Chapter 19: Legal/Ethical Issues DSM V: Recommended Changes Abnormal Psychology April 28, 2009 Class #29

The Insanity Defense  Issues  Insanity is a legal term  Different states have different rules for determining insanity  Opinion differs as to how strict or lenient the rule for determining insanity should be  Implications of the John Hinckley case

Are "sane" and "insane" psychiatric terms?  Not anymore… The word "insane" is a legal term  Because research has identified many different mental illnesses of varying severities, it is now too simplistic to describe a severely mentally ill person merely as "insane" In fact, the vast majority of people with a mental illness would be judged "sane" if current legal tests for insanity were applied to them  A mental illness may explain a person's behavior It seldom excuses it

Effects of the John Hinckley Case  The insanity defense got a lot of attention when John Hinckley--the man who shot President Reagan to impress the actress Jody Foster--used it in his trial. It has had a big impact on the way we now feel about the insanity defense

“Hinckley Insane, Public Mad”

“The President is Shot”

Hinckley is believed to have watched this movie at least 15 times…

St. Elizabeths Hospital

Video Clip: Andrea Yates

American Psychiatric Association viewpoints…  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 the offense

Another question…  Should psychiatrists determine whether someone with a mental illness is really responsible for his or her actions? After all, they're the experts… APA says no…

APA opinions…  The APA believes psychiatrists' role in the legal process should be restricted to giving medically based testimony on the defendant's alleged illness  It is the job of the jury, as society's representative, to determine responsibility

The M’Naghten Rule  Individual did not know what they were doing or did not know it was wrong  Does not take into consideration: That the individual knew the act was wrong but had to commit it because of hallucinations or delusions Irresistible impulse (the elbow rule)

The American Law Institute  In 1972, many courts adopted this new rule: A person is not responsible for criminal conduct if at the time of such conduct as a result of mental disease or defect they lack substantial capacity either to appreciate the wrongfulness of their conduct or conform their conduct to the requirements of law

Guilty but mentally ill” rule  Person is held responsible for the crime but is ensured that they will be given treatment for their mental illness

Practical problems with the insanity defenses…  Decision is made by a jury  Expert witnesses may disagree  Jury must determine individual’s state of mind at the time the act was committed  Often incarceration for insanity is longer than a regular prison sentence  Individual is presumed sane until proven insane

Competency to Stand Trial  Individuals whose disorders result in such mental confusion that they cannot understand the proceedings or cannot contribute to their defense can be declared incompetent to stand trial

Potential Problems  Faking Well, obviously this is a common ploy used by some criminals  Confinement for treatment may be longer than penalty for crime Sometimes while they are being treated Other times because of bureaucratic bungling  See recent case study of deaf man with mental illness who was wrongly jailed for almost two years Laws now protect such individuals  Misuse by law officials Its way to get individuals off the street for longer periods than are justified by their illegal acts

Civil Commitment  The involuntary confinement of a person judged to be a danger to himself, herself, or others, even though the person has not committed a crime

Hospitalization and the Rights of Patients  Voluntary and involuntary hospitalization Voluntary hospitalization Involuntary hospitalization  Protection of the individual (parens patriae) Right to equal protection  Protection of society (police power of the state)  Involuntary outpatient commitment  Procedures for involuntary hospitalization Emergency (involuntary) hospitalization

Hospitalization and the Rights of Patients  Rights of hospitalized mental patients Right of the “least restrictive alternative” Right to receive treatment and be released

Hospitalization and the Rights of Patients  Rights of hospitalized mental patients Other rights of patients  Physical environment  Personal clothing  Patient labor  Civil rights

Right to refuse treatment  Strict limits have been put in place by the courts to prevent forcibly medicating mentally ill patients so that they will then be competent to stand trial Must be in “best interest of the defendant”  Religious reasons are usually respected  Prolonging a terminal illness is also usually respected

Deinstitutionalization  Shifting of responsibility for the care of mental patients from large institutions to agencies within the local communities

Therapist-Client Relationship  Dangerousness of mental patients  The public’s right to protection “Duty to warn” principle Tarasoff ruling

Should we let psychologists prescribe meds?  New Mexico was first state to do so  Louisiana was next  Connecticut is debating this issue

DSM-V: Where do we go from here?  A final look at DSM-IV  Your recommendations to the experts for changes to be included in the next edition