What are the features of effective community care: supervised residences

-unable to live on their own/ w their fams
-halfway houses (crisis house/group homes)
-live in staff are usually parapros
-run w a milieu therapy philosophy that emphasizes mutual support, residential responsibility, and self-governing

occupation training and support

-employment provides income, independence, self-respect, and stimulation of working with others brings companionship and order to one's stabile life -> important for schizo
-sheltered workshop: supervised workplace for ppl who are not yet ready for compet

how has community tx failed?

fewer than 1/2 the ppl that need them receive appropriate community MH services
-b/t 40-60% of all ppl w schizo receive no tx at all
-prim factors responsible: poor coordination of services and a shortage of services

how has community tx failed?: poor coordination of services

-various MH agencies in a com. fail to communicate w one another
-patient may not have continued contacts w the same staff & fail to receive consistent services
-poor communication b/t state hosp. and com. MH centers, particularly at times of discharge

how has community tx failed?: shortage of services

-small # available
-com MH centers generally fail to provide adequate services for ppl w severe dis -> spend more time on ppl w less debilitating probs
-reasons for shortage: 1. econ: today more funds are available on one hand; 1963- $1 B, tofay $171 B; o

what are the consequences of inadequate com. tx?

- L #s receive no tx at all; others spend a short time in a state hosp/semihosp and are then discharged prematurely, often w/o adequate follow up tx
-many survive on gov disability payments, & a # spend their days wandering through neighborhood sts.

promise of com. tx

- # of national interest groups have formed in countries around the world that push for better com. tx
-National Alliance on MH: source for info, support, & guidance for members; also a lobbying force in state & national legislatures & it has pressured co

law & MH

-2 social institutions have a strong impact on the MH profession: the legislative & judicial systems; protect the public good & the rights of the ind
-psych in law: clinical practitioners & researchers operate w/in the legal system
-law in psych: legislat

Psych in law: how do clinicians influence the criminal judicial system

-to arrive at justice & appropriate punishments, the courts need to know whether defendants are responsible for the crimes they commit & capable of defending themselves in court
-in some instances ppl who suffer from severe mental instability may not be r

criminal commitment & insanity during commission of crime

-prosecution provoking the defendant to be sane beyond reasonable doubt
-few years later, congress passes making it the defenses burden in federal cases that defendants are sane
-"insanity" is a legal term written by legislators, not clinicians

what concerns are raised by the insanity defense?

-fundamental differ between the law & science of human b: law- ind have free will and are responsible for their actions; human b- assume that physical/psychological forces act to determine the ind's b
-uncertainty of scientific knowledge about abnormal b:

what other verdicts are available?

-guilty but mentally ill: defendants are guilty of committing a crime but are also suffering from a mental illness that should be tx during imprisonment
-found unsatisfactory; has not lowered the # of guilty by reason of insanity verdicts & often confuses

what are sex-offender statutes

-mentally disordered sex offenders: repeatedly found guilty of sex crimes -> mental dis
-sent to a MH facility instead of prison; helps protect them from physical abuse in prison
-many states abolished this; law is diff to apply; some of the laws require

criminal commitment & incompetence to stand trial

-mental incompetence: state of mental instability that leaves defendants unable to understand the legal charges and proceeding they are facing & are unable to prep an adequate defense w their attorney
-issue of competence is most often raised by the defen

law in psych, how do the legislative & judicial systems influence MH careq

-legal system has a major impact on clinical practice
-courts & legislation have dev the process of civil commitment which allows certain ppl to be forced in MH tx
-the legal system, on behalf of the state, has taken on the responsibility of protecting pa

civil commitment

-committed to mental institution/outpatient civil commitment laws allow patients to be forced into com. tx programs
-in some ways, thee law provides more protection for ppl suspected of being criminals that for ppl suspected for being psychotic

why com. mh?

-when they are considered to be in need of tx & dangerous to themselves or others
-seek to harm others/unintentionally place others @ risk
-protect interest of the ind and of society:the principles parens patrial and police power

what are the processes for civil commitment

-vary from state to state
-some are basic & common to most of laws
-often fam members begin commitment proceedings
-if a minor, the supreme court has ruled that a hearing is not necessary, as long as a qualified MH professional considers commitment necess

who is dangerous?

-in the past, ppl w mental dis were less likely than others to commit violent/dangerous acts
-related to the fact that many lived in institutions
-dis w the strongest relationship to violence are sever SUD, impulse ctrl dis, & antisocial p dis., & psychot

What are the probs w civil commitment?

-difficultly of assessing a persons' dangerousness
-legal definitions of "mental illness" & "dangerousness" are vague
-sometimes questionable therapeutic values of civil commitment
-many ppl commit invol. do not respond well to therapy
-suggest abolishing

trends in civil commitment

-1962: Robinson vs California, supreme court ruled that imprisoning ppl who suffer from drug addiction might violate the constitution's ban on cruel & unusual punishments & it recommended invol. civil commitment to a mental hosp as a more reasonable actio

Protecting patients rights: how is the right to tx protected?

-right to tx: the legal right of patients, particularly those who are invol. comm. to receive adequate tx
-bc conditions in state hosp were so terrible, the judge lead out goals that state officials had to meet, including more therapists, better living co

Protecting patients rights: how is the right to refuse tx protected?

-right to refuse tx: the legal right of patients to refuse certain forms of tx
-rulings usually target one specific tx at a time
-most center on bio tx; right to refuse psychosurgery; right to refuse ECT; # of state's continue to permit ECT to be forced o

what other rights do patients have?

-patients who perform work in mental institutions are guaranteed at least a minimum wage
-1974: patients released from state mental hosp. have a right to aftercare & to an appropriate community residence, such as a group home
-ppl w psych dis should recei

the rights debate

-many clinicians express concerns that the patients rights rulings & laws may unintentionally deprive them of opportunity for recovery

in what other ways do the clinicians legal fields interact?: Law in psychology: malpractice suits

-the # of malpractice suits (lawsuit charging a therapist w improper conduct in the course of tx) has risen so sharply in recent years that clinicians have coined terms for being sued- litigaphopia & litigastress
-claims have been made against clinicians

in what other ways do the clinicians legal fields interact?: Law in psychology: law in psych: professional boundaries

-given more authority to psychologists & blurred the lines that once separated psychiatry from psychology
-a growing # of states are ruling that psychologists can admit patients to the state's hosp., a power previously held only by psychiatrists
-in 1991,

in what other ways do the clinicians legal fields interact?: Law in psychology: psych in law: jury selection

-"jury specialists"- advise lawyers about which potential jurors are likely to favor their side & which strategies are likely to win jurors' support during trials
-make suggestions based on surveys, interviews, analyses of jurors backgrounds & attitudes,

in what other ways do the clinicians legal fields interact?: Law in psychology: Psych in law: psych research of legal topics

-sometimes conducted studies & dev expertise on topics of great importance to the CJ system -> influence the system
-eyewitness testimony
-75% of wrongful convictions were based on mistaken eye witness testimony
-highly unreliable
-most crimes are unexpec

what ethical principles guide MH professionals?

-clinicians don't rely exclusively on the legislative & court systems to ensure proper & effective clinical practice
-regulate themselves by continuing dev & revising ethical guidelines for their work & b
-each profession w/in MH field has its own code of