custody may be contraindicated in situations where
parents have an emotionally charged, conflictual
relationship. In these instances, legal custody may
be granted to one parent, while the other parent
is granted visitation rights.
In making a child custody evaluation, the psy-
chologist must remember that the critical element is
a system of past, present, and future relationships
among parents, children, and sometimes other rela-
tives. Custody evaluations should consider informa-
tion from multiple sources so that three major issues
can be addressed (American Psychological Associa-
tion, 1994): (a) the child’s development and psy-
chological needs; (b) each parent’s strengths and
limitations; and (c) the way each member of the
family interacts with the others. The ultimate goal
is identifying a situation in which the best interests
of the child are served. Other specific issues, such as
changes in previously established custody arrange-
ments or visitation rights, follow the same overrid-
ing principle.
Rights of PatientsThe rights of hospitalized mental patients have
come under increasing judicial scrutiny. Beginning
in the early 1970s, courts have held that patients
who are involuntarily hospitalized have a constitu-
tional right to individualized treatment that offers
them a realistic chance for “cure” or at least
improvement (Schwitzgebel & Schwitzgebel,
1980). The courts have been less attentive to the
rights of voluntary patients because it is assumed
they can leave the hospital if they so choose.
Additional rights and standards involve the
physical environment (dayrooms, lavatories, dining
rooms, etc.), personal clothing, and personal activi-
ties (opportunities for physical exercise, regular out-
door opportunities, or social activities). In addition,
involuntary labor is prohibited, and when labor is
undertaken voluntarily, appropriate wages must be
paid. Although many states recognize patients’
rights to correspondence and visitation, institutional
personnel often have wide discretion in controlling
visits (except by lawyers, physicians, or clergy).
Statutes have also generally asserted the patient’s
right to dignity and privacy. In practice, however,
these rights tend to be subject to wide interpreta-
tion and discretion. Indeed, as observed earlier, sta-
tutes and court orders are one thing; their actual
implementation in practice is another.
A controversial and complex issue is the right
to refuse treatment or medication. The question is
one of informed consent. Not every involuntarily
hospitalized patient is mentally incompetent, and
these individuals have the right to decide their
own fate. But what about patients who are incom-
petent? How does one protect the rights of the
competent while also ensuring that the incompe-
tent can experience the benefits of treatment?
These are truly complex problems, as indicated in
Box 19-3.Predicting Dangerousness
As we saw in Chapter 3, theTarasoffcase resulted in
a California court decision that therapists have a
duty to protect potential victims from their patients’
violent behavior. Beyond this, many would agree
that, by law or moral imperative, we all have the
obligation to protect others from those who are
deemed dangerous. But how accurately can psy-
chologists or anyone else predict dangerous behav-
ior? Although a history of violence is more
common among those with mental disorder diag-
noses (especially substance use disorders), 90% of
those with mental illness have no history of vio-
lence (Monahan, 1992). The reality is that to truly
protect against those individuals who are dangerous,
we would have to fish with a very large net—a net
that would snare large numbers of individuals who
would never actually commit a violent act (Ogloff,
1998).
Violent acts are highly overpredicted—a large
percentage of those predicted to become violent do
not do so (Monahan, 1981). But many people seem
willing to sacrifice many to protect society from
one. There are undoubtedly many reasons people
tend to see danger when none exists (Monahan,
1976). But as much as anything, it is probably the
television program or news story that describes how
a mental patient was released only to kill someone,550 CHAPTER 19