Forensic Psychiatry

By Dr. Greg Brown

        

Forensic psychiatry is a subspecialty of the field of general psychiatry. In order to become a board certified forensic psychiatrist, you must first attend medical school, then you are required to complete a residency in general psychiatry, followed by a fellowship in forensic psychiatry. The main topic of forensic psychiatry is bridging an interface between the medical specialty of psychiatry and the law, each of which use a very different specific type of language to communicate.

The goal of a forensic psychiatric evaluation is to take sometimes complicated psychiatric concepts and render them easy to understand for the court and to help the court comprehend how a psychiatric condition might or might not affect an individual’s behavior. This requires a more sophisticated and detailed assessment than merely a description of psychiatric symptoms. As an example, a series of psychiatric symptoms might include a lack of contact with reality, formally termed psychosis, with the presence of either hallucinations, delusions, ideas of reference, or other findings. However, the presence of a psychosis, which may even result in a diagnosis of schizophrenia, schizoaffective disorder, or a mood disorder with psychotic features, does not necessarily equate to the behavior at question for a medico-legal purpose.

The behavior may involve understanding the charges against one in a criminal setting, or may involve the capacity to work in various positions in a workers’ compensation case, or the events leading to a personal injury in a personal injury case. How the person’s symptoms present may affect the behavior or understanding level being assessed, and the symptoms also may not. It is this additional layer of analysis that is of use to a third party who engages a forensic psychiatrist to perform an evaluation.

Although the clinical experiences within psychiatry are essential for the forensic psychiatrist to understand the illness and condition of the evaluee, the additional skill set of the forensic psychiatrist is the ability to translate this symptom-based lexicon into a terminology and understanding useful to people outside the field of psychiatry.

The range of evaluations in the criminal court setting may include competence to stand trial and not guilty by reason of insanity evaluations. In the family court system, there are evaluation of competence to parent, need for guardianships at the end of life or early in life, the criteria for civil involuntary commitment to psychiatric facilities, and capacity to write wills or trusts for estate planning. At the level of the civil court process, forensic psychiatry may be involved in examining causation for psychiatric claims in the context of personal injury, or state of mind at the time that an injury occurred.

Outside the court system, forensic psychiatrists often evaluate individuals for long-term or short-term disability, capacity to perform work, and confirming medical leaves as medically necessary. The unique aspect of forensic psychiatry as opposed to general psychiatry is that the entity which owns the information and the report is often not the person being evaluated. Thus, it becomes essential and ethical to inform the evaluee that neither the report nor the information technically belongs to them. This is a different relationship between doctor and evaluee than occurs in clinical practice and provides a subtle distinction which must be communicated clearly in this unique and fascinating subset of psychiatry.


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