The Forensic Psychiatrist at Work and as Expert Witness

1
The Forensic Psychiatrist at Work and as Expert
Witness

• John Pankiewicz M.D.

2
Definition-Forensic Psychiatry

• Forensic psychiatry is a subspecialty of
  psychiatry in which scientific and clinical
  expertise is applied to legal issues in legal
  contexts embracing civil,criminal,correctional or
  legislative matters should be practiced in
  accordance with guidelines and ethical principles
  enunciated by the profession of psychiatry

3
Forensic Psychiatry-Rephrased

• Interpreters of medical and psychological
  findings into language which judges,attorneys and
  administrators and, in common law jurisdictions
  the common man,can understand and to which they
  can apply their rules.
• Norbert Nedopil 2009

4
Training

• Medical School
• Approved Residency in Psychiatry
• Approved Fellowship in Forensic Psychiatry
• General Psychiatry Boards
• Forensic Psychiatry Boards

5
Affiliation, Membership,Certification

• Academic
• Primary Forensic Organizations-AAPL (National and
  Regional)
• Other organizations
• Editorial Boards
• Certifications-Real or Vanity
• Other medical specialty
• Other professional or academic degree
• Legal

6
Experience

• Clinical- Assessment and treatment of mental
  illness-??Ongoing
• Forensic
• Testimony-Deposition

7
Psychiatric Legal Issues

• Civil
• 1.Conservatorship/Guardianship
• 2.Child Custody/Parental Fitness/TPR
• 3.Child Abuse/Neglect
• 4.Psychiatric Disability-SocSec,Workmans
  comp,Private Insurance
• 5.Testamentary Capacity
• 6.Psychiatric malpractice/negligence
• 7.Personal Injury

8
Psychiatric Legal Issues

• Criminal
• 1.Competence to stand trial
• 2.Competence to plea
• 3.Testimonial capacity
• 4.Voluntariness of confession
• 5.Criminal Responsibility/Insanity
• 6.Diminished Capacity
• 7.Release of insanity acquitees
• 8.Sentencing Issues-Risk Assessment

9
Psychiatric Legal Issues

• Legal Regulation
• 1.Involuntary commitment
• 2.Voluntary hospitalization
• 3.Confidentiality
• 4.Right to refuse treatment
• 5.Informed consent

10
Psychiatrist or Psychologist

• Medical basis versus behavioral
• Psychometric Testing
• Treatment issues-evolution of mental illness and
  medical treatment
• Understanding of medical conditions with
  psychiatric symptoms

11
Is it Science?

• 1960 and earlier-Included moralizing and
  psychodynamic speculation
• Diagnoses based largely on subjective
  report-Observational accuracy is critical
• Biology is advancing
• Treatment advances have advanced diagnostics

12
Roles and duties

• Not a patient doctor relationship
• Usually not confidential
• Duty to legal system
• Oath of truth-Defend opinion but do not provide
  one sided argument

13
Criminal Competence

• Present state evaluation
• Most often an assessment of stability of
  defendant with chronic mental illness
• Sometimes confused with NGRI
• Challenges come with cognitively impaired
  defendants,malingerers and client attorney
  miscommunication

14
Insanity

• A retrospective analysis
• Used in less than 1 of cases-Success rates
  vary-One eight state study 25
• Stereotyped as easily faked and viewed
  skeptically
• Requires significant validation-Diagnostic,Histori
  cal,
• Behavioral
• Usually associated with severe mental
  illness-Schizophrenia, Bipolar Disorder

15
Risk Assessment

• Civilly committed, insanity aquitees,sexual
  violent persons, return to duty
• Risk management and mitigation, not risk
  prediction- Actuarial instruments have
  limitationsbased on groups

16
Psychic Harm

• Typically very contentious
• Arena of Big law firms
• Causable mental diseases-Traumatic Brain
  Injury,PTSD
• Exacerbation of native illness-Very difficult to
  determine
• Neuropsychiatric Testing frequently necessary
• Psychological Testing-Particularly personality
  profiling very helpful

17
Myths

• All forensic patients are sociopaths-Correctional
  institutions have become de-facto mental
  institutes throughout US
• Most mentally ill patients are violent or
  dangerous-Most dangerous are Substance
  Abusersgreater risk if substance abuse paired
  with personality disorder or mental illness

18
Concerns

• One way experts-Those who only opine for one side
  or for those who pay
• Untrained and inexperienced experts
• Television Profilers

19
Audience Response

• It is preferable for a guilty defendant to go
  free than for an innocent defendant to be
  convicted.
• A. Agree
• B. Disagree

20
Audience Response

• It is preferable for a sane man to be found not
  guilty by reason of insanity than for an insane
  man to be convicted.
• A. Agree
• B. Disagree