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.     

Chapter 4: Psychiatric Expert Examination of Convicts,Witnesses, and Victims

For persons who have been convicted of a crime and are serving a prison sentence, the need for a psychiatric examination arises when the court must decide on early release because of mental disease or when a court judgment must be reviewed because of newly discovered circumstances relative to the mental soundness of the prisoner at the time the crime was committed.     

道路交通事故所致精神损害的法医学评价

目的研究RTA所致PTSD的相关法医学问题,为司法实践中精神损害赔偿提供科学依据和司法建议。方法对156例因RTA申请伤残程度鉴定的被鉴定人,通过临床精神病学检查确定PTSD的诊断,法医临床学检查评定躯体损伤的伤残程度,并通过问卷调查进一步确定受害人的心理社会状态。结果156例被调查对象PTSD发生率为51.92%。男女PTSD的发生率具有统计学的显著性差异;随着伤残程度的严重性增加,发生PTSD的可能性也随着增加;PTSD组与非PTSD组在生活质量总均分和生理、心理、社会关系、环境四个维度以及焦虑、抑郁的各项得分中都有显著性差异;获得赔偿将明显降低PTSD的发生率。结论RTA作为创伤性事件,申请赔偿的RTA受害人存在较高的PTSD发生率,获得良好的赔偿可以明显地降低申请赔偿的RTA受害人PTSD的发生率。     

Sexsomnia – a forensic psychiatric challenge – a case report

In rare penal cases, a defendant makes a claim that he or she was asleep at the time of an alleged crime. This article discusses a case of alleged sexsomnia where a man claimed that he had been asleep during a sexual encounter (rape) with a woman. The question that often arises during an investigation and in court is how complex a behaviour is someone able to perform and still be asleep? To assist the court in answering this question, forensic psychiatric experts may be appointed. But the experts were not present during the act and must therefore consider each case on the basis of the available information and existing research. This paper provides a brief overview of the research regarding sexsomnia. It will also discuss what kind of information is important to elaborate in these cases in order to clarify the premises for the experts’ conclusions to the court.     

South Glamorgan County Council v. W and B

A Family Division English court held that a minor can be admitted to a psychiatric care facility against her wishes if it is in the best interest of the minor. The affected minor had been previously assessed by various psychiatrists and social workers after she had refused to attend school and begun to lead a reclusive life. Their recommendation had been that she be removed from her present home with her father and be admitted into an adolescent unit where she could receive psychological therapy. Following the divorce of her parents, the minor's temperament and mental health had seriously deteriorated. Although her father opposed these proceedings, her mother and her court appointed guardian both thought that psychiatric care was most appropriate for the minor. The court agreed, stating that the best interests of the child override any other considerations.     

Right to refuse treatment: impact of Rivers v. Katz

This article examines the impact of the New York court decision, Rivers v. Katz, which in June 1986 dramatically changed the state procedure for responding to involuntarily committed psychiatric patients who formally refused psychopharmacologic treatment. The court rejected the medically administered review process that had been used to respond to involuntarily committed psychiatric patients who formally refused medication, and replaced it with a judicial determination of competent and "substituted judgment" provided by the court. Post-Rivers, the rate of patients consistently refusing treatment decreased, and the time from refusal to resolution increased. The clinical, legal, and economic implications of the Rivers procedure are discussed.     

Chapter 2: The Legal Position and Organizational Forms of Forensic Psychiatric Expert Examination

The practical task of forensic psychiatry, which is one of the subdivisions of psychiatry, is to give an expert evaluation, on assignment from investigatory agencies and courts, and to devise and recommend measures for the prevention of socially dangerous acts by the mentally ill. Forensic psychiatric expert examination, like forensic medical, criminal, or any other type of expert examination, aids agencies of justice in establishing the facts in a case. Forensic psychiatric expert examination is called upon to assist the investigator and the court in determining whether an individual is a criminal or a legally irresponsible, mentally ill person; whether a person sentenced to a prison term should, because of mental illness, be released before his time is served; whether the investigator and the court may pursue the interrogation of a witness or victim with mental disorders, and whether the testimony of such persons may be used as court evidence. Such an expert examination is necessary in a civil suit in deciding the question of an individual's competence.     

