Health Law and Policy Commons^™

Prevalence And Predictors Of Substance-Related Emergency Psychiatry Admissions, M. Scott Young, Kathleen A. Moore

Mental Health Law & Policy Faculty Publications

Background: Individuals commonly present for emergency psychiatry services for reasons related to their use of alcohol or illicit drugs. This study assessed the prevalence of these phenomena and explored characteristics distinguishing emergency psychiatry admissions with versus without presenting problems related to substance use. Methods: Data included standardized emergency psychiatry intake interviews from 2,161 consecutive admissions to three hospital-based emergency psychiatry departments in Florida’s Tampa Bay area. Admissions were classified as substanceinvolved if substance use was ascertained to be related to the presenting problem(s). Cases with only substance-related presenting problems were classified as substance-only admissions. Descriptive statistics compared substance-involved admissions to …

Gambling Disorder, Vulnerability, And The Law: Mapping The Field, Stacey A. Tovino

Faculty Articles

This Article seeks to descriptively map the sub-field of gambling disorder and the law and ask whether individuals with gambling disorder are vulnerable under the law. Like other scholarship that descriptively maps ethical, legal, and social implications of lesser known conditions and developments, this Article seeks to describe the treatment of individuals with gambling disorder in a variety of illustrative, but not exhaustive, legal contexts, to identify the limited scholarship assessing the application of the law to individuals with gambling disorder, and to invite members of the health law academy to bring their significant expertise to bear on these issues …

Don't Call Me Crazy: A Survey Of America's Mental Health System, Justin L. Joffe

Chicago-Kent Law Review

Unfortunately, the typical exposure to mental illness for most Americans comes via tragic mass shootings or highly publicized celebrity mental breakdowns. However, the vast majority of mentally ill individuals are not violent murderers or hyper-tweeting celebrities. Rather, they are the ordinary, everyday people that make up the tens of millions of American adults suffering from some form of mental illness. The American mental health system has a lamentable history. The initial policy of locking up mentally ill individuals in jails transitioned to a system of confinement in asylums that quickly became notorious for their poor living conditions and treatment. The …

Wollschlaeger, A Patient’S Right To Privacy, And A Renewed Focus On Mental Health Treatment, Chad A. Pasternack

University of Miami Business Law Review

In response to doctors pushing gun control agendas on patients, Florida enacted the Firearm Owners Privacy Act. The law, upheld by the Eleventh Circuit in Wollschlaeger v. Governor of Florida, protects patients from intrusive lines of inquiry unrelated to their treatment and from discrimination due to firearm ownership. While patients in Florida benefit greatly from the Firearm Owners Privacy Act, this note argues for more specific language in the law, which would parallel language in the Florida Mental Health Act (“Baker Act”). The proposed changes would limit inquiries into firearm ownership to instances where there is a substantial likelihood …

Neuroscience And Health Law: An Integrative Approach, Stacey A. Tovino J.D., Ph.D.

Akron Law Review

Neuroscience is one of the fastest growing scientific fields in terms of the numbers of scientists and the knowledge being gained. In recent years, both the scope of neuroscience and the methodologies employed by neuroscientists have broadly expanded, from biochemical and genetic analysis of individual nerve cells and their molecular constituents, to the imaging of brain structure and function. Perhaps the most significant recent neuroscientific achievement is the ability of neuroimaging technologies, including functional magnetic resonance imaging (fMRI), to image brain function. Clinicians and scientists use fMRI not only to map sensory, motor, and cognitive function, but also to study …

A Failure To Rehabilitate: Leaving Disability Insurance Out Of The Mental Health Parity Debate, Christopher R. Wilson

Washington and Lee Journal of Civil Rights and Social Justice

No abstract provided.

