Fundamentals of Psychological Disorders - 3rd edition Part VI Mental Disorders - Block 5 Module 15 Contemporary Issues

Fundamentals Disorders Module 15 Contemporary Issues in Psychopathology edition as of July 2023 Module Overview In our final module , we will tackle the issue of how clinical psychology interacts with law . Our discussion will include topics related to civil and criminal commitment , patient rights , and the therapist relationship . We end on an interesting note and discuss whether gaming can be addictive . Enjoy . Module Outline . Legal Issues Related to Mental Illness . Patient Rights . The Relationship Module Learning Outcomes Describe how clinical psychology interacts with law . Describe issues related to civil commitment . Describe issues related to criminal commitment . Outline patient rights . Clarify concerns related to the relationship . Legal Issues Related to Mental Illness Section Learning Objectives Define forensic . Describe potential roles a forensic psychologist might have . Define civil commitment . Identify criteria for civil commitment . Describe dangerousness . Outline procedures in civil commitment . 288

Fundamentals Disorders Define criminal commitment . Define . Describe pivotal . in relation to the concept of insanity . Define . Clarify what it means to be competent to stand trial . Forensic According to the American Psychological Association , forensic is when clinical psychology is applied to the legal arena in terms of assessment , treatment , and evaluation . Forensic psychology can also include the application of research from other in psychology to include cognitive and social psychology . Training includes law and forensic psychology , and solid clinical skills are a must . According to APA , a forensic psychologist might perform such tasks as threat assessment for schools , child custody evaluations , competency evaluations of criminal defendants and of the elderly , counseling services to victims of crime , death notification procedures , screening and selection of law enforcement applicants , the assessment of stress disorder and the delivery and evaluation of intervention and treatment programs for juvenile and adult A key issue investigated by forensic psychologists includes mens rea or the insanity plea . We will discuss this shortly . To learn more about forensic psychology , or to investigate the article mentioned above , please visit . Civil Commitment . What is civil commitment ?

When individuals with mental illness behave in erratic or potentially dangerous ways , to either themselves or others , then something must be done . The responsibility to act falls on the government through what is called or father of the country or country as Action , in this case , involves involuntary commitment in a hospital or mental health facility and is done to protect the individual and express concern over their , much like a parent would do for their child . An individual can voluntarily admit themselves to a mental health facility , and upon doing so , staff will determine whether treatment and extended stay are needed . Criteria for civil commitment . Though states vary in the criteria used to establish the need for civil commitment , some requirements are common across states . First , the individual must present a clear danger to either themselves or others . Second , the individual demonstrates that they are unable to care for themself or make decisions about whether treatment or hospitalization is necessary . Finally , the individual believes they are about to lose control , and so , needs treatment or care in a mental health facility . Assessment of Dangerousness can best be defined as the 289

Fundamentals Disorders capacity or likelihood of harming themselves or others . Most people believe that those who are mentally ill are more dangerous than those free of mental illness , especially when espousing conservatism and ( Authoritarianism Gonzales , Chan , and , 2017 DeLuca and , 2015 ) or after tragic events such as a mass shooting ( MacLeish , 2015 ) The media plays a role in this , and as et al . 2014 ) found , 70 of news coverage of serious mental illness ( and gun violence over a period ( 1997 to 2012 ) focused on extreme events and described specific shootings by persons with . The authors wrote , Even in thematic news coverage focused on describing the general problem of and gun violence , the majority of news stories did not mention that most people with are not violent or that we lack tools capable of accurately identifying persons with who are at heightened risk of committing future They concluded that media coverage of persons with as violent might contribute to negative public attitudes . 2017 ) showed that mental illness is a weak risk factor for violence though this is not to say that the mentally ill do not commit violent acts . The authors write , it has been documented repeatedly that people who report diagnosable levels of psychiatric symptoms also report more involvement in acts of violence toward others than the general population Approximately of criminal violence can be attributed to the mentally ill ( MacLeish , 2015 ) while those with mental illness are three times more likely to be targets and not perpetrators of violence ( et , 2008 ) Regardless of this , we do attempt to identify the level of dangerousness a person may exhibit or have the potential to exhibit . How easy is it to make this prediction ?

As you might think , it can be very difficult . First , the definition of dangerousness is vague . It implies physical harm , but what about psychological abuse or the destruction of property ?

Second , past criminal activity is a good predictor of future dangerousness but is often not admissible in court . Third , context is critical in some situations , the person is perfectly fine , but in other circumstances , like having to wait in line at your local Department of Motor Vehicles , the person experiences considerable frustration and eventually anger or rage . Procedures in civil commitment . The process for civil commitment does vary somewhat , but some procedures are held in common . First , a family member , mental health professional , or primary care practitioner , may request that the court order an examination of an individual . If the judge agrees , two professionals , such as a mental health professional or physician , are appointed to examine the person in terms of their ability for , need for treatment , psychological condition , and likelihood to harm on self or others . Next , a formal hearing gives the examiners a chance to testify as to what they found . Testimonials may also be provided by family and friends , or by the individual . Once testimonies conclude , the judge renders judgment about whether confinement is necessary and , if so , for how long . Typical last from months to year , but an indefinite period can be specified too . In the latter case , the individual has periodic reviews and assessments . In emergencies , the process stated above can be skipped and commitment made , especially if the person is an imminent threat to themself or others . Before we move on , consider for a minute that a person who is accused of a crime is innocent until proven guilty , has a trial , and if found guilty beyond a reasonable doubt ( or almost complete certainty ) is only then incarcerated . This is not true for the mentally ill , who may be committed to a facility without ever having committed a crime or having a trial , but simply because they were judged as having the potential to do so ( or was seen as dangerous ) This potential means that there must be clear and convincing proof , which the Supreme Court defines as 75 certainty . The standard to commit is 290

