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Forensic psychiatry. Forensic psychiatry and forensic psychiatrist (expert witness) Forensic psychiatry is a branch of medicine which focuses on the interface.

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Presentation on theme: "Forensic psychiatry. Forensic psychiatry and forensic psychiatrist (expert witness) Forensic psychiatry is a branch of medicine which focuses on the interface."— Presentation transcript:

1 Forensic psychiatry

2 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. Expert witnesses 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.

3 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.

4 Criminal law Competence to stand trial – in the presence of mental disorder, defendant is able 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.

5 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.rightsdutiesobligationsmarriedcontractsgiftswil 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.)

6 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?

7 Another expertises in civil law Driving and gun license Financial compensation for pain and social handicaps Involuntary hospitalization etc.

8 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.

9 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.

10 The standards for a helpful forensic psychiatry report Berger, S.H. - J Am Acad Psychiatry Law 36:3:388-392 (September 2008) 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).

11 WPA’s Section of Forensic Psychiatry's Consensus Paper on Guidelines for Independent Medical Examination -2010 Content of report Qualifications and experience of the IFP. A statement about who commissioned the report. A statement regarding the examinee’s consent to the release of information. Demographic data, including the name and date of birth of the examinee, the domestic situation, marital status and number of children. Personal history, including developmental, educational, occupational, sexual and relationship, substance use and forensic history. A description of the examinee’s personality, interests, hobbies and coping style. History of the present complaint as presented by the examinee and reports from informants. Past psychiatric history. Family history of psychiatric illness.

12 Content of report II. Medical history. 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. Tests and investigations. 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. 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. Comments on special issues may be required, including prognosis, management, impairment, disability and legal concepts such as competency.

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