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Forensic Psychiatric Assessment


investigation, even where the index of suspicion would not be high enough to warrant such investigation in an ordinary clinical situation.


Within the clinical assessment itself attention will also be paid to the possibility of feigning of symptoms beyond what might routinely be pursued in an ordinary clinical assessment.


What is special about the context? The effect of difference of purpose


Te purpose of any forensic psychiatric assessment will usually also imply the need to provide frank advice to the patient’s legal advisors. Further, there is likely to be no direct effect on the patient’s clinical care, which marks the assessment out very clearly from a general adult psychiatric assessment.


However, for example by making recommendations about detention in hospital rather than prison, a forensic psychiatric assessment can lead to therapy and treatment.


Difference by stage of death penalty case


As with all forensic assessments, those assessments in death penalty cases can be for pre-trial, trial or sentencing issues. However, one clear difference in regard to sentencing reports is that they will be directed towards legal criteria, which are usually that of ‘beyond reformation’ which are utilised in determining whether the discretionary death penalty should be imposed. Tere may also be relevance of psychiatric factors to the other legal test of ‘the worst of the worst’, where the court addresses not only the nature of the killing per se but also individual ‘characteristics’ of the defendant, as they may relate to the nature of the killing (see generally Chapter 12 dealing with assessment for sentencing and Chapter 7 concerning risk assessment). Reports might also be requested in relation to mercy hearings, where ‘softer’ mental condition data may be relevant than within a sentencing hearing. Finally, a report may be requested in relation to whether a convicted prisoner awaiting execution is ‘fit for execution’.


More generally, as with any forensic assessment, an important aspect will be the need to assess an individual’s mental state, not only currently but also as it was at some time in the past.


Difference of relationship


Te relationship between doctor and assessee is different in a forensic context than in general psychiatry, crucially captured by the distinction between assessment of a ‘patient’ and of a ‘defendant’. Tat is, the particular situation and role of the assessee determines an entirely different relationship with the assessor than applies within a general psychiatric assessment.


In terms of the implications of this unusual relationship, typically, when seen by a doctor, the patient can withdraw their consent, if necessary by leaving the interview room. Defendants in forensic assessments, including and perhaps especially those facing the death penalty, are far less autonomous. Tey might not wish to be assessed at all, or may not wish to discuss particular aspects of their history, yet there will likely be pressure on them to do so, both ‘externally’ from lawyers and ‘internally’ from


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