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Forensic psychiatry

Forensic psychiatry

Overview
Forensic psychiatry is a sub-speciality of psychiatry
Psychiatry
Psychiatry is the medical specialty devoted to the study and treatment of mental disorders. These mental disorders include various affective, behavioural, cognitive and perceptual abnormalities...

 and an auxiliar science of criminology
Criminology
Criminology is the scientific study of the nature, extent, causes, and control of criminal behavior in both the individual and in society...

. It encompasses the interface between law
Law
Law is a system of rules and guidelines which are enforced through social institutions to govern behavior, wherever possible. It shapes politics, economics and society in numerous ways and serves as a social mediator of relations between people. Contract law regulates everything from buying a bus...

 and psychiatry. A forensic psychiatrist provides services – such as determination of competency to stand trial – to a court of law to facilitate the adjudicative process.

Forensic psychiatrists work with court
Court
A court is a form of tribunal, often a governmental institution, with the authority to adjudicate legal disputes between parties and carry out the administration of justice in civil, criminal, and administrative matters in accordance with the rule of law...

s evaluating an individual's competency to stand trial
Trial (law)
In law, a trial is when parties to a dispute come together to present information in a tribunal, a formal setting with the authority to adjudicate claims or disputes. One form of tribunal is a court...

, defences based on mental diseases or defects (e.g., the "insanity" defense), and sentencing
Sentence (law)
In law, a sentence forms the final explicit act of a judge-ruled process, and also the symbolic principal act connected to his function. The sentence can generally involve a decree of imprisonment, a fine and/or other punishments against a defendant convicted of a crime...

 recommendations.
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Unanswered Questions
Encyclopedia
Forensic psychiatry is a sub-speciality of psychiatry
Psychiatry
Psychiatry is the medical specialty devoted to the study and treatment of mental disorders. These mental disorders include various affective, behavioural, cognitive and perceptual abnormalities...

 and an auxiliar science of criminology
Criminology
Criminology is the scientific study of the nature, extent, causes, and control of criminal behavior in both the individual and in society...

. It encompasses the interface between law
Law
Law is a system of rules and guidelines which are enforced through social institutions to govern behavior, wherever possible. It shapes politics, economics and society in numerous ways and serves as a social mediator of relations between people. Contract law regulates everything from buying a bus...

 and psychiatry. A forensic psychiatrist provides services – such as determination of competency to stand trial – to a court of law to facilitate the adjudicative process.

Court work


Forensic psychiatrists work with court
Court
A court is a form of tribunal, often a governmental institution, with the authority to adjudicate legal disputes between parties and carry out the administration of justice in civil, criminal, and administrative matters in accordance with the rule of law...

s evaluating an individual's competency to stand trial
Trial (law)
In law, a trial is when parties to a dispute come together to present information in a tribunal, a formal setting with the authority to adjudicate claims or disputes. One form of tribunal is a court...

, defences based on mental diseases or defects (e.g., the "insanity" defense), and sentencing
Sentence (law)
In law, a sentence forms the final explicit act of a judge-ruled process, and also the symbolic principal act connected to his function. The sentence can generally involve a decree of imprisonment, a fine and/or other punishments against a defendant convicted of a crime...

 recommendations. There are two major areas of criminal evaluations in forensic psychiatry. These are Competency to Stand trial (CST) and Mental State at the Time of the Offence (MSO).

Competency to stand trial (CST)


This is the competency evaluation
Competency evaluation (law)
In the United States criminal justice system, a competency evaluation is an assessment of the ability of a defendant to understand and rationally participate in a court process....

 to determine that a defendant has the mental capacity to understand the charges and assist his attorney. This is seated in the Fifth Amendment to the US Constitution, which ensures the right to be present at your trial, to face your accusers, and to have help from an attorney.

