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Law and Psychiatry


Keeping boundaries via mutual understanding


A psychiatrist pursuing knowledge and understanding of the legal system does not run enhanced risk of being used improperly by it. Rather, knowledge and understanding is likely to encourage a boundaried relationship, accompanied by mutual respect, and the enjoyment of difference. Doctors and lawyers do not need to become fully acquainted with each other’s professions and epistemologies. However, each does need to have enough understanding of the other to operate effectively at the interface of their disciplines.


Co-operation not contamination


Te objective must be mutual co-operation between psychiatry and law, without mutual contamination. Te proper role of a doctor acting as expert is to aid the effecting of justice, through cooperation with the law, and not aiming to affect justice, via contamination of their medical role.


However, the inherent bias of psychiatry towards welfare, rather than justice, can result in psychiatrists inadvertently or even deliberately, tailoring their opinions so as to achieve a result that they see as in the patient’s best interests, despite the law. Some may even give evidence tailored towards their own view of what would be the just outcome. Tis practice is ethically and legally indefensible.


Is there a risk of convergence between psychiatry and the criminal justice system?


Early in the development of forensic psychiatry, the discipline approached public protection essentially as an adjunct to, or knock-on effect of, the treatment of patients. Tis amounted to the ‘rescue’ approach to forensic psychiatry; that is, achieving diversion from the justice system into mental health care services (sometimes with discontinuance of the justice process) of those with severe mental disorders.


Increasingly, however, society has demanded to be kept safe from the people it fears, and has therefore increasingly expected forensic psychiatrists to manage and contain the risks posed by mentally disordered offenders, whether or not they can offer benefit to the patient through treatment. Tese forces have caused forensic psychiatry to converge on law’s public protection functions – as distinct from law and psychiatry converging with the common purpose of welfare-based rescue.


Manifestations of convergence include:


• A developing shift in the clinical balance adopted between the goals of treatment of the patient and protection of the public


• A widening of definitions within mental health legislation so as to allow the detention of those who may not benefit from treatment


• Te increasing involvement of forensic psychiatrists in the administration of risk-based sentencing


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