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
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 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?
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