Forensic Psychiatry

by Seymour Block, DO

There are many psychiatric-legal issues that come under the heading of a Forensic Psychiatrist's responsibility. In the civil arena, a Forensic Psychiatrist may be called upon to evaluate an individual to be or need a conservator or guardianship. The area of family law often requires a Forensic Psychiatrist to do child custody or visitation determinations in divorce matters. Additionally, parental competency and at times termination of parental rights are also called into question and require evaluations. The areas of child abuse and child neglect are also areas that involve family law. In other civil matters, a Forensic Psychiatrist may be called in to determine an individual's psychiatric disability within either Social Security or Worker's Compensation. Forensic Psychiatrists may also evaluate an individual's testamentary capacity in writing a Will and may also be called on to evaluate cases of psychiatric negligence and/or malpractice. Lastly, personal injury litigation issues are often a source of psychiatric injury and may require the services of a Forensic Psychiatric Evaluation.

In the criminal arena, Forensic Psychiatrists are often called upon to discuss competency issues. A defendant's competency to stand trial, their competency to enter a plea, or their competency when volunteering a confession are major sources of Forensic Psychiatric duties in the area of criminal law. An individual's testimonial capacity, as well as the variety of psychiatric defenses in criminal/legal proceedings, are also within the duties of a Forensic Psychiatrist's obligations to the Court. Defenses such as insanity, diminished capacity, or sentencing considerations at the time of trial fall within this area. Additionally, for those individuals who have been acquitted by reason of insanity, the question of their release from confinement is one that can be quite complicated and obviously requires the assistance of a consultation.

Within the area of legal regulation of psychiatry, the issue of civil and voluntary commitment for psychiatric hospitalization is perhaps the most widely discussed. However, the area of voluntary hospitalization, right to treatment, an individual's right to refuse treatment, and informed consent regarding psychiatric or other medical treatment are all areas that fall within the realm of Forensic Psychiatry. Very importantly, and recently in the news, are the issues involving the Internet, computer medicine and confidentiality. Obviously, these very broad topics relate not only to an individual's hospital records, but other areas of medical concern and remain a significant field in which Forensic Psychiatrists play a role.

Since there are 50 state jurisdictions, the District of Columbia, and the Federal jurisdiction, each of these has a separate Constitution, a separate set of legislative statutes, a separate set of judge-made case law, and a separate set of administrative codes. Given this context, there is no universal Forensic Psychiatric assessment available for everyone in the United States. Rather, the Forensic Psychiatrist has a duty to know the specific psychiatric-legal issue being questioned and how that is dealt with in his particular jurisdiction. The legal criteria are first determined and the relevant data is then evaluated. The next step in a Forensic Psychiatric Evaluation involves the reasoning process; that is how the data obtained can be applied to the legal criteria so as to yield a thoughtful psychiatric/legal opinion. This reasoning must be deductive, rational and sound. However, it need not mean that every Forensic Psychiatrist's ultimate opinion with regard to a psychiatric/legal issue be the same. Clearly, individuals differ, and their ability to determine different formulations is also going to differ. Because of these differing determinations, Forensic Psychiatry has often been accused of being less than scientific. Obviously, the individual making the determination should be well trained and qualified. Currently, the American Board of Psychiatry & Neurology, Inc. does not have a specific sub-specialty board for Forensic Psychiatry, but does grant a Certificate of "Added Qualifications in Forensic Psychiatry". This sub-specialty certification requires arduous study given the rigors of this most-intensive examination. At the present time, to receive this Added Qualification status, an individual must take a Fellowship for one year in Forensic Psychiatry. Unfortunately, there are not many of these programs available throughout the country at this time. Various university settings are encouraging the growth of Forensic Psychiatric Fellowships, but this is an evolving process.

ABOUT THE AUTHOR:

Dr. Block maintains a general adult psychiatric practice with an emphasis on Forensic Psychiatry in Great Neck, NY, and is currently the Co-Chairperson of the Division of Psychiatry at St. Francis Hospital in Roslyn, NY. Dr. Block received his undergraduate degree in psychology at the George Washington University and his medical degree from the Philadelphia College of Osteopathic Medicine. Dr. Block is Board Certified in Adult Psychiatry and Forensic Psychiatry. He is a Past-President of the Greater Long Island Psychiatric Society (former Nassau Psychiatric Society), has chaired the Continuing Medical Education Committee and is a member of the Ethics Committee. He was also Program Chairperson of the Tri-State AAPL Forensic Clinical Conference held in Puerto Rico in December 2000