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Handbook of Forensic Psychiatric Practice in Capital Cases


Overview


Te form and detail of any psychiatric assessment depends upon the context of the assessment and any action that is likely to be needed; for example, the approach taken when seeing a patient who presents himself to hospital suffering with psychosis and asking for treatment will be different from the interview techniques and assessment process used when seeing a defendant facing serious criminal charges in prison, with the aim of preparing a court report. Each psychiatric interview is therefore different, specific to the circumstances and particularly in forensic psychiatry to the legal question that needs to be addressed.


Te ethical issues that pertain will also be dependent upon the context and purpose of the assessment. Assessing a patient for treatment differs in its ethical implications markedly from assessing a defendant for trial, for example in relation to a possible mental condition defence (see Chapter 11). Te relationship between assessor and assessee is different, as are the implications of the assessment for the assessee.


Tere are, however, general principles that apply to all forensic assessments, since assessing a defendant for court requires application of the same clinical techniques as assessment of a patient, even though the result may be applied to legal rather than medical questions.


Te general aim of any psychiatric interview is to elicit symptoms of mental disorder, if there be such, and to understand these symptoms in terms of diagnosis and implications for behaviour. Te reader should therefore consult a general psychiatry text for detailed advice about assessment. However, a forensic assessment also requires particular clinical focus upon antisocial behaviour, attempting to ascertain its relationship with mental symptoms experienced, or disabilities inherent in the individual’s condition, including in terms of ‘formulation’ (see Chapter 6).


Also, there should be detailed ‘dissection’ of symptoms and of their relationship with behaviour, in order to try to establish a detailed understanding of that relationship, beyond what might be pursued in ordinary clinical practice, given that the genesis of behaviour may be subject to scrutiny within a legal paradigm and not just a medical one. Hence, for example, if in a murder case there is a possibility of the defence raising the partial defence of ‘diminished responsibility’, or the full defence of ‘insanity’, then the assessment of ‘the causes of behaviour’ will have to be both detailed and conducted in light of the legal definitions that apply in relation to each of those defences.


What is also added to a forensic assessment is utilisation of more and different information. Hence, it commonly requires collection of much more collateral information, plus information of history back to childhood, as well as consideration of information contained within legal papers that are relevant to diagnosis (for example, evidence in witness statements of abnormal behaviour in the defendant).


Specialist investigations may also need to be taken further than would normally be indicated in a solely clinical context, particularly where the civil liberty effect of a finding of guilt in the absence of mental disorder is high, through imprisonment or execution, such that the principle of ‘leaving no stone unturned’ applies. For example, any suggestion of the possibility of brain damage must result in a full neuropsychological examination and brain scanning, and possibly electrical encephalographic


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