Psychiatric expert testimony on aggressive offenders in juvenile court proceedings

The empirical study presented concerns juvenile court cases (aggressive offences) in West Berlin during which the offenders (N = 94) were subject to psychiatric expert testimony (1975-1982). The conditional factors determining forensic-psychiatric testimony are examined and the investigation shows, with the aid of discriminant analysis, that differences in the form of the expertise given are best explained by the variable 'convention-orientation'. Ratings on the quality of psychiatric letters (N = 49) were based on the semantic differential technique. Employing factor analysis, three independent aspects determining the quality of expert opinion are revealed, namely the factors 'cogency of message', role-conception', and 'recipient-orientation'.     

Sociodemographic and diagnostic characteristics of homicidal and nonhomicidal sexual offenders

The aims of this study were to compare the prevalence of psychiatric disorders and "psychopathy" in homicidal and nonhomicidal sexual offenders and to investigate the specificity of previous studies on psychiatric morbidity of a sample of sexual murderers. Information from court reports of 166 homicidal and 56 nonhomicidal sex offenders was evaluated using standardized instruments (SCID-II, PCL-R) and classification systems (DSM-IV). Sexual murderers were diagnosed more often with a personality disorder (80.1% vs. 50%; p < 0.001), especially schizoid personality disorder (16.3% vs. 5.4%; p < 0.05), as well as with sexual sadism (36.7% vs. 8.9%; p < 0.001) and sexual dysfunctions (21.7% vs. 7.1%; p < 0.05). Additionally, they had more often used alcohol during the offense (63.2% vs. 41%; p < 0.05). The results indicate that sexual murderers have more and a greater variety of psychiatric disorders when compared to nonhomicidal sex offenders.     

An experimental trial of adaptive programming in drug court: outcomes at 6, 12 and 18 months

Objectives

To test whether an adaptive program improves outcomes in drug court by adjusting the schedule of court hearings and clinical case-management sessions pursuant to a priori performance criteria.

Methods

Consenting participants in a misdemeanor drug court were randomly assigned to the adaptive program (n?=?62) or to a baseline-matching condition (n?=?63) in which they attended court hearings based on the results of a criminal risk assessment. Outcome measures were re-arrest rates at 18 months post-entry to the drug court, and urine drug test results and structured interview results at 6 and 12 months post-entry.

Results

Although previously published analyses revealed significantly fewer positive drug tests for participants in the adaptive condition during the first 18 weeks of drug court, current analyses indicate the effects converged during the ensuing year. Between-group differences in new arrest rates, urine drug test results and self-reported psychosocial problems were small and non-statistically significant at 6, 12, and 18 months post-entry. A non-significant trend (p?=?.10) suggests there may have been a small residual impact (Cramer’s v?=?.15) on new misdemeanor arrests after 18 months.

Conclusions

Adaptive programming shows promise for enhancing short-term outcomes in drug courts; however, additional efforts are needed to extend the effects beyond the first 4 to 6 months of enrollment.     

Mass murders in Germany – classification of surviving offenders based on the examination of court files

Personality, psychopathology, and motives of 44 surviving offenders committing mass murder in Germany over 25 years (1984–2009) were analyzed using court files and psychiatric expertises. Initially, 123 mass murders in Germany were detected in the time period 1980–2010 (inclusive deceased offenders). Using a data entry form based on ViCLAS (Violent Crime Linkage Analysis System), we categorized the 44 surviving mass murderers into three prototypes using the ‘TwoStep Cluster’-method (separation of the offenders in different groups depending on their similarity of specific items): 1. Narcissistic or aggressive men suffering from addiction or affective disorder, committing mass murder out of rage/hate when being intoxicated by alcohol, 2. Psychotic offenders with schizophrenia and comorbid substance abuse. 3. Aggressive, narcissistic or anxious adolescents, half of them suffering from affective disorder or ADHD, committing mass murder out of rage/hate. Not included are such events where the offenders died and therefore no court files or psychiatric expertises were available. Classification and subtyping of the offenders’ personalities and psychopathological conditions might help to improve the chances for an early detection of persons at risk.     