In English and Welsh law a similar concept is that of "fitness to plead
Fitness to plead
In the law of England and Wales, fitness to plead is the capacity of a defendant in criminal proceedings to comprehend the course of those proceedings. The concept of fitness to plead also applies in Scots law. Its United States equivalent is competence to stand.-Test:If the issue of fitness to...

".

As an expert witness


Forensic psychiatrists are often called to be expert witness
Expert witness
An expert witness, professional witness or judicial expert is a witness, who by virtue of education, training, skill, or experience, is believed to have expertise and specialised knowledge in a particular subject beyond that of the average person, sufficient that others may officially and legally...

es in both criminal
Criminal law
Criminal law, is the body of law that relates to crime. It might be defined as the body of rules that defines conduct that is not allowed because it is held to threaten, harm or endanger the safety and welfare of people, and that sets out the punishment to be imposed on people who do not obey...

 and civil
Civil law (common law)
Civil law, as opposed to criminal law, is the branch of law dealing with disputes between individuals or organizations, in which compensation may be awarded to the victim...

 proceedings. Expert witnesses give their opinion about a specific issue. Often the psychiatrist will have prepared a detailed report before testifying. The primary duty of the expert witness is to provide an independent opinion to the court. An expert is allowed to testify in court with respect to matters of opinion only when the matters in question are not ordinarily understandable to the finders of fact be they judge or jury. As such, prominent leaders in the field of forensic psychiatry, from Thomas Gutheil Gutheil, Thomas:The Psychiatrist as Expert Witness Second Edition 2009 from Harvard to Robert Simon and Lisa Gold The American Psychiatric Textbook of Forensic Psychiatry and others Sadoff, Robert Eithical Issues in Forensic Psychiatry Minimizing Harm p 102 have identified teaching as a critical dimension in the role of expert witness. The matter is a simple one: the expert will be asked to form an opinion and to testify about that opinion, but in so doing will perforce explain the basis for that opinion which will include important concepts, approaches and methods used in psychiatry.

Mental state opinion


This gives the Court an opinion, and only an opinion, as to whether a defendant was able to understand what he was doing at the time of the crime. This is worded differently in many states, and has been rejected altogether in some, but in every setting, the intent to do a criminal act and the understanding that it was a criminal act bear on the final disposition of the case. Much of forensic psychiatry is guided by significant Court rulings or laws that bear on this area which include the following three standards:
  • M'Naghten rules
    M'Naghten Rules
    The M'Naghten rules were a reaction to the acquittal of Daniel McNaughton. They arise from the attempted assassination of the British Prime Minister, Robert Peel, in 1843 by Daniel M'Naghten. In fact, M'Naghten fired a pistol at the back of Peel's secretary, Edward Drummond, who died five days later...

    : Excuses a defendant who, by virtue of a defect of reason or disease of the mind, does not know the nature and quality of the act, or, if he does, does not know that the act is wrong.
  • Durham rule
    Durham rule
    The Durham Rule or "product test" was adopted by the United States Court of Appeals for the District of Columbia Circuit in 1954, in the case of Durham v. U.S. , and states that "... an accused is not criminally responsible if his unlawful act was the product of mental disease or defect". Durham...

    : Excuses a defendant whose conduct is the product of mental disease or defect.
  • ALI test: Excuses a defendant who, because of a mental disease or defect, lacks substantial capacity to appreciate the criminality (wrongfulness) of his conduct or to conform his conduct to the requirements of law.


"Not guilty by reason of insanity" (NGRI) is one potential outcome in this type of trial. It is important to note that insanity
Insanity
Insanity, craziness or madness is a spectrum of behaviors characterized by certain abnormal mental or behavioral patterns. Insanity may manifest as violations of societal norms, including becoming a danger to themselves and others, though not all such acts are considered insanity...

 is a legal and not a medical term. Often there will be a psychiatrist(s) testifying for both the defense and the prosecution.

