mental illness according to their own will.
Homelessness happened.
AFFECTING 2 GOALS
CIVIL 1. to close the large state mental hospitals
COMMITMENT 2. to create a network of community mental
health centers

Transinstitutionalization- movement of people

with severe mental illness from large psychiatric
hospitals to others
PROCEDURAL
CHANGES Reactions to Strict
AFFECTING
CIVIL
Commitment
COMMITMENT Procedures
 JOYCE BROWN... Homeless but Not Helpless
During a 1988 winter emergency in New where she received a diagnosis of
York City, Mayor Ed Koch ordered that all paranoid schizophrenia. She had been
homeless people who appeared to be homeless for some time, swearing at
mentally ill should be involuntarily people as they walked by; at one point,
committed to a mental health facility for their she adopted the name Billie Boggs
protection. He used the legal principle of after a New York television personality
parens patriae to justify this action, citing the
with whom she fantasized a
need to protect these individuals from the
cold and from themselves. One of the people
relationship. Supported by the New
who was taken off the streets, 40-year-old York Civil Liberties Union, Brown
Joyce Brown, was picked up against her will contested her commitment and was
and admitted to Bellevue Hospital, released after 3 months (Tushnet,
2008)
In the years between 1930 and
1960, some states passed “sexual
psychopath laws” that provided
hospitalization instead of
incarceration, but for an indefinite
period.
 03
Criminal
Commitment
(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

(2) they have been found not guilty of a crime by

reason of insanity.
 Important Factors in the Evolution of the Insanity
Defense

M’Naghten rule American Law Insanity Defense

Institute (ALI) rule Reform Act
1843
1962 1984

1 2 3 4 5
Durham rule Diminished
1954
capacity
1978
M’Naghten rule - It must be clearly proved that at the time
of committing the act, the party accused was labouring
under such a defect of reason, from disease of the mind, as
not to know the nature and quality of the act he was doing;
or if he did know it, that he did not know what he was doing
was wrong.
Durham rule - An accused is not criminally responsible if
his unlawful act was the product of mental disease or
mental defect
American Law Institute (ALI) rule -
1. A person is not responsible for criminal conduct if at the
time of such conduct as a result of mental disease or defect
he lacks substantial capacity either to appreciate the
criminality (wrongfulness) of his conduct or to conform his
conduct to the requirements of law.
2. As used in the Article, the terms “mental disease or
defect” do not include an abnormality manifested only by
repeated criminal or otherwise antisocial conduct.
Diminished capacity - Evidence of abnormal mental condition
would be admissible to affect the degree of crime for which an
accused could be convicted. Specifically, those offenses requiring
intent or knowledge could be reduced to lesser included offenses
requiring only reckless or criminal neglect.

Insanity Defense Reform Act - A person charged with a

criminal offense should be found not guilty by reason of insanity
if it is shown that, as a result of mental disease or mental
retardation, he was unable to appreciate the wrongfulness of his
conduct at the time of his offense.
THE THEORY OF CRIMINAL INTENT

•MENS REA
mental state

•ACTUS REA
physical act
Reactions to the Insanity
Defense
91% - judges and juries have a hard time telling
whether the defendants are really sane or insane
90% - insanity plea is a loophole that allows too
many guilty people to go free
Guilty But Mentally Ill
- in theory allows the system
both to treat and to punish the
individual
 Therapeutic Competence to
Jurisprudence Stand Trial
When individuals A person determined
withpsychological to be incompetent to
disorders break stand trial typically
thelaw, they may loses the authority to
now find themselves make decisions and
in one of a variety of faces commitment
“problem-solving
courts”.
Duty to Warn

the Tarasoff case has been

used ever since as a standard
for therapists concerning
their duty to warn a client’s
potential victims.
 Mental Health
Research suggests that mental Professionals as
health professionals can make Expert Witnesses
reliable predictions of
dangerousness over the short
term, for 2 to 20 days after the
evaluation. They have not,
however, been able to make
reliable predictions of violence
after longer periods
Patients’ Rights and
Clinical Practice
Guideline
 1. more to less structured living;
The Right to
2. large to smaller facilities;
Treatment 3. large to smaller living units;
> One of the most 4. group to individual residences;
fundamental rights 5. segregated from the community
> Wyatt v. Stickney to integrated into the
> least restrictive community;
alternative 6. Dependent living to
independent living.
 The Right to Refuse > Washington v. Harper
Treatment > a due process hearing
that allows mental health
> One of the most controversial professionals to argue
issues for the merits of
> Riggins v. Nevada medication use and the
> people cannot be forced to take patient to provide a
antipsychotic medication counterargument
 The Rights of Research Participants

1. The right to be informed about the purpose of the research study

2. The right to privacy
3. The right to be treated with respect and dignity
4. The right to be protected from physical and mental harm
5. The right to choose to participate or to refuse to participate without
prejudice or reprisals
6. The right to anonymity in the reporting of results
7. The right to the safeguarding of their records
Evidence-Base Evidence-Based Practice (EBP):
d Practice and health-care practices supported by
Clinical research findings demonstrating that
Practice they are effective
Guidelines Clinical practice guidelines -
evidence is put in the form of
recommendations on how to treat a
particular problem
 two simultaneous considerations, or axes

clinical efficacy axis clinical utility axis

(internal validity) (external validity)

determine whether the effectiveness of the

intervention in question is intervention in the
effective practice setting in which it
is to be applied
TWO ISSUES IN CLINICAL
UTILITY AXIS

1. Feasibility

2. Generalizability
THANK YOU AND
GOD BLESS!