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Sociology of mental health law
Abstract
Reviews the contributions of research on the sociology of mental health law to the understanding of the conditions and costs of various legal paths to social order, individual liberty, and mental health. It is argued that a focus on issues of legal effectiveness has led to the neglect of theory testing and development, and D. Black's (1972, 1976) theory of law is suggested as a guide to future research on mental health law phenomena. (5 ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
... Civil commitment is defined as the compulsory confinement of an individual to a mental health facility by reason of an incapacitating mental disorder, whether this be for 120 hours or one year. Ontario, 1970-1983Year 197019711972197319741975197619771978197919821983 centred at the end of the pre-intervention period (i.e., -8, -7, ...,0, 1, ..., +5). A third variable (X3), the cross-product of (XI) and (X2), represented the interaction between these variables. ...
... Civil commitment is defined as the compulsory confinement of an individual to a mental health facility by reason of an incapacitating mental disorder, whether this be for 120 hours or one year. Ontario, 1970-1983Year 197019711972197319741975197619771978197919821983 centred at the end of the pre-intervention period (i.e., -8, -7, ...,0, 1, ..., +5). A third variable (X3), the cross-product of (XI) and (X2), represented the interaction between these variables. ...
... This finding suggests that the subsequent increase in total involuntary admissions may be attributable to readmissions. However, although Ontario 1970-1983Year 197019711972197319741975197619771978197919821983 Total there is a significant reduction at the point of intervention for the proportion of involuntary first admissions (t (1,9) = 2.97,p < .02) but not the proportion of involuntary readmissions (f (1,9) = 0.76, p < .46), ...
De nombreuses juridictions en Amérique du nord ont révisé leurs lois d'internement civil. En général, ces lois spécifient plus précisément sous quelles conditions une personne peut être hospitalisée sans son consentement, l'objectif juridique étant de réduire les internements civils. La présents étude analyse les effets de telles réformes sur les taux d'admission dans les hôpitaux psychiatriques ontariens. Les résultats montrent qu'en dépit d'une tendance marquée vers une diminution du taux d'hospitalisation sans consentement avant la réforme juridique, une tendance inverse vers un accroissement des internements civils's est manifestée dans les années qui ont suivi la réforme juridique. Ces résultats soulèvent de sérieuses réserves quant à la capacité des législateurs à réglementer les pratiques des professionnels de la santé mentale.
... In particular, research findings suggest that social support may help protect youth against the negative effects of stressors and promote more positive mental health outcomes [18] [19]. So far, much of the work focusing on the positive effects of social support on psychological health has emphasized the role of perceived support with a specific source [21], but there is still limited research about how social support from multiple sources (i.e., parents, peers, and community) differentially predict adolescents' mental health outcomes. Such an understanding is needed, in part, so that researchers and practitioners can make more informed decisions regarding where to focus prevention and intervention efforts. ...
Globally, adolescents are at risk of depression, traumatic stress, and suicide, especially those living in vulnerable environments. This article examines the mental health of 15- to 19-year-old youth in five cities and identifies the social support correlates of mental health.MethodsA total of 2,393 adolescents aged 15–19 years in economically distressed neighborhoods in Baltimore, MD; New Delhi, India; Ibadan, Nigeria; Johannesburg, South Africa; and Shanghai, China were recruited in 2013 via respondent-driven sampling to participate in a survey using an audio computer-assisted self-interview. Weighted logistic regression and general linear models were used to explore the associations between mental health and social supports.ResultsThe highest levels of depression and posttraumatic stress symptoms were displayed in Johannesburg among females (44.6% and 67.0%, respectively), whereas the lowest were among New Delhi females and males (13.0% and 16.3%, respectively). The prevalence of suicidal ideation ranged from 7.9% (New Delhi female adolescents) to 39.6% (Johannesburg female adolescents); the 12-month prevalence of suicide attempts ranged from 1.8% (New Delhi females) to 18.3% (Ibadan males). Elevated perceptions of having a caring female adult in the home and feeling connected to their neighborhoods were positively associated with adolescents' levels of hope across the sites while negatively associated with depression and posttraumatic stress symptoms with some variation across sites and gender.Conclusions
Adolescents living in the very economically distressed areas studied register high levels of depression and posttraumatic stress. Improving social supports in families and neighborhoods may alleviate distress and foster hope. In particular, strengthening supports from female caretakers to their adolescents at home may improve the outlooks of their daughters.
... It should be mentioned that although in some of these studies (Hiday, 1977;Joost & McGarry, 1974;Luckey & Berman. 1979;Miller, 1976;Warren, 1977) an immediate and significant drop in involuntary admissions was demonstrated in the first year following reform, in the subsequent years involuntary admissions rose (Hiday, 1983). That there have been steady declines in length of stay may be attributable to legislative action requiring earlier and more frequent review rather than to actual changes in commitment criteria per se. ...
