Forensic psychiatry

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Court work[edit]

Forensic psychiatrists work with courts in evaluating an individual's competency to stand trial, defences based on mental diseases or defects (e.g., the "insanity" defense), and sentencing 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)[edit]

This is the competency evaluation to determine that a defendant has the mental capacity to understand the charges and assist his attorney. In the United States, this is seated in the Fifth Amendment to the US Constitution, which ensures the right to be present at one's trial, to face one's accusers, and to have help from an attorney.

In English and Welsh law a similar concept is that of "fitness to plead".

As an expert witness[edit]


Mental state opinion[edit]

This gives the Court an opinion, and only an opinion, as to whether a defendant was able to understand what he/she 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 of the criminal nature of the 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:[5]

  • Durham rule: Excuses a defendant whose conduct is the product of mental disease or defect.[7]



Risk management[edit]

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 psychiatric teams made up of 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.









Concerns have been expressed[citation needed] that the Canadian criminal justice system discriminates based on DSM IV diagnosis within the context of part XX.1 of the Criminal Code of Canada, [1]. 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". Critics have also expressed concerns[citation needed] that use of the DSM-IV-TR may conflict with Section 2(b) of the Canadian Charter of Rights and Freedoms, [2] which guarantees the "fundamental" "freedom of thought, belief, opinion and expression".

The position of the Canadian Psychiatric Association [3], stated in The Confidentiality of Psychiatric Records and the Patient's Right to Privacy(2000-21S), and [4] 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 presented in the publication The Forensic Mental Health System In Ontario published by the Centre for Addiction and Mental Health, [5] 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"[6]. 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."[7].

It is noteworthy that the emphasis in The Guide is on the right to refuse participation. This 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" [8]). The Criminal Code of Canada describes "defense of mental disorder" in Part I General section 16. However, it can also be presented by the court or the Crown, rather than solely by the defense attorney, differentiating it from many other legal defenses.

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-disciplinary team over a thirty or sixty day period.[citation needed] Concerns have been expressed that an accused may 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 .[citation needed]

There are internet references addressing treatment/assessment conflict as it relates to various justice systems, particularly civil litigation in other jurisdictions including [9],[10]. The American Academy Of Psychiatry and the Law states in its ethics guidelines [11] that "when a treatment relationship exists, such as in correctional settings, the usual physician-patient duties apply", which may be seen as contradiction.

Training Standards[edit]

Some practitioners of forensic psychiatry have taken extra training in that specific area. In the United States, one year fellowships 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 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 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[edit]


  1. ^ Howells K, Day A, and Thomas-Peter B. (2004). "Changing Violent Behaviour: Forensic Mental Health and Criminological Models Compared". Journal of Forensic Psychiatry & Psychology 15 (3): 391–406. doi:10.1080/14788940410001655907. 
  3. ^ Simon, Robert and Lisa Gold, ed. (2010). American Psychiatric Textbook of Forensic Psychiatry. American Psychiatric Publishing. ISBN 1585622648. 
  5. ^ Bursztajn HJ, Scherr AE, Brodsky A. "The rebirth of forensic psychiatry in light of recent historical trends in criminal responsibility," Psychiatric Clinics of North America, 1994; 17:611-635

External links[edit]