Forensic psychiatrists are also involved in the care of prison
Prison
A prison is a place in which people are physically confined and, usually, deprived of a range of personal freedoms. Imprisonment or incarceration is a legal penalty that may be imposed by the state for the commission of a crime...

ers, both those in jails and those in prisons, and in the care of the mentally ill and dangerous (such as those who have been found not guilty by reason of insanity).

Risk management


Many past offenders against other people, and suspected or potential future offenders with mental health problems or an intellectual or developmental disability, are supervised in the community by forensic teams containing a variety of professionals, including psychiatrists, psychologists, nurses and care workers. These teams have dual responsibilities, to promote both the welfare of their clients and the safety of the public. The aim is not so much to predict as to prevent violence, by means of risk management.

Risk assessment and management is a growth area in the forensic field, with much academic work being done in Ontario and British Columbia. This began with the attempt to predict the likelihood of a particular kind of offence being repeated, by combining "static" indicators from personal history and offence details in actuarial instruments such as the RRASOR and Static-99, which were shown to be more accurate than unaided professional judgment. More recently, use is being made also of "dynamic" risk factors, such as attitudes, impulsivity, mental state, family and social circumstances, substance use, availability and acceptance of support, to make a "structured professional judgment." The aim of this is to move away from prediction to prevention, by identifying and then managing risk factors. This may entail monitoring, treatment, rehabilitation, supervision and victim safety planning and depends on the availability of funding and legal powers. These schemes may be based on published assessments such as the HCR-20 (which incorporates 10 Historical, 5 Clinical and 5 Risk Management factors) and the RSVP (Risk of Sexual Violence Protocol) from Simon Fraser University
Simon Fraser University
Simon Fraser University is a Canadian public research university in British Columbia with its main campus on Burnaby Mountain in Burnaby, and satellite campuses in Vancouver and Surrey. The main campus in Burnaby, located from downtown Vancouver, was established in 1965 and has more than 34,000...

, BC.

Britain


In Britain most forensic psychiatrists work for the National Health Service
National Health Service
The National Health Service is the shared name of three of the four publicly funded healthcare systems in the United Kingdom. They provide a comprehensive range of health services, the vast majority of which are free at the point of use to residents of the United Kingdom...

, in specialist secure units caring for mentally ill offenders (as well as people whose behaviour has made them impossible to manage in other hospitals). These can be either medium secure units (of which there are many throughout the country) or high secure hospitals (also known as Special Hospitals), of which there are three in England and one in Scotland (The State Hospital, Carstairs), the best known of which being Broadmoor Hospital
Broadmoor Hospital
Broadmoor Hospital is a high-security psychiatric hospital at Crowthorne in the Borough of Bracknell Forest in Berkshire, England. It is the best known of the three high-security psychiatric hospitals in England, the other two being Ashworth and Rampton...

. The other 'specials' are Ashworth hospital in Maghull, Liverpool and Rampton hospital in Nottinghamshire. There are also a number of private sector medium secure units, which sell their beds exclusively to the NHS, as there are not enough secure beds available in the NHS system. (There are no 'private' paying patients in Forensic Psychiatry!)

Forensic psychiatrists often also do prison inreach work, in which they go into prisons and assess and treat people suspected of having mental disorders; much of the day to day work of these psychiatrists comprises care of very seriously mentally ill patients, especially those suffering from schizophrenia
Schizophrenia
Schizophrenia is a mental disorder characterized by a disintegration of thought processes and of emotional responsiveness. It most commonly manifests itself as auditory hallucinations, paranoid or bizarre delusions, or disorganized speech and thinking, and it is accompanied by significant social...

. Some units also treat people with severe personality disorder
Personality disorder
Personality disorders, formerly referred to as character disorders, are a class of personality types and behaviors. Personality disorders are noted on Axis II of the Diagnostic and Statistical Manual of Mental Disorders or DSM-IV-TR of the American Psychiatric Association.Personality disorders are...

