Cameron Miranda
Mental health law is a complex and multifaceted area of legislation that varies across different jurisdictions. It encompasses a range of legal topics, including employment laws, insurance laws, housing laws, education laws, and laws governing treatment professionals. Mental health laws aim to protect the rights of individuals with mental health conditions, ensure equal access to treatment and services, and outline procedures for involuntary commitment and compulsory treatment. The laws also cover areas such as informed consent, confidentiality, and legal definitions of mental capacity and sanity. In this regard, notable pieces of legislation include the Mental Health Act 1983 in England and Wales, the Americans with Disabilities Act of 1990, and the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 in the United States. These laws provide a framework for managing and treating mental health issues, protecting individuals' rights, and ensuring equal access to opportunities and services.
| Characteristics | Values |
|---|---|
| Legislation | Mental Health Act 1983, Mental Capacity Act 2005, Americans with Disabilities Act of 1990, Mental Health Parity Act of 1996, Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 |
| Purpose | To guide the compulsory treatment and care of people with mental health problems, giving mental health professionals the ability to commit individuals, treat them without consent, and place restrictions on them while in public through outpatient commitment |
| Rights | Humane treatment environment, confidentiality of records, access to records, referral to other providers upon discharge, individualized treatment plan, treatment based on plan, periodic review and reassessment of treatment, appropriate revision of plan, ongoing participation in planning of mental health services, reasonable protection from harm, privacy, informed consent, right to appeal |
| Involvement of family members | Nearest relative has certain rights, including the ability to object to detention for treatment and to write to hospital managers for discharge |
| Involvement of professionals | Decisions made by mental health professionals, with independent doctors checking that treatment is appropriate and that the patient's views and wishes have been considered |
| Jurisdiction | Court orders may be required for compulsory treatment, depending on the jurisdiction |
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What You'll Learn
The right to a treatment plan and revisions
In the context of mental health treatment, the law recognises the right of individuals to receive a treatment plan and make revisions to it. This right is enshrined in various pieces of legislation, such as the Mental Health Act 1983 and the Mental Capacity Act 2005, which provide a legal framework for mental health professionals to deliver appropriate care.
The Mental Health Act 1983, applicable in England and Wales, guides the compulsory treatment and care of individuals experiencing mental health challenges. When an individual is hospitalised under this Act, they are entitled to receive a leaflet outlining their rights and the specific section of the Act under which they are being detained. One of the fundamental rights afforded by the Act is the right to an independent mental health advocate, who provides free and confidential support to help individuals understand their rights.
The right to a treatment plan is further reinforced by 42 U.S. Code § 9501, which stipulates the right to an "individualized, written, treatment or service plan." This plan is to be developed promptly after a person is admitted to a program or facility for mental health services. The same code also guarantees the right to treatment based on this plan and the right to periodic review and reassessment of treatment needs.
Additionally, individuals have the right to participate in the planning of their mental health services, as outlined in 42 U.S.C. § 9501. This includes their ongoing participation, in a manner appropriate to their capabilities, in developing and periodically revising the treatment plan. Mental health professionals are obliged to provide a reasonable explanation of the plan and any revisions in terms that the individual can understand, taking into account their condition and abilities.
The law also addresses the rights of individuals who may lack the capacity to consent to treatment. In such cases, a parent or legal guardian can exercise these rights on their behalf, ensuring that the individual's best interests are considered. This includes the right to provide authorisation for treatment and access to confidential records.
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Involuntary commitment and compulsory treatment
Legal Authority:
Mental health professionals, including psychiatrists and approved mental health professionals, are authorised by mental health laws to make decisions about involuntary commitment and treatment. In some jurisdictions, court orders may also be required for compulsory treatment. These professionals follow established procedures and codes of practice to ensure patient rights are respected.
Patient Rights:
Individuals who are detained and treated involuntarily have certain rights protected by law. These rights include access to free and confidential support from an independent mental health advocate (IMHA) or a legal guardian, who can help them understand their rights and the legal process. Patients also have the right to be involved in decisions about their care, treatment, and support, promoting their empowerment and independence. The principle of "least restrictive option" guides professionals to impose minimal restrictions on the patient's liberty while ensuring safe and lawful treatment.
Assessment and Treatment:
Involuntary commitment often begins with an emergency situation where there are serious concerns about an individual's mental health. Once detained, a mental health assessment is carried out by medical professionals to determine the need for further hospitalisation and treatment. This assessment considers the patient's mental health history, current condition, and potential treatment options. Treatment plans are then developed, with the patient having a right to ongoing participation in the planning process, ensuring their views and wishes are considered.
Discharge and Appeal:
Involuntary commitment and treatment are not indefinite. There are mechanisms in place for discharge, such as the involvement of the patient's nearest relative, who can object to detention and initiate discharge procedures. Additionally, patients have the right to appeal their detention and seek alternatives, such as community treatment orders, which allow them to leave the hospital while still receiving care and supervision.
Safeguards:
Mental health laws include safeguards to protect patients' rights and ensure the proper use of involuntary commitment and compulsory treatment. Mental health tribunals, independent doctors, and regular scrutiny procedures are in place to review decisions, handle complaints, and ensure compliance with the law. These safeguards help prevent potential abuses of power and protect the rights and well-being of individuals undergoing involuntary treatment.
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Employment laws and discrimination
Mental health conditions in the workplace are protected by the Americans with Disabilities Act (ADA). The ADA defines disability as a physical or mental impairment that substantially limits one or more major life activities. This includes major depressive disorder, PTSD, bipolar disorder, and schizophrenia.
