Chapter 16 -- Legal and Ethical Issues

I. Criminal Commitment

A. Held while accused and determine whether clients are Competent to Stand Trial
1. Are defendants aware of criminal proceedings?
2. Are they able to participate in their defense?
B. Found not Guilty by Reason of Insanity
1. Because of a mental disorder, client is not responsible for specific criminal actions (irresistible impulse in Virginia)
2. Defense must show evidence of severe disturbance (no personality disorders)
C. Prediction of Violent Behavior
1. Past violent behavior predicts future behavior best
2. History of violence in defendant’s family
3. History of drug abuse predicts reduced behavioral inhibitions

II. Civil Commitment of Clients

A. Trends in Mental Health Law
1. A liberal era from 1960 to 1980 that was characterized by individual rights and fairness
2. A neoconservative era from 1980 to 2008 focused on majority concerns and law and order
B. Involuntary Commitment
1. Person has a mental illness and needs treatment
2. Danger to self or others
3. Unable to care for self
4. Medical and Mental Health Professionals and Police may sign an application for commitment (10 days)
C. Right to Treatment (not just confinement)
D. Right to Refuse Treatment (Court order needed to compel taking medication)
E. Deinsititutionalization and Homelessness increased the numbers of mentally ill persons who were arrested and jailed
F. Efforts focused on outpatient commitment

III. Research Participants’ Rights

A. Informed consent is agreeing to participate after knowing the purpose of the study and any risks and benefits
B. Privacy
C. Treated with respect and dignity
D. Protected from physical and mental harm
E. Choose (or refuse) to participate at any time without penalty
F. Anonymity in the reporting of results
G. Safeguarded records

IV. Responsibilities of Therapists

A. Therapist Competence
1. Training
2. Experience
3. Emotional Stability
B. Informed Consent
1. Spells out the service and financial cost
2. Policy for missed sessions
C. Confidentiality
1. Limits when there are dangers to self or others (mandated reporting, duty to warn)
2. Limits for legal proceedings and insurance reports
D. Duty to Warn (Tarasoff case)