, learning disabilities. The areas of assessment for courts are also somewhat different in Britain, because of differing mental health law. Fitness to plead, and mental state at the time of the offence are indeed issues given consideration, but the mental state at the time of trial is also a major issue, and it is this assessment which most commonly leads to the use of mental health legislation to detain people in hospital, as opposed to their getting a prison sentence.

Learning disabled offenders who are a continuing risk to others may be detained in learning disability hospitals (or specialised community-based units with a similar regime, as the hospitals have mostly been closed) as suffering from "Mental Impairment" in England and Wales, and without use of that term in Scotland. This includes those who commit serious crimes of violence, including sexual violence, and fire-setting. They would be cared for by learning disability psychiatrists and registered learning disability nurses (RNLD). Some psychiatrists doing this work have dual training in learning disability and forensic psychiatry or learning disability and adolescent psychiatry. Some nurses would have training in mental health also (RMN and RNLD).

Many past offenders against other people, and suspected or potential future offenders with mental health problems or a learning disability, are supervised in the community by forensic teams containing a variety of professionals, including psychiatrists, psychologists, nurses and care workers. These teams have dual responsibilities, to promote both the welfare of their clients and the safety of the public. The aim is not so much to predict as to prevent violence, by means of risk management.

Court work (medico-legal work) is generally undertaken as private work by psychiatrists (most often 'forensic' psychiatrists) as well as forensic and clinical psychologists, who usually also work within the National Health Service (NHS). This work is generally funded by the Legal Services Commission (used to be called Legal Aid).

Canada


In Canada certain credentialed medical practitioners may, and apparently at their sole discretion, make state
State (polity)
A state is an organized political community, living under a government. States may be sovereign and may enjoy a monopoly on the legal initiation of force and are not dependent on, or subject to any other power or state. Many states are federated states which participate in a federal union...

-sanctioned investigations into and diagnosis of "mental illness". These diagnoses appear to be based at least in part, and in some cases entirely upon, the investigator's expressed perception of the validity of the subject's thoughts and beliefs. This aspect of diagnosis is manifest in the Diagnostic and Statistical Manual of Mental Disorders
Diagnostic and Statistical Manual of Mental Disorders
The Diagnostic and Statistical Manual of Mental Disorders is published by the American Psychiatric Association and provides a common language and standard criteria for the classification of mental disorders...

 IV Text Revision (DSM-IV-TR)
glossary definition of "delusion" which begins; "A false belief based on...", and is found on page 821 of the DSM-IV-TR and, similarly, elsewhere. Significantly the presence of "delusions" seem to form a primary criterion for the diagnosis of the majority of DSM-IV-TR "psychotic" disorders including Schizophrenia
Schizophrenia
Schizophrenia is a mental disorder characterized by a disintegration of thought processes and of emotional responsiveness. It most commonly manifests itself as auditory hallucinations, paranoid or bizarre delusions, or disorganized speech and thinking, and it is accompanied by significant social...

 and Schizoaffective Disorder
Schizoaffective disorder
Schizoaffective disorder is a psychiatric diagnosis that describes a mental disorder characterized by recurring episodes of elevated or depressed mood, or of simultaneously elevated and depressed mood, that alternate with, or occur together with, distortions in perception.Schizoaffective disorder...

 (Criterion A1 in the case of Schizophrenia). The DSM-IV-TR also states that "No laboratory findings have been identified that are diagnostic of Schizophrenia". This statement is also applied to Major Depressive episodes and Manic episodes.

The application of DSM-IV-TR criteria to the various pieces of criminal as well as federal health and provincial mental health law in Canada seems still to occur in spite of their conflict in this respect with Section 2(b) of the Canadian Charter of Rights and Freedoms
Canadian Charter of Rights and Freedoms
The Canadian Charter of Rights and Freedoms is a bill of rights entrenched in the Constitution of Canada. It forms the first part of the Constitution Act, 1982...

