Topics Law & Psychiatry Law & Psychiatry Clinical vs. Forensic Psychiatry Clinical vs. Forensic Psychiatry Child Custody Determination Child Custody Determination Special Issue Special Issue
Law & Psychiatry OldHistoryYoung Free Will PhilosophyDeterminism Client Rights Objective Patient Needs Cases & Codes Education Clinic & Lab AdversarialApproachConsensus
Sources of Conflict Professional Differences in background, education, and training. Inter-Professional Experiences at the interface: legal regulation of psychiatric practice & psychiatric input into legal decisions. Personal Pre-existing personal issues. Prior negative contacts with “them.”
Overcoming Conflict Professional Practice within expertise. Prepare well. Answer the questions. Inter-Professional Educate each other. Practice good conflict resolution technique. Personal Get real! Psychiatrist not opponent. Lawyer not narcissistic threat.
Clinical Psychiatry Ends are medical. - Doctor-patient relationship. - Focus is on diagnosis and treatment. Ethical principles - Do no harm. - Best interests Forensic Psychiatry Ends are legal. - No doctor-patient relationship. - Focus is on a pplying psychiatric expertise to legal questions in legal contexts. Ethical principles - Truth-telling - Respect for person
Role of Forensic Psychiatry Goal Assist administration of justice by applying psychiatric expertise to legal questions in legal contexts. Objective Produce targeted medical-legal evaluation, report, and testimony. Standard of Care Apply ethics & practice guidelines of forensic psychiatry. Caveat Bias. Speculation. Conflicts of interest. Expert for own patient.
Guidelines of Forensic Psychiatry Full Disclosure Not treatment. Limited confidentiality. Need for informed consent. Honesty Address all evidence. Challenge own findings. Expose limits of certainty. Competence Clinical, scientific, & forensic expertise. Report writing and courtroom skills Framework Identify legal question, legal rules, relevant data, and reasoning process.
Child Custody Determination History History Best Interest of Child Best Interest of Child Role of Child Custody Evaluator Role of Child Custody Evaluator Uniform Standards Uniform Standards Sexual Abuse & Sexual Abuse Allegations Sexual Abuse & Sexual Abuse Allegations
History Parental rights. Parental rights. Parens patriae. Parens patriae. Family privacy. Family privacy. Tender years doctrine. Tender years doctrine. Best interest of the child. Best interest of the child. Mental Health Input
“Best Interest” Legal Standard or Psychological Premise? Toddler is kidnapped. Kidnapper marries. New couple becomes good psychological parents. Child does well. A decade later, child is discovered. By this time, biological parents are angry, depressed, drink too much and live on fringes of society but they want their child back as a matter of right.
Best Interest of the Child Child’s Needs Loving, nurturing, safe, permanent home. Loving, nurturing, safe, permanent home. Education, health care, spiritual/ethical training. Education, health care, spiritual/ethical training. Guidance in interpersonal development. Guidance in interpersonal development. Parent’s Skills View child as distinct being with its own needs. View child as distinct being with its own needs. Refrain from using child for self-gratification. Refrain from using child for self-gratification. Respond to daily needs & protect from harm. Respond to daily needs & protect from harm. Set appropriate limits for welfare of child. Set appropriate limits for welfare of child. Promote relationship to non custodial parent. Promote relationship to non custodial parent.
Role of Custody Evaluator Goal Assist Court resolve custody disputes and protect children from future harm. Objective Produce targeted medical-legal custody evaluation, report, and testimony. Standard of Care Apply forensic and practice guidelines applicable to custody determinations. Caveat Bias. Speculation. Conflict of interest. Serving as expert for own patient.
Uniform Standards Legal Case Law Case Law California Codes California Codes Fam. Code 3110, 3011, 3118 Rules of Court Rules of Court Rules 1257.3, 1257.4, 1257.7 Psychiatric Competence Clinical, scientific, forensic, specific additional areas of training and experience. Standard of Care Practice Parameters for Child Custody Evaluation of American Academy of Child & Adolescent Psychiatry
Sexual Abuse & Abuse Allegations Sexual Abuse Clinical impact Clinical impact Legal impact Legal impact Factor in custody/visitation determination Factor in custody/visitation determination Tactic in custody/visitation dispute Tactic in custody/visitation dispute Abuse Allegations Abuse Allegations Overview Overview Forensic assessment Forensic assessment Reporting duty Reporting duty Consequences of false allegations Consequences of false allegations
The Special Issue
Do you think a 40-hour week is a vacation? Do you think going to jail is a good way to relax? Does your blood pressure equal your hourly rate? When your mate asks how you feel, do you say…
STOP INTERROGATING ME !
and is this the response you get?
Attorney Stress Burnout Burnout Secondary Traumatic Stress Secondary Traumatic Stress Impact on Practice Impact on Practice Prevention Prevention Treatment Treatment
People v. Arno 90 Cal App. 3d 505, FN 2 “ We feel compelled by the nature of the attack in the dissenting opinion to spell out a response: 1.Some answer is required to the dissent’s charges. 2.Certainly we do not endorse “victimless crime.” 3.How that question is involved escapes us. 4.Moreover, the constitutional issue is significant. 5.Ultimately, it must be addressed in light of precedent. 6.Certainly the course of precedent is clear. 7.Knowing that, our result is compelled…”
Summary Custody evaluation is a medical legal activity of utmost value to society. Custody evaluation is a medical legal activity of utmost value to society. Experts need clinical expertise, familiarity with applicable law, and be able to perform consistent with the principles and practices of forensic mental health assessment. Experts need clinical expertise, familiarity with applicable law, and be able to perform consistent with the principles and practices of forensic mental health assessment. Manage stress before stress manages you! Manage stress before stress manages you!