Dr. Robert Brown’s FAQs
What is forensic psychiatry, and what is a forensic psychiatrist? Forensic psychiatry, a subspecialty of psychiatry, is the field of professional study that properly establishes and interprets mental health (neuropsychiatric) evidence before courts of law and administrative bodies. The usefulness of forensic psychiatry is maintained only as long as it is applicable and suitable to the work of courts and administrative bodies. A forensic psychiatrist is a psychiatrist who has received additional training in the history, practice, ethics, and regulation of forensic psychiatry. Forensic psychiatrists have completed a training fellowship and most have successfully passed a national examination (known as a board examination).
What training does a forensic psychiatrist have? Forensic psychiatrists are medical doctors who have graduated from medical schools, completed residency training programs in psychiatry and fellowship training in forensic psychiatry. Often, forensic psychiatry fellowships are jointly managed by major schools of medicine and law, which properly teaches the interface of medicine and law and allows the forensic psychiatry fellow to conduct supervised forensic evaluations, forensic report writing, and testimony. The forensic psychiatry fellowship, upon completion, allows the future forensic psychiatrist to sit for the specialty board examination.
How is forensic psychiatry different from forensic psychology? In the US only a medical doctor (M.D. or D.O.) can become a forensic psychiatrist and practice forensic psychiatry. A forensic psychologist generally holds a PhD in psychology before completing additional training. Psychologists and forensic psychologists are discouraged from offering medical diagnostic opinions especially as these may relate to issues of medical causation in personal injury cases.
In what ways are forensic psychiatrists helpful in administrative law cases? Social Security disability, workers’ compensation cases, Veterans Administration adjudication, Merit System Protection Board hearings, security clearance revocations, and fitness for duty determinations are all examples of administrative law. Forensic psychiatrists review the relevant records, conduct evaluations and write reports that address medical and psychiatric diagnosis, prognosis, impairments, residual functional capacity, and whether the specific agency’s definitions of disability are met in that particular case.
In what ways are forensic psychiatrists helpful in civil law cases? Examples of civil law cases include personal injury, class actions, products liability, malpractice claims, intentional infliction of emotional distress, civil rights violations (EEOC, etc.), contested wills and estates, competency of an adult to manage financial or healthcare decisions, and many similar matters. In civil law cases there is generally a plaintiff and a defendant, and depending on the nature of the case one, the other, or both may require forensic psychiatric evaluation. A judge may elect to order the forensic examination. The forensic psychiatric evaluation explores background, education, work, social and mental health history, symptoms, syndromes, diagnoses, causation, prognosis, and treatments likely to help in the future. These are placed in a written report that also communicates professional opinions about the relevant matters. The ultimate usefulness of any offered opinion is to be found in its accuracy and clarity.
In what ways are forensic psychiatrists helpful in criminal law cases? In criminal law, fairness requires that the defendant understand the charges and have the ability to assist in the preparation and presentation of the defense. The defendant’s abilities can be called into question when he or she appears to have mental illness. A forensic psychiatric evaluation can address these concerns and others. It may be possible to treat the mental illness and restore competence. A criminal defendant’s mental state at the time of the offense can be called into question and necessitate a forensic psychiatric evaluation of legal sanity. Another area of interest is whether the defendant is capable of self-representation. A history of mental illness or new evidence of mental illness may become important mitigating issues in sentencing. The best way to address these matters is often a court ordered forensic psychiatric evaluation.
Why do forensic psychiatrists’ opinions occasionally disagree? The most likely cause of the disagreement can be found in what records were reviewed, or not reviewed by the forensic psychiatrists, who differ in opinion. Fairness and striving for objectivity requires a comprehensive review of all of the available relevant records. These include medical, mental health, and many other important records, which can be thousands of pages.
How do forensic psychiatrists guard against bias? This is accomplished through careful comprehensive review of the relevant records and detailed examination of the person being evaluated. The forensic psychiatrist has learned through training that advocacy leads to bias. The presence of bias in the opinion offered by the forensic expert is often exposed during the cross examination of the expert in deposition or at trial.
Are forensic psychiatrists paid a contingency fee? An attorney representing personal injury clients collects a contingency fee (a percentage) based upon the amount of money the attorney helps the client win. In American jurisprudence, the attorney vigorously advocates for the injured client. Contingency fees are unethical for forensic psychiatrists because these can lead to advocacy and bias. A forensic psychiatrist should be paid by the hour for the services provided because this fosters objectivity.
What is the American Academy of Psychiatry and the Law (AAPL)? This is the organization to which most forensic psychiatrists belong because of its long history of educational emphasis and attention to potential controversy in the field. It is useful to forensic psychiatry fellowship programs, and AAPL teaches the forensic psychiatry board review course.
Are there ethical guidelines for the practice of forensic psychiatry? Yes, these important guidelines are maintained by the American Psychiatric Association and the American Academy of Psychiatry and the Law. Among other important things, the ethical guidelines stress respect, objectivity and striving for fairness.
What major factors have shaped forensic psychiatry? Three main factors have shaped forensic psychiatry, and these are concepts of fairness in social science, major court decisions, and advances in the diagnosis and treatment of mental disorders. There are more than 100 major legal cases that have shaped the useful practice of forensic psychiatry, called landmark cases. These decisions balance competing needs and goals found in society. Many of these decisions came from the US Supreme Court, others from appellate courts, and a few from lower courts. Forensic psychiatry continues to be shaped by landmark court decisions because forensic psychiatry serves courts of law. Advances in the diagnosis and treatment of mental disorders help shape accurate and meaningful expert opinion in specific cases evaluated by forensic psychiatrists.
What does the word forensic mean? As found in Black’s Law Dictionary, 1996, pocket edition by West Publishing Company, the word forensic means, “Used in or suitable to courts of law…” People often think forensic implies “deceased” and while this is often sadly true in forensic pathology; it is generally not the case in forensic psychiatry.