, http://laws.justice.gc.ca/en/Charter/index.html which guarantees the "fundamental" "freedom of thought, belief, opinion and expression". Part VII -- General, of the Canadian Constitution Act, 1982
Constitution Act, 1982
The Constitution Act, 1982 is a part of the Constitution of Canada. The Act was introduced as part of Canada's process of "patriating" the constitution, introducing several amendments to the British North America Act, 1867, and changing the latter's name in Canada to the Constitution Act, 1867...

states that "any law that is inconsistent with the provisions of the Constitution "...(which contains the Charter of Rights and Freedoms)..."is, to the extent of the inconsistency, of no force or effect".

The potential for state sanctioned involuntary detainment and treatment exists pursuant to the Criminal Code of Canada
Criminal Code of Canada
The Criminal Code or Code criminel is a law that codifies most criminal offences and procedures in Canada. Its official long title is "An Act respecting the criminal law"...

, http://laws.justice.gc.ca/en/ShowTdm/cs/C-46 and these health acts. The Ontario Mental Health Act
Ontario Mental Health Act
The Ontario Mental Health Act is an Ontario law which regulates the administration of Mental Health Care. The main purpose of the law is to regulate the involuntary admission of people into a psychiatric hospital...

, http://www.e-laws.gov.on.ca/DBLaws/Statutes/English/90m07_e.htm for example contains references to circumstances under which involuntary admission to psychiatric facilities can occur.

However, legal involvement and involuntary detainment and treatment is not fundamental to the DSM-IV-TR nor, again according to the DSM-IV-TR, are implications of violent behavior at frequencies exceeding that of the general population attributed to those diagnosed. To a significant degree courts are in fact cautioned against the use of DSM-IV-TR diagnosis in the DSM-IV-TR introduction itself in its section entitled Use of DSM-IV-TR in Forensic Settings.

In the Canadian criminal justice system, again, in spite of the Charter Freedoms, individuals continue to be subjected to discrimination
Discrimination
Discrimination is the prejudicial treatment of an individual based on their membership in a certain group or category. It involves the actual behaviors towards groups such as excluding or restricting members of one group from opportunities that are available to another group. The term began to be...

 based on DSM IV diagnosis within the context of part XX.1 of the Criminal Code of Canada
Criminal Code of Canada
The Criminal Code or Code criminel is a law that codifies most criminal offences and procedures in Canada. Its official long title is "An Act respecting the criminal law"...

, http://laws.justice.gc.ca/en/ShowTdm/cs/C-46. This part sets out provisions for, among other things, court ordered attempts at "treatment" before individuals receive a trial as described in section 672.58 of the Criminal Code. Also provided for are court ordered "psychiatric assessments".

Confidentiality

The position of the Canadian Psychiatric Association http://www.cpa-apc.org/index.php itself, stated in The Confidentiality of Psychiatric Records and the Patient's Right to Privacy(2000-21S), and http://publications.cpa-apc.org/browse/documents/69 holds that "in recent years, serious incursions have been made by governments, powerful commercial interests, law enforcement agencies, and the courts on the rights of persons to their privacy." It goes on to state that "breaches or potential breaches of confidentiality in the context of therapy seriously jeopardize the quality of the information communicated between patient and psychiatrist and also compromise the mutual trust and confidence necessary for effective therapy to occur."

An outline of the Forensic Psychiatric process as it occurs in the Canadian Province of Ontario is attempted in the publication The Forensic Mental Health System In Ontario published by the Centre for Addiction and Mental Health
Centre for Addiction and Mental Health
The Centre for Addiction and Mental Health is a consortium of mental health clinics at several sites in Toronto, Ontario, Canada. Its name in French is Centre de toxicomanie et de santé mentale...

