Advance directives for mental health care: An analysis of state statutes.

State statutes enabling individuals to draft written durable advance directives for health care have approached future decisions about mental health care and treatment in several quite different ways. While some states incorporate mental health care into the generic advance directive law, others exclude some kinds of mental health care from the generic law, and a growing number of states have established distinct processes for mental health directives. The author surveys the state statutes and examines the extent to which the statutes may create barriers to the use of advance directives by people with mental illness. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Religious advance directives: the convergence of law, religion, medicine, and public health

Because of the deep interpersonal significance of decisions made at the end of life, it is not surprising that religion has played an important role in patient and family decision making. Specific religious concerns about death and dying have led to religious advance directives. Advance directives offer a case study of models of interaction between religious communities and secular institutions. This paper examines why such directives have been created and how they may affect health care decisions. An analysis of their strengths and weaknesses concludes that specific religious instructions are unnecessary in written directives and may undermine both the religious and health care goals of patients.     

Disability and the law: Attitudes of police, lawyers, and mental health professionals.

A literature review on the attitudes of police officers, lawyers, and mental health professionals toward the disabled indicates that police officers' attitudes are related to the extent of their formal education and the amount of information they have about relating to persons with various types of disabilities. Lawyers who have disabled clients tend to be more knowledgeable and to have more positive attitudes than lawyers without such clients, but it is not easy to turn lawyers into advocates for disabled clients. Mental health professionals, who may be called on to provide advice to police officers or lawyers or to testify in court cases, have some negative aspects that may impair their helpfulness, but their attitudes are more positive than those of less educated persons. Data also indicate that the attitudes of psychologists are less negative than those of psychiatrists. It is concluded that rehabilitation psychologists need to undertake studies of the attitudes of these groups and to set up programs designed to change the attitudes of members of these professions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Making law therapeutic for lawyers: Therapeutic jurisprudence, preventive law, and the psychology of lawyers.

The integration of therapeutic jurisprudence (TJ) with preventive law (PL) offers a uniquely satisfying and humanistic way of practicing law. The author uses the psychological data on the personality characteristics of lawyers to argue that TJ/PL is particularly well suited for lawyers with certain personality traits atypical of lawyers generally. These traits reflect altruistic, humanistic, or interpersonally oriented values; 2 of these atypical traits have been empirically linked to career dissatisfaction among lawyers. Because of the pervasiveness of the problem of lawyer job dissatisfaction, solutions are needed. TJ/PL is more than simply an alternative way of practicing law; it may actually hold the key to solving some of the problems currently besieging the legal profession. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Advance directives for psychiatric treatment: A view from the trenches.

Medical advance directives for end-of-life decisions at times that patients cannot express their preferences have become a major trend in recent state and federal legislation. The author argues that an extension of directives to cover future psychiatric treatment are fraught with both practical and ethical dilemmas. Although the potential for increasing patient autonomy is certainly positive, the potential for implementing covert ideological agendas has been present from the beginning, and the significant differences between medical end-of-life decisions and ongoing treatment of psychiatric patients must weigh against psychiatric advance directives unless major changes are made in existing procedures. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Advance directives: the price of life

Advance directives support the concepts of patient autonomy and resource allocation. Promotion of advance directives by nurse managers according to the suggested paradigm should be an economic and policy priority.     

Teaching mental health and law: A reply to Goldenberg.

In a recent article Goldenberg (1978) indicated that Shealy (1977), in his presentation of a format for teaching mental health workers basic forensic procedures and issues, failed to specify the potential rewards and costs of courtroom participation. Having participated as clinical psychology interns in a forensic psychology seminar led by and modeled after Shealy's (1977) format, the authors felt they could offer a meaningful rejoinder based on their personal experiences with both the rewards and potential pitfalls of such judicial participation, and on our understanding of the basic adversary nature of the legal system. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Advance directives: the emerging body of research

