Mental Health Services

Front 1

What are the Scylla and Charybdis of mental health practice?

Back 1

Mental health treatment must navigate between control and liberality. If they veer to far towards control, they face the danger of violating the patients' individual rights. If they are too liberal or laissez-faire in their treatment of patients, they face the danger of putting society or the patient at risk.

Front 2

What is parens patriae?

Back 2

It means "the state as parent," that the government has a right to intervene when it discerns that citizens are not acting in their own best interests. (This and police power are the two general principles under which a government claims a right to commit people)

Front 3

In Canada, are the laws defining the criteria for commitment a provincial or federal responsibility?

Back 3

provincial

Front 4

In which way is Quebec different from other provinces in the legislation surrounding commitment of patients?

Back 4

Quebec uniquely does not require there to be a diagnosable mental illness.

Front 5

All Canadian provinces require what two laws surrounding patient commitment?

Back 5

The patients must be informed of the reasons for his/her detention. Also, the committed patient must either be dangerous to him/her self or to others.

Front 6

Which province has the broadest scope for clinicians to decide whether a person is a potential harm? Which provinces is the most strict, such that there is no way to commit someone simply to prevent deterioration?

Back 6

BC = broadest scope
Ontario = most strict

Front 7

Which province is unique in NOT mandating that a committed patient has a right to legal counsel? (though patients do have a right to appeal a commitment order to the court)

Back 7

Alberta

Front 8

In Alberta, are patients allowed to refuse medication?

Back 8

Yes

Front 9

In Alberta, how long does the first certificate for commitment last? how about the second? third and fourth? fifth?

Back 9

first commitment lasts for 24 hours. If a second certificate is filled out in those 24 hours, the hospital can keep the patient for up to one month from the time of issue. The next two are for one month each. After that they last for SIX months.

Front 10

What are the four members of a review panel that reviews any commitment order? Who are they appointed by?

Back 10

Any commitment order can be reviewed by a review panel (in no more than three weeks) appointed by the minister of health, made up of a
lawyer,
a non-psychiatric medical doctor,
a psychiatrist, and
a member of the general public

Front 11

What is the total cost to appeal a decision made by a commitment order reviewing panel?

Back 11

$2000 - $3000

Front 12

In Alberta, can psychosurgery be performed without patient consent?

Back 12

No.

Front 13

Is a valid DSM diagnosis sufficient for deeming a person 'mentally ill' in order for commitment?

Back 13

No. The definition of "mentally ill" varies by province, but none of them simply accepts a valid DSM diagnosis as being sufficient for being deemed mentally ill.

Front 14

How is the legal definition of mental illness entirely separate from the clinical definition? (which is for functional purposes?)

Back 14

In the legal sense, it is a FUNCTIONAL definition. E.g., it focuses on whether a person is incapacitated by mental illness.

Front 15

What are the two vague terms used in the Alberta Mental Health Act's definition of mental illness?

Back 15

"substantial" and "grossly"

“a substantial disorder of thought, mood, perception, orientation or memory that grossly impairs judgment, behaviour, capacity to recognize reality, or ability to meet the ordinary demands of life.”

Front 16

What % of those diagnosed with mental illness have a history of harming themselves or others?

Back 16

10% (90% of those diagnosed with mental illness have no history of harming themselves or others)

Front 17

Only those with which category of disorder are more likely to cause harm than the undiagnosed?

Back 17

A meta-analytic study of this issue showed that only those diagnosed with PSYCHOTIC disorders (especially if they were delusional and/or hallucinating) were more likely to cause harm than the undiagnosed.

Front 18

What is the HCR-20?

Back 18

It is a psychometric instrument with a twenty-item checklist that assesses violence risk in a systematic way. HCR stands for the three scales: Historical, Clinical, and Risk Management

Front 19

How accurate is the HCR-20? (how many discharged patients accurately classified in %) Which is the most important of the three scales?

Back 19

A prospective study found that it (+ some other predictors) classified about 85.7% of 129 discharged patients accurately.

However, the last two scales add little to the predictor model. The best predictor is personal HISTORY.

Front 20

When did the process of de-institutionalization for mental patients begin?

Back 20

Started in the 1960s and continued through the 1980s.

Front 21

In 1955, what % of psychiatric treatment was on an in-patient basis? Today, the same % of treatment is on an OUT-patient basis.

Back 21

75% of treatment was on an in-patient basis; now 75% is on an out-patient basis

Front 22

Between 1968 and 1978, the US in-patient population dropped by __ %. and the drop from 1968 to 1998?

Back 22

65% (from 399,000 to 132,000)

By 1998, there were just 57,561 in-patients, a drop of 86%

Front 23

Between 1957 and 1975, the CANADIAN in-patient population dropped by __%.

Back 23

36% (from 70,300 to 44,847)

Front 24

Of mentally ill people arrests, what % are arrested for charges serious enough to warrant incarceration? What % are incompetent to stand trial?

Back 24

12% serious enough to warrant incarceration; 54% are incompetent to stand trial

Front 25

Are the mentally ill more likely to be arrested?

Back 25

Research suggests yes.

Front 26

What % of the American homeless are estimated to be mentally ill?

Back 26

1/3 to 1/2

Front 27

Between 1960-1980, when neuroleptics became widely available, what did criminally-institutionalized rates look like?

Back 27

They were still approximately flat.

Front 28

When did the criminally-institutionalized rate begin to sky-rocket?

Back 28

Around 1980 once deinstitutionalization + the "war on drugs" becomes policy.

Front 29

Since ____, Canadian law was recognized that people are not responsible for the their behavior if, due to a mental disorder, they do not know what they are doing or do not know that what they are doing is wrong.