, http://www.camh.net/ in Toronto. The Guide states; "Whatever you tell a forensic psychiatrist and the other professionals assessing you is not confidential". The Guide further states; "The forensic psychiatrist will report to the court using any available information, such as: police and hospital records, information given by your friends, family or co-workers, observations of you in the hospital"http://www.camh.net/Care_Treatment/Resources_clients_families_friends/Forensic_Mental_Health_Ontario/forensic_mhontario_whathappens.html. Also according to The Guide;"You have the right to refuse to take part in some or all of the assessment. Sometimes your friends or family members will be asked for information about you. They have the right to refuse to answer questions too."http://www.camh.net/Care_Treatment/Resources_clients_families_friends/Forensic_Mental_Health_Ontario/forensic_mhontario_whathappens.html.

It is noteworthy that the emphasis in The Guide is on the right to refuse participation. The adversarial tone of The Guide may seem unusual given that a result of Not Criminally Responsible by reason of Mental Disorder (NCR) verdict is often portrayed as desirable to the defense. The Insanity defense is the language used to describe the equivalent process in the United States. The language here in Canada can be confusing. In the popular sense NCR is a "defense" (for example in this page from The Supreme Court of Canada website which refers to "mental illness defense" http://www.scc-csc.gc.ca/court-cour/ju/spe-dis/bm05-02-17-eng.asp). The Criminal Code of Canada describes "defense of mental disorder" in I General section 16. However it is a "defense" which can be imposed by the court or the crown, not one that is sought only through application by a defendant or "the defense" in the usual sense. This process is also described in section 672.12 of The Code. Essentially, the Crown (an adversarial entity in Canadian law) or the Court itself (a neutral entity) can make an application to "defend" the "defendant" against the wishes of "the defense".

Also noteworthy is that an accused placed in a hospital setting is there presumably due to a perception at some level that there are reasonable grounds to believe that that person is ill in the first place. It is difficult to imagine then that they or those around them would not need, or at very least feel a need, to divulge information to that hospital in order to secure appropriate treatment. Indeed information about allergies, medications, past diagnosis etc. may be fundamental to the safety of any stay in custody whether there is an actual "need" for hospitalization proper, or not.

This raises the reasonable possibility that if the information in the guide is correct, and that "any information" can be used for the purpose of reporting to the court, that a dynamic of torture is set up whereby the court is apprised of information gathered from accused persons, their families, and their doctors under the premise of its necessity for the purpose of ethical medical treatment.

Treatment/Assessment Conflict

In Ontario a court ordered inpatient forensic assessment for criminal responsibility will typically involve both treatment and assessment being performed with the accused in the custody of a single multi-disiplinary team over a thirty or sixty day period. An accused may, as may any of the other potential sources mentioned, feel compelled on ethical, medical or legal grounds to divulge information, medical or otherwise, to "assessors" in an attempt to allow for and ensure safe and appropriate "treatment" during that period of custody. This to their own benefit and to that of other "patients" and the facility staff themselves. An accused placed in the custody of a forensic psychiatric practitioner or entity imbued with the dual, and conflicting, responsibilities of caregiver and assessor may be compromised for that reason. Involved parties may also be moved to provide information as a result of concern over how victims, the families on both sides, they themselves, or indeed "society" may be affected by perceived possible outcomes.

The author is at a loss to find an instance of reference to the occurrence of this dual assessment/treatment paradigm in an inpatient criminal setting without citing case law apparently covered by publication ban. The omission of statements ruling out the dynamic of assessment/treatment conflict in The Forensic Mental Health System in Ontario an Information Guide and in descriptions of various Forensic inpatient assessment units in Ontario; Whitby http://whitbymentalhealthcentre.ca/fact.htm, CAMHhttp://www.camh.net/About_CAMH/Guide_to_CAMH/Mental_Health_Programs/The_Law_and_Mental_Health_Program/guide_assessment_triage.html, Royal Ottawa http://www.rohcg.on.ca/programs-and-services/forensic-psychiatry-e.cfm, Thunder Bay http://www.tbrhsc.com/programs_&_services/forensic_program.asp is perhaps telling enough.

