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