Lesson 16: Mental Health Services: Legal and Ethical Issues

Attention

Questions of competence, human rights, civil rights, and the right to refuse treatment are key components of practice within the Mental Health field

Who defines what is an OK way to live your life?

Learning Outcomes

Upon completion of this lesson's material, students will be able to:

• Discuss the nature and applicaiton of involuntary commitment in the State of Maine.
• Discuss the concept of Assisted Outpatient Treatment.

Teaching

Chapter 16-Mental Health Services: Legal and Ethical Issues

Ron, a single, 28 year-old automobile mechanic, was recently admitted to a local mental health facility on an involuntary basis.  It seems that he had made overt suicidal gestures in the presence of his employer and coworkers. Specifically, Ron doused himself with gasoline and attempted to light himself on fire.  As he pulled out his lighter, he was tackled from behind by a guy working in the next bay.  The lighter was knocked from his grasp in the act.  Two other coworkers helped hold him down while his boss dialed 911. 

At the hospital, it was found that Ron was under the influence of PCP.   He was released about twenty hours later.  While he was certainly not “mentally healthy” at the time, he asked to leave. As the treatment team found no grounds to continue to hold him against his will, they were legally obligated to comply. When Ron’s mother arrived to pick him up, she asked to speak with the attending psychiatrist.  Luckily, she happened to be on the floor at the time.  She cried and begged her to keep Ron in the facility.  There was nothing the doctor could do.  He did not meet the criteria for imminent danger to self and/or others or grave disability.  She legally had to let him leave.  Two or three days later, Ron was “dusting again.”  This time, he succeeded.  He was burned beyond recognition.

What do we do when someone is obviously seriously mentally ill and won’t seek help?  To make matters even worse, some states don’t consider substance abuse or dependence mental illness.  While this issue is extremely complicated, the good news is that some states allow a person to be involuntarily committed on an outpatient as well as an inpatient basis. That means that a person can be forced into treatment without the necessity of going to a mental facility to stay for a period of time.  Given that Ron had just performed a very serious suicide attempt and had a long history of substance abuse, he really should have been ordered into treatment. Unfortunately, this state did offer that option.

Now, what about when someone makes a vague threat to kill a bunch of people?  Does that qualify as imminent danger to others?  Can we put them in jail so that no one gets hurt? Do you remember the shooting at Virginia Tech? (http://en.wikipedia.org/wiki/Virginia_Tech_massacre) As you will soon learn, we cannot do this without the name of an intended victim and an indication that the attempted murder IS going to take place. So, how do we live with ourselves if that patient carries out the crime?  Mental health practitioners must learn to cope with these questions and traverse the rather confusing and convoluted legal world in which they practice.  This last chapter in the text introduces you to some of the legal and ethical considerations which must be addressed within these fields.

CLASS ACTIVITIES

Lesson 16 Discussion A

Read the posted document regarding involuntary commitment in the State of Maine. What should be the criteria for involuntarily committing someone with severe mental illness to a mental health facility?  Is imminent dangerousness to self or others sufficient? Why or why not? What are the problems which may arise if the admission criteria are less stringent?

Lesson 16 Discussion B

Click HERE to read about Assisted Outpatient Treatment

Click HERE to visit the page on Maine in the Treatment Advocacy Center website.

This will show the odds that a severely mentally ill person will be in prison or in treatment facilities in a given state.  How well is Maine doing?  What do you think about what you heard and read?  I am curious as to your perspective on “forcing” the severely mentally ill to receive help against their will on an outpatient basis