BACKGROUND: With the passage of the Patient Self-Determination Act in 1990, new procedures and documents became available for planning end-of-life care. These new procedures and documents are now being examined scientifically. OBJECTIVE: To review existing research on the use of advance directives. DATA SOURCES: Computer search using Grateful Med software from the National Library of Medicine with MEDLINE and BIOETHICSLINE databases. STUDY SELECTION: Studies that showed an emerging consensus or reported vastly differing results were selected. Selected studies examined these specific areas: demographic data on patients with advance directives, completion rates, capacity to complete, patients' preferences, stability of patients' decisions over time, treatment choices, proxy decision makers, treatment provided, and cost. RESULTS: The body of important research about advance directives is growing. A profile of their clinical utility is emerging. CONCLUSIONS: The research done so far can stimulate future research and can begin to suggest possible changes in practice. However, the body of research is not yet large enough or well controlled enough to answer conclusively many of the questions about planning of end-of-life care.     

The side effects of incompetency labeling and the implications for mental health law.

In addition to labeling people as mentally ill, the law often labels them as incompetent to exercise certain rights or to play particular roles. Indeed, under the broad dicta of Zinermon v. Burch, incompetency labeling may increase dramatically. This article uses principles of social and cognitive psychology to examine the effects of incompetency labeling. Such labeling is shown to produce potentially serious adverse effects. It often alters the way others view and react to the labeled individual and affects his or her self-esteem and self-concept in ways that may inhibit performance, diminish motivation, and depress mood. After analyzing those negative side effects of incompetency labeling, the article examines the implications of these findings for mental health law and makes a number of proposals for changing the law to avoid or minimize these adverse effects. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Hero/heroine modeling for Puerto Rican adolescents: A preventive mental health intervention.

Culturally sensitive treatments of the special mental health needs of high-risk Puerto Rican adolescents are lacking. The hero/heroine intervention was based on adult Puerto Rican role models to foster ethnic identity, self-concept, and adaptive coping behavior. 90 nonclinical Puerto Rican 8th and 9th graders were screened for presenting behavior problems in school and randomly assigned to an intervention and a control group. After 19 sessions, the intervention significantly increased adolescents' ethnic identity and self-concept and reduced anxiety. Treatment outcomes varied as a function of grade level, sex, and household composition. Self-concept was negatively affected among girls from intact families. The study supports the effectiveness of the culturally sensitive modality as a preventive mental health intervention for high-risk Puerto Rican adolescents, especially from single-parent families. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Roles for mental health professionals in critical law enforcement incidents: An overview.

Law enforcement personnel routinely face various critical incidents in the course of their workday including confrontations with irate, violent, and/or mentally challenged individuals. While less frequent, law enforcement personnel also are called in response to hostage incidents, barricaded subject incidents, and attempted suicide/suicide by cop incidents. Over the past 30 years, response strategies utilized by law enforcement personnel have been evolving and have been influenced by mental health professionals. This article briefly reviews the histories of Critical Incident Teams (CITs) and Crisis Negotiation Teams (CNTs), discusses the roles of mental health professionals in the development and continuing evolution of CITs and CNTs, presents some of the obstacles to mental health involvement with law enforcement, and highlights areas in need of more empirical research. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Advance directives for psychiatric care: A theoretical and practical overview for legal professionals.

An advance directive for psychiatric care is a legally enforceable document that specifies the manner in which psychiatric treatment decisions are to be made in the event that a person later becomes incompetent to make informed health care decisions. Although the concept of psychiatric advance directives has gained considerable popularity in recent years, the groundswell of interest in these instruments largely precedes the development of a coherent body of governing law. Existing state statutes and case law provide significant legal authority for the use and enforcement of advance directives in psychiatric settings, but serious questions remain concerning the scope of their enforceability, particularly in the context of involuntary treatment. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Validity generalization of a school-based preventive mental health program.

