WHAT ARE THE REASONS FOR FORENSIC PSYCHIATRIC EVALUATIONS ?
B ) WHAT ARE THE STEPS IN FORENSIC PSYCHIATRIC EVALUATIONS ?
C ) WHAT IS CRIMINAL RESPONSIBILITY ?
A 8 INTRODUCTION
1 Forensic psychiatry is an important subspecialty of psychiatry.
2 Forensic psychiatrists play an important role in the society in assisting the judiciary in many complicated cases.
3 In India, forensic psychiatry work is undertaken mostly by the general psychiatrists.
4 Forensic psychiatric assessments are often associated with an element of anxiety or fear for a young psychiatrist.
A ) REASONS FOR FORENSIC PSYCHIATRIC EVALUATIONS
1 The need for a forensic evaluation is generally prompted by the need for an objective opinion regarding the presence, severity, or treatment of a mental illness.
2 They may be used in criminal or civil court, by employers, or by insurance companies to determine the following **-
A ) Competency to stand trial
B ) Not guilty by reason of insanity
C ) Mitigation
D ) Personal injury
E )Parental fitness or custody
F ) Guardianship
G ) Competency to enter into a contract
H ) Testamentary capacity -
1 - Testamentary capacity refers to the ability of a person to make a will.
2 - Will is a legal document, signed by the testator, the person making a will
3 - It is essential that the testator should have sufficient capacity to understand the conditions of his property, his relations with the persons who were or should or might have been object of his bequest and the scope or the bearing of the provisions of his will.
4 - To be valid, the will needs to be signed by the testator in the presence of at least two witnesses.
5 - So , A psychiatrist may be asked to report on a person, whether the person is competent to make a will. One needs to assess whether the will is being made voluntarily and there is no external pressure, coercion or compulsions to make a will. The person making a will should be aware of the act he is undertaking
I ) Fitness for duty
J ) Risk assessment
K ) Disability
3 Even within these diverse categories, there is additional variation based on the party requesting evaluation.
A ) For example, different jurisdictions have different criteria to define “not guilty by reason of insanity.”
B ) Similarly, different insurance policies have variations in their construction to determine when an evaluee receives payment.
4 Because of this diversity of purposes and standards, it is imperative to have as exact a standard as possible before agreeing to provide an evaluation.
5 Clarification with the retaining party, prior to agreeing to serve in an expert capacity, ensures sufficient information to form an opinion.
1 The primary relative contraindication for a forensic evaluation is an existing treatment relationship with the evaluee.
For example, a patient who has engaged in psychotherapy for an extended period with a provider may reveal information that he or she would elect not to provide to a neutral evaluator.
B ) STEPS IN FORENSIC PSYCHIATRIC EVALUATIONS
1 Forensic psychiatric assessment involves a comprehensive psychiatric history ** including details of the event leading to request for current assessment.
A ) One should always note the marks of identification along with a photo-identity proof and a recent photograph of the person being examined for the purpose of records.
B ) A photo-identity proof will establish the identity of the person, who has been referred for assessment, and prevents the mistake of examining a wrong person or an impersonator.
2 A photograph is helpful in identifying the person later in the court, if the psychiatrist is called to the court as an expert witness.
3 As a part of good ethical practice, the person should be informed that the information divulged during assessment may go against him or her in the court of law.
4 Assessments should specifically include -
A ) forensic history, if any
B ) family details like socioeconomic status
C ) history of psychiatric illness
D ) substance abuse, or a criminal record in the family
E ) personal history
F ) mental status examination, and
G ) personality assessment.
H ) Minor modifications in the assessment format may be required depending on the kind of request.
5 Hospitalization v imp may be required if the person needs to be observed over a period, before a definite opinion can be given about the diagnosis.
A ) If hospitalization is not indicated or is not feasible due to lack of a suitable facility, repeated assessments over a period should be conducted.
B ) Physical investigations should be ordered depending on the case.
C ) Psychological testing for personality profile, intelligence, cognitive functions and differential diagnosis may also be required.
6 Preparing a report for the court is the final step after a detailed assessment.
A ) The report should mainly address the questions asked by the court.
B ) It should be brief, and use simple and clear language without any scientific jargon.
C ) Sources of information like old clinical records, if available or family members or other informants, need to be mentioned.
D ) Dates and nature of assessments like clinical examination, inpatient observation and investigations including psychological assessment should be mentioned.
E ) All the questions asked by the court should be answered.
F ) If it is not possible to give a response to a question due to scientific limitations, it should be mentioned along with the reasons
G ) One should never make moral judgments or blame someone in the report.
H ) A psychiatrist simply makes an assessment to the best of his/her ability and the judgement is to be made by the judge.
I ) If the person being examined is in need of medical or psychiatric treatment, it should be clearly mentioned, even if it has not been asked.
J ) Names of the doctors or psychologists who conducted the assessment should also be mentioned in the report.
K ) The report should be accompanied by a photograph of the person examined.
L ) A copy of the report should be kept for the records.
C ) CRIMINAL RESPONSIBILITY
1 Criminal responsibility means whether a person with a mental illness can be exempted from being responsible for a criminal act, he/she has committed, on grounds of the mental illness.
2 In the Indian law, the definition of criminal responsibility has been adapted from the McNaughton Rules.
3 Section 84 of the Indian Penal Code (IPC) refers to criminal responsibility -
A ) It refers to it as an act of a person with an unsound mind and states ‘Nothing is an offence which is done by a person who, at the time of doing it, by reason of unsoundness of mind, is incapable of knowing the nature of the act, or that he is doing, what is either wrong or contrary to law.
1 There is a related concept, partial insanity or diminished responsibility, which has also been a focus of attention.
2 In partial insanity, dysfunction is primarily in form of delusions, while understanding and memory are intact.
A ) For example, an accused kills another person under a delusion that he was attempting to take his life.
B ) The action is in self-defense, since the person does not know what he was doing was wrong or contrary to law. Or a person sacrifices his child before a Goddess under a delusion that the Goddess will make the child alive by Her powers and bestow his family with Her blessings VV IMP
1 The insanity defense is usually used in charges of murder to escape capital punishment.
A ) When successful, the accused is considered ‘not guilty’.
B ) However, the person is sent to a mental hospital for treatment.
2 For a defense on ground of the mental illness, the unsoundness of mind should have existed at the time of committing the offence.
Subsequent unsoundness is not a defense, but may affect the trial.
3 Sometimes, a person may feign the illness to get bail or to delay the proceedings.
A ) The readers are referred to an historical article by Somasundarum, which very lucidly discusses the concepts of insanity and criminal responsibility.
4 According to the Indian law, idiots, imbeciles and persons who are deprived of all understanding and memory, and children below 7 or those between 7 and 12, of immature understanding, are clearly not criminally responsible.
5 There are a number of pointers which may indicate that the crime could have been a result of mental illness.
A ) These include absence of motive in the crime
B ) absence of secrecy while committing the crime, want of preparedness, use of needless force in the crime
C ) absence of accomplices in the act.
D ) The person might have committed multiple murders without any apparent motive
6 The court ( V IMP ) often asks about the mental state of the accused at the time of the crime, which might have happened many months or a few years ago.
A ) It may not be humanly possible to give a definitive opinion about the mental state of the person at that time.
B ) The opinion in such situations depends on circumstantial evidence, old treatment records if available and history gathered from the accused and others.
C ) One also needs to be sure how much reliable and accurate information one is getting from different sources.
7 It is important to mention here that the expert evidence does not relieve the court from forming an independent opinion.
8 The question of insanity is to be primarily decided by the court, based on the available evidences.