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Mental Health & Violence

Balancing Individual Rights vs. Public Safety

There is much discussion about the connection between mental health and violence. Recent incidents of gun violence by individuals with a mental or emotional disorder have led to pressure about changing both gun laws and civil commitment laws. Is the balance changing — moving away from protection of the individual rights of mental health patients and more toward protection of the public’s right to safety? How have the rights of Virginia mental health patients been affected by recent changes in Virginia’s laws?  How is our work as mental health professionals affected, as we balance a patient’s right to autonomy and confidentiality against the possibility that someone else might be harmed? How do we decide?


  I.  Separating Myths from Facts

II.   Individual Rights

Autonomy, Informed Consent, & Voluntariness
Privacy & Confidentiality
Justice & Equality

III. Practical Complications & Clinical Concerns

Difficulty With Violence Prediction & Risk Assessment
Clinical Uncertainty & Ambivalence
Violent Events Driving Legislative Change
Political & Media Pressures on Public Policy
Confusion About Legal Options
Limited Resources & Dwindling Funding

 IV.  Ethical & Professional Issues

Erosion of Confidentiality
Questions of Competence

  V.  Legal Issues

How Imminent is the Dangerousness?
Civil Commitment Laws
Involuntary Outpatient Commitment

VI. Recommended Solutions

Alternative Legal Options
Alternative Treatment Options
Proposal for Equitable Approaches to Potential Dangerousness
Preparing to Manage the Stresses of High-Risk Cases

Learning Goals:

1. Name some facts and some myths about the connection between mental health and violence.

2. Describe some impacts of the changes in Virginia’s involuntary commitment laws.

3. Indicate your role in affecting the balance between patients’ rights and public safety.