The duties of the psychiatrist include: Duty to Protect (__________) Duty to Inform (Informed Consent) Duty to Report (Child/Elder Abuse, Domestic Violence) Duty to Prescribe (Specific requirements prior to dispensing medication) Charting (Specific requirements about how to document notes in the patient’s chart) What is forensic psychiatry? What is a forensic psychiatrist? Is a forensic psychiatrist the same thing as a forensic psychologist? How is forensic psychiatry useful to the legal process? Are forensic psychiatrists "advocates" for one side or the other in legal matters? Why does there always seem to be a psychiatrist (or other professional) willing to testify on either side of a trial? Doesn’t the lawyer always want to retain experts who agree with his or her side of the case? Are there professional ethics to which forensic psychiatrists are expected to adhere? What is forensic psychiatry? Forensic psychiatry is a branch of medicine which focuses on the interface of law and mental health. It may include psychiatric consultation in a wide variety of legal matters (sometimes with expert testimony), as well as clinical work with perpetrators and victims. This web page focuses on forensic work with attorneys, courts, or other parties involved in actual or potential litigation (going to court in a civil or criminal matter). Incidentally, a few readers may confuse forensic psychiatry with forensic pathology. Forensic pathologists (one kind at least) are the physicians who perform autopsies, a different medical specialty altogether. So don't ask me (as a few people actually have), "how do you do psychiatry on dead people." :-) What is a forensic psychiatrist? A psychiatrist is a medical doctor (M.D. or D.O. in the U.S.) who has completed several years of additional training in the understanding, diagnosis, and treatment of mental disorders. A forensic psychiatrist is a psychiatrist who has additional training and/or experience related to the various interfaces of mental health (or mental illness) with the law. Is a forensic psychiatrist the same thing as a forensic psychologist? No. Psychiatrists are physicians with specialty training in the understanding, diagnosis, and treatment of mental disorders. This includes biological evaluations and treatments (such as laboratory tests and medications), psychotherapy, and family & social issues. Doctoral-level (such as Ph.D., Psy.D., or Ed.D.) psychologists do not go to medical school, but are professionals in their own right, and may have special expertise in topics not usually studied in detail by psychiatrists (such as psychological testing). How is forensic psychiatry useful to the legal process? When legal matters involve issues outside lay (general public) expertise, lawyers and judges regularly seek consultation from professionals in a wide variety of fields, including medical specialties. Such professionals are often called "experts" or "expert witnesses." Although forensic experts usually are truly knowledgeable, the criteria for "expert" designation in such cases are legal ones, and not necessarily scientific. Sometimes the expertise is sought in an effort to provide the best possible information to judges or juries, but there are many other situations in which a prudent attorney, judge, or other party may request consultation. Are forensic psychiatrists "advocates" for one side or the other in legal matters? Usually not. Ethical forensic psychiatrists try to avoid bias. They focus on the data or evidence within their areas of expertise, and comment objectively on the information as they see it. Although we have some familiarity with the law, we are not attorneys or judges. We are often consultants to advocates (lawyers) or courts, and at other times we may participate in advocacy strategy, but we consider it unethical to combine our expert opinions (testimony, reports, or affidavits, for example) with advocacy per se. Ethical forensic psychiatrists do not accept contingency fees or otherwise conduct themselves in ways that may interfere with, or imply, a lack of professional objectivity. Why does there always seem to be a forensic psychiatrist (or other forensic professional) willing to testify on either side of a trial? Such an impression of the expert's role is often misleading. When working in civil or criminal litigation, the forensic psychiatrist’s job is to assess the relevant facts thoroughly and, if asked, offer an opinion about them. If the expert’s opinion is helpful to the lawyer’s case, he or she may be asked to express that opinion via report or testimony. This is the attorney’s decision, not the expert’s (except when the expert is appointed specifically for the court’s own use). If the opinion does not support the lawyer’s case, the expert will not be asked to report or testify, and the opinion remains hidden from the court. Thus, the testimony one sees in court is very likely to be favorable for the lawyer who retained the expert, but not because the expert is biased or unethical. In some cases, a lawyer may consult with many experts before finding one whose opinion supports his or her side of the case; that's a lawyer's strategy, not the forensic expert's. Experts