LEGAL AND ETHICAL ISSUES IN MENTAL HEALTH SERVICES

A. The Mental Health System
1. Practitioners: who provides the services?
2. Funding and reimbursement: how are they paid for?
3. Providing the full range of services
   a. Hospital and other residential
   b. Partial hospital and day/evening programs
   c. Out-patient services
   d. Community supports
4. Prevention and treatment
   a. Primary prevention
   b. Secondary prevention

B. Civil and Criminal Commitment
1. History of commitment statutes and court decisions
   a. The paternalism model
   b. The libertarian model
2. The legal issues
   a. Mental illness
   b. Dangerousness
      (1) Definitions
      (2) Determinations
      (3) How close is the link between psychopathology and dangerousness?
3. The psychological issues
   a. Responsibility
   b. Competence
4. Ethical issues
   a. Deinstitutionalization and homelessness
   b. Recent shifts from civil to criminal processing
   c. Type I vs. Type II errors: whose rights are paramount?
5. Insanity and diminished capacity
   a. Definitions
   b. Punishment vs. treatment
   c. NGRI and GBMI
6. Competence to stand trial
7. Using mental health professionals as expert witnesses
   a. Advantages
   b. Disadvantages and risks

C. Rights and Responsibilities
1. Patients’ right to treatment
   a. Proper treatment
   b. Least restrictive
2. The right to refuse treatment
3. Confidentiality
   a. Unauthorized disclosures
   b. The duty to warn
   c. Subpoenas
4. Family issues
   a. Divorce and custody
   b. Abuse and neglect
   c. Age of consent
5. Patients’ civil rights
6. Professional negligence and malpractice
7. Using patients as research subjects

D. Improving Services
1. Access
2. Achieving good outcomes
   a. Efficacy vs. utility
   b. How do we now that a treatment is effective?
      (1) Time
      (2) Placebo
      (3) Non-specific effects
3. “Consumer” protection
   a. Finding the right professional
   b. Choosing the right approach
   c. Clinical vs. statistical significance

Copyright ©1998 Beverly J. Volicer and Steven F. Tello, UMass Lowell.  You may freely edit these pages for use in a non-profit, educational setting.  Please include this copyright notice on all pages.