1. Legal and ethical issues in abnormal psychology (p. 595) Behaviors ranging from murder to public profanity to therapists touching their clients. all have legal and ethical implications. Mental health decisions involve legal issues when psychologists consider a client or defendants claim of insanity, competence to stand trial, need for involuntary hospitalization, dangerousness to others, or rights as a patient. The Tarasoff case raises questions about therapists responsibility to potential victims versus their obligation not to breach confidentiality. Ethical questions also relate to therapists' conduct with clients.
2. Criminal commitment (p. 600) Criminal law assumes individual actions are based on free will. Criminal commitment is the incarceration of an individual for having committed a crime is the consequence of criminal acts. The insanity defense recognizesthat individuals may not always be held accountable for their criminal actions. The Kenneth Bianchi case highlights the need for psychologists to be on guard against those faking mental illness. The M'Naghten Rule defines insanity as not knowing right from wrong. The irresistible impulse test says that insanity is also involved when a person could not control his or her actions. The Durham standard argues that insanity must be a product of mental disease. The American Law Institute (ALI) code (1962) combines earlier definitions. In some regions, the concept of diminished capacity has been added, allowing that a mental disease or defect may reduce a persons specific intent to commit a crime.
   After the successful insanity defense by John W. Hinckley, Jr., the man who attempted to assassinate President Ronald Reagan, the definition of insanity changed to the individual not understanding what he or she did. The plea of guilty, but mentally ill was developed as well by some states, to separate mental illness and criminal responsibility. Thomas Szasz argues against both the insanity defense and involuntary commitment as being contrary to individual liberty and responsibility.
   Competency to stand trial assesses the individual's mental state at the time of the trial. There are several criteria for competence. If individuals are found incompetent, they are committed, but only for finite periods (Jackson v. Indiana, 1972), thereby protecting due process.
3. Civil commitment (p. 605) Individuals can. be hospitalized against their will, although this should be avoided if possible. The criteria for commitment include danger to self or others, inability to care for self, inability to make responsible decisions, and unmanageable level of panic. Assessment of dangerousness is very difficult because it is rare, is influenced by specific situations, is best predicted by evidence inadmissible by courts, and is ill-defined.
   Involuntary civil commitment occurs when a client does not consent to hospitalization and it follows procedures that include a concerned person, professional testimony, formal hearings, and set periods of treatment. Controversy exists over the helpfulness of committing people for treatment against their will. Mental patients can be committed only with a level of proof that is clear and convincing(Addington v. Texas, 1979). Treatment should be provided in the least restrictive environment, confining people. to hospitals only when they cannot care for themselves in less structured settings. Wyatt v. Stickney (1972) established the concept of right to treatment and stipulated minimal living conditions for care. O'Connor v. Donaldson (1975) also affirmed the right to treatment, although there is debate about who defines treatment.
   Several cases have supported the patient's right to refuse treatment and to receive treatment that takes the least intrusive form possible.
4. Deinstitutionalization (p. 612) Deinstitutionalization is a policy begun in the 1960s involving the discharge of patients from mental hospitals. Reasons for this movement include the belief that living in institutions is harmful, that mainstreaming (integrating) patients back into the community can be accomplished, and that insufficient public funds necessitate early discharge. Critics of deinstitutionalization point to the problem of dumping patients can city streets and to the related problem of homelessness. The lack of community resources for discharged patients is a primary reason for the problems with deinstitutionalization.
5. Therapist-client relationship (p. 614) Ethics prohibits therapists from divulging information given by clients, in much the same way that attorneys and doctors may not reveal information. However, there are a number of situations that call for breaking the ethical standard of confidentiality. A narrower legal concept is privileged communication, which prevents disclosure of information without the clients permission. There are at least five situations in which the therapist is obliged to disclose privileged communications. One of them is when a client is likely to carry out a threat to attack someone else. The Tarasoff v. Board of Regents case (1976) established the duty-to-warn principle. It is unclear whether this principle applies to clients who are infected with the AIDS virus. There are several criticisms of the duty-to-warn principle.Sexual misconduct by therapists is considered one of the most serious of all ethical violations and is condemned by virtually all professional organizations. Clients who become sexually involved with their therapists (almost always female clients with male therapists) are adversely affected. Professional organizations process ethical complaints against therapists who engage in misconduct.
6. Cultural competence and the mental health profession (p. 619) The proportion of racial, cultural, and ethnic minorities in the population of the United States is increasing. Mental health professionals need to be aware of biases, have adequate training, and adjust their methods to provide culturally appropriate services. DSM-IV-TR includes information on culture specific symptom patterns; the American Psychological Association has published guidelines for professionals serving culturally diverse populations. In a historic move by the American Psychological Association (2003), the council of representatives passed Guidelines on multicultural education, training, research, practice and organizational change for psychologists.