Mental Health Law
I.
History
A.
Ancient
History
1.
Psychotic
ramblings may be interpreted as holy messages
2.
Psychotic
ramblings may be interpreted as signs of evil
B.
Roman
Law
1.
Parens
patriae: power of state to act on behalf of mentally incompetent; used to
protect families against financial mismanagement by incompetents
C.
Middle
Ages
1.
"Village
idiot" and "court fool" alternate with persecution
2.
Saxon
king Aethelred II adopts parens patrie
3.
Edward
II (1324) codifies as prerogative regis
D.
Renaissance
1.
Gradual
move to "humane" incarceration of insane in mental institutions
through 1700's.
2.
First
mental hospital opened in the American colonies in 1752 as response to homeless
mentally ill.
E.
Industrial
revolution
1.
Dix
and other reformers advocate institutionalization of homeless mentally ill.
2.
In
re Oakes (1845). Oakes is 67 year old
wharf builder from Cambridge MA.
Following death of wife, takes to drinking and consorting with
"loose" women. Plans to marry
woman of "bad character."
Family objects and has him committed to mental asylum because
"laboring under a hallucinations of mind." MA Supreme Court says insane person has no state of mind of own
and allows indefinite confinement at discretion of medical authorities.
3.
Mentally
ill confined if had "need for treatment" -- triumph of medical model
of mental illness.
F.
Social
Revolution of 1960's
1.
By
1960's large numbers of people confined in mental institutions (e.g., 1963:
679,000 in mental institutions, 250,000 in prisons).
2.
Szaz
critique that mentally ill incarcerated not for own benefit but because of
breaking of social norms
3.
Development
of powerful "antipsychotics" and tranquilizers.
4.
Soviet
Union uses mental facilities to house dissidents.
5.
Financial
cost of mental facilities is high.
6.
Movement
towards deinstitutionalization in favor of community mental health centers.
II.
Legal History
A.
Rouse v. Cameron, 1966 "Right to Treatment"
1.
Rouse
convicted of CCW. Placed in hospital
after being declared insane under Durham.
After 3 years, Rouse contends that he hasn't received treatment. Because maximum penalty for CCW is 1 year,
could not justify incarceration as retribution. Decision: hospital must show good faith attempt to provide
treatment. Note: hospitals avoided cases
by releasing troublesome patients.
B.
Wyatt v. Stickney (1971). Least
restrictive conditions
1.
Right
to treatment considered right under 14th amendment. Evidence presented at trial showed that in Alabama had 1
psychiatrist/2000 patients. Court rules
that mental patients entitled to humane physical and psychological environment. Rights to privacy, dignity, and the
"least restrictive conditions" necessary to achieve the purposes of
the commitment. Rights to mail and
telephone communications and visitation.
Right to refuse unnecessary, excessive or punitive medications. Right to refuse shock treatment,
psychosurgery, behavior mod programs using aversive stimuli. Outlaw unpaid patient labor. Set forth minimum staffing levels, etc.
C.
Donaldson v. O'Connor (1974)
1.
Can’t
incarcerate if patient is not dangerous, doesn’t want to be locked-up, could
survive outside hospital, and is not receiving minimally adequate treatment.
D.
Addington v. Texas (1979)
1.
Burden
of proof for involuntary confinement is "clear and convincing
evidence." Standard intermediary
between "preponderance of the evidence" and "beyond a reasonable
doubt".
III.
Involuntary Commitment
A.
Typical
Standards
1.
Danger to self
2.
Danger to others
3.
Gravely disabled and in need of treatment
B.
Typical
Procedure
1.
Emergency/Temporary commitment - 72 hour hold for evaluation
a)
peace
officer or member of staff of evaluating facility makes decision
2.
Intensive/temporary - 14 days
a)
physician
and mental health professional make decision and certify
3.
Intensive continuing treatment - 14 days
a)
physician
and mental health professional make decision and certify
b)
court
notified; judicial review possible
4.
Additional confinement - 90 days
a)
physician
and mental health professional make decision and certify
b)
court
notified; patient advised of rights
5.
Conservatorship