The judge's view of competency evaluations. II

Twenty trial court judges were surveyed to determine what information they considered pertinent in psychiatric examinations for competence. These judges showed a clear understanding of what they were asking for in ordering the examinations but also showed a significant tendency to use the competency exam to advise them about other issues in addition (e.g., dangerousness or the need for treatment). As a group the judges appeared to be eager for psychiatric input. Typical judges could be described as pragmatic in their views of psychiatry in the courtroom, having a relatively low level of expectation but a high degree of satisfaction with the psychiatric opinions they receive.     

Mental disorder as the cause of a crime

An offender's punishment can be reduced when a court decides that his mental disorder reduces his responsibility for what he did. Courts have sought to establish whether a mentally disordered offender's responsibility is reduced by asking whether his disorder caused the crime. Acceptance of this “causation by mental disorder” criterion has fluctuated, however. This may be because causal explanations are not the types of explanations we are accustomed to offering for the kinds of acts that bring defendants, and psychiatric witnesses, to court. More often, we offer what philosophers have called “possibility” explanations for these acts. The application of psychiatry to possibility explanations has not been widely explored. It offers the potential for the improved use of psychiatric evidence in criminal proceedings.     

Can Courtroom Behavior Predict Recidivism? An Assessment of the Courtroom Behavior Check List for Women Presenting in Drug Court

The U.S. criminal justice system is overwhelmed with individuals affected by substance use and psychiatric disorders often co-morbid with criminal behavior. Locally, an evaluation of St. Louis downtown municipal ordinance violators found that 49 % of offenders reported mental health problems, 30 % reported alcohol-related problems, 86 % had a history of prior arrests and 71 % had failed to appear in the St. Louis City Municipal Court within the previous 2 years (Downtown St. Louis Community Court Evaluation Report, St. Louis, MO). These compounded conditions and their corresponding treatment needs are costly and complicate correctional rehabilitation efforts. Drug courts have emerged as alternative ‘therapeutic jurisprudence’ avenues designed to reduce drug use and associated individual risk behaviors. Unfortunately, there are few evidence-based measures available for rapid, onsite evaluation of an individuals’ potential for success with drug court. A new assessment tool, the Courtroom Behavior Check List (CRBCL), was developed to measure behavioral compliance in court as a predictor of future behavior, as we believed that behavior in court would predict future criminal behavior. We found scores on the CRBCL declined (e.g., improved) among the 127 women interviewed from baseline through the 8-month follow-up, and that a poorer score predicted re-arrest for a criminal offense (OR?=?2.84; 95 % CI 1.20–6.69). Based upon these findings, the CRBCL may be a useful tool to measure the likelihood of re-offending among women in drug court. Policy implications and directions for future research are discussed.     

Psychiatric disorder,IQ, and emotional intelligence among adolescent detainees: A comparative study

Objectives. To document criminality, psychiatric difficulty, IQ, EQ, and EI amongst Irish, male juvenile detainees (Detainee Group). To compare their IQ, EQ, and EI to non‐offending boys attending a child psychiatry clinic (Psychiatric Group) and boys without offending or psychiatric problems (Community Group). To compare psychiatric morbidity between the detainee and psychiatric groups. Method. Criminality levels of 30 detainees were evaluated using official court charge sheets. Psychiatric status was assessed through structured clinical interview (DISC‐IV); IQ through an individually administered IQ‐scale (WASI); EQ using the BarOn EQi:Youth Version (EQi:YV); and EI using the MSCEIT: Youth Version – Research Edition (MSCEIT:YV‐RE). IQ, EQ, and EI levels in the psychiatric and community groups were compared. Psychiatric morbidity between detainee and psychiatric groups were compared. Results. A total of 335 crimes led to the detention of detainees. Eighty‐three percent of detainees had a psychiatric disorder compared to 60% of young people in the psychiatric group. Detainees had 3.1 disorders each compared to 1.4 disorders in the psychiatric group. A total of 63.3% of detainees had an externalizing problem, 37.9% an internalizing problem, and 66.7% a substance dependency or use problem. A total of 21.4% of detainees had an IQ score below 70. The detainee and psychiatric groups had similar deficits in EI and significantly lower EI than the community groups. Conclusions. Serious levels of criminality and psychiatric disorder exist amongst Irish detainees. They have significantly lower IQ than young people attending a psychiatry clinic and both share deficits in the ability to accurately identify emotions, use emotions to guide thought processes and to prioritize thinking and to effectively regulate emotions.     

