Medical school forensic psychiatry units in health care delivery facilities rather than criminal justice institutions: an alternative model

We have presented a model for developing forensic psychiatric treatment and teaching services of a medical school Department of Psychiatry, but where these services are the basic comprehensive health care delivery system for the entire community. These offer consultative and treatment services for adult and family court clinic, psychiatric forensic services, of forensic psychiatry open bed and medium security-type bed, as well as day hospital and outpatient services. All of these are sited in the normal health care delivery system of the university teaching hospitals and its patient treatment, teaching, and research facilities. Consultative services are offered on request to the criminal justice system, but the basic health care delivery system is controlled administratively by the ordinary university teaching hospital authorities and exists as a one of a kind unit at the Royal Ottawa Hospital. The Royal Ottawa Hospital is a private nonprofit hospital, with its own Board of Trustees, and is affiliated with the medical school, as part of a major university network. We believe it important to present this model for an overall forensic psychiatric service, in contradistinction to the more commonly established forensic psychiatric facilities in state mental hospitals, in a special facility for the criminally insane, or in a criminal justice system institution such as a penitentiary. We believe that our model for forensic psychiatric facilities has great advantages for the patient. Here the patient is treated in a specialized facility (as all psychiatric patients with specialized problems should be); but one which is a specialized forensic facility, within the range of specialized psychiatric facilities that are needed by an urban community.(ABSTRACT TRUNCATED AT 250 WORDS)     

THE SCIENTIFIC BASIS OF PSYCHOLOGICAL TESTING

The legal standards for admissibility of expert testimony have recently been raised following several U.S. Supreme Court decisins. Although forensic mental health experts have relied on psychological testing as a method of data collection for many years, the scientific basis of such testing has traditionally gone unquestioned in court. Given the increased scrutiny currently being applied to expert testimony, it is more important now than ever for attorneys, judges and forensic experts to understand the scientific principles underlying psychological tests. In this article, the scientific principles of validity and reliability are explained, and scientifically acceptable methods for the forensic use of psychological testing are discussed. The application of recent case law to several well-known tests is described.     

Psychological Injury and Law: Defining a Field

This article elaborates definitional and conceptual issues relevant to the field of psychological injury and law. It reviews the literature in the major areas that mark the field—law, forensic psychology, disability, and assessment/malingering. To meet admissibility requirements of testimony in court, psychologists and other mental health professionals need to maintain a comprehensive, impartial, and scientifically informed approach to assessments based on a state-of-the-art knowledge, such as made available in this journal.     

Clinical Assessment of Parents in Child Protection Cases: An Empirical Analysis

We investigated the content and legal relevance of clinical evaluations of parents conducted in child abuse and neglect cases. The sample consisted of 190 mental health evaluation reports, randomly selected from major providers, that had been completed on parents involved in a large, urban juvenile court system. We coded evaluations on 170 objective and qualitative characteristics in order to assess for criteria recommended in the forensic literature. We compared evaluations across groups categorized by type (e.g., psychological, psychiatric, bonding/parenting, substance abuse) and where the assessments were performed (outside or inside the court). We found numerous substantive failures to meet those criteria for forensic relevance. Evaluations of parents typically were completed in a single session, rarely included a home visit, used few if any sources of information other than the parent, often cited no previous written reports, rarely used behavioral methods, stated purposes in general rather than specific terms, emphasized weaknesses over strengths in reporting results, and often neglected to describe the parent's caregiving qualities or the child's relationship with the parent. Some relevant differences were evident across assessment groups, pointing to examples of more thorough, parenting-specific evaluation practices. We recommend ways to improve current practices in forensic parenting assessment.     

The mental health service crisis of neoliberalism -- an antipodean perspective

Major transformations in forms of governance of the liberal state have been wrought over the course of the last century, including the rise of neoliberalism and 'new public management.' Mental health too has witnessed change, with pharmacological treatment displacing residential care, a shift to community-based services, mainstreaming with general health care, and greater reliance on civil society institutions such as the family or markets. This article considers whether mental health law, and its court/tribunal 'gatekeepers' have kept pace with those changes. It argues that the focus of the liberal project needs to shift to measures which will better guarantee access to mental health services, and keep a more watchful eye on both 'hidden' coercion of people on community treatment orders, and passive neglect of human need.     

