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Civil Commitment

by: Amy Turk

Civil Commitment PSYCH-30111

Amy Turk

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About this Document

Full week of notes on Civil Commitment for Forensic Psychology
Forensic Psychology
Dr. Anthony Tarescavage
Class Notes
Forensic, civil, Psychology, Lecture, powerpoint
25 ?




Popular in Forensic Psychology

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This 4 page Class Notes was uploaded by Amy Turk on Wednesday April 13, 2016. The Class Notes belongs to PSYCH-30111 at Kent State University taught by Dr. Anthony Tarescavage in Spring 2016. Since its upload, it has received 6 views. For similar materials see Forensic Psychology in Psychlogy at Kent State University.


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Date Created: 04/13/16
CIVIL COMMITMENT ● Involuntary hospitalization or mandated treatment ○ Of mentally ill people ○ Who exhibit dangerous tendencies ○ Towards themselves or others ● Shaped by two major legal doctrines ○ Parens patriae​ = parent of the nation ■ Protect mentally ill from themselves ○ Police power​ = protect other people from mentally ill History ● Early 1900s ○ Patients hospitalized indefinitely based on a mental health professional’s recommendation ○ No need for a precise diagnosis or assessment of dangerousness to self or others ○ In 1955, over 500,000 people were psychiatrically hospitalized ● 1960s - current ○ As court cases gave patients more civil rights and antipsychotic medications were developed, the number of psychiatrically hospitalized individuals began to decrease ○ Currently less than 100,000 Landmark Cases ● Lake vs Cameron​ = 1966 ○ Required that treatment should be in least-restrictive setting ● Lessard vs Schmidt​ = 1972 ○ Commitment proceedings should have some safeguards as criminal proceedings ○ Ex. right to trial and right to attorney ● O’connor vs Donaldson​ = 1975 ○ An individual must exhibit both a mental illness AND dangerousness in order to be civilly committed Criteria ● Presence of a mental illness ● Presence of dangerousness to self or others Mental Illness ● Typically only severe and treatable mental illnesses like schizophrenia and major mood disorders qualify ● Labeling effects can impact whether or not someone is judged to have a mental illness ● People who have been institutionalized (or are being evaluated for institutionalization) are more likely to be labeled as mentally ill ● Labeling effects​ = a form of bias Rosenhan Study ● Sane in insane places ● “I hear a voice saying things like empty and thud.” ● The number of people admitted into the hospital and the average length of stay demonstrated the power of labeling effects Dangerousness ● At risk for committing bodily harm to others or engaging in suicidal attempts, gestures, or ideation ● We’re not good as risk assessment ○ More difficult in civil commitment evaluations because there is typically a need for an immediate decision with limited info ● Grave disability = occurs when a person is unable to care for themselves and provide for their own basic needs ○ Young people, not the elderly ● Two paths of civil commitment ○ Extended ○ Emergency Extended Commitment ● Numerous civil protections are in place ● Length of hearings = 12 minutes ● Patient is committed from 2 weeks to one year ● Periods of formal re-evaluation needed to maintain commitment ○ Every three months Emergency Commitment ● Less formal with fewer protections ● Authorized by a law enforcement officer or mental health pro ● Allows for a short hospitalization ○ 24 hours to one week ● Requires re-evaluation to maintain commitment ○ After 48 hours ○ Wancheck and Bonnie = this might be too soon ■ 72 hours instead Outpatient Commitment ● The person involuntarily participates in some form of treatment but does not reside at a facility 24 hours a day ● Traditional​ = meets criteria for civil commitment but the least restrictive setting is the community ● Preventative commitment​ = people do not meet criteria for civil commitment but expected to deteriorate and meet the criteria in the future ● Conditional release​ = person has been recently released from a psychiatric hospital with the condition that they participate in outpatient treatment Criticisms ● Traditional = if someone is dangerous enough to be civilly committed, they are too dangerous to be in the community ● Preventative = leads to more people who are involuntarily given treatment ● Conditional release = gives power back to mental health pros ● In practice, outpatient commitment is rarely used Coercion of Civil Commitments ● Over 30% of psychiatric patients are committed involuntarily ● Persuasion ● Threat or force ● Legal force ● Giving an order ● Deception Impact of Coercion ● A barrier to patients seeking mental health treatment ○ 36% afraid ● Huss & Zeiss = found that explaining to patients they had a right to a commitment hearing reduced their perceived level of coercion ○ Related to better treatment outcomes Sources of Coercion ● Mental health pros = most important source ● Perceptions of level of coercion is related to their perception of procedural justice = notion that an individual has been treated fairly regardless of outcome ● Frequency of coercion ○ Persuasion = 61% ○ No one asked patient for preferences = 57% ○ Legal force = 33% Civil Commitment Treatment Cases ● Wyatt vs Stickney = 1972 ○ Patients have a right to treatment that gives them a realistic opportunity to improve their mental conditions ● Washington vs Harper = 1992 ○ The state can forcibly medicate some people ● Sell vs United States ○ Patients hospitalized as incompetent to stand trial may be involuntarily medicated if… ■ The treatment is medically appropriate ■ The treatment does not have significant side effects ■ Less intrusive methods are considered Competency to Make Medical Decisions ● The majority of mentally ill are competent to make these decisions ● Appelbaum = 50% of schizophrenics and 76% of severely depressed patients had passing scores on a measure of competency Mental Health Advanced Patients ● Allow the patient to make any treatment decisions before they became incapacitated ● Hospital staff are largely unaware of their existence and are hesitant to encourage use ● Only 4 to 13% of psychiatric patients had signed one ● Over 77% reported they would complete one Assessment of Danger To Self ● Risk factors for suicide ○ History of suicide ○ Suicidal thoughts ○ Severe hopelessness ○ Family history of suicide ○ Acute abuse of alcohol ○ Loss or separation of relationships ● In general, assessment of grave disability is easier because you do not need to make a prediction ● Identification of mental illness as a risk factor is controversial ○ May encourage stereotypes of the mentally ill ○ Vast majority of mentally ill are not violent and are more likely to be victims of violence than perpetrators ● The relationship is a complex one and depends on the mental illness itself, presence of certain symptoms, and substance abuse ● Structured and actuarial violence risk assessments are not typically completed because of the lack of info available and the focus on immediate risk for violence


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