Back 29

1894

Front 30

Until ____, mentally ill criminals were detained in a mental institution until they were deemed sufficiently improved to be released– which amounted to an indefinite sentence and which often subjected the accused to longer detention that the court would have ordered.

Back 30

1991

(In 1991, the Supreme Court ruled that indefinite detention was an infringement of rights and imposed caps on how long a person could be held, that were tied to the maximum criminal penalty for the crime.

However, the court can still order detention for life.)

Front 31

What % of people agree that "judges and juries have a hard time telling whether someone is really sane or insane"?

Back 31

91%

Front 32

What % of people agree that "the insanity plea is used too much"

Back 32

90%

Front 33

What % of crime-doers are deemed criminally non-responsible?

Back 33

~3% (1000 people compared to 32,000 deemed criminally responsible)

Front 34

What three conditions deem a person unfit to stand trial?

Back 34

If they are unable to (1) understand the nature or PURPOSE of the trial, or the (2) CONSEQUENCES of the trial, or are (3) unable to COMMUNICATE with counsel.

Front 35

If a person is found unfit to stand trial, how soon must the court make a decision? What if they cannot?

Back 35

Immediately. If it cannot, a review board must make a decision with 45 days.

Front 36

Can a review board issue psychosurgery or ECT?

Back 36

No. They can order that the accused receive treatment (but only in rare cases, and the order cannot exceed 60 days).

Front 37

For those unfit to stand trial, what decisions must a review board make for them?

Back 37

The must decide whether or not to
(1) conditionally discharge the accused
(2) detain the accused in hospital (initially for either 45 or 60 days for assessment)
(3) order that the accused receive treatment

Front 38

Who determines whether a person is unfit to stand trial?

Back 38

The burden of proof is on whoever makes the claim: the prosecutor or the accused's counsel (which will be court-ordered if there is none)

Front 39

What does the Fitness Interview Test (Revised) ask questions about?

Back 39

The Fitness Interview Test (Revised) is a structured interview that asks a series of questions about:
(1) Understanding the proceedings
(2) Understanding the consequences of the proceedings
(3) Ability to communicate with counsel

Front 40

When did the issue of when a health professional has a duty to warn someone that they may be subject to harm by a patient come to the forefront?

Back 40

In 1969, when a paranoid schizophrenic student murdered a women, after hinting to two therapists that he might do so.

Front 41

are health professionals duty-bound to report if there is a chance a patient will commit suicide?

Back 41

Yes.

Front 42

What % of accused criminals are estimated to malinger?

Back 42

77%

Front 43

Is the MMPI a good test for detecting malingering? Which is the best known scale used for such?

Back 43

Textbook says so. But it's controversial. The 43-item LEES-HALEY is the best known MMPI-II scale for detecting malingering, but some say it is a poor scale invented as a 'MONEY PUMP' for its author. Some say that the results only indicate that it is more likely to measure general MALADJUSTMENT and somatic complaints rather than malingering.

Front 44

Is the MMPI said to be better at discriminating
normals from faking-bad normals
OR
faking-bad normals from real patients?

Back 44

It is easier to discriminate normals from faking-bad normals than faking-bad normals from real patients.

Front 45

Is the MMPI said to be good at discriminating between patients and faking-bad patients?

Back 45

It is said that it is NOT EASY to discriminate between patients and faking-bad patients.

Front 46

What is the cut-off to distinguish genuine from faked MMPIs?

Back 46

There is NO universal cut-off.

Front 47

Testing positive on a rare psychiatric symptom can be a clue that malingering is going on. For example, only __% of auditory hallucinations are vague or inaudable. Do few or many patients feel compelled to obey hallucinated commands?

Back 47

Only 7%. They are always intermittent and very few patients feel compelled to obey hallucinated commands.

Front 48

What three broad (and inter-related) areas does the Canadian Code of Ethics for Psychology cover, and who is bound by it?

Back 48

In Canada all psychologists are bound by it. The three areas are:
1. Boundary issues
2. Harm-limiting issues
3. Competence limit issues

Front 49

When was the idea of a "right" to treatment first put forth and by whom? and when was it legally established?

Back 49

in 1960 in an article written by an attorney-physician, Morton Birnbaum.

The right was legally established in a landmark American case filed in Alabama in 1972, Wyatt vs. Stickney.

Front 50

How many in-patients were living in terrible conditions at Bryce State Hospital in 1970?

Back 50

5200

Front 51

What led to the low funds at Bryce State Hospital?

Back 51

The state cut a cigarette tax that was supposed to fund mental health facilities, which resulted in "cutbacks."

Front 52

At Bryce State Hospital, there was one physician per ___ patients, one nurse per ___, and one psychiatrist per ____.

Back 52

350,
250,
1700.

Front 53

Did employees win a lawsuit filed against the Bryce State Hospital?

Back 53

No. The judge ruled that the hospital was within its rights to make hiring and firing decisions.

Front 54

Do all Canadian provinces recognize a right to refuse treatment?

Back 54

Most (but not all) provinces, including Alberta, recognize this as law.

Front 55

When was the right of the mentally ill to refuse treatment established in Ontario? What was the impetus behind it?

Back 55

It was established in a 1980 case where George Reid, a violent robber diagnosed with schizophreniform disorder was granted to the right to refuse treatment on the grounds that forced treatment violates SECTION SEVEN of the Canadian Charter of Rights and Freedoms, which grants the right to life, liberty, and security of the person (inc. protection of "psychological integrity")

Front 56

Is mental illness a legal or psychological term?

Back 56

Legal term.