Under the ADA, employers are prohibited from discriminating against individuals with a history of psychiatric disability or those regarded as having a psychiatric disability. This means that employers cannot treat employees with mental health conditions differently or deny them equal opportunities, such as promotions. Employers are also required to provide reasonable accommodations to employees with disabilities to help them perform their jobs, unless doing so would cause significant difficulty or expense. Reasonable accommodations may include altered break and work schedules, quiet office spaces, or changes in supervisory methods.
In addition to the ADA, employees may also have rights under other laws, such as the Family and Medical Leave Act (FMLA), which entitles eligible employees to up to 12 weeks of unpaid leave for treatment or recovery from a serious health condition. Mental health claims may also arise from hostile work environment or retaliation claims.
It is important to note that employees are not required to disclose their mental health conditions or disabilities during the job application process. However, if an employee chooses to disclose their condition, the employer must keep this information confidential. If an employee suspects discrimination based on their mental health, they may file a charge of discrimination with the Equal Employment Opportunity Commission (EEOC) or a similar state or local agency. There are strict time limits for filing a discrimination charge, typically within 180 days of the alleged violation.
To mitigate the risk of mental health discrimination claims, employers should ensure that their human resources professionals, supervisors, and managers are adequately trained to support employees with mental health conditions and handle requests for accommodation. Employers should also be aware of potential uncertainty in navigating mental disability claims due to the varying presentations of mental disabilities.
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Insurance laws and coverage
Mental health treatment can be costly, and insurance coverage can help make it more accessible. There are federal and state laws that ensure individuals receive necessary mental health care. These laws apply to health coverage for mental health and substance use disorders. Federal law, under the Affordable Care Act (ACA), mandates that mental and behavioural health services must be covered. This includes behavioural health treatment, such as counselling and psychotherapy, inpatient mental health services, and substance use disorder treatment.
The ACA has helped millions of Americans gain access to health coverage, including mental health services. It requires equal access to mental health services, classifying them as essential health benefits. This means that marketplace plans cannot deny coverage or charge higher premiums due to pre-existing mental health conditions. They must also provide parity protections, ensuring that limits applied to mental health services are no more restrictive than those for medical and surgical services.
While federal laws provide a baseline, some states have implemented additional protections. For example, California law requires every health plan in the state to cover specific mental health conditions, including outpatient diagnosis and treatment, inpatient services, partial hospitalization, and prescription drugs. Similarly, Georgia has defined clinical standards that insurers must use when making coverage decisions about mental healthcare.
However, it is important to note that insurance companies can still restrict mental health care. They have the authority to determine what treatment is medically necessary, and some states allow insurers to set their own standards for medical necessity, which can lead to conflicts of interest. In such cases, patients may have the option to appeal their insurance company's decision, depending on the type of insurance they have. They can also seek help from the Federal Center for Medicaid and Medicare Services or the U.S. Department of Labor to enforce parity laws and obtain coverage for therapy costs.
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Criminal laws and insanity defence
Criminal laws pertaining to mental health include the insanity defence, which has been in use since ancient Greece and Rome. The insanity defence is a legal concept that protects individuals from criminal charges if they were deemed incapable of understanding their actions or determining right from wrong at the time of the offence. The specific criteria for establishing a claim of mental disorder vary across different jurisdictions.
In the United States, the M'Naghten Rule, first established in 1843, is a widely recognised standard for determining insanity. It states that a defendant is deemed insane if, at the time of committing the act, they were "labouring under such a defect of reason, from the disease of the mind, as not to know the nature and quality of the act he was doing or, if he did know it, that he did not know what he was doing was wrong". This rule focuses on the defendant's cognitive state and their ability to comprehend the nature of their actions and their wrongness. The M'Naghten Rule has been adopted in various states, including New Hampshire, and has been reinterpreted in modern cases such as People v. Serravo.
The Durham Rule, employed in New Hampshire, holds that a defendant is not guilty by reason of insanity if their "mental disease or defect" was the reason they committed the crime. This rule has been deemed too broad by other states and jurisdictions. Additionally, the American Law Institute, a panel of legal experts, developed a new rule as part of the Model Penal Code in 1972. This rule states that a defendant is not responsible for criminal conduct if, due to a mental disease or defect, they did not possess the "substantial capacity either to appreciate the criminality of his conduct or to conform his conduct to the requirements of the law". This rule provides a broader understanding of "wrongfulness" or "criminality", acknowledging the complexity of evaluating these concepts.
In Victoria, Australia, the Defence of Mental Impairment was introduced in 1997, replacing the common law defence of insanity. This defence requires that the accused was suffering from a mental impairment that affected their ability to understand the nature and quality of their conduct or know that it was wrong. Similarly, in New South Wales, the defence has been renamed the 'Defence of Mental Illness' in the Mental Health (Forensic Provisions) Act 1990, with definitions derived from M'Naghten's case.
It is important to note that the insanity defence has been controversial, with public sentiment suggesting it is too frequently applied. However, studies show that it is used in only about 1% of felony cases in the United States and is successful in a small number of cases annually. Additionally, defendants found not guilty by reason of insanity are typically transferred to the custody of a psychiatric facility or mental health institution for treatment.
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Frequently asked questions
The Mental Health Act 1983 (updated in 2007) is a law in England and Wales that guides the compulsory treatment and care of people with mental health problems. Other laws that relate to mental health include insurance laws, employment laws, housing laws, and education laws.
Patients have the right to free and confidential support from an independent mental health advocate (IMHA) who can help them understand their rights under the Act. They also have the right to an individualized, written treatment plan, the right to treatment based on that plan, and the right to periodic review and reassessment of treatment.
An assessment is carried out by two doctors and an approved mental health professional to decide whether the individual should receive care and treatment under the Act. The professionals will consider principles from the Code of Practice, including least restrictive options, empowerment and involvement, respect and dignity, and purpose and effectiveness.
