Lesson 4: Legal and Ethical Issues in Mental Health Practice Attention Public safety Personal privacy Sexual predators Stalking To name a few terms for which complex discussions and narratives ensue. Date: March 30, 1981. Attempt on the then President Ronald Reagan's life. All told, four people were wounded, and, initially unbeknownst to the public, the President had been VERY seriously wounded!!! His assaillant John Hinckley, Jr., had planned this attack for months. He was in personal therapy, and had dialogued this machination with his therapist. The motive: to impress an actress in a movie that Hinckley had seen, "Taxi Driver." By the way, one of the injured, press secretary James Brady passed away in August, 2014.
In 1982, when the prosecution on this case went forward, Hinckley's lawyers succeeded in defending their client as innocent by reason of insanity. In the entire criminal justice system for the United States, with only this one exception, a defendant is either found guilty, or not guilty of what they are accused. However, in a psychiatric setting, diminished capacity, or, mental illness might eventuate in an innocent by reaon of insanity finding. For the most part, public, and professional outrage at this resolution culminated in the Insanity Defense Reform Act (1983), at least for federal prosecution. The burden of proof shifted from the need that prosecution DISPROVE insanity, to the need the that DEFENDANT prove insanity. In therapeutic settings, three standards must be maintained.
If any of these requirements are violated, therapist is obligated to elevate casework to legal authorities. The therapeutic relationship has ceased. It is now a matter for the criminal justice system. Sad to say, again, and again, we have learned that voiced, written, or texted threat can be real. We routinely tell parents, siblings, peers, that if a child, or adolescent indicates such intention by specifying timeline, victim, and method, this needs to be taken with the UTMOST seriousness. The children we don't read about, do not make news headlines, and there are many, got the help they WE ALL needed. Learning Outcomes Upon completion of this lesson's material, students will be able to:
Teaching Reading
Lecture Nowhere do fields collide more than at the juncture of the criminal justice system, psychiatry, and community mental health. The language, the definitions, the predictability and reliabillity of behavior and diagnostic intervention "hit a wall." Anytime there is overlapping concerns, and these concerns are fields in motion simple solutions will not be available. Patient rights, patient advocacy, public safety, community healthcare all come into play. Much of the population without permanent domicile (homeless), have serious untreated, or failed treament mental health issues. High on the list is schizophrenia, and substance abuse. Not rare, not new. But, for schizophrenia, its onset, during adolescence or early adulthood puts the individual on a difficult life trajectory. Hospitalization, medication, release, symptom relapse- all are predictable. With budgetary cutbacks at virtually every level of federal, state, and community services, the potential for supervised home living, sheltered worksops, or walk in clinics are hard hit. The eigth largest economy in the world is constituted by California. The population is 38 million people. But, 12 million live below the Department of Health and Human Services poverty line as of 2012. Needless to say, homelessness, poverty, and gang violence driven by turf wars dominates the news headlines. The elderly, the young (children and adolescents), and the homeless need the most, but, routinely get the least from the healthcare system. Assessment Lesson 4 Quiz
Lesson 4 Discussion What if you "ruled the world?" What would your priorities be terms of other people? Assuming vast financial resources, and, believe it or not, such does exist, but not neceassirily targetted to help those in need, how would you change up the game? No plan is not a plan. If we go forward without setting goals, even if the finances became available, the solution would not take place. It will be interesting to watch the new mayor of New York City (and, a new police commisioner), struggle with staggering disparity between the wealthy and the reality of communities that are educationally, healthcare and financially challenged. Would you believe I just saw a listing for a private home in New York City, a six story building, sale price in excess of 114 million dollars. That's $114,000,000.00, just in case you are trying to imagine this figure!
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