PowerPoint  Lecture Notes Presentation
Chapter 17
Legal and Ethical Issues
Abnormal Psychology, Eleventh Edition
by
Ann M. Kring, Gerald C. Davison, John M. Neale,
& Sheri L. Johnson
Criminal Commitment

People with mental illness who are alleged to have
broken the law are subject to criminal commitment
» A procedure that confines a person to a mental hospital
either for:
– Determination of competency
– After acquittal by reason of insanity

mens rea
» Guilty mind


“No crime without an evil intent”
Concept of insanity
» A disordered mind can’t be a guilty mind
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Insanity Defense

Insanity a legal term
» Not a psychiatric or psychological concept


Based on mental state of the accused at
the time the crime was committed
Insanity defense
» Defendant not responsible for an illegal act if it
is attributable to mental illness or not knowing
right from wrong
» Pleaded in fewer than 1% of cases
» Rarely successful

Requires judgments by lawyers, judges,
jurors, and clinicians
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Two Kinds of Insanity Pleas

Not guilty by reason of insanity (NGRI)
» Accused not responsible for the crime because of mental
illness
» Indefinite commitment to a forensic hospital
– Only released when no longer mentally ill
» John Hinckley

Guilty but mentally ill (GBMI)
» Found guilty and responsible for the crime
» Mental illness plays a role in sentencing
– Can be committed for treatment until no longer mentally ill

Then sent to prison to serve remainder of sentence
– Most are incarcerated and may or may not receive any
psychiatric care
» Jeffrey Dahmer
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Table 17.1 Comparing NGRI and
GBMI
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John Hinckley’s Letter to Jodie Foster
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Landmark Laws and Cases
Irresistible impulse (1834)
 The M’Naghten rule (1843)
 The Durham test (1954)
 American Law Institute Guidelines
(1962)
 Insanity Defense Reform Act (mid
1980s)
 Guilty but mentally ill

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Table 17.2 Landmark Cases and
Laws Regarding the Insanity Defense
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Competency to Stand Trial

Accused must be able to participate in his or her
defense
» 1960 US Supreme Court decision
– “…ability to consult with his lawyer”
– “…rational as well as a factual understanding of the
proceedings against him”
» Courts do not want a person to be brought to trial
in absentia

Determination of competency made before
individual is tried
» Prosecutor, judge, or defense attorney can raise
issue
» Andrea Yates

Mental illness does not necessarily imply
incompetence.
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Table 17.3 Standards of Proof
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Competency to Stand Trial

Synthetic sanity
» If medication can produce rationality, trial
can be held
– Even if discontinuation of the drug would again
render the defendant incompetent

Forced medication to restore
competency can be used only in very
limited circumstances
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Insanity, Mental Retardation, and
Capital Punishment

US Supreme court
» Unconstitutional to execute individuals who
are insane or mentally retarded
– Execution would constitute cruel and unusual
punishment
» However, definition of mental retardation
varies from state to state
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Civil Commitment

An individual can be committed to a
psychiatric hospital against his wishes if
» Person is mentally ill, and
» Danger to self or others
– Commitment should end when person is no longer
dangerous

Formal commitment
» Requires a court order

Informal commitment
» Initially no court involvement is needed
– 2PC Two physician certificate
– Further detainment requires formal judicial commitment
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Preventive Detention and Problems
in the Prediction of Dangerousness

When substance abuse is not a factor,
mentally ill are no more likely to commit
violent crimes than the average person.
» Only 3% of violent crimes linked to mentally
ill
» If violent, target is usually family or friends,
not strangers
» Men with threat delusions more likely to be
violent than men w/out threat delusions or
women with any type of delusion
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Preventive Detention and Problems
in the Prediction of Dangerousness

Factors that influence accuracy of violence
prediction:
» Repeated violent acts in the past
» Individual returns to same environment in
which past violent acts were committed and
individual’s personality has not changed
» Person is on the brink of committing a violent
act
» Drug/alcohol abuse
» Medication noncompliance

Sex offenders can be committed in some
states
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Protection of Patient Rights
Courts try to balance patient rights and
the right of the public to be protected
 Supreme Court ruled that evidence for
commitment must be clear and
convincing
 Danger must be imminent
 Tarasoff case

» Duty to warn and protect
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Protection of Patient Rights

Least restrictive alternative
» Required to be provided when treating
mentally ill

Right to treatment
» State required to provide treatment after
civil commitment

Right to refuse treatment
» Unless person is a danger to self or others
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Deinstitutionalization, Civil Liberties,
and Mental Health

Deinstitutionalization
» In the 60s, many states released patients from state
psychiatric hospitals
» Community treatment preferred

Many cities lack sufficient community mental
health facilities
» Many mentally ill end up homeless
» Some end up in jail
– Justice department survey found that 16.2% of prison
population is mentally ill
» Police officers increasingly called on to work
with mentally ill
– New laws provide funding for special training
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Ethical Dilemmas in Therapy and
Research

Research
» Ethical restraints to avoid abuse and exploitation of
participants
» Institutional review board approval necessary
» Researchers must receive training in research
ethics

Researchers must insure that mentally ill
participants understand risks of research
before participating
» Informed consent
– Sufficient information must be provided to allow an
individual to make an informed decision to participate
» Freedom to withdraw at any time for any reason
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Ethical Dilemmas in Therapy and
Research

Therapy
» Confidentiality
» Privileged communication

Both can be broken if:
» Patient is a danger to self or others
» Patient is under age 16 and a crime or abuse
victim
» Patient has filed a malpractice suit against a
therapist
» Patient is trying to avoid arrest for a crime
committed or planned
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COPYRIGHT
Copyright 2009 by John Wiley & Sons, New
York, NY. All rights reserved. No part of the
material protected by this copyright may be
reproduced or utilized in any form or by any
means, electronic or mechanical, including
photocopying, recording or by any information
storage and retrieval system, without written
permission of the copyright owner.
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