Ethics and Marginal Cases: the rights of the mentally handicapped

ABSTRACT  Some beings, including children, animals and the mentally handicapped, seem to deserve moral consideration, despite the fact that they are not rational or moral agents. These so-called marginal cases create a problem for theories that heavily stress the role of moral and/or rational agency in ethics: the latter seem unable to account for the former's moral status. This paper discusses the recent and original attempt of Loren Lomasky to solve this problem. It is argued that Lomasky's arguments are self-defeating because they can only succeed by relying on common-sense morality and, thus, by giving up the heavy stress on the role of rational agency in ethics.     

Character and behavior in the mentally ill and well mother

The purpose of this study was to examine character and behavior in a group of mentally ill and well mothers. Mentally ill mothers differed from well mothers in mother-child interaction in their positive involvement in the feeding context and in overall optimal mothering during feeding. On measures of intrapsychic conflict and concern, mentally ill mothers demonstrated significantly more conflict in areas of trust, anger, self-esteem, mutuality and nurturance and more concern with issues of self-esteem, and giving and caring than well mothers. For the mentally ill mothers postpartum onset of illness and number of separations from her child were related to some aspects of character and behavior.     

Guilty but mentally ill: An alternative verdict

Despite opposition from professional groups such as the American Psychiatric Association and the American Bar Association, “Guilty But Mentally Ill” (GBMI) statutes now exist in at least 12 states and are being considered in others. This paper reviews the development of the GBMI alternative to the insanity defense from a historical perspective, focusing especially on the reasons for its development in Michigan, the first state to pass GBMI legislation over 9 years ago. Using the Michigan experience, the GBMI statute is reviewed in terms of its perceived purpose and its success in accomplishing that purpose. Then recommendations for future changes are made.     

Firearms and the mentally ill: A legislative overview and jurisprudential analysis

This article examines federal and state laws that prohibit the mentally ill from possessing firearms and assesses the jurisprudence that has developed as courts have applied the federal law. It argues that although there is little or no empirical data linking the mentally ill with firearms violence, legislative activity and popular political debate invariably include such restrictions on the mentally ill. Notwithstanding the proliferation of firearms and antecedent violence, this article suggests that legislators and policy-makers must separate this issue from the broader and more emotional issue of “gun control” in order to effectuate better public policy and simultaneously protect the constitutional rights of the mentally ill.     

Treatment rights of the mentally retarded: The cost of refusal

The cost of the mentally retarded client's rights to refuse treatment, in both monetary and human terms, varies under different legal/clinical circumstances. The process of placing severely retarded clients into the community with poor or no supervision, especially those who refuse or are denied treatment, can result in devastating costs for the client and others. The complexities associated with mental retardation require sophisticated treatment considerations. Moreover, these clients often need guidance in making meaningful decisions relevant to their quality of life. In order for this process to produce desirable results, for both the mentally retarded client and society, in general, a balance must be struck between the legal and clinical factors involved.     

Outpatient civil commitment of the mentally ill: An overview and an update

Civil commitment to outpatient psychiatric treatment has only recently become the subject of significant discussion, not only in the professional literature, but also in state legislatures and mental health departments. Task Forces from the American Psychiatric Association and the National Center for State Courts have drafted detailed reports on outpatient commitment, and a growing number of states have modified their statutes and regulations governing the process. The author presents the existing research literature on outpatient commitment in practice, reports recent statutory developments, and discusses specific areas of concern for those planning to propose or implement new procedures, including the right to refuse treatment, confidentiality, and the duty to warn or protect third parties.     

Mental health needs of the chronically mentally ill elderly

The treatment histories and current social, financial, and clinical status of 111 chronically mentally ill (CMI) persons over the age of 60 were examined. Information was obtained from Ss, family, mental health records, and mental health professionals familiar with Ss. Psychiatric symptoms were observed in 74% of Ss. Many Ss experienced long periods without acute episodes of illness. Recurring episodes eventually appeared in most Ss, however, and ongoing deficits in daily functioning and social contacts were prototypical. Two thirds of the Ss were living in the community, relying heavily on family contacts; the rest lived primarily in nursing homes (23.4%) or psychiatric hospitals (7.2%). Social support was the best predictor of level of functioning. Findings suggest that failure of CMI elderly to use mental health services is not due to lack of need. Mental health services currently do not appear to be meeting the needs of this population.     

Developmental patterns in the infants and young children of mentally ill mothers

The development of children (ages 2 to 49 months) of mentally ill mothers was compared with that of children of matched “well” mothers. The children of mentally ill mothers scored lower on measures of intelligence and had a less adaptive coping style in the testing situation. The children of “well” mothers were more socially competent; that is, they sought the attention of adults more often, responded more to social initiatives, displayed more positive affect, and sent clearer signals. Clinical data on the children of mentally ill mothers complemented the research data, indicating that these children displayed problems in the areas of interpersonal relationships, verbal-conceptual functioning, attentional skills, and mood and affect.     

Treatment of the chronically mentally ill: an opportunity for the group therapist

This article focuses on the therapist's task of engagement in the group treatment of the chronic mentally ill. The dynamics of individual and group processes are reviewed with an emphasis on the contributions of social, interpersonal, and intrapsychic factors. Drawing upon the observations of Friedman (1988), the presentation explores therapists' efforts to restore their inner balance by (1) acting like a therapist, that is, according to their theory; (2) satisfying their curiosity; and (3) eliciting "something desirable," which is formulated as the therapist's search for interactive responses. Examples illustrate these elements as they emerge in group psychotherapy.     

Evaluating professionally operated and self-help programs for the seriously mentally ill

Reviewed a study by Bond et al. (1990) that evaluates assertive community treatment (ACT), an intensive community-based program for the seriously mentally ill. Such programs have been developed at a rapid pace in recent years but lack extensive research support. This randomized study supports the effectiveness of ACT and is a significant contribution to the mixed findings from the existing literature. However, its methodological flaws include (a) differential dropout from the ACT and comparison groups, (b) a relatively short follow-up period (12 months), and (c) limitations of the ACT intervention which prevents rehospitalization but lacks impact in other domains (e.g., social relationships, housing stability, employment). Self-help programs, poorly represented by the comparison group in this research, may offer the sorts of societal niches required by the mentally ill. Further research, giving such programs a "fair shake" against professionally controlled programs, is sorely needed.     

Transition planning and recidivism among mentally ill juvenile offenders

OBJECTIVES: To determine the extent to which transition planning and community service would predict lower levels of recidivism among mentally ill juvenile offenders. DESIGN: Review of legal, medical and social service records including examination of 3-month period following community release. PARTICIPANTS: Juvenile offenders incarcerated for 6 months or more (N = 44) transitioning to community. MEASURES: Child and Adolescent Functional Assessment Scale (CAFAS), sum of different documented pre- and post-release discharge planning contacts, documented community service contacts. OUTCOMES: Re-offense during the first year post-release. RESULTS: Documented community service contacts in the 3 months following discharge were rare for mental health (20.5%), substance abuse (38.6%), financial assistance (29.5%), and school placement (34.1%). The average number of different pre-release and post-release discharge planning contacts was also low, M(SD)=1.86(1.68) and M(SD)= 2.34(1.71) respectively. Post-release discharge planning and the receipt of financial assistance and mental health services were all associated with lower levels of reoffending. CONCLUSIONS: Community transition planning, including the coordination and provision of community services, is an essential component of community reintegration for juvenile offenders and is associated with lower rates of recidivism during the first year post-discharge.