Notes that many community mental health centers in North America have on their staff paraprofessionals (PPs) who are indigenous to the community. Sharing the same cultural background as the community, they can often bridge the wide cultural barriers between the professional and the population served. Despite this, PPs have traditionally held a relatively subservient role in relation to their professional colleagues, with the more crucial decisions left to the professionals—specifically, the involuntary commitment of the potentially dangerous person. Because of their understanding of the community culture, PPs' involvement in civil commitment procedures would seem critical. Although medical-psychological training is adequate for assessing dispositional traits, the very nature of such training prohibits an emphasis on cultural–contextual variables. The use of indigenous PPs in the commitment process would reduce this methodological dilemma and would also attenuate the potential misuse of mental health facilities as agents of social control. (French abstract) (2 p ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
... In effect, a strong possibility exists that mental health professionals, in addition to judicial authority and legal counsel, are not implementing the law as intended. In a review of the studies examining the effects of statutory change on the decision-making process among various professionals involved in civil commitment proceedings, including lawyers, judges, and psychiatrists, Hiday (1983) reported that "there is still lingering Ijudicial] deference to psychiatric recommendation, commitment without evidence of facts of dangerousness and a passive or nonadversary counsel" @. 114). ...
Many jurisdictions across North America have revised their statutes pertaining to the criteria for civil commitment with the legislative intent to either increase or decrease the use of involuntary hospitalization. The impact of these revised statutes has been examined in many jurisdictions, but there has been no consensus regarding their effectiveness in changing the rates of involuntary admissions. The present article reviews the literature from a methodological perspective, comparing the differing analyses, results and interpretations. When the legislative revision has sought to expand medical prerogative, results indicate a sustained increase in civil commitments. When legislation has aimed at limiting medical discretion, there was an immediate decline in civil commitment rates, but a subsequent increase in the period following the initial post-reform declines. These results are discussed in terms of readmission trends, deinstitutionalization, and the possible reaction of mental health professionals who perceive legislation as an unnecessary constraint in the treatment of the mentally ill.
This chapter reviews the law’s role as society’s agent for controlling the deviant behavior of persons with mental illness and empirical research examining that role and its effects. In considering the civil law, it describes changes in use of involuntary hospitalization but focuses on use of outpatient commitment and other forms of leveraged treatment to control the deviance of persons with severe mental illness who live in the community and no longer stay in hospitals for extended periods. This chapter critically examines studies on police encounters; prevalence and types of arrest; and forces leading to arrest, incarceration, and diversion out of the criminal justice system. It also describes and evaluates treatment under criminal justice, diversion, and a particular diversion program, mental health courts. It concludes with questions for future research, a categorization of mentally ill offenders, and an admonition to remember that most persons with severe mental illness do not offend.
Since the classic contributions of Weber and Durkheim, the sociology of law has raised key questions on the place of law in society. Drawing together both theoretical and empirical themes, in this book Mathieu Deflem reviews the field's major accomplishments and reveals the value of the multiple ways in which sociologists study the social structures and processes of law. He discusses both historical and contemporary issues, from early theoretical foundations and the work of Weber and Durkheim, through the contribution of sociological jurisprudence, to the development of modern perspectives to clarify how sociologists study law. Chapters also look at the role of law in relation to the economy, politics, culture, and the legal profession; and aspects of law enforcement and the globalization of law. This book will appeal to scholars and students of the sociology of law, jurisprudence, social and political theory, and social and political philosophy.
Cancer diagnoses have significant consequences that extend beyond the individual to family members. Our research builds on prior research by examining how a family history of breast cancer is related to women's retirement preparations.
Taking guidance from the stress process model, we generate and test hypotheses using multivariate logistic regression and unique data on retirement planning and familial cancer histories for 467 women. We supplement this analysis with the qualitative findings from two focus groups.
We find consistent evidence that women with a mother and/or sister who had a breast cancer diagnosis are significantly less likely to engage in retirement preparation activities than otherwise similar women with no family history. The same effect is not observed when other first-degree relatives have different cancer diagnoses. The face validity of these quantitative findings is confirmed by the focus group analysis.
Our research suggests that the stressors experienced by close female relatives of women who have had breast cancer may lead to behaviors and attitudes that have consequences for their post-retirement quality of life. Copyright © 2015 John Wiley & Sons, Ltd.
Copyright © 2015 John Wiley & Sons, Ltd.