Diagnosis Dangerous: Why State Licensing Boards Should Step In To Prevent Mental Health Practitioners From Speculating Beyond The Scope Of Professional Standards, Jennifer S. Bard

UF Law Faculty Publications

This Article reviews the use of mental health experts to provide testimony on the future dangerousness of individuals who have already been convicted of a crime that qualifies them for the death penalty. Although this practice is common in many states that still retain the death penalty, it most frequently occurs in Texas because of a statute that makes it mandatory for juries to determine the future dangerousness of the defendant they have just found guilty. Both the American Psychiatric Association and the American Psychological Association have protested the use of mental health professionals in this setting because there are …

Taking Pedophilia Seriously, Margo Kaplan

Washington and Lee Law Review

This Article pushes lawmakers, courts, and scholars to reexamine the concept of pedophilia in favor of a more thoughtful and coherent approach. Legal scholarship lacks a thorough and reasoned analysis of pedophilia. Its failure to carefully consider how the law should conceptualize sexual attraction to children undermines efforts to address the myriad of criminal, public health, and other legal concerns pedophilia raises. The result is an inconsistent mix of laws and policies based on dubious presumptions. These laws also increase risk of sexual abuse by isolating people living with pedophilia from treatment.

The Article makes two central arguments: (1) although …

The Dsm-5 And Criminal Defense: When Does A Diagnosis Make A Difference?, Nancy Haydt

Utah Law Review

In June 2013, the American Psychiatric Association published the Fifth Edition of the Diagnostic and Statistical Manual of Mental Disorders (“DSM-5”). The DSM-5 was intended to be an updated guidebook for the clinical diagnosis of mental disorders. It received mixed reviews from the mental health community. The reception from the forensic mental health community is likewise varied. The evolution of conceptualizing mental illness, its origins and treatment efficacy, may weaken the authority of the DSM and further confuse its application in forensic situations. This Article explores the possible effects of the DSM-5 in criminal cases.

Will Neuroscience Redefine Mental Injury?: Disability Benefit Law, Mental Health Parity Law, And Disability Discrimination Law, Stacey A. Tovino

Faculty Articles

No abstract provided.

The Dsm-5: Implications For Health Law, Stacey A. Tovino

Faculty Articles

In May 2013, the American Psychiatric Association released the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders ("DSM-5"). Among other changes, the DSM-5 includes new entries for hoarding disorder and premenstrual dysphoric disorder as well as a reclassified entry for gambling disorder. Using these changes as examples, this Article examines the implications of the DSM-5 for key issues in health law, including health insurance coverage, public and private disability benefit eligibility, and disability discrimination protection. As a descriptive matter, this Article illustrates how the addition of new disorders and the reclassification of existing disorders in the DSM-5 …

Confronting Legal And Technological Incongruity: Remote Testimony For Child Witnesses, Elizabeth A. Mulkey

Vanderbilt Journal of Entertainment & Technology Law

Child victims are often the only eyewitnesses in cases against their abusers. A child's testimony may be necessary for a prosecutor to secure a conviction. However, the child must often face his or her abuser and relive the traumatic experience while giving this testimony. Any accommodations or protection of a child witness at trial must be balanced against the defendant's rights under the Confrontation Clause. The Supreme Court's decision in Maryland v. Craig allows child victims to testify via one-way, closed-circuit television in some circumstances, but the Court has not addressed two-way, closed-circuit testimony or remote testimony. In the absence …

Rethinking The Childhood-Adult Divide: Meeting The Mental Health Needs Of Emerging Adults, Barbara L. Atwell

Elisabeth Haub School of Law Faculty Publications

Part I of this article describes ADHD and explores the extent of ADHD medication abuse, especially among young adults. Part II discusses the characteristics of emerging adults, who may be more likely than their older counterparts to make unwise decisions about medications and other life choices.34 While we protect minors by requiring parental consent for their medical treatments, emerging adults are effectively able to obtain any drug on the market if they convince the doctor that they have the requisite diagnosis. Part III explores HIPAA, the medical malpractice standard of care and the challenges associated with a society that is …

Aggressive Policing And The Mental Health Of Young Urban Men, Amanda Geller, Jeffrey Fagan, Tom Tyler, Bruce Link

Faculty Scholarship

Objectives: We provide the first population-based analysis of the health implications of contemporary policing. Many cities have adopted “proactive” policing models, which engage citizens – often aggressively – at low levels of suspicion. We survey young men on their experiences of police encounters and subsequent mental health. Methods: We conducted a population-based phone survey of 1,261 young men in New York City. Respondents reported how many times they were approached by New York Police Department (NYPD) officers, what these encounters entailed, any trauma they attributed to the stops, and their overall anxiety. Data were analyzed using cross-sectional regression. Results: Respondents …

