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Forensic Psychiatry

Forensic Science Guide: Forensic Psychiatry

Forensic psychiatry combines psychiatry with criminology and is considered a sub-specialty of psychiatry. Forensic psychiatrists stand between psychiatry and the law, helping juries to determine competency, both at the time of the crime and at the time of trial. They also act as expert witnesses to testify to the medical condition of the accused in a variety of legally relevant circumstances.

This resource is meant to provide students, teachers and those interested in the field with valuable information on forensic psychiatry. As an ongoing effort to provide the best resources on forensic science, compiled below are lists of useful sites that offer information on entering the field of forensic psychiatry, important contacts and organizations in the field and representative court cases.

Forensic Psychiatry: An Overview

Forensic psychiatry is a unique field that blends medicine and law to determine individual culpability by assessing mental health and competency. Forensic psychiatrists are medical doctors who often see patients in hospitals or a private practice in addition to working in the courts. Many forensic psychiatrists have both a medical degree (M.D.) and legal training. Some have a complete law degree, though this is not required to work in the courts.

Forensic psychiatrists are called into court to answer two types of questions: What was the defendant’s mental state at the time the crime was committed (MSO), and is the patient competent to stand trial (CST)? Forensic psychiatrists are often called into court as expert witnesses. They are asked to review the evidence and the patient’s history and to form an opinion about a specific aspect of the case. This is an independent opinion only, based on expertise as much as facts, and it is a controversial practice, since the personality and moral character of the psychiatrist can so subjectively affect the outcome of the trial. Forensic psychiatrists are required to prepare a report for the court, outlining the evidence and reasoning involved in passing judgment.

Forensic psychiatrists (and psychologists, the non-medical, social-science branch of the field) also often work in risk management, outside courts and hospitals. Risk management assesses the danger mentally ill people pose to the community. Risk assessment forensic psychiatrists work to treat and manage mental illness with the goal of re-integrating patients into the community where they can become productive citizens. If this is not possible because a patient is violent to himself or others, risk assessment psychiatrists commit patients to hospitals for further treatment and supervision.

Becoming a forensic psychiatrist requires a medical degree with a psychiatry specialization. It is also helpful to study law, and to gain hands-on work experience with mentally ill criminals before working in the courts.

Competency to Stand Trial (CST)

 

Competency to stand trial is evaluated based on interviews and psychological tests meant to assess cognitive ability. The forensic psychiatrist will study the defendant’s medical history, interview family and friends, and review any medications. The psychiatrist must determine if the defendant can understand the charges against him, answer questions and assist his attorney. This is dictated by the Fifth Amendment to the Constitution, which secures the rights of the accused to face his accusers, be present at his trial and have the assistance of an attorney.

Mental State Opinion (MSO)

The forensic psychiatrist provides the court with her expert opinion regarding the state of mind of the defendant at the time the crime was committed. This is highly controversial since the psychiatrist can only make an educated guess about the mental state of the defendant in the past, but it is an important factor in determining guilt. There are primary standards that guide court rulings, each of which was the result of a court case in which a defendant was deemed incompetent to stand trial.

  • The M’Naghten Rule, also called the “right-wrong test” was designed (as the name implies) to determine whether or not a defendant could distinguish between right and wrong. However, the M’Naghten Rule was black and white and did not consider complex circumstances and emotional states that may influence a defendant’s right-wrong determination.
  • The Irresistible Impulse Test was designed to expand upon the simple right-wrong dichotomy of M’Naghten, to determine whether a defendant could control his impulses.
  • The Durham Rule was created by Judge David L. Bazelton in 1954 in Durham v. United States. The rule dictates that, “an accused is not criminally responsible if his unlawful act was the product of mental disease.” The Durham Rule replaced the M’Naghten Rule.
  • The ALI test, developed by the American Law Institute to apply to an insanity defense states, “a person is not responsible for criminal conduct if at the time of such conduct as a result of mental disease or defect he lacks substantial capacity either to appreciate the criminality of his conduct or to conform his conduct to the requirements of the law.” The ALI test was designed to combine all of the elements of the earlier tests (right-wrong, impulse control and the presence of mental disease) under one unified set of diagnostic criteria.

Becoming a Forensic Psychiatrist

While it is traditionally expected that an aspiring forensic psychiatrist will complete medical school with a concentration in psychiatry before attempting to become a forensic psychiatrist, there are some medical school programs that start students specializing early.

  • Visit Reid Psychiatry for frequently asked questions about forensic psychiatry including links to educational resources, courses of study and further reading on professional ethics.
  • Visit the American Academy for Forensic Sciences for information on professional events, meetings, educational opportunities and news.

Mental Illness and the Court

 

While cases involving forensic psychiatry continue to supplement current legal policy, there are three landmark cases that shaped legal precedent for determining mental health in the courtroom.

  • Rennie v. Klein: This 1978 landmark case gave involuntarily committed psychiatric patients the right to refuse treatment.
  • Daubert v. Merrell Dow Pharmaceuticals: In 1993, this case set the standard for allowing expert testimony in federal court cases.
  • Kansas v. Hendricks: In 1997, this case set the standard for the civil commitment of convicted sex offenders, deemed dangerous due to mental illness or injury.
  • Treatment Advocacy Center provides a database of landmark mental health cases in the United States courts.

Articles about Forensic Psychiatry

 

The field of forensic psychiatry is controversial as it continues to evolve and doctors continue to attempt to make their practice less subjective and more science-based. Several regular publications print essays and critiques of the field alongside full-text court cases relevant to the field’s development.

Mental Health Legal Resources

 

If you are in need of a forensic psychiatrist for treatment advice, mentorship or for an upcoming court date, visit the following sources. Many of them offer direct contact information for private-practice forensic psychiatrists, and links to directories of organizations that match doctors with patients.

  • The Massachusetts Mental Health Legal Advisors Committee works to protect mentally ill patient’s rights in the courts. While this resource will be most helpful to readers living in Massachusetts, they provide a directory of links to resources and publications about other advocacy programs nation-wide.
  • ForensicPsychiatry.com is an online educational magazine offering a range of resources on current challenges facing forensic psychiatry as well as links to practicing forensic specialists.
  • Treatment Advocacy Center is “a national nonprofit organization dedicated to eliminating barriers to the timely and effective treatment of severe mental illness. The organization promotes laws, policies and practices for the delivery of psychiatric care. […]”
  • The Jed Foundation works with college students to reduce suicide rates and to advocate for young mentally ill defendants in court cases.

International Forensic Psychiatry

 

Forensic psychiatry is a growing field worldwide. Legal precedents and policies vary from country to country and are largely dependent on culture and history. The following resources will provide an overview of the many different perspectives on cross-cultural forensic psychiatry with directories of resources for further reading.