Fundamentals Disorders much different for those accused of criminal acts and those who are mentally . Criminal Commitment When people are accused of crimes but found to be mentally unstable , they are usually sent to a mental health institution for treatment . This is called criminal commitment . Individuals may plead not guilty by reason of insanity ( or as it is also called , the insanity plea . When a defendant pleads they are acknowledging their guilt for the crime ( red ) but wish to be seen as not guilty since they were mentally ill at the time ( mens rea ) The origins of the modern of insanity go back to Daniel in 1843 England . He murdered the secretary to British Prime Minister , Robert Peel , during an attempted assassination of the Prime Minister . He was found to be not guilty due to delusions of persecution , which outraged the public and led to calls for a more precise of insanity . The rule states that having a mental disorder at the time of a crime does not mean the person was insane . The individual also had to be unable to know right from wrong or comprehend the act as wrong . But how do you know what the person level of awareness was when the crime was committed ?

Dissatisfaction with the rule led some state and federal courts in the to adopt instead the irresistible impulse test ( 1887 ) which focused on the inability of a person to control their behaviors . The issue with this rule is in distinguishing when a person is unable to maintain control rather than choosing not to exert control over their behavior . This meant there were two choices in the in terms of how insanity was defined the rule and the irresistible impulse test . A third test emerged in 1954 from the United States case , though it was . The test , or products test , stated that a person was not criminally responsible if their crime was a product of a mental illness or defect . It offered some degree of for the courts but was viewed as too . Since almost anything can cause something else , the term product is too vague . In 1962 , the American Law Institute ( ALI ) offered a compromise to the three precepts in use at the time . The American Law Institute standard stated that people are not criminally responsible for their actions if , at the time of their crime , they had a mental disorder or defect that did not allow them to distinguish right from wrong and to obey the law . Though this became the standard , it also became controversial when defense attorneys used it as the basis to have John , accused of attempting to assassinate President Ronald Regan , found not guilty by reason of insanity in 1982 . Public uproar led the American Psychiatric Association to reiterate the stance of the test and assert people were only insane if they did not know right from wrong when they committed their crime . The Federal Insanity Defense Reform ACT ( of 1984 was the first comprehensive federal legislation governing the insanity defense and the disposition of individuals suffering from a mental disease or defect who are involved in the criminal justice The ACT included the following provisions significantly modified the standard for insanity previously applied in the federal courts placed the burden of proof on the defendant to establish the defense by clear and convincing evidence limited the scope of expert testimony on ultimate legal issues eliminated the defense of diminished capacity , created a special verdict of not guilty only by 291

Fundamentals Disorders reason of insanity , which triggers a commitment proceeding provided for federal commitment of persons who become insane after having been found guilty or while serving a federal prison sentence . Source 984 This is the current standard in all federal courts and about half of all state courts , with Idaho , Kansas , Montana , and Utah choosing to get rid of the insanity plea altogether . For more on the insanity plea , please visit Another possibility is for the jury to deliver a verdict of guilty but mentally ill ( effectively acknowledging that the person did have a mental disorder when committing a crime , but the illness was not responsible for the crime itself . The jurors can then convict the accused and suggest they receive treatment . Though this looks like an excellent alternative , jurors are often confused by it ( 2002 ) verdicts have not been reduced , and all prisoners have access to mental health care anyway . Hence it differs from a guilty verdict in name only ( 2011 2009 ) A final concept critical to this discussion is whether the defendant is competent to stand trial and refers to the accused mental state at the time of psychiatric examination after arrest and before going to trial . To be deemed competent , federal law dictates that the defendant must have a rational and factual understanding of the proceedings and be able to rationally consult with counsel when presenting their defense ( et , 2007 Fitch , 2007 ) This condition guarantees criminal and civil rights and ensures the accused understands what is going on during the trial and can aid in their defense . If they are not fit or competent , then they can be hospitalized until their mental state improves . Key Takeaways You should have learned the following in this section Forensic psychology is when clinical psychology is applied to the legal arena in terms of assessment , treatment , and evaluation , though it can include research from other to include cognitive and social psychology . Civil commitment occurs when a person acts in potentially dangerous ways to themselves or others and can be initiated by the person or the government . Dangerousness is defined as the person capacity of harming themselves or others and implies physical harm but not necessarily psychological abuse or the destruction of property . Criminal commitment occurs when a person is accused of a crime but found to be mentally unstable . Several rules or tests have been attempted to determine if a person is responsible for their actions at the time a crime was committed . These include the rule , irresistible impulse test , 292

Fundamentals Disorders test , and the American Law Institute standard . Section Review Questions ' Describe the of forensic psychology . What is civil commitment and what criteria is used when establishing its need ?