Mental health courts (MHCs), nontraditional problem-solving courts designed to address underlying causes of offending rather than apportion guilt and punishment, have been reported to reduce offending among persons with mental illness and consequently have been spreading. Graduation from a MHC has been found to be a major predictor of reduced recidivism; yet few studies have examined factors affecting MHC graduation. This study examines what participants brought to MHC, their processing in MHC, and their behaviors during MHC. It found that noncompliant participant behaviors during MHC had the strongest impact on graduation, increasing the odds of failure to graduate and reducing, if not eliminating, the direct effects on completion of the risk factors participants brought into court. (PsycINFO Database Record (c) 2014 APA, all rights reserved)
This article, written from a less than detached standpoint by the chairperson of the body concerned, takes the recently completed review of child welfare practice and legislation in the Australian State of Victoria, as a case study of the contours, and of the factors which shape, law reform in areas of social policy. Substantive issues dealt with in the body of the Report1 will not be addressed here. Rather, the article considers some of the reasons which might explain why the task was not entrusted to one of the existing structures for the review of law and social policy in this State, and it canvasses some of the features which may make review by such a free-standing committee the preferred approach when reviewing social policy.
The main theme to be explored is that of the role of reviews in accelerating (or inhibiting) the process of change in a legal, welfare practice and public policy context. To this end the article addresses such matters as: the significance of the composition of the review body; its techniques of consultation with the public and with government; its dealings with government and major centres of power; and related matters which bear on its capacity to discharge its basic mandate. The contextual pressures which favour system inertia, or which may transform reform measures into something other than what was intended by the proponents of change, will also be alluded to.
It will be argued that the model of expert independent committee suffers from a vulnerability to the effects of external factors and relationships. These may leach away much of its capacity to undertake a thorough, detached evaluation of its specified field, and preclude it from building up significant momentum for change. Nevertheless, it is contended that these weak points are capable of being shored up. As a consequence it is concluded that this model is superior to its competitors when a significant area of social policy is thought to be ripe for evaluation and change.
For most of history, society controlled mentally disordered behavior informally; but with modernization it developed formal
organizational controls for the behavior it recognized as mentally disordered. This chapter examines relatively recent formal
attempts by two systems, the legal and mental health systems, to define and execute control over persons with mental illness
whose behavior violates societal norms. It begins with a brief history of the posture of the legal and mental health systems
toward mentally disordered persons prior to the mid-twentieth century. It then describes the collision which occurred following
civil rights reforms which made the legal system the arbiter of the mental health system’s decisions in treatment and hospitalization,
especially involuntary treatment and hospitalization. It describes societal forces beyond the two systems which brought about
conditions leading to their cooperation. It then examines the new cooperation that is beginning to occur, giving some detail
to one promising program of cooperation. Finally, it discusses directions for future inquiry by researchers who study the
two systems’ efforts in controlling deviance of persons with mental illness.
This paper assesses the impact of a statutory change in psychiatric commitment laws on the dangerousness of involuntarily committed civil patients in one metropolitan area. More restrictive local guidelines for commitment emphasizing assaultiveness were replaced by a new state law which expanded the criteria to those whose health might deteriorate from neglect. Using an interrupted time-series analysis, we find that changes in the proportion of persons hospitalized as dangerous (or assaultive) occurred more among normally less assaultive groups such as older, white and female patients than among normally more assaultive categories of younger, black and male patients. The less assaultive groups contained an increasing proportion of dangerous patients under the period of restrictive guidelines but the proportion dropped dramatically following the implementation of the less restrictive law. Groups typified by higher rates of assaultiveness remained at a relatively high level, unaffected by changes in the statutes or time. Given the relative stability in the numbers of OTA patients committed over time, the results suggest that changes in the proportion of patients said to be dangerous may be an artifact of the way petitioners for patients and providers make use of the mental health system.
The statutory requirements for involuntary civil psychiatric confinement have become increasingly restrictive. In the jurisdiction under investigation, patients were originally admitted under an Order to Apprehend (OTA) procedure simply on the petition of two affiants who indicated the patient was in need of care. A newly elected judge instituted changes requiring affiants to claim the subject was "dangerous" to self or others and asking for a clinical assessment and recommendation before signing the petitioned request for involuntary confinement. It might be expected that the more restrictive procedures would have produced a population of more assaultive patients. A study of petitions signed under in the earlier (N = 133) and later, more restrictive (N = 218) procedures indicated that the proportion of assaultive or dangerous patients was virtually identical. Further investigation, using hospital data an OTA patients from this area in both time periods, suggested that while patients were not more assaultive, they appeared to be more seriously ill or psychiatrically impaired. Apparently, movement to a dangerousness standard that allows clinical discretion in interpreting its presence may result in involuntary commitments for more seriously ill, although not necessarily more assaultive, patients.