Summarizes results of 6 independent evaluations of school district implementations of the Primary Mental Health Project (PMHP), a program for early detection and prevention of school adjustment problems. Data indicate that each district program was effective beyond chance expectation. The pooled change profile, based on 370 primary-grade children seen through the 6 district programs, was positive. Findings support the soundness and utility of PMHP's underlying program model and suggest that it can be implemented flexibly and effectively in a variety of settings. (22 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Meta-analysis of cognitive-behavioral interventions on HIV-positive persons' mental health and immune functioning.

Objective: To evaluate the efficacy of cognitive-behavioral interventions (CBIs) for improving the mental health and immune functioning of people living with HIV (PLWH). Design: Comprehensive searches of electronic databases from 1988 to 2005, hand searches of journals, reference lists of articles, and contacts with researchers. Meta-analytic approaches were used in synthesizing findings. Main Outcome Measures: Intervention effects on symptoms of depression, anxiety, and anger, stress, and CD4 cell counts were assessed. Results: Data from 15 controlled trials were analyzed. Significant intervention effects were observed for improving symptoms of depression (d = 0.33), anxiety (d = 0.30), anger (d = 1.00), and stress (d = 0.43). There is limited evidence suggesting intervention effects on CD4 cell counts (d = 0.08). The aggregated effect size estimates for depression and anxiety were statistically significant in trials that provided stress management skills training and had more than 10 intervention sessions. Conclusion: CBIs are efficacious in improving various psychological states of PLWH. Future research should examine the relationship among interventions, psychological states, medication adherence, and immune functions, and identify other relevant factors associated with intervention effects. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Professional responsibility, therapeutic jurisprudence, and preventive law.

In this essay, the author considers how therapeutic jurisprudence and preventive law might inform the field of professional responsibility. He suggests that many principles underlying professional responsibility standards are rooted in hidden psychological assumptions about the interaction between clients and lawyers. These principles often are ignored. Scientific research into the psychological assumptions underlying professional responsibility norms could have numerous beneficial effects, including clarifying professional responsibility norms and teaching lawyers to deal with clients in a way that will help clients cope with the legal system and avoid tensions with their lawyers. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Review of Canadian mental health law and policy.

Reviews the book, Canadian Mental Health Law and Policy by John E. Gray, Margaret A. Shone, and Peter F. Liddle (2000). The authors of this book have produced a multidisciplinary text that succinctly summarizes the main points of Canadian mental health laws and the variability across provinces and territories in these laws and in their typical interpretation and application. This book offers a concise guide to the laws dealing with key issues such as involuntary hospital admission, authorization of psychiatric treatment, and treatment refusal. Although not always an easy read for those unfamiliar with legal terms and writing, the book is geared to a wide audience that includes legal and policy specialists, mental health professionals, and advocates for the mentally ill. These authors are to be congratulated for their efforts to disseminate and explain information on Canadian mental health law and to promote a more humane and scientifically grounded set of legal standards and interpretations that are pertinent to the disposition and treatment of Canadian citizens with severe mental disorders. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The impact of AIDS on practitioner and client: Notes for the therapeutic relationship.

This article discusses the dynamics of the psychotherapeutic relationship using antibody status for the human immunodeficiency virus (HIV) as a frame of reference. The psychological and social ramifications of individuals' knowledge or lack of knowledge about their antibody status are discussed, as well as their reactions to testing either positive or negative for HIV antibodies. The impacts of the combined antibody statuses of therapist and client within the therapeutic interaction are described. Case reports are presented in order to convey a deeper understanding of transference and countertransference issues in those affected by the AIDS epidemic. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Interactions between mental health and law enforcement systems: problems and prospects for cooperation

This article examines the challenges posed by system specialization, as illustrated by the difficulties of coordinating the roles of the mental health and law enforcement agencies working with people with severe mental illness. Dealing with the needs of clients in one system when they are most appropriately served by the other may make both law enforcement and mental health systems appear ineffective and inefficient. This could increase the incidence of disorderly or violent behavior, which forments the myth that the seriously mentally ill are inherently dangerous. Despite the evident need to manage these issues, conventional methods of coordinating services have failed. This article concludes by developing a contracting model that creates more appropriate incentives for the two systems and bridges the gap between them.