Forensic Psychiatry: Not Guilty by Reason of Insanity

forensic psychiatryMost, if not all, of you have seen Criminal Minds on CBS. Who doesn’t want to work for the Behavioral Analysis Unit of the FBI? If that stimulates you, let us introduce you to something else – forensic psychiatry. This is what tracking and capturing criminals is based on, so then what really is forensic psychiatry? This can be just as exciting and thorough as a real life detective show. Forensic psychiatry is in the medical field and it involves the intersection of law and mental disorder. To brush up on your medical education, take a look at our course, Primary Medicine. Forensic psychiatry involves a criminal defendant’s competency to stand trial and diagnosis of mental illness. They are often asked to testify in criminal or civil trials. If that piques your curiosity, let me show you the ins and outs of this amazing field.

The two primary fields that forensic psychiatrists work in are court work and risk management. Court work involves making determinations about the criminal defendant and testifying in trials. Risk management involves assessing criminal offenders and people with mental illness to evaluate their risk to the community. This occurs at in-patient centers like mental hospitals and prisons, and out-patient centers for people out with the general public. If someone you care about is afflicted with a mental disorder, learn more about how you can help them and how you can cope through our courses A Path to Health and Healing and Coping Strategies.

Criminal Court Work

“Not guilty by reason of insanity.” It’s the one statement that, if made by the court, almost certainly leads to a lessened charge or penalty for the accused. Sometimes it is stipulated to based on a forensic psychiatric evaluation, while occasionally, it is actually the verdict in trial. Whether or not the defendant was sane at the time of the offense and at the time of trial, will change the outcome of the trial. If the defendant is not sane at the time of trial, the proceeding cannot go forward because the defendant is incompetent to stand trial. If the defendant is found competent to stand trial, the question becomes whether he or she was insane at the time of the offense. The defendant’s state of mind is crucial in instances that involve premeditation or malice aforethought. So, a defendant may not be convicted of first degree murder, but instead may be found guilty of a lesser charge. In addition, the court will consider sanity in sentencing of the defendant.

Further, a forensic psychiatrist may be asked to rule in on whether the defendant is committing perjury on the stand or whether they were competent to confess at the time. Occasionally, people who are in prison are found to be mentally ill and it can be determined that the never committed the crimes for which they were sentenced. What will happen is that they will confess to a crime they never committed as a result of their mental illness. A forensic psychiatrist may be able to determine whether that is the case and can see to it that an innocent man is released and justice is served.

Learn everything you need to know from the crime scene to the court room here.

Civil Court Work

In civil court, the work that a forensic psychiatrist does is very different. The stakes often involve name and money, instead of a person’s liberty. They still do conduct many competency determinations, including the ability to draft or sign wills, dispose of property or deny medical care. In instances of child custody, they can both evaluate the parent’s fitness to care for a child, as well as the child’s autonomy, understanding of the events, and the significance of their wishes to the court based upon their age.

They also weigh in on situations involving PTSD and emotional harm. The forensic psychiatrist must made a deep and meaningful connection with the person and their history to understand what may have triggered this emotional weakness. Also, they need to be skilled at detecting deception such as faking, exaggerating, malingering, or misattributing.

Further, they also make determinations in cases of worker’s compensation, discrimination, sexual harassment, and negligence. They can also help determine death based on a psychological autopsy. Sometimes they will be called in to testify in cases of medical malpractice where there is a sudden spike in accusations of sexual exploitation of patients by doctors.

forensic psychiatry Community Care & Evaluations

Forensic psychiatrists also do consultation behind closed doors. There is witness evaluation, preparation, jury selection, client management, and witness credibility. Each individual case may not require all the services a forensic psychiatrist can offer but there is a wide variety of options if help should be needed.

When conducting an evaluation, a forensic psychiatrist must review countless documents, take multiple interviews, and review and compare data in order to get a proper finding. The process can often be lengthy and costly. Forensic psychiatrists will take the data, verbal and nonverbal, and compare that to corroborating evidence. Nonverbal data might include sequence, tone, or gestures. Corroborating evidence is often made up of police or medical records, interviews, other expert witnesses, and psychological tests.

It is important to find a balance because when a person feels embarrassed or threatened, they will often falsify information or minimize harm. Stress can cause people to misattribute harm to another person, deny it ever occurred, or completely forget events ever happened. To find a balance means to establish the client as a trusted ally, where both parties are working together to put the pieces of the story together. If the client sees it as a collaboration and not as patient-doctor, they will be more inclined to help and be honest with the forensic psychiatrist.

Risk Management

Forensic psychiatrist will often supervise past offenders in the community or other mental health patients to manage their conditions and prevent future harm in the community. Sometimes this occurs through community centers, mental hospitals, or prisons. There are teams of doctors working together to manage a patient’s medication, treatment, therapy and risk factors. Risk management aims to prevent violence to the patient and in the community.

If forensic psychiatry interests you and you are interested in learning more about mental health and some of the changes that have occurred in legislation, check out our course on Mental Health Reform.