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SOCIETAL & LEGAL ISSUES IN ABNORMAL PSYCHOLOGY - Coggle Diagram
SOCIETAL & LEGAL ISSUES IN ABNORMAL PSYCHOLOGY
perspectives on prevention
universal interventions
targeted at the general public or a whole population group
ex: legal age at which alcohol and cigarettes can be bought, advertising campaigns, school-based programs (managing conflict or drug use)
altering risk factors & establishing protective factors
epidemiologic studies tell us where to focus our efforts (biological, psychosocial, and sociocultural efforts)
any effort aimed at improving the human condition would be considered a part of the universal prevention
biological strategies
promoting adaptive lifestyles
improving diet, physical exercise, good health habits, overall physical well-being
psychosocial strategies
skills for problem solving, constructively expressing emotions, engaging in satisfying relationships, healthy context for identity development (failure to do so puts an individual at risk for coping with stress)
changing the psychosocial factors underlying unhealthy habits like smoking, excessive drinking, lack of exercise, or poor eating habits
sociocultural strategies
supportive community, safe, attractive
public education, social security, economic planning, environmental protections, legislation directed at ensuring adequate health care for all
selective intervetions
aimed at a specific subgroup whose risk of developing a mental health problem is thought to be significantly higher than average
ex: certain groups of adolescents or ethnic minorities, young girls engaging in unhealthy dieting behaviors
more effective than universal programs in reducing the extent of depressive disorders! (has major improvements), BUT difficult to formulate, mobilize, and carry out
23% 8th, 42% 10th, 62% 12th graders reported some drinking
alcohol use is related to many problems (illegal drugs, fighting, stealing, driving under the influence, unplanned sex, school problems; strong predictor of lifetime alcohol abuse or dependence
many are focused on family interventions w/ good success
the potential risk and protective factors change with age -- not the same for everyone
D.A.R.E. at school has limited success; current versions now focus less on drugs and emphasize smart decision more broadly
best way to prevent adolescent alcohol or drug use: multicomponent programs (combining 2+ effective approaches such as family-based and school-based (main component w/ diff add-ons) ones)
indicated interventions
directed toward high-risk individuals who are identified as having minimal but detectable symptoms of a mental disorder but do not meet the criteria for a clinical diagnosis
ex: individuals who have just experienced a traumatic event (disaster), adolescents at high risk for schizophrenia
a program that screens school children for depression and anxiety offers a group-based intervention to teach them strategies for decreasing the symptoms (same w/ alcohol or drugs)
basically just identifying individuals from a subset of the population that have elevated symptoms of whatever and offering them strategies to cope
inpatient mental health treatment
involuntary commitment
people not recognizing how ill they are, not interested in receiving any treatment, or dangerous to themselves/those around them, unable to provide for their own care
civil commitment
through the judicial system
people who have not committed crimes but are judged to be potentially dangerous because of their psychological state may be confined in a psychiatric hospital
different for people w/ different illnesses
being mentally ill is not sufficient grounds for involuntary commitment; more necessary conditions
dangerous to themselves or to others and/or
incapable of providing for their basic physical needs and/or
unable to make responsible decisions about hospitalizations and
in need of treatment at a hospital
filing a petition (usually by a concerned relative or physician or mental health professional) --- judge appoints two examiners to evaluate the patient (one must be a physician in MN, one a psychiatrist/psychologist) --- psychiatric evaluation --- commitment hearing
the hospital must report to the court within 60 days of commitment to see if they need to be committed for even longer (no report - release)
imminent danger -- emergency hospitalization without commitment hearing (the patient may refuse treatment) for ab 72 hours unless a petition is filed during that period
1976 Memmel vs Mundy
(the subject of a petition is granted due process, including rights to formal hearings and the right to legal counsel at the hearings)
assessment of dangerousness
patients w/ history of violence, substance abuse, diagnosis of schizophrenia or another psychotic disorder (esp if comorbid w/ substance abuse), presence of antisocial traits... more likely to exhibit dangerous behavior again
typically over-predict violence -- understandable from the professionals' side, but it may be a violation of an innocent patient's civil rights
duty to warn
in most states (except Maryland, Texas, and Pennsylvania), the therapist is required by law to violate confidentiality and take action to protect people from the threat of imminent violence against them --> duty to warn the prospective victim