关于刑事诉讼法修改中有关司法鉴定问题的思考

由省级人民政府指定的医院进行司法鉴定,不仅限制了司法鉴定机构的执业权利,造成法律适用上的混乱,而且在实践中也不具有可行性。此外,对于鉴定人无正当理由拒绝出庭作证的法律责任,无论是从法院与鉴定人的关系,鉴定人强制出庭作证来看,还是从司法拘留的适用性质来看,都不应当强制鉴定人出庭。上述是刑事诉讼法中有关司法鉴定的两个重要问题,应当借此次修改的机会,完善刑事诉讼领域的司法鉴定制度,促进法律协调统一。     

Saleem Shah

This article describes the important ways in which Saleem Shah contributed to the improvement of delivery of forensic mental health services in state mental health systems throughout the nation. In addition, it describes his impact on the development of forensic mental health law, policy, and services internationally, especially in China and the former Soviet Union.     

Training of legal professionals in DNA evidence

The South African Criminal Legal System is based on Roman Dutch law. Court proceedings are led by a single presiding officer of the court. Prosecutors and defence advocates present the court with evidence in an adversarial manner. This system has inherent advantages and disadvantages and therefore the training of legal professionals in handling DNA evidence in court is important. The prosecutors resort under the National Prosecuting Authority and the defence advocates act independently or e.g. under the auspices of Legal Aid South Africa.Education curricula of legal professional do not include forensic science evidence. Principles such as evidential value in the forensic context are not addressed. Training of legal professionals with our Essential DNA Evidence™ Course has been a multiplier of forensic science knowledge in the legal profession in South Africa. We present prosecution and defence perspectives in an unbiased manner, compensating for the possible subjective interpretations of evidence that may be presented in court. Forensic evidence is subsequently carefully evaluated prior to being court presentation thus improving court efficiency, and allowing for a more focussed approach to the presentation of evidence. Approaches to the customisation of course content that adds value has been identified via evaluation of training programmes.Experience has shown that legal professionals have the ability to incorporate relatively complex scientific concepts into their legal arguments if provided with the appropriate training opportunity. Appropriate training in DNA evidence has made the court process more effective, both in terms of time and costs, and ultimately serves justice.     

鉴定资料收集之法律控制研究

随着我国法制的健全和人权保障意识的增强,鉴定资料收集过程的控制问题已经引起理论界的关注。总体来看,我国比较注重鉴定的结果价值,即获取鉴定结论,这就使得制度设计上偏重于如何有效地运用鉴定结论,而忽视了对于鉴定资料收集过程的法律控制。与此相对的是,各国立法都对鉴定资料的收集过程作出法律规制。对鉴定资料收集过程予以完善的法律规制,有助于司法鉴定质量的提高,同时也是正确认定案件事实的保障。     

法庭科学实践教学探索

法庭科学是以科学技术手段确认相关法律事实的证据,是诉讼活动与科学技术密切结合的产物。在社会法制化程度日趋提高的今天,法庭科学已经成为法学专业培养高级人才不可缺少的一门重要学科。由于法庭科学具有自然科学的属性,专业性、实践性很强,针对缺少法庭科学前期基础的法学学生而言,采用实验及多媒体组合等多种实践教学模式不仅能够缩短教学时间、提高教学效率,突破教学的重点和难点,保证教学质量,而且能够充分发挥学生学习的主动性,极大地促进其能力的培养和综合素质的提高。本文通过对法庭科学人才素质培养目标的论证,阐述了法庭科学实践教学的主要模式及必备的条件,并结合现阶段法庭科学实践教学中存在的主要问题,有针对性地提出了相关的完善措施。     

From Helping Court to Community‐Based Services: The 30‐Year Evolution of Australia's Family Relationship Centres

As a centrepiece of Australia's 2006 family law reforms, the community‐based Family Relationship Centres (FRCs) represented a major development in the Government's commitment to incorporate family relationship services into its family law system. This paper sees FRCs as a logical development of the original conceptualising the Family Court of Australia as a “helping court”. The paper suggests that the aspiration to create a helping court was partially achieved in 1976 via the creation of an in‐house family court counselling service, which was primarily focused not on law and legal principles, but on supporting the ways in which family members were managing the task of redefining relationships. While generally valued by judges and others, this service nonetheless found itself in tension with the Family Court's continued primary commitment to legally informed and adversarially driven negotiation and decision‐making processes. Since 2006, the creation of FRCs has spearheaded a family law system that provides relationship‐focused interventions away from the courts as the default option for most parenting disputes. Consistent with this aim, there is evidence of a diminished percentage of cases now requiring judicial intervention. The 2006 legislation also provides for courts to conduct “less adversarial trials.” Paradoxically, this has occurred alongside unequivocal evidence from the Australian Institute of Family Studies’ evaluation data that judicial officers are dealing mainly with families displaying seriously dysfunctional attitudes and behaviours. The legal challenge in dealing with these cases is for courts to provide child focused, fair and non‐destructive internal processes. In addition, however, it is increasingly clear that to support and help facilitate their decisions, courts also need good working relationships with FRCs and other community based services. FRCs and the 2006 reforms offer the possibility of moving beyond the ideal of a “helping court” to the broader concept of helping family law system.     