Adjudicating Sex Crimes As Mental Disease, Melissa Hamilton

Pace Law Review

The psychiatric diseases of the paraphilias are now entrenched in the law in decisions concerning culpability, desert, and risk. Though, as the foregoing cases suggest, it is a tough balancing act, considering the existence of psychiatric illness suggests less responsibility, while at the same time implying a greater risk of future dangerousness. To better navigate this conundrum, the law has drawn on the psychiatric sciences. Part II of this Article outlines a basic need for law and science to serve each other even though they may not share objectives. With respect to the advent of new laws to control sex …

Advocacy In Health Proceedings In New York State, Kia C. Franklin

Touro Law Review

Individuals and communities navigating the healthcare system without an advocate often experience devastating outcomes and become burdened with unnecessary costs. These negative outcomes undermine the very utility of our healthcare system. The creation of a legal right to counsel for individuals with critical health related claims would meet an important and unmet need in our health and legal systems by empowering patients, improving the quality of health for many, and preventing unnecessary costs to the health care system.

A dedicated group of healthcare advocates, lawyers, public policy analysts, and other concerned individuals gathered together at Touro Law Center to strategize …

All Roads Lead From Vietnam To Your Home Town: How Veterans Have Become Casualties Of The War On Drugs, Susan Stuart

Law Faculty Publications

No abstract provided.

When Coercion Lacks Care: Competency To Make Medical Treatment Decisions And Parens Patriae Civil Commitments, Dora W. Klein

University of Michigan Journal of Law Reform

The subject of this Article is people who have been civilly committed under a state's parens patriae authority to care for those who are unable to care for themselves. These are people who, because of a mental illness, are a danger to themselves. Even after they have been determined to be so disabled by their mental illness that they cannot care for themselves, many are nonetheless found to be competent to refuse medical treatment. Competency to make medical treatment decisions generally requires only a capacity to understand a proposed treatment, not an actual or rational understanding of that treatment. This …

Legal And Policy Standards For Addressing Workplace Racism: Employer Liability And Shared Responsibility For Race-Based Traumatic Stress, Robert T. Carter, Thomas D. Scheuermann

University of Maryland Law Journal of Race, Religion, Gender and Class

No abstract provided.

Reforming State Mental Health Parity Law, Stacey A. Tovino

Faculty Articles

This Article is the final installment in a three-part project that presents a comprehensive challenge to lingering legal distinctions between physical and mental illness in the context of health insurance. The first installment in this series narrowly inquired as to whether the postpartum mood disorders should be classified as physical or mental illnesses in a range of health law contexts, including the context of health insurance. The second installment was broader in scope and challenged a number of federal provisions that allow publicly- and privately-funded health care programs and plans to provide mental health insurance benefits that are less comprehensive …

"Sell's" Conundrums: The Right Of Incompetent Defendants To Refuse Anti-Psychotic Medication, Christopher Slobogin

Vanderbilt Law School Faculty Publications

The Supreme Court's 2003 decision in Sell v. United States declared that situations in which the state is authorized to forcibly medicate a criminal defendant to restore competency to stand trial "may be rare." Experience since Sell indicates that this prediction was wrong. In fact, wittingly or not, Sell created three exceptions to its holding (the dangerousness, treatment incompetency, and serious crime exceptions) that virtually swallow the right to refuse. Using the still-on-going case of Jared Loughner as an illustration, this essay explores the scope of these exceptions and the dispositions available in those rare circumstances when none of them …

Further Support For Mental Health Parity Law And Mandatory Mental Health And Substance Use Disorder Benefits, Stacey A. Tovino

Faculty Articles

In this Article, I provide additional support for my recent proposal (All Illnesses Are (Not) Created Equal: Reforming Federal Mental Health Insurance Law, Harvard Journal on Legislation, Vol. 49, forthcoming 2012.) to extend federal mental health parity law and mandatory mental health and substance use disorder benefits to all public healthcare program beneficiaries and private health plan members. I begin by examining health-related doctrine outside the context of mental health insurance law, including disability discrimination law, civil rights and human rights law, health information confidentiality law, healthcare reform law, and child and adult health and welfare law, and …

