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What is Forensic Psychiatry?
Forensic Psychiatry is that branch of Medicine that seeks to apply psychiatric expertise to legal issues involving civil, criminal, correctional or legislative matters. A Forensic Psychiatrist is a physician who is qualified by training, experience and credentials to provide expert evaluation and testimony in the civil and/or criminal legal contexts where it is needed to assist the courts to arrive at a final decision. A typical criminal situation may arise where a defendant may be charged with a serious crime but may use as a defense mental impairment causing diminished responsibility or insanity. A civil situation may arise where the competence of an individual to make legal or financial decisions may be in question. In both cases a psychiatrist can assist the courts to arrive at a decision based on the psychiatrist’s evaluation of the individual’s mental state.

History of Forensic Psychiatry:
The history of forensic psychiatry goes back to the origins of Psychiatry as a medical specialty over 200 years ago. However, using mental illness as a defense to criminal responsibility is an ancient common law tradition. As far back as the 13th century, the insane, the infant and the imbecile were not held liable for criminal behavior. Psychiatry took on a prominent role in the early part of the 19th century when over a dozen psychiatrists testified at the trial of Daniel Mnaghten who was eventually acquitted, by reason of insanity, of murdering the English Prime Minister’s secretary. This so incensed Queen Victoria that she summoned the Law Lords and compelled them to produce a coherent and , of course, more restrictive use of the insanity defense. Their conclusions, despite numerous efforts to liberalize them, have survived the vicissitudes of time, and remain the standard today, with some modification. Notably it was the Hinckley verdict that caused the Federal Government to revert to the insanity defense standard as espoused in the Mnaghten rule.

What qualifications do they have?
The forensic psychiatrist of today is generally a clinician who has by virtue of experience and practice developed skills in the field. Recently, formal training programs have been developed offering a 1-year Fellowship to those psychiatrists who have completed the basic 4-year specialization in general psychiatry. A certifying examination is now conducted by the American Board of Psychiatry and Neurology to certify competence in Forensic Psychiatry, allowing the successful candidate to claim “ additional qualifications in Forensic Psychiatry”. To be eligible psychiatrists must have obtained Board Certification in Psychiatry, which certifies competence in clinical psychiatry. As of the end of December 2000, there were 1000 certified Forensic Psychiatrists in the United States of a total of 35, 000 practicing psychiatrists.

What is the duty of a Forensic Psychiatrist?
The duty of a forensic psychiatrist is to his client. Quite often the client is an attorney. The obligation is a contractual one, not a therapeutic relationship, with the individual represented by the attorney. Except in correctional institutions, forensic psychiatrists do not treat patients. Consequently, the duties are different from that of the treating physician. The forensic psychiatrist has an obligation to review records, evaluate the examinee when necessary, prepare a report if requested to do so, inform the referring attorney regarding the referral questions and testify if called upon to do so. The forensic psychiatrist does not have a duty to the client referred by the attorney. All reports, requests for release of information and so forth are channeled through the referring attorney unless there is a court order to do otherwise.

When a Forensic Psychiatrist is called upon Forensic psychiatrists are called upon to provide opinions in a variety of cases. These include the following:
  • Criminal cases: Insanity, fitness to stand trial, pre sentencing mitigating factors, diminished responsibility, ability to form specific intent, readiness for release from confinement in a mental institution, juvenile waiver.
  • Parental Custody, termination of parental rights, best interests of the children issues.
  • Competency questions: competence to write a will, manage person and/or estate, get married, enter contracts, consent to medical treatment.
  • Disability evaluations
  • Medical malpractice: standard of care evaluations
  • Civil commitment: is the individual subject to involuntary hospitalization to a psychiatric institution.
Arranging for a Forensic Evaluation:
The client, an attorney, insurance company, an employer or, sometimes, even an individual, initiates contact with the forensic psychiatrist. Generally, individuals are advised to go through their attorney, but sometimes this is not feasible, as the attorney may not wish to be the client. In addition, it is often not possible to maintain the purity of the relationship and strictly confine it to that of an opinion giver, when, in fact, some treatment intervention may be necessary. At the time of the original contact an agreement is made regarding the referral questions, the time involved and the fees. It is necessary for the agreement to be followed by a written contract. It is not uncommon for forensic psychiatrists to request a retainer in anticipation of the time commitments on the case. The referring client must send records for review prior to any examination of the individual in question or the issuance of an opinion. Furthermore, the client must pose a specific question to be answered by the psychiatrist. It is not enough to request a psychiatric evaluation. If an examination is required of the individual in question, it is the responsibility of the client to make sure the scheduled appointment is kept.

The Forensic Evaluation:
This is similar to the standard psychiatric examination. The only major difference is that the individual is advised that the examination results may not be confidential as they may be released to others, such as the court or the opposing side, depending on the client’s intentions or the order of the court. The interview is oral, involves obtaining information regarding the individual’s reason for the referral, past psychiatric history, medical history, previous arrests, illicit drug and alcohol usage, family background, and concludes with an assessment of memory, intelligence and judgment. At times others may also be interviewed with the individual’s permission, and psychological testing can also be conducted by the psychiatrist or by a psychologist. Psychological testing is not always required. However, it can provide useful insights, especially when there is a suspicion of malingering or when the individual is not receptive to the oral interview. By no means, however, does testing offer a definitive diagnosis. On completion of the evaluation the psychiatrist provides an oral report to the client unless a written assessment is requested or required. The report contains the findings, and is followed by an opinion on the questions posed in the referral. Forensic records are the property of the client, and, in the case of attorneys, are considered their work product and fully confidential unless they choose to release them. The psychiatrist who prepares the report should also make himself available for testimony.

Ethics of Forensic Psychiatry
Forensic psychiatrists are physicians first, and are bound by the ethical principles established by the American Medical Association. The American Academy of Psychiatry and the Law has further developed these principles to apply to forensic psychiatry. Complaints of unethical conduct are usually referred to the local branch of the American Psychiatric Association, if the forensic psychiatrist is a member, or to the state Medical Board.