The 4 Ds of Forensic Mental Health Assessments of Personal Injury

The field of psychiatric/psychological injury and law concerns tort and other legal claims for injuries sustained in events at issue, such as in motor vehicle accidents (MVAs), worker compensation, or the veteran affairs (VA). The 4 Ds refer to the requirement that legal action in these types of cases can proceed when there is a duty, the duty has been discharged with dereliction, the resultant act has caused directly tortious harm, and damages are applicable. In contrast, the related 4 Cs refer to the conditions of effective forensic testimony. The principles of forensic mental health assessment (FMHA; Heilbrun et al., 2009) underscore the scientific requirements in forensic assessments, as do the American Psychological Association’s (APA, 2013) forensic specialty guidelines. For example, Brodsky’s maxims for effective work in court (Brodsky & Gutheil, 2016) cover a broad spectrum of ethical and practice guidelines for the profession. Similarly, Young (2016 a, b, c) has specified the parameters of admissible evidence in court, functioning ethically for the court, and the need to be comprehensive, scientifically informed, and impartial in forensic mental health assessments. All these sources lead to an integrated set of the principles for effective and ethical practice in the forensic arena of mental health work, referred here as the 4 Ds for the field of psychiatric/psychological injury and law. These revised 4 D principles involve Dignity, Distance, Data, and Determinations.     

Are Forensic Evaluations “Health Care” and Are They Regulated by HIPAA?

Forensic mental health providers (FMHPs) typically do not release records to the examinee. The Health Insurance Portability and Accountability Act (HIPAA) federal regulations might change this position, given that they have created a basic right of access to health care records. This legislation has led to a disagreement regarding whether HIPAA regulates forensic evaluations. The primary argument (and the majority of scholarly citations) has been that such evaluations do not constitute “health care.” Specifically, in this position, the nature and purpose of forensic evaluations are not considered related to treatment (amelioration of psychopathology) of the patient. In addition, it asserts that HIPAA applies solely to treatment services; thus, forensic evaluations are inapplicable to HIPAA. We describe the evidence for and against this argument, the strengths and limitations of the evidence, and recent court decisions related to it. The weakest part of the “HIPAA does not regulate forensics” argument is that HIPAA has no exclusion criteria based on type of services. It only creates an inclusion criteria for providers; once “covered,” all services provided by that provider are thence forward “covered.” Authoritative evidence for patient access can be found in the HIPAA regulations themselves, the US Department of Health and Human Services’ commentaries, additional statements and disciplinary cases, the research literature, other agency opinion, and legal opinion. It appears that the evidence strongly suggests that, for those forensic mental health practitioners who are covered entities, HIPAA does apply to forensic evaluations. The implication is that FMHPs potentially face various federal, state, and civil sanctions for refusing to permit patient access to records.     

Forensic Methods and Procedures Applied to Child Custody Evaluations: What Judges Need to Know in Determining a Competent Forensic Work Product

Judges are seeing an increase in the number of forensic reports in the area of child custody. This increase in forensic mental health involvement suggests that judges need to better understand the application of current forensic mental health methodology to assist them in determining a competent forensic work product. Recent literature has argued that child custody evaluators need to craft their reports consistent with scientific methods and procedures as well as legal standards governing admissibility of scientific evidence. This paper provides a framework for judges to assist in determining whether a child custody evaluation has been crafted consistent with current behavioral science literature pertaining to use of forensic mental health methods and procedures.     

It's just so difficult to get anything done: Teen mental health in the family court setting

Navigating the family court setting to protect teen mental health, meet teens' mental health needs, and promote resilience and coping skills is challenging. We have tools that can help us meet that challenge. That toolkit includes: expanding who is involved in the work to develop a parenting plan or treatment plan; not reducing the case to a one-dimensional fact pattern; restructuring family court proceedings for ongoing problem-solving, providing protections for the teen's privacy; using consensual dispute resolution and adjudication on parallel tracks; and educating the decision makers through expert declarations and Brandeis briefs (even at the trial court level).     

