PSYCH 412 1st Edition Lecture 5 I have put both lectures 5, the lecture that occurred right after the exam and lecture 6 in this document because GradeBuddy had no spot for lecture 5 to upload it to. Also, starting now this material will be on the second exam.Outline of Current Lecture I. Issues in Mental Healtha. Social Issuesb. Legal IssuesCurrent LectureI. Issues in Mental Healtha. Social Issuesi. Deinstitutionalization – This is the movement of people who have severe mental illnesses out of the large psychiatric hospitals that they were livingin and back into their communities, where a network of community mental health centers would serve them1. With deinstitutionalization, there were services that were supposed to be provided and put into the communities that these severely mentally ill people were living in such as:a. Residential careb. Day treatment programsc. Crisis interventiond. Outpatient servicese. Vocational rehabilitation programs2. This did not happen due to lack of funding and resources. The people who left the institutions faltered due to:a. A lack of social supportb. Lack of adequate skills for community livingc. Difficulty finding or keeping jobsThese notes represent a detailed interpretation of the professor’s lecture. GradeBuddy is best used as a supplement to your own notes, not as a substitute.d. They were inadequately monitorede. They received no psychiatric treatmentf. They lived in substandard housingii. This created the revolving door problem, people would be constantly in and out of hospitals and the hospitalization rates skyrocketed.iii. “Trans-institutionalization” – this is where many of the people who wouldhave been in psychiatric facilities getting treatment are now in other institutions such as jails, prisons, nursing homes, and non-psychiatric hospital wards.iv. Managed care1. There is a huge gap between the people who need mental health services and the services that are provided. A lot of homeless are mentally ill and many of the mentally ill are in prisons or they havesubstance abuse problems.b. Legal Issuesi. A basic premise of criminal law is that all of us are responsible being who exercise free will and are capable of choices and legality has a significant influence of the mental health field.ii. People who are accused of committing a crime but who are mentally ill are subject to possible criminal commitment. This goes off the premise that a diseased mind cannot be a guilty mind. If a person who commits a crime is not of “sound mind” they cannot be held criminally responsible for their crime.iii. A person who is subject to criminal commitment can be:1. Involuntarily sent to a psychiatric facility to be assessed for competency to stand trial2. Can be involuntarily sent to a psychiatric hospital if found not guilty of the crime due to their mental illness.iv. Mental illness or limited intelligence may lead to unawareness of what is going on and a person cannot be held morally and criminally responsible and punished unless he or she intended to commit a crime, but just because someone is mentally ill it does not mean that they aren’t competent.v. Competence to stand trial1. Is the defendant currently able to work with her or her lawyer with a reasonable degree of understanding?2. Does the defendant have factual and rational understanding of theproceedings against him or her?vi. Insanity defense1. This is the basic idea that a defendant should be not be held accountable for a crime if it is attributable to a severe mental illness or defect.2. NGRI - not guilty by reason of insanity3. The insanity plea is used in less than 1% of all court cases and is generally unsuccessful.vii. M’Naghten Rule1. This rule was formed in British courts, our handling of the mentally ill committing crimes is based on this rule.2. If the defendant was suffering from a mental illness such that theydid not understand the nature and quality of the act they engagedin, if they did know this, the defendant did not know what he or she was doing was wrong.viii. Civil Commitment1. Civil commitment concerns individuals who are mentally ill and dangerous but who have not committed a crime they are subject to civil commitment to a psychiatric hospital.2. Grounds for civil commitmenta. Person is mentally ill as legally defined by the state and b. Person is a danger to themselves orc. Person displays imminent danger to others.3. This can then lead to involuntary hospitalization if they person fits these standards for grounds of civil commitment.ix. Emergency Detention1. Local police can take any person acting in a dangerous manner to a psychiatric hospital against their will if the police believe the person may be mentally ill and the hospital can hold them up to 72 hours.x. Patient rights1. Even when people are hospitalized against their will they still have patient rights such as:a. The right to treatmentb. The right to the least restrictive alternativesi. This permits the greatest freedom consistent with the patient’s condition in terms of personal safety and security of others.c. The right to refuse treatmenti. The patient must be fully informed regarding their treatment and its side effects, the expected benefits, and the alternative options of intervention and they have to sign consent toreceive treatment and they can refuse to consent to the treatment.xi. Confidentiality – this is an ethical standard that protects patients from disclosure of personal information without their consent.1. Tarasoff Decisiona. This limits confidentiality when a client threatens to harm another person. The therapist then has the following duties:2. Duty to warna. A therapist can breach confidentiality when a patient threatens harm to another person and the therapist has a duty to warn the intended victim if the patient is judged to pose a serious danger of doing violence to others.3. Duty to protecta. When a therapist determines that their patients are likely to be dangerous to another identifiable person(s), the therapist must take whatever steps that are reasonably necessary to protect the potential victim(s).LECTURE 6Outline of lecture 6I. Nature of AnxietyII. Generalized Anxiety DisorderIII. Panic DisorderIV. Phobic DisordersV. Obsessive Compulsive DisorderVI. Theories of Anxiety DisordersVII. Treatment of Anxiety DisordersLecture 6I. Nature of Anxietya. Anxiety is a common, normal bodily function and emotion. Anxiety can actually be quite helpful otherwise we