There are however abundant internet references to treatment/assessment conflict as it relates to various justice systems, particularly civil litigation in other jurisdictions including http://www.informaworld.com/smpp/content~content=a908410627~db=all, http://www.citeulike.org/user/pseudopharm/article/1219643, http://expertpages.com/news/should_the_treating_clinician_be_an_expert_witness.htm.

The American Academy Of Psychiatry and the Law does state in its ethics guidelines http://www.aapl.org/ethics.htm that "when a treatment relationship exists, such as in correctional settings, the usual physician-patient duties apply." It is however not clear whether this statement refers to evaluation in a correctional setting or treatment of those living in a correctional setting independent of the involvement of the court system. Arguably the practice of psychiatry involving incarcerated persons independent of the court's interest is by definition not truly forensic psychiatry, but simply psychiatry, though it may be offered by a practitioner with forensic qualifications who happens to practice in a correctional institution.

The dynamic of assessment/treatment conflict, particularly in a court mandated inpatient setting, arguably constitutes "torture
Torture
Torture is the act of inflicting severe pain as a means of punishment, revenge, forcing information or a confession, or simply as an act of cruelty. Throughout history, torture has often been used as a method of political re-education, interrogation, punishment, and coercion...

". The dangers reasonably perceived and associated with modern psychiatric treatment, and the potential dangers of non-treatment or mistreatment as a result of the lawful omission of information pertaining to an accused by the accused or by interested third parties cause an ethical dilemma. It is akin to placing a person with any dangerous illness or disease into custody, isolating them from outside treatment, and telling them, their families, their doctors, and anyone else with pertinent information, that if they give that information, which they may reasonably feel is vital to management of that disease, that that information can and will be used to produce a case against that person in a court of law.

Notably the experience of torture applies not only to an accused but potentially to third parties such as witnesses, families, friends, associates, doctors, caregivers, police, and even victims. Any party from which information relating to the accused or alleged crime may be collected is vulnerable to the dynamic. The process thus appears to allow these parties to suffer torture as described in section http://laws.justice.gc.ca/en/showdoc/cs/C-46/bo-ga:l_VIII-gb:s_264_1//en#anchorbo-ga:l_VIII-gb:s_264_1269.1(1)(a)(i) of the Criminal Code of Canada which states "torture" means any act or omission by which severe pain or suffering, whether physical or mental, is intentionally inflicted on a person (a) for a purpose including (i) obtaining from the person or from a third person information or a statement. The United Nations Convention Against Torture
United Nations Convention Against Torture
The United Nations Convention against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment is an international human rights instrument, under the review of the United Nations, that aims to prevent torture around the world....

http://www.hrweb.org/legal/cat.html provides a similar set of criteria. The condition of being tortured set out in these texts seems also to extend to members of the forensic mental health and Justice community itself faced with the conflicting demands of ethical medical care and the precedent of court mandated assessment in an environment that does not separate these two roles.

Outcomes

With a finding of "Not Criminally Responsible on Account of Mental Disorder" as described in section 672.34 of the Criminal Code lifelong restrictions on freedom, mandatory "treatment", and indefinite detention subject to periodic non-judicial review appear possible well beyond the scope of set limits for detention of those found to be criminally responsible for the same or even much more serious offenses. Section 672.12 of the Criminal Code states "The court may make an assessment order at any stage of proceedings against the accused of its own motion, on application of the accused or, subject to subsections (2)and (3), on application of the prosecutor" implying that the test is not universally applied.

Training Standards


Some practitioners of forensic psychiatry have taken extra training in that specific area. In the United States
United States
The United States of America is a federal constitutional republic comprising fifty states and a federal district...

