Transcript forensic psychiatrist

Forensic psychiatry
Forensic psychiatry and
forensic psychiatrist (expert witness)
• Forensic psychiatry is a branch of medicine which focuses on the interface
of law and mental health.
• It may include psychiatric consultation in a wide variety of legal matters
• A forensic psychiatrist is a psychiatrist who has additional training and/or
experience related to the various interfaces of mental health (or mental
illness) with the law.
• Expert witnesses give their opinion about a specific issue associated with
psychiatry and explain the basis for that opinion which includes
important concepts, approaches and methods used in psychiatry.
• The expert will be asked to form an opinion and to testify about that
opinion, but in so doing will explain the basis for that opinion which will
include important concepts, approaches and methods used in psychiatry.
Areas of concern
• Civil law:contracts, testamentary capacity, negligence &
malpractice, disability determination, child abuse &
neglect, custody issues, etc.
• Criminal law: fitness to stand trial, insanity defense,
sentencing considerations, issues in correctional settings,
etc.
• Legal Regulation: civil involuntary commitment,
confidentiality, right to refuse treatment, informed
consent, ethical guidelines, etc.
Criminal law
• Competence to stand trial – in the presence of mental disorder,
defendant is able
1. to understand charges against him
2. Can assist in his defense
• Criminal responsibility (the insanity defense) –
1. The defendant did know what he was doing or that is it wrong
(right/wrong test, cognitive test, M´Naghten rule)
2. Irresistible impulse – the evaluator must determine if defendant ´s
mental mental disorder rendered him unable to refrain from his
behavior
3. Durham rule (product test) - it excuses a defendant whose
conduct is the product of mental disease or defect.
Legal competence (capacity)
• competence concerns the mental capacity of an individual to
participate in legal proceedings
• The capacity of persons determines whether they may make
binding amendments to their rights, duties and obligations, such as
getting married, entering into contracts, making gifts, or writing a
valid will etc.
• Incompetence in one area does not imply incompetence in all areas
• Capacity is limited by mental illness, addiction of drugs and alcohol
for a long time (i.e. chronic, severe mental diseases – chronic
schizophrenia, dementia, organic mental disorders etc.)
Civil Competencies
• Is there a mental disorder?
• Does the disorder impair the capacity to carry
out the specific civil function in question?
• Will the disorder be likely to respond to
treatment or intervention?
Another expertises in civil law
• Driving and gun license
• Financial compensation for pain and social handicaps
• Involuntary hospitalization etc.
Involuntary hospitalization
• general rule, competent patients have a right to refuse treatment
• treatment without the informed consent of a competent patient is
tortious
• the patient's choice to make a decision should be respected even if
one thinks it is wrong
• Involuntary hospitalization is authorized in every state when a
proposed patient is mentally ill and dangerous to him- or herself or
to others. To this basic model, myriad different categories have
been added.
Involuntary hospitalization
• Seclusion and restraint are issues that arise during involuntary
hospitalization and raise complex psychiatric legal issues.
• Generally, the law permits the use of restraints and seclusion
only when a patient poses a risk of harm to self or others and
no less restrictive alternative is available.
The standards for a helpful forensic psychiatry report
Berger, S.H. - J Am Acad Psychiatry Law 36:3:388-392
(September 2008)
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State who requested the evaluation.
List the questions to be answered in the report.
List the sources of the data on which the evaluation is based.
Document the information (and warnings) given to the examinee at
the beginning of the examination.
Document, source by source, the relevant information gathered.
Document the examiner's (objective) observations of the examinee.
Discuss the examiner's reasoning in reaching his or her conclusions.
List the examiner's unambiguous answers to the questions to be
answered in the report (second listed item).
WPA’s Section of Forensic Psychiatry's Consensus Paper on
Guidelines for Independent Medical Examination -2010
Content of report
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Qualifications and experience of the IFP.
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A statement about who commissioned the report.
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A statement regarding the examinee’s consent to the release of information.
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Demographic data, including the name and date of birth of the examinee, the domestic situation,
marital status and number of children.
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Personal history, including developmental, educational, occupational, sexual and relationship,
substance use and forensic history.
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A description of the examinee’s personality, interests, hobbies and coping style.
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History of the present complaint as presented by the examinee and reports from informants.
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Past psychiatric history.
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Family history of psychiatric illness.
Content of report II.
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Medical history.
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Mental State Examination should include a description of appearance and behaviour;
emotional tone; speech; thought stream, form and content; orientation and sensory
perception; higher mental functioning; insight and judgement.
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Tests and investigations.
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A summary and formulation, or synthesis of the case, and diagnosis should be recorded. The
formulation should take the form of a biopsychosocial explanation of the presumptive
causative factors in the examinee’s condition. Inconsistencies between reported symptoms
and observed mental state or physical examination should be noted. Indications of
malingering should be noted, but its determination and weight, however, is best left to the
decision-making body to make.
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Finally, an opinion is offered, in relation to questions posed by the requesting body. The
report itself should clearly demonstrate how conclusions were reached. Limitations to the
examination should be explained in the report and mention made of investigations or other
data that are required to reach a conclusive opinion.
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Comments on special issues may be required, including prognosis, management, impairment,
disability and legal concepts such as competency.