Given the controversy that coercive treatment has generated in psychiatry and law, it is surprising that there is not a wealth of data on the extent and outcomes of coercion. One would expect that the most basic data on the incidence of formal, legal involuntary hospitalization within a nation would be published by each government. Most nations, however, do not compile and/or publish data on involuntary hospitalization or on any other type of compulsory psychiatric treatment as they compile and publish demographic, economic, social and health data; accordingly, there is no such compilation by nation published by the United Nations or any of its agencies. Where national statistics are published, as in the United States, they are subject to variation by hospital type and region, and the individual studies we have make generalizations tentative. There is still much we do know. From legislation, court decisions, and legal and psychiatric writings, we know that the dominant philosophy in Western Europe and North America favors community treatment without coercion and favors a maximum of patient autonomy in all treatment modes (26;52;68;106). Congruent with this philosophy are data that show that the number of persons residing in psychiatric institutions and their lengths of stay have been declining. Some national data also indicate that formal legal involuntary admissions have been declining. When individual studies from within nations are taken together, they also indicate declines in legal coercive hospitalization, though they may not be representative of their respective nations at one point in time. Data on the extent of nonformal coercive mental hospitalization and other coercive psychiatric treatments are much less available and less informative of trends. Data on the admission process of voluntary hospitalization indicate that coercion is common, that other coercive psychiatric treatments are used with voluntary as well as involuntary patients, and that ECT and psychosurgery are seldom used with involuntary patients. Because of small sample sizes, lack of representativeness, and variation in definitions, we do not know whether these indications from individual studies can be generalized, that is, whether they actually hold throughout the nations with studies and whether they hold in nations where there are no studies. Most notable is the little we know about the extent of involuntary hospitalization and other coercive measures in less developed countries. We encourage more research to fill in the missing information. Most basically, efforts should begin to encourage governments and the World Health Organization to collect and publish periodically data on the incidence of formal, legal categories of mental hospital admissions. Until then, researchers might combine in international working groups to obtain such basic data from official governmental sources of nations representing political or geographic regions. We encourage researchers to coordinate their efforts in investigating outcomes of coercion so that studies may have comparable measures, a greater opportunity for natural field experiments, and if efforts are combined, larger sample sizes with the ability to control relevant variables statistically. Researchers in nations with in- and outpatient case registers should take advantage of the possibilities of record linkage, which eases the collection of follow-up data between hospital and community treatment; however, because of legal restrictions in some nations, reliability problems with secondary data, and lack of important variables in patient records, primary data collection following individual patients is necessary if we are to obtain answers to many of the aforementioned questions. We also need more qualitative and quantitative investigation at the front end of the coercive process to identify reasons for resorting to coercion and to identify mechanisms by which both formal and informal coercion can be avoided. In this research, attention should be paid to the definitions and criteria for coercion, placing our understanding in the wider context of caring and respect for patients, as the work of Hoge, Lidz, Westrin, and their colleagues are doing in the United States and Sweden (8;24;42;50;56;57;114). A major question in coercive psychiatric treatment is whether these treatments are abusive, that is, used for social control without beneficence. Numerous studies show that involuntary hospitalization and other coercive measures are used for both social control, i.e., to protect the individual patient and to protect others, and beneficence, i.e., to bring treatment to patients and reduce illness-induced suffering (31;32;93;94). However, a full assessment of coercive psychiatric technology would seek to answer the question of whether the social control and beneficence can be achieved without formal invocation of the state's coercive power. Because of methodological problems with existent outcome studies, we do not know whether we can avoid the coercive measures and yet achieve positive outcomes. It may be that by reaching out more than is currently done to meet the needs and address the concerns of mentally ill persons, particularly those who are severely and persistently ill, both social control and beneficence can be achieved (99). That is surely an important research task yet to be done.
The revised commitment laws in the United States in general and in New York State in particular are reviewed to show that dangerousness is not the paramount criterion for commitment and that expanded discretion granted to admitting officials is the essence of the new laws. A qualitative portrait of psychiatric admission in the context of the new laws is offered followed by a discussion of implications for the societal reaction model.
"Advocacy" has emerged as a key concept in the process of the modernization of western psychiatry. This article combines a general discussion of the advocacy approach with an analysis of its application in practice. Two projects which are among the most advanced projects of professional advocacy in European mental health are used for discussion. The comparison shows a number of common organizational characteristics between the two models but also some striking differences which mainly concern the advocate-patient relationship. These differences can be traced back to specific socio-political and cultural backgrounds in the two countries.
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