Mental Health and the Law

In caring for those with mental illness, physicians often find their guiding ethical principles in conflict with one another. Mental illness can impair a patient’s capacity to give informed consent to treatment, when consent is fundamental to medical ethics. Those with mental illness may also threaten their own well-being or that of others, causing physicians to restrict their action or report their threats. And the justice system may call on doctors to give testimony that is not in their patients’ best interest. Contributors to the October issue contend with these and other difficult ethical dilemmas.

Volume 15, Number 10: 825-920 Full Issue PDF
  • From the Editor
    Oct 2013

    To Treat, Advocate, and Protect

    Laura M. Blinkhorn, MD
    Primary care doctors and psychiatrists balance competing responsibilities: putting the patient’s interests first and alerting others to harms that patient might inflict.
    Virtual Mentor. 2013;15(10):827-828. doi: 10.1001/virtualmentor.2013.15.10.fred1-1310.
  • Case and Commentary
    Oct 2013

    Speculating on a Public Figure’s Mental Health

    John Henning Schumann, MD
    The American Psychiatric Association proscribes its members from commenting on the mental health of public figures under its nonbinding “Goldwater Rule,” which followed a published survey of more than 1,000 psychiatrists commenting on Barry Goldwater’s emotional fitness for the presidency.
    Virtual Mentor. 2013;15(10):829-833. doi: 10.1001/virtualmentor.2013.15.10.ecas1-1310.
  • Case and Commentary
    Oct 2013

    Pedophilia: Is There a Duty to Report?

    Fabian M. Saleh, MD and H. Martin Malin, PhD, MA, LMFT
    In treating patients whose sexual fantasies do not trigger an immediate legal duty to report, psychiatrists must be vigilant for signs that the patient intends to act on a fantasy.
    Virtual Mentor. 2013;15(10):834-839. doi: 10.1001/virtualmentor.2013.15.10.ecas2-1310.
  • Case and Commentary
    Oct 2013

    The Treating Psychiatrist and Worker’s Compensation Reporting

    Charles C. Dike, MD, MPH
    When psychiatrists must submit evaluations of their patients in legal settings, they must provide complete and factual accounts even if the patient's attorneys would rather redact some information.
    Virtual Mentor. 2013;15(10):840-843. doi: 10.1001/virtualmentor.2013.15.10.ecas3-1310.
  • Case and Commentary
    Oct 2013

    Civil Commitment for Substance Abuse

    Jeffrey C. Eisen, MD, MBA
    Determining which patients are appropriate candidates for mandated substance-abuse treatment remains controversial and complicated.
    Virtual Mentor. 2013;15(10):844-849. doi: 10.1001/virtualmentor.2013.15.10.ecas4-1310.
  • In the Literature
    Oct 2013

    The Evolving Definition of Posttraumatic Stress Disorder: Legal Ramifications

    Daniel Yohanna, MD and Maxwell R. Rovner, MD, JD
    Forensic psychiatrists need to be familiar with the use of posttraumatic stress disorder as a legitimate and proper defense in criminal cases, especially given changes to its classification in the Diagnostic and Statistical Manual of Mental Disorders.
    Virtual Mentor. 2013;15(10):852-856. doi: 10.1001/virtualmentor.2013.15.10.jdsc1-1310.
  • Health Law
    Oct 2013

    Juvenile Forensic Psychiatric Evaluations

    Susan Buratto, MD and Stephen H. Dinwiddie, MD
    The duty of forensic psychiatrists is to serve as objective experts to courts, but special circumstances in juvenile forensic evaluations and expectations about the patient-physician relationship may encourage confusion between the roles of forensic evaluator and treating psychiatrist.
    Virtual Mentor. 2013;15(10):860-865. doi: 10.1001/virtualmentor.2013.15.10.hlaw1-1310.
  • State of the Art and Science
    Oct 2013

    Dynamic Descriptions of Personality Disorder in the DSM-5

    Carl C. Bell, MD
    The DSM-5 introduces dimensional, psychodynamic criteria for identifying healthy personalities and personality disorders.
    Virtual Mentor. 2013;15(10):857-859. doi: 10.1001/virtualmentor.2013.15.10.stas1-1310.
  • Policy Forum
    Oct 2013

    Court Diversion for Juveniles with Mental Health Disorders

    Eric Trupin, PhD, Sarah Cusworth Walker, PhD, Hathaway Burden, and Mary Helen Roberts
    Mental health diversion programs show promise in effectively addressing the treatment needs of youth with mental health and substance use disorders who come in contact with the justice system.
    Virtual Mentor. 2013;15(10):866-872. doi: 10.1001/virtualmentor.2013.15.10.pfor1-1310.
  • Policy Forum
    Oct 2013

    Civil Commitment for Sex Offenders

    Corey Rayburn Yung, JD
    When called to consult or to testify at “sexually violent predator” hearings, medical professionals’ primary task is adapting recognized medical terminology to the SVP label; they are asked to shoehorn medical diagnoses into ill-fitting legal language.
    Virtual Mentor. 2013;15(10):873-877. doi: 10.1001/virtualmentor.2013.15.10.pfor2-1310.
  • Medicine and Society
    Oct 2013

    Sanism and the Law

    Michael L. Perlin, JD
    Sanism, irrational prejudice against people with mental illness including erroneous and stereotypical beliefs, perverts legal proceedings involving the mentally ill.
    Virtual Mentor. 2013;15(10):878-885. doi: 10.1001/virtualmentor.2013.15.10.msoc1-1310.
  • History of Medicine
    Oct 2013

    Deinstitutionalization of People with Mental Illness: Causes and Consequences

    Daniel Yohanna, MD
    Movements to deinstitutionalize people with mental illness and to make institutionalization more legally difficult have resulted in a lack of space and resources for the care of those with severe mental illness, and many have ended up in jails and prisons.
    Virtual Mentor. 2013;15(10):886-891. doi: 10.1001/virtualmentor.2013.15.10.mhst1-1310.
  • Personal Narrative
    Oct 2013

    Mental Illness, Inside and Out

    Fred Friedman, JD
    Fred Friedman's experiences with mental illness treatment and homelessness.
    Virtual Mentor. 2013;15(10):892-897. doi: 10.1001/virtualmentor.2013.15.10.mnar1-1310.
  • Viewpoint
    Oct 2013

    Registries, Violence, and Threats of Harm

    Howard Zonana, MD
    Registries of those considered dangerous focus wrongly on those with mental illness, who account for only 4 percent of violent acts committed in the United States.
    Virtual Mentor. 2013;15(10):898-903. doi: 10.1001/virtualmentor.2013.15.10.oped1-1310.