Module 15: Contemporary Issues in Psychopathology

MODULE 15: CONTEMPORARY ISSUES IN
PSYCHOPATHOLOGY
Module Overview
This module tackles the issue of how clinical psychology interacts with law.
Discussions include issues related to civil and criminal commitment, patient’s rights,
and the patient-therapist relationship.
Module Outline
 15.1. Legal Issues Related to Mental Illness

 15.2. Patient’s Rights
 15.3. The Therapist-Client Relationship
Module Learning Outcomes
 Describe how clinical psychology interacts with law.

 Describe issues related to civil and criminal commitment.
 Outline patient’s rights.
 Clarify concerns related to the therapist-client relationship.
5.1. Legal Issues Related to Mental Illness
Section Learning Objectives
 Define forensic psychology/psychiatry.

 Define civil and criminal commitment.
 Describe dangerousness.
 Define NGRI and GBMI
 Describe pivotal rules/acts/etc. in relation to the concept of insanity.
 Clarify what it means to be competent to stand trial.
15.1.1. Forensic Psychology/Psychiatry
According to the American Psychological Association, forensic

psychology/psychiatry is when clinical psychology is applied to legal arena in
terms of assessment, treatment, and evaluation. Forensic psychology can also include
the application of research from other subfields 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 post-traumatic stress disorder and the delivery and evaluation of
intervention and treatment programs for juvenile and adult offenders.” A key issue
investigated by forensic psychologists includes “mens rea” or the insanity plea.
15.1.2. Civil Commitment
When individuals with a 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 parens patriae or “father of the
country” or “country as parent.” 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 well-being; much like a parent would do for their child. It should be
noted that an individual can voluntarily admit themselves to a mental health facility
and upon doing so, staff will determine whether or not treatment and extended stay,
are needed.
Criteria for civil commitment. Criteria that are common across states are: First,
the individual must present a clear danger to either themselves or others. Second, the
individual demonstrates that he or she is unable to care for him or herself or make
decisions about whether treatment or hospitalization is necessary. Finally, the
individual believes he/she is about to lose control and so is in need of treatment or
care in a mental health facility.
Assessment of “dangerousness.” Dangerousness can best be defined as the

person’s capacity or likelihood for harming self or others. Most people believe that
those who are mentally ill are more dangerous than those free of mental illness,
especially when espousing self-reported conservatism.
15.1.3. 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
(NGRI) or as it is also called, the insanity plea. When a defendant pleads NGRI they
are acknowledging their guilt for the crime (actus rea) but wish to be seen as not guilty
since they were mentally ill at the time (mens rea).
The M’Naghten 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.
Some states and federal courts in the U.S. adopted 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.
The Durham 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 flexibility for the courts, but was viewed as too flexible. Since almost anything
can cause something else, the term product is too vague.
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.
The American Psychiatric Association to reiterate the stance of the M’Naghten 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 (IDRA) 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 system.” 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 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.
Another possibility is for the jury to deliver a verdict of guilty but mentally ill
(GBMI), 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 he or she receive treatment. Though this
looks like an excellent alternative, jurors are often confused by it, NGRI 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.
Competent to stand trial refers to the accused’s mental state at the time of mental
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 his/her
defense. This condition guarantees criminal and civil rights and ensures the accused
understands what is going on during the trial and can aid in his or her defense. If they
are not fit or competent then they can be hospitalized until their mental state
improves.
15.2. Patient’s Rights
 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 – The right to treatment is a constitutional right and failure

to provide resources cannot be justified due to insufficient resources.
A country or a state is constitutionally obligated to provide all people who were

committed to institutions with adequate treatment and had to provide more
therapists, privacy, exercise, social interactions, and better living conditions for
patients.
Patients’ cases had to be reviewed periodically to see if they could be released and
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 – Patients too have the right to refuse treatment
such as biological treatment, psychotropic medications, and electroconvulsive
therapy.
 Right to Less Restrictive Treatment – 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 – State mental hospital patients have the right
to live in adult homes in their communities.
5.3. The Therapist-Client Relationship
 Describe three concerns related to the therapist-client relationship.
Three concerns are of paramount importance in terms of the therapist-client

relationship. These include the following:
 Confidentiality – It guarantees that information about you is not disseminated

without your consent. This applies to students in 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 cannot be disseminated without the patient’s permission. There
are a few exceptions to this which include the client being younger than 16, when
they are a dependently 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 – A patient’s right to confidentiality ends when there is a danger
to the public, and that if a therapist determines that such a danger exists, he/she
is obligated to warn the potential victim. Therapists have a legal and ethical
obligation to their client but at the same time a legal obligation to society. A
therapist does not have a duty to warn if the threat is nonspecific.

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MODULE 15: CONTEMPORARY ISSUES IN

 15.1. Legal Issues Related to Mental Illness

Module Learning Outcomes

 Describe how clinical psychology interacts with law.

5.1. Legal Issues Related to Mental Illness

Section Learning Objectives

 Define forensic psychology/psychiatry.

15.1.1. Forensic Psychology/Psychiatry

According to the American Psychological Association, forensic

15.1.2. Civil Commitment

When individuals with a mental illness behave in erratic or potentially dangerous

Assessment of “dangerousness.” Dangerousness can best be defined as the

15.1.3. Criminal Commitment

Section Learning Objectives

 Right to Treatment – The right to treatment is a constitutional right and failure

A country or a state is constitutionally obligated to provide all people who were

5.3. The Therapist-Client Relationship

Section Learning Objectives

 Describe three concerns related to the therapist-client relationship.

Three concerns are of paramount importance in terms of the therapist-client

 Confidentiality – It guarantees that information about you is not disseminated

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