1976 Tarasoff vs Regents of the University of California et al.
Tarasoff decision = duty to warn ruling
unclear if the patients threatens suicide, or global threats
confidentiality is important to the therapeutic relationship, but the protection privilege ends where public peril begins
APA = official professional ethic codes; compel compliance with relevant laws regardless of one's personal predilections; where the law itself is vague, there is much room for individual interpretation, which leads to a great risk of lawsuits
patients' rights
right to receive treatment (1972)
Wyatt v. Stickney
mental illness or intellectual disability = right to receive treatment
right to compensation for work (1973)
Souder v. Brennan
the supreme court nullified this ruling with state hospitals, it still applies to private facilities
freedom from custodial confinement (1975)
if they are not dangerous to themselves or to others and if they can safely survive outside of custody
O'Connor v. Donaldson
right to less restrictive treatment (1975)
Dixon v. Weinberger
receiving treatment in less restrictive facilities than mental institutions
rights to formal hearings and to legal counsel (1976)
Memmel v. Mundy
the subject of a petition for commitment is granted due process, including formal hearings and legal counsel at them
need for confinement must be based on demonstrable evidence (1979)
Addington v. Texas
the title says it all
limitations on patients' rights to refuse psychotropic medication (1990)
Washington v. Harper
a washington state prison can override a disturbed patient's refusal of psychotropic medication
in cases where individuals might be considered dangerous to themselves or others / severe symptoms that they are unable to take care of themselves in the community
therapeutic community / milieu therapy
the social environment is manipulated to provide the patient w/ the greatest benefit
staff expectations are clearly communicated
patients are involved in the decisions made concerning them
all patients belong to social groups on the unit
deinstitutionalization
hospitalization is a permanent refuge from the world
reducing the population of inpatients by closing hospitals and treating them as outpatients; preventing long hospitalization and costs, rise of biological treatments
aftercare programs
line-in facilities that serve as a home base for former patients as they try to make the transition back to adequate functioning in the community; run by the residents themselves
less compliant: unskilled employment, nonpsychotic symptoms, have committed a crime, or are more transient (geared at those with more extreme symptoms)
holistic approach is quite effective in reducing symptoms and assimilating the patient back to outside institutions
the insanity defense
main idea = people who cannot comprehend or control their criminal behavior should not be punished; an act, even if it is a criminal act, may lack moral blameworthiness if there was a lack of intentionality because the defendant did not posses their full mental capacities at the time of the crime (if a mental disorder renders the person unable to have this knowledge, then they cannot be considered culpable).
not guilty by reason of insanity (NGRI)
insanity is a legal, not a medical term!
highly unlikely to succeed (0.0005% end successfully)
if successful, the person is automatically committed to a psychiatric institution w/ no limit to how long they can be confined (end up being incarcerated for much longer than being sent to prison) because there is no monitoring of such people (no organization or central registry)
extensions may be granted if there is a continued need to protect the public; some may never fully recover
most states and the District of Columbia have either the ALI or the more restrictive M'Naghten standard (4 states, Idaho, Kansas, Montana, and Utah, have entirely eliminated the insanity defense)
ALI = cognitive aspect of M'Naghten = volitional focus of irresistible impulse; the defendant, owing to mental disease or defect, lacked substantial capacity either to appreciate the act's criminal character or to conform their behavior to the law's requirements
M'Naghten standard = people are assumed to be sane unless it can be proved that at the time of committing the act they were under a disease of the mind that they did not know the nature of the act they were doing or they did not know what they were doing was wrong
guilty but mentally ill (GBMI) (optional plea and verdict)
a defendant may be sentenced but placed in a treatment facility rather than in a prison
so they can serve just sentences if they are found to be guilty but then in no further need of additional treatment and let out after a minimal sentence is completed
such a person would remain in the custody of the correctional department until the full sentence has been served
confusing to jurors and should be eliminated; outcomes have been disappointing
competence to stand trial
if the defendant is deemed unable to stand trial due to intellectual deficits or mental health problems, they can be hospitalized until their mental state is judged to be improved sufficiently to stand trial
cognitive abilities + psychiatric symptoms
more likely to be found incompetent: psychotic disorder, previous psychiatric hospitalization, unemployed....
1/2 found competent in the foreseeable future
organized efforts for mental health & challenges for the future
1700s and 1800s dealing w/ mental disorders was the responsibility of state and local agencies -- WWII -- organized measures
federal government
National Mental Health Act (NMHA, 1946)
central research and training center
headquarters for the administration of a grants program designed to support research and training all over the nation
helping state and local communities expand and improve their mental health services
two companion institutes: NIAAA (alcohol) and NIDA (drugs)
national professional organizations in the mental health field
APA, APS, AMA, ABCT, IACFP, NASW...
application of insights and methods to contemporary social problems; serving as consultants on mental health problems and programs
establishing and reviewing training qualifications, accreditation of undergraduate and graduate programs and clinics and hospitals, investigating cases of unethical conduct and taking disciplinary action
volunteer organizations and agencies
Mental Health America, 1909
improvement of services in community clinics and mental hospitals, training volunteers for aftercare programs, works for new mental health legislation, offers special mental health programs for fostering positive mental health
The Arc
intellectual and developmental disabilities
AA, NAMI...
private industry
improving employee morale and performance
Americans with Disabilities Act = people w/ psychiatric problems cannot be discriminated against in the workplace; employers are encouraged to accommodate
control over the pace of work, stable schedule, defined roles, career security, supportive relationships among colleagues, creativity, contributing to the ultimate product...
EAPs are means through which larger corporations can actively provide mental health services to employees and their family members
20% for substance abuse and 40% for mental illness actually receive treatment for their problems
more effective planning at local, national, and international levels
influence of the individual: ministry, law enforcement, teaching -- training in these fields; volunteering, working toward improved public education and government...