1. Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved. Chapter 18 Mental Health and the Law

2. Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved. Chapter 18 Competency to Stand Trial People who do not have an understanding of what is happening to them in a courtroom and who cannot participate in their own defense are said to be incompetent to stand trial. (In NC, “incapacity to proceed” (see Article 56 of the NC statutes -- http://www.psychlaws.org/LegalResources/StateLaws/NorthCarolinastatute.htm Defense attorneys suspect impaired competence in their clients in up to 10 percent of cases. Psychologists have developed tests of cognitive abilities important to following legal proceedings, and can identify people who perform poorly on these tests.

3. Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved. Chapter 18 Critical Judgments That Mental-Health Professionals Are Asked to Make About People Accused of Crimes Whether they are competent to stand trial Whether they were sane at the time the crimes were committed.

4. Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved. Chapter 18 Insanity Defense Insanity is actually a legal term rather than a psychological or medical term, and it has been defined in various ways. All definitions of insanity reflect the fundamental doctrine that people cannot be held fully responsible for their acts if they were so mentally incapacitated at the time of the acts that they could not conform to the rules of society. Two videos (re: Andrea Yates’ trial)

5. Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved. Chapter 18 Insanity Defense Rules (Table 18.2) M’Naghten Rule At the time of the crime, the individual was so affected by a disease of the mind that he or she did not know the nature of the act he or she was committing or did not know it was wrong. Irresistible Impulse Rule At the time of the crime the individual was driven by an irresistible impulse to perform the act or had a diminished capacity to resist performing the act. Durham Rule The crime was a product of a mental disease or defect.

6. Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved. Chapter 18 Insanity Defense Rules ALI Rule At the time of the crime, as a result of mental disease or defect, the person lacked substantial capacity either to appreciate the criminality (wrongfulness) of the act or to conform his or her conduct to the law. APA Definition At the time of the crime, as a result of mental disease or mental retardation, the person was unable to appreciate the wrongfulness of his or her conduct. Guilty but Mentally Ill Defendants convicted are incarcerated for the normal terms designated for their crimes, with the expectation that they will also receive treatment for their mental illness.

7. Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved. Chapter 18 Insanity Defense, continued While the lay public often thinks of the insanity defense as a means by which guilty people “get off,” the insanity defense is used much less often than the public tends to think. Fewer than 1 in 100 defendants in felony cases file insanity pleas, and of these only 26% result in acquittal.

8. Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved. Chapter 18 John W. Hinckley, Jr. Shot Reagan to impress J. Foster Found NGBI using ALI standards Immediately after the verdict, Hinckley was committed to St. Elizabeth's Hospital in Washington D.C.. He underwent a psychiatric evaluation and was classified as a danger to himself, Jodie Foster, and any other third party whom he would consider incidental to his ultimate aims. It was apparent Hinckley would remain hospitalized for a long time. Backlash against the Insanity Defense

9. Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved. Chapter 18 Civil Commitment Small Group Exercise Consider how you feel about involuntary treatment of people with mental illness. Under what circumstances, if any, should they be treated against their will? Discuss issues such as – What is abnormality? – The rights of the individual vs. those of the group – Civil liberties vs. the survival needs of persons with presumably impaired judgment

10. Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved. Chapter 18 Civil Commitment Small Group Exercise (cont) Consider how you feel about involuntary treatment of people with mental illness. Now, imagine that you are the parent of a young adult who is wandering the streets, running from imaginary pursuers, not eating much, and sleeping in doorways? Does this imagery affect your views on involuntary treatment?

11. Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved. Chapter 18 Civil Commitment Before 1969, in the U.S., the need for treatment was sufficient cause to hospitalize people against their will. Such involuntary hospitalization is called civil commitment. Since 1969, the need for treatment alone is no longer sufficient legal cause for civil commitment in most states.

12. Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved. Chapter 18 Criteria for Involuntary Commitment Grave Disability Dangerousness to Self* Dangerousness to others* *In many states the danger posed must be imminent.

13. Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved. Chapter 18 Involuntary Commitment and Civil Rights People who have been committed to a mental institution often feel that they have given up all their civil rights. But numerous court cases over the years have established that these people retain most of the civil rights, and have certain additional rights due to their committed status: – Right to treatment – Right to refuse treatment

14. Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved. Chapter 18 Clinicians’ Duties to Clients and Society To provide competent and appropriate treatment for client’s problems Not to become involved in multiple relationships with clients To protect client confidentiality To protect persons who might be in danger because of their clients To report suspected abuse of elderly persons or children To provide ethical service to culturally diverse populations