Mental Health and the Law

This chapter explores cases that involve the law in the lives of people with mental health problems, focusing on when a person can be committed against his or her will. Then we examine how the law regards a person charged with a crime who might have a mental disorder. Finally, we discover how a person who has a mental disorder and is convicted of a crime is treated.

Civil Commitment
Prior to the mid-twentieth century, in the United States the need for treatment was sufficient cause to hospitalize people against their will and force them to undergo treatment. Such involuntary hospitalization is called civil commitment

Criteria for Civil Commitment

All that was needed for civil commitment was a certificate signed by two physicians stating that a person needed treatment and was not agreeing to it voluntarily. The person could then be confined, often indefinitely, without recourse to an attorney, a hearing or an appeal. (Meyer and Weaver 2006)

 The need for treatment alone is no longer sufficient legal cause for civil commitment in most states in the United States. This change came about as part of the Patients Rights movement of the 1960s, which raised concerns about the personal freedom and civil liberties of mental patients. There also were disturbing cases of the misuse of civil commitment proceedings in the United States.

 Procedurally. Most states now mandate that persons being considered for involuntary commitment have the right to public hearing, the right to counsel and the right o confront witnesses, the right to appeal decisions, and the right to be placed in the least restrictive treatment setting

 In the United States and many other countries, individuals must be judged to meet one of the following criteria in order to be committed to a psychiatric facility against his/her will. 1. Grave disability 2. Dangerousness to self 3. Dangerousness to others

Grave Disability
Requires that people be so incapacitated by mental disorder that they cannot provide for their basic needs of food, clothing and shelter. This criterion, is in theory, much more severe than the need for treatment criterion because it requires that the persons survival be in immediate danger because of mental illness.

Dangerousness to self
This criterion is most often invoked when it is believed that a person is imminently suicidal. In such cases, the person often is held on an inpatient psychiatric facility for a few days while undergoing further evaluation and possibly treatment.

Dangerousness to others
The third criterion under which people can be committed involuntarily. If a person with mental disorder is going to hurt another person if set free, then society has claimed the right to protect itself. While this action may seem justified, the appropriateness of this criterion rests on predictions of who will be dangerous or who will not.

Violence and People With Mental Disorders

In one major study, researchers followed 1,136 men and women with mental disorders for 1 year after being discharged from a psychiatric hospital. Monitoring their self-report of violent behaviors, reports in police and hospital records, and reports by other informants, such as family members.

 Serious violent acts were defined as battery that resulted in physical injury, sexual assaults, assaultive acts that involve the use of a weapon, and threats made with a weapon in hand. The former psychiatric patients records of violent activity were compared to those of 519 people living in the same neighborhoods that the patients lived in after their hospital discharge. The likelihood that the former patients would commit a violent act was strongly related to their specific diagnosis and

 whether they had a substance abuse problem. The rate of violence in the community sample was also strongly related to whether individuals had a history of substance abuse. Eleven percent of those with a substance abuse problem committed a violent act during the year of the study, compared to 3 percent of those with no substance abuse problem.

 Racial stereotypes lead people to expect mentally ill persons from ethnic minority groups to be more likely to commit acts of violence than White mentally ill people.(Mulvey, 1995.) Thus, research is clarifying the true rates of violence among mentally as well as some predictors of violence for this group. Violence by children and teenagers with mental health problems has been in the news all too often in the recent years.

 Depictions of going on shooting rampages led to public demands for more intervention with troubled youth