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In general, the forensic psychiatrist should not rely solely on the evaluee's self-reported family history. Testing the strength of delusional beliefs during an assessment, particularly when the interview is conducted in a correctional facility, requires tact and careful listening to the defendant, who may become argumentative or aggressive. In some jurisdictions (such as Canada), mental health experts commonly address deterrence in presentencing evaluations. Differing conceptions of the purpose of the assessment, the expert's role, standards, and ethics-related requirements can lead to honest but varying approaches to the task. endstream Nevertheless, the literature reveals some particular strategies that the clinician may include in a comprehensive evaluation, to differentiate malingerers from genuine claimants. Some forensic evaluees are uncooperative through concealing their genuine psychiatric symptoms in an attempt to appear mentally healthy. John Wiley & Sons. 0000032495 00000 n A full discussion of these scales is outside the scope of this Guideline. Rogers and colleagues,217 in a comprehensive meta-analysis, concluded that the Fp and D scales are the most useful. Yy2HREh6 `M S]TYp9{^D/ W[6h_n. The complaint is usually countered by a list of specific questions (interrogatories) from the defense, followed by the plaintiff's answers to these interrogatories. /Resources 188 0 R In many cases, a more detailed sexual history is important (e.g., cases involving sexual offenses and certain civil claims). Generally, this documentation is found in a police report or a series of police reports from the different officers involved in an arrest. The evaluation of malingering or exaggeration of symptoms by individuals with mild ID can present particular challenges (see Section 10.3, Assessments of Persons with Intellectual Disability). There are common situations in which a psychiatric assessment of a child or adolescent may be relevant during the course of civil litigation. In other respects, the assessment should address the same aspects that are assessed in general psychiatric settings. Similarly, in sentencing assessments, the evaluator should use police reports and official documentation of the offense to enhance understanding of the details of the criminal conduct and in elucidating patterns of conduct and the relationship of mental illness or substance use to the crime. Cultural considerations should inform the forensic assessment of psychological and behavioral problems, since the legal matters prompting such assessments, whether civil, criminal, or family-related, often have serious consequences.164. that can inform forensic assessment.In 2010, Griffith and colleagues4 conceptualized the forensic psychiatric report as a performative nar-rative. Interviews of the evaluee, a review of school and social agency records, and, if possible, interviews with caregivers are sometimes helpful. Depending on the nature of this balance, it may be ethical to conduct a medical evaluation with an outcome that the evaluee regards as contrary to his interests. Finding a quiet, private place can limit this confounding factor. Collateral sources should be selected because they will provide information directly relevant to the questions at hand. It is critical that the forensic evaluator know which definitions of disability and work impairment are being applied to the referred case. In general, the evaluator should review relevant documents as they become available. endobj In risk assessment, a psychiatric opinion can affect the evaluee's interests. It is especially important to consider whether any of the evaluee's reported symptoms may be related to substance use. The American Medical Association's Code of Ethics states that physicians have an obligation to assist in the administration of justice.22 Forensic psychiatrists are physicians who are trained to diagnose and treat patients within the ethics principles embedded in the doctorpatient relationship. The current self-report of symptoms should be compared with descriptions in the medical, psychiatric, or correctional mental health records.193,200 Such evaluees often indicate current psychiatric symptoms that are inconsistent with their recent level of functioning208 or with other professed symptoms or observed behavior. Transference and countertransference may require additional attention in cross-cultural contexts; self-examination of bias regarding ethnicity and belief systems should be conducted.178 The psychiatrist should also be aware that attitudes toward mental illness and the stigma that it carries differ across groups. endobj Information on the achievement of developmental milestones is important when the evaluee is a child or adolescent. << The next questions normally deal with the relationship between the symptoms and signs of the mental illness and the degree of impairment, if any, in occupational functioning. The evaluator may have to obtain full and informed legal consent from a guardian or obtain a judicial order. Some institutions do not allow video-recording, in which case an alternative approach may be chosen or, if possible, the interview should be conducted at another location. For example, a female evaluee in a sexual harassment case who was stalked by an ex-boyfriend may be especially offended or unnerved when a male coworker absentmindedly stares in her direction, although the coworker's behavior was not intended to be discriminatory or threatening. The statement continues by advising that additional information be elicited about the evaluee's functional impairments that may be related to the specific legal standard. Finally, his consent must be free and voluntary. The presence of a third party may be appropriate when a young child has significant separation difficulties, has demonstrated an inability to be interviewed alone, or needs an interpreter.151 If others are to observe, it is important to set appropriate ground rules (such as whether the observers will be in view of the child and whether they can participate). Other approaches are to append the full police report or to simply list it as a source of information. uqsW>V{~9Lf~~CS"E4? For example, forensic experts should not administer a psychological test to evaluees outside the standardization sample of the test (e.g., the Static 99 cannot be used to assess risk in female sex offenders).117. In disability or fitness-for-duty assessments, sufficient information about functioning in the current job should be gathered to relate an impairment to a specific job responsibility. This assessment may include a retrospective chart review, with or without an interview. During the assessment, the psychiatrist should take time to explain tests and procedures as simply and clearly as needed for the evaluee to follow what is happening and to reduce the evaluee's anxiety. Regardless of whether the matter is civil or criminal, the general purpose of forensic assessment is to answer a legal question. >> Such facts can be pertinent in cases of suspected malingering or somatization. In addition to the types of offenses, it is often helpful to include their outcomes, length of incarceration (incarcerated 2 years after being found guilty in a jury trial), and defaults or probation violations. In the course of their practice, all forensic psychiatrists have to deal with evaluees with a history of aggression. Special considerations in sentencing include young-offender statutes that require consideration of developmental disabilities; sexual offenses, which may involve a period of civil commitment after the sentence; and special assessments, which determine the appropriateness of a drug court, mental health court, or other special program for an offender with a mental disorder. In one study examining aggression toward forensic evaluators, 42 percent reported having received threats of physical harm or nonviolent injury.144 When aggressive behavior toward clinicians occurs in forensic settings, it may be related to psychosis or may be precipitated by situational factors, such as the denial of an evaluee's demands. Translation choices may alter some of the content of questions and responses, with substitutions, omissions, or distortions.36,179 Hence, the interpreter should be asked to translate verbatim, and the evaluator should maintain eye contact with the evaluee throughout the interview.179, Although psychological testing can provide valuable insight, care should be taken to ensure that the test is interpreted in a culturally meaningful way. Some evaluees may deny problematic use of prescription medications, believing that, since drugs are prescribed, they are not substances in the sense described by the term substance use disorder. /Subtype /Type1 suggest a hearing shall be held in all cases. hBQ:j! endobj Assessments of children and adolescents for civil suits often involve observations of the parentchild relationship and sometimes a childsibling relationship. It is generally considered important to make a thorough record of interviews. Some cautious suspiciousness, as distinguished from paranoia, is adaptive among those of some minority ethnic groups.172, Expressions of various types of distress, regardless of whether they meet the criteria for a specific psychiatric disorder, may be affected by culture. In particular, different groups may display different affects in the presence of strangers.164 An expressed belief might be interpreted as a delusion by an evaluator who is unfamiliar with religious beliefs in another culture. /Flags 262176 The Council on Ethical and Judicial Affairs of the American Medical Association, in consultation with the American Psychiatric Association (APA), has developed an ethics policy providing guidance for psychiatrists and physicians who deal with death row inmates in either a forensic or a treatment role.91 These guidelines, which have also been adopted by the APA, should be consulted when the psychiatrist is considering treatment to restore competency for an inmate to be executed or is unsure of what constitutes unethical participation in an execution. The evaluator in the latter case must understand the admission criteria, referral process,88 and focused goals of participation in these special programs, to determine whether a defendant is a good candidate for any of them. For negligence to be established, all four components must be present. These evaluations should therefore be thorough and often include psychological testing, brain scans, and collateral interviews of individuals who knew the defendant. In forensic assessments, it is particularly important to identify all occurrences and ascertain whether and to what degree they have contributed to the evaluee's presentation and prognosis. The effects of the incident can be reviewed in the immediate period (from the day of to a month after the incident); the medium term (more than one month to one year after the incident); and the long term (more than one year after the incident). Where there are wider discrepancies in practice, the Guideline provides options with advantages and disadvantages, or remains deliberately open-ended in its conclusions. A positive family history can help in formulating an accurate diagnosis. Because of differences among jurisdictions and in practice, certain protocols are not clear cut. Some aspects of psychiatric phenomenology that are of significance in forensic assessments are listed in Summary 6.3. The opinion should be substantiated and its foundation clearly delineated.8 The evaluator should keep in mind that the scientific foundation for the opinion may have to withstand a Daubert135 challenge in court. The answer may not be a simple yes or no. Authors Graham D . Forensic psychiatrists should be familiar with both current and past techniques used to assess neurophysiological function; more important, they should be aware of the substantial limitations that have been ascribed to these methods to date.