Upload
blaise-joel-mcdaniel
View
220
Download
2
Tags:
Embed Size (px)
Citation preview
Chapter 19:Legal/Ethical IssuesDSM V: Recommended Changes
Abnormal Psychology
April 28, 2009Class #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