aapl practice guideline for the forensic assessment

Evaluees who are malingering are more likely to be eager to thrust forward their illness, in contrast to those with, for example, genuine schizophrenia, who are often reluctant to discuss their symptoms.203 Malingering evaluees may attempt to take control of the interview or otherwise behave in an intimidating or hostile manner in an effort to cause the psychiatrist to terminate the interview prematurely. It is critical that the forensic evaluator know which definitions of disability and work impairment are being applied to the referred case. /Length 10474 The psychiatrist may identify additional sources of information that is missing from an attorney's summary, which should then be sought. With this in mind, ethical practice can be guided by the two principles of truth-telling and respect for persons. Military history should include the type of discharge and a description of disciplinary actions, if any. Several studies and articles have assessed the quality of forensic psychology and psychiatry practice.10,,16 A review of the literature concluded that the level of practice falls short of professional aspirations for the field, although there have been incremental improvements during the 1990s.12 No studies to date have observed forensic psychiatric interviews, although some, mainly in the field of psychology and the law, have looked at the content of forensic reports. In medical malpractice cases, the forensic evaluator should determine whether the treating physician took a full family history and whether relevant family history may have been ignored or overlooked: for example, whether the physician inquired about a family history of suicide when conducting a suicide risk assessment.79. /CapHeight 663 Including culture-bound syndromes in the DSM raises the question of whether these syndromes meet criteria for mental illness sufficient to be used in a defense of not guilty by reason of insanity.179 For example, latah is a startle-induced dissociative reaction described in the Malay culture.164 Although amok is often regarded as a Malaysian culture-bound syndrome, amok-like indiscriminate massacre behavior after a stressor has been observed in other cultures.164,180 Belief in voodoo death, which is thought to occur when a person breaks a taboo and then suddenly dies, has been observed in multiple cultures.164, The evaluator should arrange for the interview to occur in the evaluee's primary language or bilingually, as misunderstandings due to language differences may lead to improper diagnosis.179 However, the presence of the interpreter may alter the assessment. By using cultural formulation in this context, the forensic psychiatrist can come to a better understanding of the evaluee's experience, while appreciating the evaluee's psychosocial environment, thereby constructing a fuller and more accurate presentation of the data. Discussions about these factors with retaining attorneys may be necessary before the interview. In very difficult cases, inpatient assessment should be considered, if possible, as psychotic symptoms are extremely difficult to fabricate and sustain while under constant, intensive observation. The approach to assessing these evaluees must be tailored to the assessment setting, the type of assessment being performed, and the need for clinical intervention for the evaluee. An interdisciplinary team approach to assessment and treatment planning is often necessary when evaluating persons with ID. First, if retained by the respondent, the evaluator may be asked to prepare a declaration outlining the nature and scope of the proposed forensic assessment of the plaintiff. The prosecuting attorney may not want the evaluator to interview the officer, and jurisdictional provisions may dictate how to proceed. Hence, a caregiver's presence may be helpful in an initial interview, but may not be necessary as the evaluation proceeds or in subsequent interviews. The background and approaches provided here are intended to contribute to training new forensic psychiatrists, assist experienced forensic experts in improving their skills and handling complex situations, provide a menu of considerations when undertaking an assessment, and identify gaps in knowledge for further research. In a standard psychiatric practice, a patient would have been identified as having ID, and longitudinal records would provide a frame of reference. These factors are also pertinent when evaluating the presence or absence of antisocial personality disorder or psychopathy. Therefore, the forensic assessment determines not only whether there were deviations from the standard of care through acts of omission or commission, but also whether the deviations were directly or proximately related to the claimed emotional damage. The evaluator should consider these possibilities in conducting a complete and accurate psychiatric assessment. Hence, rather than asking evaluees whether they have taken specific medications or specific classes of drugs, the evaluators can inquire whether evaluees have taken pain pills or anything to help them sleep and investigate further if the response is positive. /Encoding /WinAnsiEncoding Most people believe that the legal system is fair, but some disagree46 and may have complex sociocultural reasons for their belief.175 Even personal concepts of wrongfulness may be steeped in cultural and social definitions, and these concepts may be taken into consideration in certain situations, such as evaluations for mitigating factors in sentencing.164, Aggarwal163 and Kirmayer174 both argued that situating behavior in its cultural context often provides insight and clarification into an individual's reasoning process. In particular, different groups may display different affects in the presence of strangers.164 An expressed belief might be interpreted as a delusion by an evaluator who is unfamiliar with religious beliefs in another culture. ;!1WPdG Forensic psychiatrists are concerned with the accuracy of the received information that forms the basis for their conclusions. Actuarial tables are designed to distinguish people with long life expectancies from those with short ones. Criminal defendants' or civil plaintiffs' reports and recollections may differ from more objective and contemporaneous records. 