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Legal Concerns

Legal Concerns. Defining “Mental Illness” Mental Illness is a Legal Concept Varies by State Not the Same as Psychological Disorder Responsible for Actions? How do you determine this?. Legal Concerns. Insanity Defense Less than 1% of all cases Even fewer succeed

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Legal Concerns

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  1. Legal Concerns • Defining “Mental Illness” • Mental Illness is a Legal Concept • Varies by State • Not the Same as Psychological Disorder • Responsible for Actions? • How do you determine this?

  2. Legal Concerns • Insanity Defense • Less than 1% of all cases • Even fewer succeed • Often spend more time locked in hospital than would be in prison • Not same as having a disorder • Knowledge of right vs. wrong, Self-control, & Diminished capacity • “Twinkie Defense” • Guilty But Mentally Ill

  3. Legal Concerns Competent to Stand Trial Understand Charges Assist in Own Defense

  4. Civil Commitment • Should People Be Committed to a Psychiatric Institution Against Their Will? • Criteria for Civil Commitment • Person has a Mental Illness • Needs Treatment • Is Dangerous (self or others) • Is Unable to Care for Self (gravely disabled) • Known as “5150” in California • Problems with determining risk and disability • Right to Refuse Treatment?

  5. Clients’ Rights • To Refuse Treatment • To Obtain Treatment • To Confidentiality • Therapeutic Effect • Limits • Imminent Harm to Self or Others • Duty to Warn (Tarasoff) • Suspicion of Child Abuse • “Least Restrictive Environment”

  6. Deinstitutionalization • Made Possible Largely Due to Medications for Severe Disorders • Intended Shift of Treatment to Community Mental Health Centers • Largely a Failure • Least restrictive environment gone awry? • Criminalization of the mentally ill • “Greyhound Therapy” • Homelessness • Other care facilities • Nursing and group homes

  7. Antipsychotic Drugs and Inpatient Treatment

  8. Current Trends • Managed Mental Health Care • Fewer Hospitalizations • Briefer Treatments • Fewer psychiatrists, and now psychologists, providing psychotherapy • Greater use of medications • Movement Toward Practice Guidelines • Manualized treatments • EVTs, ESTs, and narrowing treatments • Treatment is in many cases very good, but some areas not very good

  9. Social Aspects of Mental Illness • Social Stigma • Choice of wording • The Myth of Mental Illness • Szasz • Mental illness is an invention not a discovery • Power of Mental Health Professions • Abuse of power, even if unintentional • “On Being Sane in Insane Places” - Rosenhan • Be Aware and Willing to NOT Pathologize People

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