Presentation on theme: "Psychotherapy Notes under HIPAA—Tarasoff Provision"— Presentation transcript:
1Psychotherapy Notes under HIPAA—Tarasoff Provision A covered entity may use or disclose psychotherapy notes without an individual’s authorization… to avert a serious and imminent threat to public health or safety, or for the lawfulactivities of a coroner or medical examiner or as required by law.BUT see Pre-emption provisions
2TarasoffWhat should we take away from the lesson of the Tarasoff case?Questionable analogies from public health precedentsProblems of prediction remainNegative effects of deputizing MH professionalsMedicalization of social problems by pretending there is a scientific solution
3Tarasoff Know the state law Distinguish between Tarasoff I and II Know other statutory duties of MHPs
4Recent Research Monahan --Risk Assessment Structured Risk Assessment v. no structureUses of Outpatient Commitment
5FEDERAL LAW ON THE CONFIDENTIALITY OF ALCOHOL AND SUBSTANCE ABUSE RECORDS
6GENERAL LEGAL PROVISIONS Federally assisted drug abuse programs may not disclose patient identifyinginformation to third parties except in specific situations:
7DISCLOSURE EXCEPTIONS The patient has given written consent;Federal regulations permit disclosure without consent;A court order is issued under federal law and is accompanied by a subpoena.
8USE IN CRIMINAL PROCEEDINGS Unless a court order is issued, no records protected by this law may be used to initiate or substantiate any criminal charges against a patient or conduct any investigation of a patientSEE Subpart E below
9Civil Commitment of Convicted Prisoner Vitek v. JonesCompare Donaldson, Addington, Cameron
10Commitment for Psychiatric Treatment following NGRI Foucha v. LouisianaCompare Donaldson, Addington, Cameron
11Forced Medication during Trial Riggins v. NevadaForced Medication after ConvictionWashington v. Harper
12Insanity Defense— the Moral Inquiry Background—From McNaughten  to Hinkley Georgia Law
14Exceptions to Mill’s Liberty Principle People who lack the necessary equipment for rational decision-making:Children?Mentally infirm?Mentally retarded? (what category?)
15M’Naughten 1843 “not in a sound state of mind” “might be affected by morbid delusions”Nevertheless, “might have a moral perception of right and wrong”Delusion “carried beyond the power of his own control and left him no such perception”“not capable of exercising any control over acts …in connexion with his delusion”
16M’Naughten 1843 “nature of the disease…..” “To go on gradually until it had reached a climax when it burst forth with irresestible intensity….…a man might go on for years quietly….but would all at once break out into the most extravagant and violent paroxysms.”
17M’Naughten 1843 Tindal jury instructions: Every man is presumed sane If insane, must prove a “defect of reason (that is related to) disease of the mind”So as not to know the nature and quality of the actOr (at least) that he did not know he was doing what was wrongIf conscious that the act was one which he ought not to do and it was illegal, he is punishable
18Criminal Culpability--Minimum Age 16-3-1 A person shall not be considered or found guilty of a crime unless he has attained the age of 13 years at the time of the act, omission, or negligence constituting the crime.
19 Mental capacity; insanity 16-3-2 A person shall not be found guilty of a crime if, at the time of the act, omission, or negligence constituting the crime, the person did not have mental capacity to distinguish between right and wrong in relation to such act, omission, or negligence.
20 Delusional compulsion 16-3-3 A person shall not be found guilty of a crime when, at the time of the act, omission, or negligence constituting the crime, the person, because of mental disease, injury, or congenital deficiency, acted as he did because of a delusional compulsion as to such act which overmastered his will to resist committing the crime.
21 IntoxicationA person shall not be found guilty of a crime when, at the time of the act, omission, or negligence constituting the crime, the person, because of involuntary intoxication, did not have sufficient mental capacity to distinguish between right and wrong in relation to such act.Voluntary intoxication shall not be an excuse for any criminal act or omission
22Special Procedures for Forensic Mental Health Cases Competence to stand trialSanity at time of the offenseNot Guilty by Reason of InsanityGuilty But Mentally IllRole of expert witnesses
23 Mental Incompetency to stand trial 17-7-130 Following a plea of MInc., special jury assessment,Transfer to Dept. of HR, orRetain custody and proceed to commitment;Special procedures for commitment while in criminal custody
24For Misdemeanors or Nonviolent Offenses Outpatient evaluation for civil commitment is allowed
25"Nonviolent offense" 17-7-130 NOT OR Murder; Rape; Aggravated sodomy; Armed robbery;Aggravated assault;Hijacking of a vehicle;Aggravated battery;Aggravated sexual battery;Aggravated child molestation;Aggravated stalking; Arson;Stalking;Fleeing and attempting to elude a police officer;Any sexual offense against a minor;Any offense with deadly weapon; and Felony offenses with actual or potential physical harm to another person.
26Civilly committed Misdemeanants If the defendant so committed is charged with a misdemeanor offense, the committing court may civilly commit the defendant for a period not to exceed one year. Following the commitment period, the charges against the defendant shall be dismissed by operation of law.
27Sanity at time of offense 17-7-130.1 When notice of an insanity defense is filed, the court shall appoint at least one psychiatrist or licensed psychologist to examine the defendant and to testify at the trial.
28Insanity or Mental Incompetency at time of crime 17-7-131 “Insane at the time of the crime" or “mentally ill” or “mentally retarded” shall not include a mental state manifested only by repeated unlawful or antisocial conduct.
29Possible Outcomes after Defense of Insanity Guilty;Not guilty;Not guilty by reason of insanity at the time of the crime;Guilty but mentally ill at the time of the crimeThe finding of guilty but mentally ill or guilty but mentally retarded shall be made only in felony cases
31Commitment of NGRI Defendant A defendant who has been found not guilty by reason of insanity at the time of the crime and is ordered committed to the Department of Human Resources may only be discharged from that commitment by order of the committing court ;
32Release of NGRI Defendant Application for the release of a defendant who has been committed upon the ground that he does not meet the civil commitment criteria may be made to the committing court, either by such defendant or by the superintendent of the state hospital in which the said defendant is detained;The burden of proof in such release hearing shall be upon the applicant.
33GBMI dispositionWhenever a defendant is found guilty but mentally ill at the time of a felony or guilty but mentally retarded, the court shall sentence him or her in the same manner as a defendant found guilty of the offense,In death penalty cases, those found GBMR will receive life in prison
34Treatment for MI or MR after conviction A defendant who is found guilty but mentally ill at the time of the felony or guilty but mentally retarded shall be committed to an appropriate penal facility and shall be evaluated then treated, if indicated, within the limits of state funds appropriated therefor, in such manner as is psychiatrically indicated for his or her mental illness or mental retardation.
35The Death Penalty and the Mentally Retarded Defendant Atkins v. VirginiaCompare Cleburne & Heller
37Different Developmental Characteristics are Related to Differing Level of Mental Retardation (DSM-IV Criteria)MildModerateSevereProfound
38Mild Mental Retardation 75% to 90% of all cases of retardationFunction at ½ to 2/3 of norm (IQ: 50 to 70)Slow in all areasMay have no unusual physical signsCan acquire practical skillsUseful reading and math skills up to grades 3 to 6 levelCan conform sociallyCan acquire vocational skills for self-maintenanceIntegrated into general society
39“Mentally retarded person" means a person having a significantly subaverage general intellectual functioning existing concurrently with deficits in adaptive behavior and originating in the developmental period
40Majority, Atkins v. Virginia DissentPamela RumpzJames Ellis