102, p 25), warns experts and others that a specific diagnosis may not be consistent with the legal criteria that may be used to draw conclusions relevant to a particular legal standard. The evaluator should review the evaluee's job description to respond with examples relevant to the specific occupation.54, If the evaluee's employer has a same-occupation policy (a policy that mandates that the evaluee cannot be moved to a different type of employment), then there will be a question about restrictions or limitations in relation to the essential tasks of that occupation. The book provides a more comprehensive review of testing for malingering. Typically, the psychiatrist completing the forensic assessment need not personally order the tests or make the referrals but may recommend that the referring agent or court arrange these additional assessments (see Section 8, Adjunctive Tests). Other approaches are to append the full police report or to simply list it as a source of information. As noted in the AAPL Ethics Guidelines, the practice of forensic psychiatry often presents significant problems regarding confidentiality because information is always released to the retaining party and may be released to other parties.39 Thus, evaluees must always be informed of the limits of confidentiality, the persons with whom the information will be shared, and the purpose of the interview. Evaluator bias may also play a significant role in the formulation of the forensic opinion.162 The evaluator may cast the findings in a better or worse light based on a expectations, desired outcome, political considerations, or pressure from the referring agent. Readers are directed to a useful meta-analysis that suggests very high specificity, but warns about the modest sensitivity of the PAI, concluding that it should be used along with other measures.215, The MMPI-2 is also useful in detecting feigned medical complaints, which may be the subject matter of forensic assessment. Racial and cultural biases not only influence the ways in which clinicians diagnose disorders, but also affect the types of treatment proposed. The writing of forensic psychiatric reports is beyond the scope of this Guideline. In particular, a contemporaneous recording of the evaluee in a disturbed mental state that is produced at trial some time later, after he has recovered, can significantly enhance the credibility of the testimony. Box 30 Bloomfield, CT 06002 Phone 860-242-5450 or 800-331-1389 Although it is not always possible, early evaluation reduces the likelihood that the evaluee has been coached or has had sufficient time to observe genuine psychosis in a hospital setting, plan a deceptive strategy, craft a consistent story, or rehearse fabrications. Recognizing the unique aspects of this practice, which is at the interface of the professions of psychiatry and the law, the Academy presents these guidelines for the ethical practice of forensic psychiatry. Furthermore, some new instruments being used in the field, such as those for risk assessment, do not require psychological training, per se, for their administration or interpretation, but their use may nonetheless require specific training. If the expert testifies, the cross-examiner may also request these notes and recordings. endobj 0000006873 00000 n /L 304203 2014;42(4 Suppl):S3-S76. Forensic psychiatrists are likely to encounter individuals with intellectual disability (ID). Such social stressors include loss of a family member or loved one, separation or difficulties in a relationship, family problems, criminal arrest, or exposure to an unrelated traumatic incident. endobj Such documentation can help the evaluator construct a picture of whether the defendant may have demonstrated symptoms of a mental disorder relevant to the question of criminal responsibility. For example, forensic experts should not administer a psychological test to evaluees outside the standardization sample of the test (e.g., the Static 99 cannot be used to assess risk in female sex offenders).117. The first is that psychiatrists and psychologists, when they are working for attorneys and courts, are serving not as clinicians but as evaluators, guided by an alternative ethic based on respecting others, truthfulness, and justice23,26,31 (see also Section 4, Ethics Foundation). It is an important characteristic of the forensic assessment that the evaluator, unlike a clinical interviewer, must take a questioning or skeptical approach to the interview.7 It is also important not to be judgmental or biased against an evaluee. The forensic psychiatrist should be alert to the presence of degenerative brain diseases such as multiple sclerosis or dementia, which can easily mimic psychiatric presentations. The advantages and disadvantages are reviewed in the guideline.68 Video recordings are routinely used in cases of child sexual abuse, as they allow the victim's early statements to be preserved, and they may protect the child from the stress of repeated evaluations and testifying. /BleedBox [ 9 9 612 792 ] Officers may be surprised to receive a cold call from a forensic evaluator and may not be willing to speak. A review of these materials may lead the psychiatrist to request additional materials or interviews. Evaluators should have a high degree of suspicion if there are any indications of ID, to ensure that complete information is obtained and a complete assessment is conducted. Malingering defendants may present themselves as doubly blameless within the context of their feigned illness. Specific competence entails four elements, some of which are the same as general competence: communication of a choice sustained long enough to implement it, factual understanding of the problems involved, appreciation of the situation and its consequences, and rational manipulation of information.97, Some of these specific competence assessments may involve consent to treatment,98 guardianship evaluations,99 testamentary capacity,100 financial competence, and competence to enter into a contract.97. Collateral information may be helpful. For example, a mother who had been involved in a traumatic car accident as a child might be overprotective in her relationships with her children, and this information would be significant (although not dispositive) in a custody assessment. When an opinion cannot be rendered to a reasonable degree of medical certainty, the referral source should be notified before the evaluator writes a report. This strategy enables a neutral exploration of the evaluee's narrative, state of mind, and style of presentation.7,64 Open-ended questions can help the individual to become comfortable with talking to the evaluator and enable the examiner to establish a rapport with the evaluee before moving to more difficult material about the forensic matter at hand.36,45 Closed questions, which demand a yes-or-no answer, may have their place in specific matters, but, as part of the strategy for seeking objectivity and honesty, the evaluator should guard against leading questions or questions that limit responsiveness from the evaluee. Limitations in the person's capacity to communicate verbally and to articulate the nature of the problem pose a challenge. Mossman and colleagues19 attempted to measure the accuracy of assessments in a quantitative manner. << In criminal cases, the law and statutes may vary according to the jurisdiction, and the expert must become familiar with the requisite law in a particular jurisdiction. Examples of such retainer letters are available.40,41 Fixed fees are common in some jurisdictions for some types of assessments, such as competence to stand trial.36.

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