Heather Zelle

Advance directives in mental health care: evidence, challenges and promise

Psychiatric advance directives (PADs) are written documents or oral statements that allow adults with decision-making capacity to declare their treatment preferences and/or to designate proxy decision makers to act on their behalf should they be deemed incapable in the future of making informed choices on their own. In the U.S., the Patient Self-Determination Act (1) created momentum for recovery-oriented care, which has led to the enactment of mental health-related advance planning legislation in about two-thirds of the states (2,3). Internationally, increasing attention to such tools is found in the U.K., Ireland, Germany, Belgium, Canada, New Zealand, Australia and India.

Psychometric Properties of the "Miranda Rights Comprehension Instruments" with a Juvenile Justice Sample.

This article describes the psychometric properties of the Miranda Rights Comprehension Instruments, the revised version of Grisso’s Miranda instruments. The original instruments demonstrated good reliability and validity in a normative sample. The revised instruments updated the content of the original instruments and were administered to a sample of 183 youth in pre- and postadjudication facilities. Analyses were conducted to establish the psychometric properties of the revised instruments and included similar analyses to those conducted by Grisso, as well as additional calculations (e.g., standard errors of measurement, intraclass correlation coefficients, Kappa coefficients). Results revealed sound psychometric properties, similar to those observed for the original instruments.

Advance Directives for Mental Health Care: Innovation in Law, Policy, and Practice

Virginia appears to be the first state to commit itself to statewide implementation of psychiatric advance directives, and its experience may be highly instructive for other states. The project began with consensus building among stakeholders (2007-2009), followed by revisions to Virginias Health Care Decisions Act (2009-2010) and designation of five of the states 40 Community Services Boards as demonstration sites for facilitation efforts. Early implementation efforts quickly showed that psychiatric advance directives are not self-executing innovations. This column describes the early policy and practice innovations, lessons learned from initial implementation efforts, and three approaches to facilitating completion of advance directives by consumers.

Building Consensus on the Characteristics of Developmental Maturity: A Cross-Disciplinary Survey of Psychologists

ABSTRACT A critical step toward ensuring a consistent approach to and communication about the construct of developmental maturity is refinement of a general, unified representation of this construct across psychological subspecialties. The current study evaluated the core characteristics of developmental maturity by examining the factor structure of this broad concept. Results of an exploratory factor analysis supported a four-factor solution of developmental maturity: independent functioning, decision making, emotion regulation, and general cognitive processing. Overall, psychologists across subspecialties did not differ significantly in their ratings of items across the four factors. Findings contribute to a cross-disciplinary, comprehensive, and operational definition of developmental maturity.

Review of Research and Recent Case Law on Understanding and Appreciation of Miranda Warnings

The Supreme Court’s decision in Miranda v. Arizona (1966) recognized that the inherently coercive atmosphere of police interrogations had to be curtailed. The Court elected to describe a safeguard that would sufficiently dispel this coercion: a set of advisements of suspects’ rights, since coined “the Miranda warnings.” This decision also articulated the legal standard for waivers of Miranda rights: knowing, intelligent, and voluntary. The purpose of this chapter is to provide an overview of the legal and psychological landscape of the Miranda warnings. It first discusses the Miranda decision and subsequent case law that shaped the evolution of police interrogation. It then describes how the field of psychology came to intersect with Miranda warnings and waivers through the work of translating the “knowing and intelligent” components of the waiver standard into constructs suitable for psychological testing and evaluation. This work is placed in the context of courts’ failure to provide a consistent operational legal definition of “knowing and intelligent.” The chapter next reviews the state of the science, that is, the factors empirically related to individuals’ abilities to offer a valid waiver of Miranda rights. Thereafter, the chapter covers developments in case law, specifically the ways in which Miranda has been contracted by several Supreme Court opinions and lower courts’ decisions. The chapter concludes with recommendations for future research and policy work given courts’ recent treatment of Miranda and gaps in the existing body of research on Miranda rights and waivers.

Attorney Perspectives on Juvenile and Adult Clients’ Competence to Plead Guilty.

An overwhelming majority of juvenile and criminal cases result in admission or guilty plea. Standards of competence apply at this stage of the proceedings, so the issue can be raised if someone—usually a defense attorney—believes the defendant lacks competence to plead. It is unclear how often defense attorneys question their clients’ competence to plead guilty and what factors lead to such decisions. This study surveyed defense attorneys about their experiences raising this issue in juvenile and criminal court and investigated factors that made them raise this issue and made them decide against formally questioning competence, despite suspecting their clients lacked requisite abilities. Most of the 199 responding attorneys reported having raised a competence issue at this stage, with more attorneys indicating they had done so at least once for an adult client than for a juvenile client. However, when asked about the number of times they raised this issue, attorneys reported doing so more frequently for juvenile clients than for adult clients. Client cognitive deficits, inadequate ability to assist counsel, and mental illness were reported to drive decisions to question competency in both courts. Attorneys endorsed choosing not to raise this issue because of concern about the low legal threshold for competence and that consequences would negatively affect their clients. Results of this study suggest a professional quandary for defense attorneys—who receive little guidance in this area—and add weight to the pressing need for meaningful examination of how the plea process works in principle and in practice.