What does the concept of dangerousness mean ?

What is criminal commitment ?

Outline the various used to determine if someone is responsible for their actions at the time of a crime . Contrast the insanity plea with the concept of being competent to stand trial . Patient Rights Section Learning Objectives Describe rights patients with mental illness have and identify key court cases . The following are several rights that patients with mental illness have . They include Right to Treatment In the 1966 case of Rouse Cameron , the District court said that the right to treatment is a constitutional right , and failure to provide resources can not be justified due to insufficient resources . In the 1972 case of Wyatt , a federal court ruled that the state of Alabama was constitutionally obligated to provide all people who were committed to institutions with adequate treatment and had to offer more therapists , privacy , exercise , social interactions , and better living conditions for patients . In the case of ( 1975 ) the court ruled that patients cases had to be reviewed periodically to see if they could be released . As well , if they are not a danger and are able to survive on their own or with help from family or friends , that they be released . Right to Refuse Treatment As patients have the right to request treatment , they too have the right to refuse treatment such as biological treatment , psychotropic medications ( Riggins Nevada , 1992 ) and electroconvulsive therapy . Right to Less Restrictive Treatment In Dixon ( 1975 ) a District Court ruled that individuals have a right to receive treatment in facilities less restrictive than mental institutions . The only patients who can be committed to hospitals are those unable to care for themselves . Right to Live in a Community The 1974 District Court case , Staff Miller , ruled that 293

Fundamentals Disorders state mental hospital patients had a right to live in adult homes in their communities . Key Takeaways You should have learned the following in this section Patients with a mental illness have a right to treatment , to refuse treatment , to have less restrictive treatment , and to live in a community . Section Review Questions . What rights do patients with mental illness have and what court cases were pivotal to their establishment ?

The Relationship Section Learning Objectives Describe three concerns related to the relationship . Three concerns are of paramount importance in terms of the relationship . These include the following Confidentiality As you might have learned in your introductory psychology course , confidentiality guarantees that information about you is not disseminated without your consent . This applies to students participating in research studies as well as patients seeing a therapist . Privileged communication Confidentiality is an ethical principle while privileged communication is a legal one , and states that confidential communications can not be disseminated without the patients permission . There are a few exceptions to this which include the client being younger than 16 , when they are a dependent elderly person and a victim of a crime , or when the patient is a danger to him or herself or others , to name a few . Duty to Warn In the 1976 the Board of the University of California ruling , the California Supreme Court said that a patient right to confidentiality ends when there is a danger to the public , and that if a therapist determines that such a danger exists , they are obligated to warn the potential victim . Tatiana , a student at UC , was stabbed to death by graduate student , in 1969 , when she rejected his romantic overtures , and 294

Fundamentals Disorders despite warnings by therapist that he was an imminent threat . The case highlights the fact that therapists have a legal and ethical obligation to their clients but , at the same time , a legal obligation to society . How exactly should they balance these competing obligations , especially when they are vague ?

The 1980 case of Thompson County ruled that a therapist does not have a duty to warn if the threat is nonspecific . Key Takeaways You should have learned the following in this section There are three concerns which are important where the relationship is concerned confidentiality , privileged communication , and the duty to warn . Section Review Questions . What are the three concerns related to the relationship ?

Describe each and state any relevant court rulings relevant to them . Check This Out Can you play video games so much , that it becomes addictive ?

Does this mean that it is a diagnosable mental illness to be listed in the ?

Currently , the disorder is only listed in the as a condition for further study and is called internet gaming disorder . It is thought to include symptoms such as Preoccupation with Internet games Withdrawal symptoms when not playing Internet games The person has tried to stop or curb playing Internet games , but has failed to do so The need to spend increasing amounts of time engage in Internet gaming A person has had continued overuse of Internet games even with the knowledge of how much they impact a person life The person uses Internet games to relieve anxiety or guilt or to escape Loss of interests in previous hobbies and entertainment except for internet gaming Interestingly , the says the mean prevalence of Internet gaming disorder is approximately across multiple countries and is similar in Asian and Western countries . It is more common in males than females . It is with major depressive disorder , OCD , and . 295

Fundamentals Disorders And , the now includes gaming disorder in its edition . For more on this disorder , check out the following articles Psychology Today The Cognitive Psychology of Internet Gaming Disorder ( 2014 article in Clinical Psychology Review ) Post WHO What do you think ?

Module Recap And that it . Our final module explored some concepts that transcend any one mental disorder but affect people with mental illness in general . This included civil and criminal commitment and issues such as or the insanity plea , what makes someone dangerous and what we should do about it , and determining competency to stand trial . We then moved to patient rights , such as the right to treatment and , conversely , the right to refuse treatment . Finally , we ended by discussing the relationship and specifically , when the patient right to confidentiality and privileged communication ends , and the therapist has a moral and legal obligation to warn . We hope you these topics interesting and explore the issues further through the links that were provided and articles that were cited . edition 296