Out on a Limb: Appointing a Parenting Coordinator with Decision‐Making Authority in the Absence of a Statute or Rule

This Article addresses the issue of whether a court may appoint a Parenting Coordinator (PC) with decision‐making authority in the absence of a statute or court rule. The Article identifies possible sources of authority for the appointment of a PC with decision‐making authority in a state with no authorizing statute or court rule. It also provides a paradigm for constructing an appointment that allows for the benefits of Parenting Coordination but does not delegate decision‐making authority to an extent that it would constitute an impermissible delegation of judicial authority.

Key Points for the Family Court Community:
• Where a court seeks to appoint a PC with decision‐making authority in the absence of an authorizing statute or court rule, the court may find some authority allowing the appointment in (1) its equitable authority over child custody and visitation, (2) its authority to enforce its own orders, or (3) its authority to appoint other extrajudicial assistants such as a special master or mediator.
• Where a court seeks to appoint a PC with decision‐making authority in the absence of an authorizing statute or court rule, the court must craft an appointment that delegates enough decision‐making authority to the PC for parenting coordination to be effective yet, at the same time, not so much decision‐making authority as to render the appointment an impermissible delegation of a judicial function, specifically:
  • The PC's role should be limited to assisting the parties in implementing custody and visitation terms already decreed by the trial court.
  • A PC should be appointed only if the parties to the divorce consent to the appointment or if the trial court makes a finding that the case is a high‐conflict case.
  • The parties must have the opportunity for the trial court to meaningfully review any decision of the PC so that the trial court retains ultimate decision‐making authority.

     

The relationship between the court and the doctor on the issue of an inpatient's refusal of psychotropic medication

New procedures, tailored after such court decisions as Rogers v. Commissioner of the Department of Mental Health, have restricted the doctor's ability to treat psychiatric inpatients with psychotropic medication and have increased the protection of a competent patient's right to refuse. This study investigates how the relationship between the doctor and the court has adapted to these new procedures. All 40 court cases of a maximum security forensic hospital over a two-year period were reviewed. Results suggest that the new procedures have had no dramatic effect upon either the treatment patients receive or the doctor-court relationship. While abstract arguments both in favor of and against these new procedures can be drawn from the same data, the concrete relationship still remains poorly understood.     

The effects of psychiatric and “biological” labels on lay sentencing and punishment decisions

Objectives

This research, using focal concerns perspective on sentencing, examines how and why psychiatric labels, and having diagnoses biologically “labeled,” affect sentencing beliefs. Dimensions of public stigma toward psychiatric illnesses are hypothesized to mediate sentencing views.

Methods

This is a 2?×?2 partially-crossed, between-subjects multifactorial experiment with a lay sample (n=?1213), presenting mediation analyses.

Results

Four psychiatric labels (Attention Deficit Hyperactivity Disorder, behavioral-variant Frontotemporal Dementia, High Functioning Autism, Borderline Intellectual Disability) led to significant beneficial effects on sentencing (less prison/rehabilitation support) as mediated by decreased stigmatization regarding lack of treatability, social acceptance, and personal responsibility. One biological “label” (Pedophilic Disorder) was mediated by decreased stigmatization (dangerousness), resulting in less prison support.

Conclusions

Data support effects of psychiatric labeling on sentencing under focal concerns. As no psychiatric labels resulted in increased discriminatory sentencing and, instead, led to decreased discriminatory sentencing behavior, psychiatric labeling may reduce punitiveness and bolster non-punitive sentencing beliefs. Biological labeling, aside from Pedophilic Disorder, may not affect sentencing.