Therapist competence — Mental health professionals are guided by professional standards and are expected to have the intellectual competence to assess, conceptualize, and treat clients whom they accept into treatment. Informed consent — Client participates in treatment goals, understands treatment plan, knows clinician’s credentials, and is advised of treatment risks. Confidentiality — The therapist has a duty to safeguard client disclosures as private. The content of therapy is legally considered privileged communication ; there is a legal privilege of nondisclosure unless the client waives it.
Every state requires some form of mandated reporting when professionals learn first-hand of cases involving child abuse or neglect. When the clinician learns a client plans to hurt another person, the clinician is required to warn the potential victim that the client plans to harm him or her. Duty to warn laws arose in response to the “Tarasoff” case of 1969. Complicating this matter is the imprecise nature of predicting dangerousness.
In addition to sexual or romantic involvements, it would be inappropriate for clinicians to become involved in business relationships with clients.
Although some clients are able to pay for their therapy, most rely on a third party to pay, such as public assistance or an insurance policy. HMOs and managed care mental health systems initially made sense to keep insurance premiums affordable. However, many clinicians struggle with recurring ethical dilemmas when trying to balance clients’ best interests against rewards, sanctions, and other inducements to limit treatment.
The role of expert witness has many challenges, in that the clinician is called on to provide specialized information in court. In cases with evidence or charges involving child abuse, a mental health professional may be asked to make recommendations about the child’s care. In some cases, the clinician is appointed as a guardian ad litem , a person appointed by the court to represent or make decisions for a person legally incapable of doing so in a civil legal proceeding.
Commitment stems from the legal principle that the state has the authority (referred to a parens patriae ) to protect those who are unable to protect themselves. This responsibility is vested in various professionals such as psychologists, physicians, and nurse specialists.
Standards for involuntary commitment have alternated between overly restrictive and overly liberal. When they were too strict, it was difficult to keep all but the most extremely disturbed individuals hospitalized, and the number of mentally ill homeless increased.
In the rapidly growing field of forensic psychology , professionals with backgrounds in law and mental health tackle a variety of questions regarding the relationship between criminal behavior and psychological disturbance.
The insanity defense originated as an attempt to protect people with mental disorders from being punished for harmful behavior resulting from their disturbed psychological state.
Standards vary between states and over the course of history.
M’Naghten Rule (the “right-wrong test”): Under the delusional belief he was commanded by God, Scottish woodcutter Daniel M’Naghten killed an English government official. He was deemed not responsible because his mental state prevented him from knowing the difference between right and wrong. The Durham Rule emerged from a 1954 court decision asserting an individual is not criminally responsible if the “unlawful act was the product of mental disease or defect.” This allowed for the insanity defense but was too broad. In 1962, the American Law Institute published guidelines saying people are not responsible if mental disorder prevents their “appreciating” wrongfulness of their actions or from controlling their actions. After John Hinckley was found not guilty by reason of insanity after shooting President Reagan, Congress passed the Insanity Defense Reform Act of 1984 trying to clear up the ambiguity inherent in ALI standards. The defense now had to prove insanity rather than rely on a “reasonable doubt” regarding the client’s sanity.
The determination of competency to stand trial is a prediction by a mental health expert of the defendant's cognitive and emotional stability during the period of the trial. To increase precision of competency assessments, forensic experts developed standardized instruments to be used in such evaluations.