Clinical Forensic Psychiatry and Legal Psychiatry
Chapter 2 of this present handbook). Legal psychiatry comprises all law relating to mental disorder, and to the treatment and care of those suffering from mental disorder. Te relationship between psychiatry and the law is bilateral, comprising the giving of psychiatric evidence in a wide variety of civil and criminal legal contexts, and the use of law for clinical purposes and for the regulation of clinical practice. Tis relationship is at the heart of forensic psychiatry, within which it is particularly strongly represented, by comparison with other branches of psychiatry.
As described in Chapter 2, there are natural tensions between law and psychiatry as disciplines, arising from the very different purposes of each discipline, and from the very different methods they apply in pursuing those differing disciplines. Te constructs relating to ‘things mental’ which arise from the ‘human welfare’ objective of psychiatry are very different from those artifices of mental functioning and status that the law constructs for its objective of pursuit of welfare.
Again as described in the Oxford Handbook, the constructs in psychiatry are determined essentially by its pursuit of human welfare, including through understanding disorder in order to reverse it or its effects. By contrast, law pursues abstract justice, albeit that this may sometimes involve balancing the welfare of different parties against one another, or against societal welfare. Even within a discipline, different branches often give rise to different approaches to determining constructs.
Since criminal law at trial, for example, is concerned with responsibility or culpability, its definitions of mental disorder (and there are a number) are characteristically tight, and address justice and not human welfare. By contrast, the constructs utilised in sentencing, sometimes relating to public protection, are often more loosely defined, although again without reference to the welfare of the individual concerned (except where sentencing occurs by way of mental health legislation).
Finally, the ‘values set’ of medicine is quite distinct from that of law and the justice system, and this presents a rich domain of ethical difficulty and challenge for clinicians, where they are required to apply medical information and techniques in order to present evidence into legal process. Specifically, the ethical underpinnings of medicine are not those of law, and so the clinician offering evidence into legal process does so essentially within an environment which is often alien to him/her (see Chapter 15).
How forensic services are related5
Te term ‘forensic’ refers to legally related work within psychiatry, the clinical services provided for mentally disordered offenders. Some of these services will be psychiatric, or forensic psychiatric, but many others will not be. Tis section seeks to explain the different forensic services and areas of practice.
Criminal justice and court services
Almost all professional groups can offer forensic testimony, so there are forensic entomologists and forensic accountants, as well as the more familiar forensic pathologists. Psychologists and psychiatrists who give expert testimony are acting as ‘forensic’ professionals, regardless of their usual clinical practice.
5 Much of this description is taken from the Oxford Handbook of Forensic Psychiatry and is applicable to the UK. 3
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