Transcript PTSD UPDATE - Stanford University

Criminal Forensic Psychiatry
ACGME Requirement
Treatment Court
Competency to Stand Trial
Forensic Report
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Quick Links
Forensic experience materials:
http://forensicpsychiatry.stanford.edu/Seminars/materials.htm
California Penal Code:
http://www.leginfo.ca.gov/calaw.html
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Law of Crimes
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Protective purpose
Restrain, rehabilitate, deter, vindicate law
Penal Code
Crime is union of actus reus and mens rea
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Link Between Mental Illness and Crime
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Impaired executive functions
Delusions and hallucinations
Overwhelming emotion
Overreaction to “threat”
Substance abuse
TBI
Personality disorder
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The Forensic Psychiatrist
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Answer legal question in legal arena
No “best interests”
No “do no harm”
Need to know law as well as psychiatry
Must understand legal reasoning
Must consider malingering in every case
Need good writing skills
Need to adapt to adversarial system
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Ethics
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Honesty, objectivity, neutrality, competence
Duty to law and to truth
Must respect patient’s “personhood”
Consent and non-disclosure statement
Consider all evidence
Explicate reasoning process
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Percipient vs. Expert Testimony
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Evidence must be relevant, probative
Judge decides admissibility
Jury decides weight to be given
Percipient vs. expert witness
Rule against admissibility of junk science
 Frye: special expertise, general acceptance
 Daubert: special expertise, general acceptance, focus on
methodology (peer reviewed, known error rates, etc.)
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Forensic Questions
 Is defendant mentally ill now?
 If so, is he currently incompetent to stand trial?
 Was defendant mentally ill at time of crime?
 If so, was he insane under California law?
 Did illness impair ability to form legal intent?
 What are the treatment options?
 What is risk to community if not incarcerated?
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Forensic Assessment
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Fact heavy
Answer legal question
Consider all the evidence plus malingering
Write for legal as well as medical audience
Explicate scientific and legal reasoning
Expose limits of certainty
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Reasoning Process
Scientific
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Scientific question
Focus on methodology
Empirical
Quantitative
Reproducible
Statistical reliability
Legal
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Legal question
Legal rule
Relevant facts
Reasoning process
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Major premise
Minor premise
Logical conclusion
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Treatment Court Movement
Decrease jail time / cost
 Law as first responder
 Therapeutic sentencing
 Reduce risk to community
 Drug, mental health, veterans courts
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Forensic Experience Rotation
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Pathways Program
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Third Thursday of month
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Assess applicants for mental health court
Prepare report to Pathways team
Maguire Jail or Probation Dept., Redwood City
Supervision by ACF forensic psychiatrist
Write report
Meet with supervisor
Other opportunities
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San Mateo “Pathways” Program
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Joint Program – Probation and Mental Health
Misdemeanor defendants who are Axis I SMI
Reduce recidivism / protect community
Modify sentence to community treatment
Progressive sanctions
Therapeutic sentencing
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Pathways Forensic Questions
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Is the defendant seriously mentally ill?
Is there a link between illness and crime?
Is there community treatment?
Would sentence modification to community
treatment decrease the likelihood of
reoffending without exposing the community
to undue risk of harm?
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Therapeutic Sentencing
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Outpatient psychotherapy
Medication management / psychotherapy
Residential care / supportive housing
AA, NA, CBT, anger management
Monitoring substance use, med compliance
Rehabilitation / reintegration programs
Intensive case management
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Generic Forensic Report
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Identify referral source
Identify forensic question and relevant law
Consent / statement of non-confidentiality
Case facts
Identify and analyze relevant documents
Clinical and forensic examination
Diagnosis
Diagnostic and forensic discussion
Medical and Legal Conclusions
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The Forensic Report for Pathways
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Two parts:
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The mental health court report
The competency to stand trial report
The online report template
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Competency to Stand Trial (1)
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Fundamental fairness – 5th, 6th, 14th
Amendments
Defined at Cal Penal Code Section 1367
Principle case law – Dusky and Sell
Critical phases of trial:
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confess, waive Miranda, plead guilty, testify,
represent self, be executed
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Competency to Stand Trial (2)
Dusky vs. US
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“whether he has sufficient present ability to
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consult with lawyer with a reasonable degree of
rational understanding and
whether he has a rational as well as factual
understanding of the proceedings against him.“
If incompetent, remand to hospital for
restoration of competency
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Competency to Stand Trial (3)
Sell vs. US
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Involuntary drugs to restore competency
Defendant must be facing serious charge
Drug must be medically appropriate
Side effects unlikely to undermine fair trial
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Competency to Stand Trial (4)
Assessment
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Mental status examination
Case related motivation / knowledge
Quality of relating to attorney
Capacity to engage legal needs at all critical
points in the case
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