Legal & Ethical Issues in Psychopathology

Current Legal/Ethical Issues Legal Issues:

Civil Commitment Criminal Commitment Duty to Warn

Ethical Issues (in Treatment): Confidentiality Competence Dual Relationships

Legal Issues

Legal Issues

Rights of patients vs. rights of public Few laws govern therapy

Required to be competent To have a license Can use collection agencies if clients fail to pay

Several unique legal issues with therapy Complex questions Burden therapist, state, others

Civil Commitment

Most hospitalizations are voluntary Voluntary is in best interest b/c can check out

In some cases, patients are involuntarily hospitalized

1. Danger to oneself (suicidality)

2. Danger to others (homocidality)

– Majority of commitments are male schizophrenics

Civil Commitment

Judge hears case & decides Hearing is requested by police, mental health

provider Civil commitment must legally be lifted when

patient is no longer dangerous Requirements protect patients - historically,

anyone could have someone committed But, goals are re: danger, not helping

The Right to Treatment

Established 1972 by Wyatt v. Stickney Rationale for commitment = treatment Thus, if hospital is unwilling or unable to provide,

patient can petition for commitment overruled Why suspend a patient’s rights unless there is a

benefit? First attempt to have minimum criteria for

mental health treatment

The Right to Treatment

Staffing levels, # of bathrooms, size of facility, variables that impact quality of life

Rulings required states to provide facilities that met minimal requirements State provides most treatment for the severely

and chronically mentally ill

The Insanity Defense

Based up on premise that people cannot be held responsible for crimes if they were unaware of the nature of their actions or were unable to control their actions

We have free will to commit or not commit crime

Legal insanity is a very narrow definition Psychological insanity: products of antecedents (a

disorder is not something we choose)

Insanity Defense Reform Act (1984)

Made it more difficult to prove insanity Unable to appreciate wrongfulness as result of

severe mental illness Defense now has burden of proof Previously, prosecution had to prove sanity

Reduced advantages of pleading insanity Fixed minimum periods of incarceration Eliminated automatic release following reduction

of danger

Guilty But Mentally Ill

Individual will be incarcerated, but acknowledges presence of mental illness

Suggests that treatment is needed during incarceration

Public Opinions of Insanity Pleas

90% of the public believes that: The insanity defense is used too much Lots of guilty people get to go free

Public estimates of how many felony cases involve insanity pleas: 33% Actual number: <1%

Public estimates of success: 50% Actual number: 25%

Public Opinions of Insanity Pleas

Public estimate of how many “insane” people are released: 50% Actual number: 15% (minor offenses that do not

result in incarceration anyway) Public also tends to believe successful

insanity pleas = short time in hospital They actually spend 50% longer in hospital

then they would have in prison if guilty

Competency to Stand Trial

Is the person capable of understanding the charges and helping attorney to prepare the case?

This is independent from sanity at the time of crime

Trial is postponed; defendant is held for treatment Protects public from possible danger

The Right to Refuse Treatment

Can usually refuse treatment if desired Unless refusal is based

on psychosis or delusions

Before all commitments, independent evaluation is required (not connected to the hospital)

Therapist’s Duty to Warn

Tarasoff v. Regents of the U. of CA (1974, 1976) Therapists have a legal responsibility to warn potential

victims when they may be at risk from a client 1969 Tatiana Tarasoff is murdered by a grad student

who suggested, in therapy, that he was going to kill her Therapist informed police, who told grad student they

were aware of his threats Grad student assured police he had no intentions of

murder

Therapist’s Duty to Warn

Therapists are required to warn/protect potential victims By telling the police By committing the client By informing the potential victim Involves breaking a client’s confidentiality

Ethical Issues

Ethical Issues in Treatment

1. Competence

2. Integrity

3. Professional & Scientific Responsibility

4. Respect for People’s Rights & Dignity

5. Concern for Others’ Welfare

6. Social Responsibility

Confidentiality

Therapy is a protected relationship - information is not shared without explicit permission

Exceptions: Knowledge of child abuse Threats to others (Tarasoff) Threat to self

Can consult with other therapists openly

Competence

Maintain the highest standards of competence

Recognize & respect the limits of competence

Provide only those services we are qualified to provide

Competence is a combination of: education, training, experience

Competence

E.g. Conducting a neuropsyc assessment without training

Be familiar with culture, gender, other differences & how those differences will effect one’s work

Remain current in the field on research and professional information

Record Keeping

Maintain records of client contact to facilitate & document treatment

Provide a basis for decisions Covers the therapist in case of legal action

E.g. decisions regarding suicidality Records are often requested by insurance

companies to determine if more services are needed

Who is the Client? (Esp. Children)

Psychologists may work with more than one person Especially with children, who have parents &

teachers, and other providers Ethics do not offer a clear line in this case

Avoid multiple roles Clarify roles if they are ambiguous

Often ask parents for child’s confidentiality

What if No Treatment Exists?

Experimentation is required to further the field Clients should be informed of experimentation Clients also should be informed of other options

that are established Often try experimental tx if an EST has been

tried and failed (in clinical work) Design based on available science

Dual Relationships

When therapist/client relationship exists at the same time as another

E.g. friend/friend or boss/employee Should therapists treat their friends? Should therapists treat/listen to their

students?

Some Practical Issues - Science vs.

Pseudoscience

The Widening Gap

Between academic psychology & popular psychology

Between research and general public knowledge

Characteristics of Pseudoscience

Overuse of ad hoc hypotheses to escape refutation Emphasis on confirmation, not refutation Absence of self-correction Reversed burden of proof Overreliance on anecdotal evidence Use of obscurantist language Absence of “connectivity” with other disciplines

Pseudoscience in Psychopathology

Explosion of unvalidated tx for trauma Use of demonstrably ineffective tx for autism Continued use of inadequate assessments Widespread use of herbal tx w/o testing Subliminal self-help tapes Explosion of self-help books and programs Suggestive techniques for memory recovery

Why Should We Care?

Why should we monitor the general public? Can’t they use whatever they want to buy?

Techniques may be harmful to the public Consumers waste time & $ they could use in

therapy Damage to our reputation & integrity Our ethical guidelines of social responsibility

What Should Psychologists Do?

Actively study & “debunk” pseudoscience Evaluate self-help materials Standardize training programs Popularize our findings & methods to the general

public, convey our scientific excitement to outsiders & show the successful applications of it

The general public is often unaware of what is proven, and what is not