Society’s Response to Maladaptive Behavior

Community Treatment Community mental health views problems as originating

(at least partly) within the social setting & social system Services should be located within the community Emphasis is on prevention & early detection Mental health professionals should act as consultants,

rather than treatment providers Paraprofessionals often are used as providers or

facilitators of services Competence & empowerment are emphasized rather

than deficits, illness or pathology Political & social change are needed to change some of

the causes of mental health problems

Abnormal Psychology, 11/e by Sarason & Sarason © 2005

Community Treatment Integrated network of services can prevent

hospitalization Unfortunately, few programs are integrated Lack of continuity and uniformity in services Day treatment, halfway houses, adequate case

management are necessary to prevent rehospitalization

Deinstitutionalization has resulted in increased admission of people for short-term stays

Abnormal Psychology, 11/e by Sarason & Sarason © 2005

One person’s experience with hospitalization

Abnormal Psychology, 11/e by Sarason & Sarason © 2005

Levels of Prevention

Primary Prevention

Secondary Prevention

Tertiary Tertiary PreventionPrevention

Abnormal Psychology, 11/e by Sarason & Sarason © 2005

Community Locations for Prevention The family

Intervene to change parenting practices that lead to child problems

Intervene during parental conflict or divorce Prevent child abuse and spouse abuse

The school Prevent behavioral disorders Strengthen social and cognitive skills

The community Help develop skills Provide role models and caring adults

Abnormal Psychology, 11/e by Sarason & Sarason © 2005

Diverse Pathways to Prevention Paraprofessionals

Consist of people of same social, economic, and ethic groups as population served

No special mental health training but make important prevention contributions

Self-help groups People with common problems come together Provide social support and normalization

Community psychology Utilize social systems and community resources to

aid in prevention

Abnormal Psychology, 11/e by Sarason & Sarason © 2005

Legal Issues in Treatment Commitment to Institutions

Voluntary – Patient agrees to admission Involuntary – Admitted pursuant to court proceeding

(civil commitment) Involuntary admission possible under Mental Health

Act (2 conditions required) Criminal commitment

Institutionalized by court order when crime deemed due to insanity, and

Necessary to protect public safety

Abnormal Psychology, 11/e by Sarason & Sarason © 2005

The Not Guilty by Reason of Insanity (NGRI) Legal Defense Insanity

Legal term that refers to state of mind when criminal act committed

Competency Person’s state of mind at any stage in judicial

proceeding Competence means ability to understand proceedings

and assist defense attorney Rule of insanity

Legal rules vary in different states Acquittal usually requires that person have severe

disorder such as psychosisAbnormal Psychology, 11/e

by Sarason & Sarason © 2005

NGRI Defense Myths Criminals use the defense to escape

punishment. Fact: Most people found not guilty by reason of

insanity spend more time confined than if they had been found guilty and sent to prison.

The defense is widely abused. Fact: The insanity defense is seldom used and

rarely successful. The defense allows criminals to “get away with

murder.” Fact: Only a small number using the defense have

committed violent crimes, especially murder. Most have been involved in minor felonies.

Abnormal Psychology, 11/e by Sarason & Sarason © 2005

Other Legal Issues in Mental Health Patient’s rights

Informed consent Right to terminate consent Least restrictive alternative

Confidentiality General duty of therapist to keep confidential patient

communications but there are exceptions (dangerousness, child abuse)

Duty to Protect Duty to warn specific third persons if patient

threatens imminent harm or death to specific others (Tarasoff decision)

Abnormal Psychology, 11/e by Sarason & Sarason © 2005