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Forensic Psychiatric Assessment


If travelling to conduct the assessment, think about how much documentation you should take with you; a full set of case papers or a summary?


Assessment The environment


Te psychiatric interview is a key opportunity to gather information, and the environment in which it takes place needs to be safe in every sense.


As regards interviewer safety, very often psychiatrists will face the prospect of interviewing patients who are not known to them. A scared or anxious interviewer will be distracted. Sensible precautions can be taken to manage any risk, for example by ensuring that staff, whether prison officers or nurses, know where you are and roughly how long you’ll be. Te interviewer should make sure that there is an unimpeded route from their chair to the exit; often sitting closest to the door of the room is best. Many would consider placing themselves squarely behind a desk as overly formal and this runs the risk of further intimidating the defendant, who is likely to be anxious; an alternative is to sit at a diagonal, keeping some distance from the patient but allowing a more relaxed interaction. Some rooms will have alarms and the position of these should be noted. It is useful to know what to expect if they are pushed. It can be a source of particular embarrassment to press a button hoping that someone will simply open the door to find that it triggers a full scale response from the prison security team.


Te interview should be conducted in a quiet room where the defendant cannot be overheard, especially as they are likely to be disclosing information that is sensitive. Prison officers, particularly those guarding death row inmates in the Caribbean, are often reluctant to leave the room while an interview is conducted. Tis can lead to awkward situations. Negotiation in advance is required to ensure privacy, with the provision of a letter agreeing to this from the governor of the prison. Any expectation of ideal conditions is likely to be disappointed and compromises will need to be made. However, there must be a limit to compromise. Facilities to examine physically, and particularly neurologically, are likely to be very limited or absent, and this can pose a challenge and ultimately a problem.


Consent


Te interview should start by the doctor describing who s/he is, what the purpose of the assessment is, how long it will last, what it will cover and who will see the report that is eventually produced, and in what circumstances. A defence commissioned report will be seen by the court and prosecution only if it is disclosed; a prosecution commissioned report will automatically be disclosed to all.


Explaining the absence of confidentiality is necessary. It is crucial that the defendant is aware that anything he says can get to the court. Patients typically meet doctors with the expectation of privacy and secrecy. In this, and other ways, forensic assessments are different from consultations in other forms of medicine, and this must be made clear at the outset. An attempt should be made to record their acceptance of the terms of the interview, at least by way of making a note of it.


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