, one year fellowship
Fellowship (medicine)
A fellowship is the period of medical training in the United States and Canada that a physician may undertake after completing a specialty training program . During this time , the physician is known as a fellow...

s are offered in this field to psychiatrists who have completed their general psychiatry training. Such psychiatrists may then be eligible to sit for a board certification examination in forensic psychiatry. In Britain
United Kingdom
The United Kingdom of Great Britain and Northern IrelandIn the United Kingdom and Dependencies, other languages have been officially recognised as legitimate autochthonous languages under the European Charter for Regional or Minority Languages...

 one is required to complete a three-year sub-speciality training in forensic psychiatry, after completing one's general psychiatry training, before receiving a Certificate of Completion of Training
Certificate of Completion of Training
CCT or Certificate of Completion of Training is the certificate that physicians in the United Kingdom receive to indicate that they have completed training in their chosen specialty and are eligible to apply for a post as a consultant or a general practitioner .This certificate is awarded by the...

 as a forensic psychiatrist. In some countries general psychiatrists can practice forensic psychiatry as well. However, other countries, such as Japan, require a specific certification from the government to do this type of work.

See also

  • Daubert v. Merrell Dow Pharmaceuticals
    Daubert v. Merrell Dow Pharmaceuticals
    Daubert v. Merrell Dow Pharmaceuticals, is a United States Supreme Court case determining the standard for admitting expert testimony in federal courts...

     which established the Daubert standard
    Daubert Standard
    The Daubert standard is a rule of evidence regarding the admissibility of expert witnesses' testimony during United States federal legal proceedings. Pursuant to this standard, a party may raise a Daubert motion, which is a special case of motion in limine raised before or during trial to exclude...

     delimiting the admissibility of scientific expert witness
    Expert witness
    An expert witness, professional witness or judicial expert is a witness, who by virtue of education, training, skill, or experience, is believed to have expertise and specialised knowledge in a particular subject beyond that of the average person, sufficient that others may officially and legally...

     testimony
  • Rennie v. Klein
    Rennie v. Klein
    Rennie v. Klein was a case heard in the Federal District Court of New Jersey in 1978 to decide whether an involuntarily committed mental patient has a constitutional right to refuse psychiatric medication...

     - right to refuse treatment
  • Kansas v. Hendricks
    Kansas v. Hendricks
    Kansas v. Hendricks is a case in which U.S. Supreme Court set forth procedures for the indefinite civil commitment of prisoners convicted of a sex offense whom the state deems dangerous due to a mental abnormality.-Fact of case:...

     - involuntary civil commitment for sexual predators
  • Settled insanity
    Settled insanity
    Settled insanity is defined as a permanent or "settled" condition caused by long-term substance abuse and differs from the temporary state of intoxication...

  • Ultimate issue
    Ultimate issue (law)
    An ultimate issue in criminal law is a legal issue at stake in the prosecution of a crime for which an expert witness is providing testimony.-Example:...

  • Twinkie defense
    Twinkie defense
    "Twinkie defense" is a derisive label for an improbable legal defense. It is not a recognized legal defense in jurisprudence, but a catchall term coined by reporters during their coverage of the trial of defendant Dan White for the murders of San Francisco city supervisor Harvey Milk and mayor...

  • Bruneri-Canella case
    Bruneri-Canella case
    The Bruneri-Canella case, called in Italian the case of the Smemorato di Collegno , is a notorious judicial and media affair concerning the alleged reappearance in 1926 of a man who had gone missing in World War I. The question of his identity was thoroughly discussed in newspapers and in...

    , an early landmark case which introduced new forensic techniques in juridic debate

External links

  • Studies in Forensic Psychiatry, by Bernard Glueck, 1916, reprinted 1969, from Project Gutenberg
    Project Gutenberg
    Project Gutenberg is a volunteer effort to digitize and archive cultural works, to "encourage the creation and distribution of eBooks". Founded in 1971 by Michael S. Hart, it is the oldest digital library. Most of the items in its collection are the full texts of public domain books...

  • The Role of a Forensic Psychiatrist in Legal Proceedings, by Harold J. Bursztajn, MD, 1993, from Journal of the Massachusetts Academy of Trial Attorneys with permission of Harold J. Bursztajn, MD.