From Trusted Confidant To Witness For The Prosecution: The Case Against The Recognition Of A Dangerous-Patient Exception To The Psychotherapist-Patient Privilege, Deborah Paruch

The University of New Hampshire Law Review

[Excerpt] “In 1996, in Jaffee v. Redmond, the U.S. Supreme Court, pursuant to the authority set forth in Federal Rule of Evidence 501, recognized a psychotherapist-patient privilege in the federal courts. In doing so, the Court acknowledged the essential role that confidentiality plays in a therapist-patient relationship and also recognized the important role that psychotherapy plays in the mental health of the American citizenry. However, in dicta set out in a footnote near the conclusion of the opinion (footnote 19 of the opinion), the Court suggested that the privilege might not be absolute, that it might need to “give way …

Law & Health Care Newsletter, V. 19, No. 1, Fall 2011

Law & Health Care Newsletter

No abstract provided.

An Institutionalization Effect: The Impact Of Mental Hospitalization And Imprisonment On Homicide In The United States, 1934-2001, Bernard E. Harcourt

Faculty Scholarship

Previous research suggests that mass incarceration in the United States may have contributed to lower rates of violent crime since the 1990s but, surprisingly, finds no evidence of an effect of imprisonment on violent crime prior to 1991. This raises what Steven Levitt has called “a real puzzle.” This study offers the solution to the puzzle: the error in all prior studies is that they focus exclusively on rates of imprisonment, rather than using a measure that combines institutionalization in both prisons and mental hospitals. Using state-level panel-data regressions over the 68-year period from 1934 to 2001 and controlling for …

Reducing Mass Incarceration: Lessons From The Deinstitutionalization Of Mental Hospitals In The 1960s, Bernard Harcourt

Faculty Scholarship

In a message to Congress in 1963, President John F. Kennedy outlined a federal program designed to reduce by half the number of persons in custody. The institutions at issue were state hospitals and asylums for the mentally ill, and the number of such persons in custody was staggeringly large, in fact comparable to contemporary levels of mass incarceration in prisons and jails. President Kennedy's message to Congress – the first and perhaps only presidential message to Congress that dealt exclusively with the issue of institutionalization in this country – proposed replacing state mental hospitals with community mental health centers, …

Is A Mentally Ill Defendant Still Considered Competent To Waive The Right To Counsel In New York After Indiana V. Edwards?, John H. Wilson

Pace Law Review

No abstract provided.

Judge William Wayne Justice: A Life Of Human Dignity And Refractory Mules Tribute., Albert H. Kauffman

St. Mary's Law Journal

Judge Wayne Justice had a deep impact on the lives of many people and was an unyielding advocate who protected the rights of all U.S. citizens. Many of the Judge’s orders and consent decrees forced Texas to comply with more stringent federal requirements in education and health care and had a far reaching effect across the nation. Judge Justice presided over Doe v. Plyler that ensured the benefit of public education for the children of undocumented immigrants. In United States v. Texas, Judge Justice required that the Texas Education Agency monitor school district actions and policies to assure that they …

Smoke-Free State Psychiatric Facility Grounds: Is Legislation Necessary And Appropriate To Remove Tobacco From These Treatment Settings?, Maureen Hackett M.D.

NYLS Law Review

No abstract provided.

The Choice To Limit Choice: Using Psychiatric Advance Directives To Manage The Effects Of Mental Illness And Support Self-Responsibility, Breanne M. Sheetz

University of Michigan Journal of Law Reform

Psychiatric advance directives are a valuable tool for individuals with mental illnesses. Ulysses directives, in particular, allow individuals to bind themselves to treatment in advance of needing it for the purpose of overcoming illness-induced refusals. This Note evaluates the effectiveness of state advance directive statutes in three areas that are especially important for Ulysses directives: defining competency to execute, activate, and revoke directives; waiving the constitutional right to refuse treatment; and encouraging provider compliance. This Note ultimately advocates for other states to adopt provisions similar to a Washington State statute. The Washington statute authorizes Ulysses directives by allowing advance consent …