Play by the Rules: why States Should Adopt Uniform Court Rules for Forensic Psychologists in Child Custody Evaluations

It is not uncommon for children to fall victim to the stress and tension of a contentious custody dispute. If a party seeks a mental health evaluation and the opposing party challenges the results, the child then endures a series of evaluations until a valid report is produced. The court will often remedy this situation by appointing a neutral forensic psychologist to perform the evaluation independent from a previous party‐hired forensic psychologist. 1 This Note proposes that the court instead appoint the forensic psychologist first to conduct an evaluation and draft a report. Only at the judge's discretion may the parties hire a private forensic psychologist to challenge the report. Additionally, states should codify court rules that enumerate standards for forensic psychologists in child custody evaluations. These rules should set forth criteria that shall be required and highlighted throughout each mental health evaluator's report, allowing judges to compare and contrast each evaluation more effectively. This legislation will not only reduce the child's exposure to excessive testing, but will also provide a more efficient way of arriving at a just result.     

Science serving justice: opportunities for enhancing integrity in forensic science in Africa

Forensic science is a unique discipline of applied science. At its core it is a science, yet finds its use in the application to cases that often go to a court of law. Practicing at the intersection of science and law poses distinct challenges, but also holds incredible potential in its ability to serve as a vehicle for integrity. The practice of forensic science in Africa is at a tipping point. Unchartered waters lie ahead for the continent and its forensic scientists. Often working in inadequately resourced environments, obstacles may seem insurmountable. As African forensic scientists, we can overcome these obstacles as we accept that we are connected and united in our goal to allow science to serve justice.     

The forensic psychiatrist of the future

The rate of change in scientific knowledge and the growing psychiatric sophistication of attorneys and courts have made it increasingly difficult for forensic psychiatrists to retain proficiency in the full spectrum of potential professional activities. As the consumers of forensic services become more sophisticated, forensic psychiatrists have an increasing need to become scientifically informed and a decreasing need to become legally informed. Traditional training in forensic psychiatry, which emphasizes clinical, legal, and institutional knowledge and experience, gives short shift to behavioral science and other technical knowledge that can enhance the validity of forensic assessments and their value to the legal system and society. Forensic psychiatrists can best respond to these changes and maximize the value of their assessments by narrowing their focus to some subset of the four branches of the discipline: criminal behavior, mental disability, forensic child psychiatry, and legal aspects of psychiatric practice. Maximal proficiency in each of these four branches requires a greater depth of knowledge and experience than was once sufficient among those who practiced in all four areas. Fellowship training programs and professional organizations should lead forensic psychiatry into the twenty-first century by organizing their efforts along these four parallel tracks.     

Forensic human identification in the United States and Canada: A review of the law, admissible techniques, and the legal implications of their application in forensic cases

Forensic human identification techniques are successful if they lead to positive personal identification. However, the strongest personal identification is of no use in the prosecution - or vindication - of an accused if the associated evidence and testimony is ruled inadmissible in a court of law. This review examines the U.S. and Canadian legal rulings regarding the admissibility of expert evidence and testimony, and subsequently explores four established methods of human identification (i.e., DNA profiling, forensic anthropology, forensic radiography, forensic odontology) and one complementary technique useful in determining identity, and the legal implications of their application in forensic cases.     

Reducing medical complaints and litigation in Malaysia: turning patients' voices into opportunities

One of the most important ironies of modern health care is that public expectations are rising faster than the ability of health services to meet them. Patients nowadays no longer want to be treated as passive recipients of medical care but as co-producers or partners able to manage their illnesses. Thus, it is not surprising that poor communication and failure to take into account the patient's perspective are at the heart of most formal complaints and legal actions in Malaysia. The difficulties of existing complaint procedures in Malaysia have become manifest over the years and this has been accentuated by patients becoming more willing to challenge the decisions of medical practitioners and health service management in court. To reduce the number of complaints and risks of litigation, a more patient-centred approach should be adopted. When patients voice their concern by making a complaint or inquiry, this should be seen as a unique source of information for health care services on why adverse events occur and how to prevent them. As well as reducing future harm to patients, better management of complaints should restore trust and reduce the risk of litigation, through open communication and a commitment to learn from the problem. The existing procedures for patients to be heard in Malaysia should be reviewed and incorporate features such as responsiveness, accessibility, impartiality, simplicity, speed and accountability.