may disagree, of course, but each should arrive his or her view objectively; opinions must not be created just to please the attorney. Doesn’t the lawyer always want to retain experts who agree with his or her side of the case? In the long run, attorneys tend to want experts on whom they can rely for honest answers, not simply experts who will always agree with them. Lawyers know they fare better when they know both the strengths and the flaws in their cases as early as possible. A malpractice plaintiff’s attorney, for example, may retain a forensic psychiatrist to help assess the merits of a case before deciding whether or not to file suit. Many forensic professionals help prevent frivolous or meritless litigation. Are there professional ethics to which forensic psychiatrists are expected to adhere? Yes. What's the difference between a forensic psychiatrist and a forensic psychologist, and how do I get to be one? A psychiatrist is a medical doctor who, after receiving his or her M.D., has completed three to five years of additional specialty training in psychiatry. It is important to note that even if you want to be a "forensic" psychiatrist or psychologist, you need to be interested in medicine and psychiatry in the first place (for psychiatry) or in mental health generally (for psychology). being a good clinician is the foundation for the forensic training and work. What Does a Forensic Psychiatrist Do? Do You Work With Lots of Criminals and Gory Crimes? Could you briefly describe a typical working day? Every forensic practice is different, and some are very different from others. In my case, I see patients, review medical records and other information, examine patients for attorneys or courts, read and keep up my clinical education, write reports or clinical papers, teach clinical and forensic topics in medical schools and training programs, and talk with clinical and forensic colleagues. I also testify in court or in other judicial proceedings such as "depositions" but, as for most forensic psychiatrists, that only occupies a small portion of my professional time. What methods do you use in your practice? That's a complicated question. I review lots and lots of records of various kinds, interview lots of people in different kinds of cases, talk to lawyers and other legal or law enforcement professionals, stay aware of how I can use the expertise of other professionals (such as forensic psychologists) in some cases, and try to understand clinical and forensic information in such a way that I can help the lawyer or court see what I think is important (e.g., in conferences, reports, or testimony). Do you still do medical things? Yes. I see patients, teach in clinical settings, and write on clinical topics. I recommend that forensic psychiatrists, psychologists, etc., not lose touch with the clinical field, since that's what the law often relies on for their expertise. Does gender make a significant difference for success in this field, either positive or negative? No. What about race? No. What about cultural things and personal preferences, like accents or the way someone dresses? Like much of psychiatry and the mental health professions, familiarity with __________ culture and society is important. Being well educated and experienced may not be enough. Forensic professionals also need to be able to communicate clearly with the people they evaluate or interview, lawyers and judges, other professionals, and sometimes juries. While some forensic fields depend a bit less on that familiarity and interpersonal communication, a lawyer who retains a forensic clinician will expect him or her to be articulate, to present himself or herself appropriately, and to be able to convey his or her findings in a clear and convincing manner. If the lawyer believes that a heavy accent or some aspect of one's physical appearance or behavior would not convey the findings very well to a judge or jury, then the attorney may choose someone else. Do you recommend your field for a career over the next 30 years? Yes, but I also recommend that you be very good at it. Many clinicians are trying out forensic work as their clinical practices become smaller or more of an administrative hassle. Some do a good job and some don't. As in any field, those who do a good job are likely to have much more rewarding lives than those who don't. Which do you think is the better field to go into, psychiatry or psychology? Would you consider forensic psychiatry to be a very high, normal, or low stress job? How much time do you spend testifying in court? What is the most interesting case you have ever worked on? Are the courses that needed to take to become a forensic psychiatrist very difficult? Do you work closely with other fields of forensic science? How much of your practice is devoted to court evaluations? Do you still have time to treat and see patients unrelated to the legal system? If so, is this typical of most forensic psychiatrists? How much of your practice is devoted to family court evaluations? How much money do you make? What do you charge for your work? Do you find your career choice rewarding and satisfying? Do you have any regrets about becoming a psychiatrist?