PSYCHIATRIC ASSESSMENT FOR PSYCHIATRIC ASSESSMENT FOR LEGAL PURPOSESLEGAL PURPOSES

The VIThe VIEEW FROM BOTH SIDESW FROM BOTH SIDES

LawLaw PsychiatryPsychiatry

SocietySociety

DONEDONE

USEDUSED

FamiliesFamilies

“Win-win” means I win twice, doesn’t it?

LOSER!

Family CourtFamily Court

LawyersLawyers

ExpertsExperts

CourtCourt

CustodyCustodyEvaluatorEvaluator

ParentParentParentParent

ChildChild

Agency

TopicsTopics

Law & PsychiatryLaw & Psychiatry Clinical vs. Forensic PsychiatryClinical vs. Forensic Psychiatry Child Custody DeterminationChild Custody Determination Special IssueSpecial Issue

LawLaw && PsychiatryPsychiatry

OldOld HistoryHistory YoungYoung

Free WillFree Will PhilosophyPhilosophy DeterminismDeterminism

Client RightsClient Rights ObjectiveObjective Patient NeedsPatient Needs

Cases & CodesCases & Codes EducationEducation Clinic & LabClinic & Lab

AdversarialAdversarial ApproachApproach ConsensusConsensus

Sources of ConflictSources of Conflict

ProfessionalProfessional Differences in background, Differences in background, education, and training.education, and training.

Inter-ProfessionalInter-ProfessionalExperiences at the interface: legal Experiences at the interface: legal regulation of psychiatric practice & regulation of psychiatric practice & psychiatric input into legal decisions.psychiatric input into legal decisions.

PersonalPersonalPre-existing personal issues. Pre-existing personal issues. Prior negative contacts with “them.” Prior negative contacts with “them.”

Overcoming ConflictOvercoming Conflict

ProfessionalProfessionalPractice within expertise. Prepare Practice within expertise. Prepare well. Answer the questions. well. Answer the questions.

Inter-ProfessionalInter-ProfessionalEducate each other. Practice good Educate each other. Practice good conflict resolution technique.conflict resolution technique.

PersonalPersonalGet realGet real!! Psychiatrist not opponent. Psychiatrist not opponent. Lawyer not narcissistic threat. Lawyer not narcissistic threat.

Clinical Clinical PsychiatryPsychiatry

Ends are medical.Ends are medical.- Doctor-patient relationship.- Doctor-patient relationship.

- Focus is on diagnosis and - Focus is on diagnosis and treatment.treatment.

Ethical principlesEthical principles- Do no harm. - Do no harm.

- Best interests- Best interests

Forensic PsychiatryForensic Psychiatry

Ends are legal. Ends are legal. - No doctor-patient relationship. - No doctor-patient relationship.

- Focus is on a- Focus is on applying psychiatric pplying psychiatric expertise to legal questions in legal expertise to legal questions in legal contexts.contexts.

Ethical principlesEthical principles- Truth-telling - Truth-telling - Respect for person- Respect for person

Role of Forensic PsychiatryRole of Forensic Psychiatry

GoalGoalAssist administration of justice by Assist administration of justice by applying psychiatric expertise to applying psychiatric expertise to legal questions in legal contexts. legal questions in legal contexts.

ObjectiveObjective Produce targeted medical-legal Produce targeted medical-legal evaluation, report, and testimony. evaluation, report, and testimony.

Standard of CareStandard of Care Apply ethics & practice guidelines of Apply ethics & practice guidelines of forensic psychiatry. forensic psychiatry.

CaveatCaveat Bias. Speculation. Conflicts of Bias. Speculation. Conflicts of interest. Expert for own patient.interest. Expert for own patient.

Guidelines of Forensic PsychiatryGuidelines of Forensic Psychiatry

Full DisclosureFull Disclosure Not treatment. Limited confidentiality. Not treatment. Limited confidentiality. Need for informed consent. Need for informed consent.

HonestyHonesty Address Address allall evidence. Challenge own evidence. Challenge own findings. Expose limits of certainty. findings. Expose limits of certainty.

CompetenceCompetence Clinical, scientific, & forensic expertise. Clinical, scientific, & forensic expertise. Report writing and courtroom skillsReport writing and courtroom skills

FrameworkFramework Identify legal question, legal rules, Identify legal question, legal rules, relevant data, and reasoning process.relevant data, and reasoning process.

Child Custody DeterminationChild Custody Determination

HistoryHistory Best Interest of ChildBest Interest of Child Role of Child Custody EvaluatorRole of Child Custody Evaluator Uniform StandardsUniform Standards Sexual Abuse & Sexual Abuse AllegationsSexual Abuse & Sexual Abuse Allegations

HistoryHistory

Parental rights.Parental rights. Parens patriae. Parens patriae. Family privacy.Family privacy. Tender years doctrine.Tender years doctrine. Best interest of the child.Best interest of the child.

Mental Health InputMental Health Input

““Best Interest”Best Interest”Legal Standard or Psychological Premise?Legal Standard or Psychological Premise?

Toddler is kidnapped. Kidnapper marries. New couple Toddler is kidnapped. Kidnapper marries. New couple becomes good psychological parents. Child does well. A becomes good psychological parents. Child does well. A decade later, child is discovered. By this time, biological decade later, child is discovered. By this time, biological parents are angry, depressed, drink too much and live on parents are angry, depressed, drink too much and live on fringes of society but they want their child back as a fringes of society but they want their child back as a matter of right. matter of right.

Best Interest of the ChildBest Interest of the Child

Child’s NeedsChild’s Needs Loving, nurturing, safe, Loving, nurturing, safe, permanentpermanent home. home. Education, health care, spiritual/ethical training.Education, health care, spiritual/ethical training. Guidance in interpersonal development.Guidance in interpersonal development.

Parent’s SkillsParent’s Skills View child as distinct being with its own needs.View child as distinct being with its own needs. Refrain from using child for self-gratification. Refrain from using child for self-gratification. Respond to daily needs & protect from harm.Respond to daily needs & protect from harm. Set appropriate limits for welfare of child.Set appropriate limits for welfare of child. Promote relationship to non custodial parent.Promote relationship to non custodial parent.

Role of Custody EvaluatorRole of Custody Evaluator

GoalGoalAssist Court resolve custody disputes Assist Court resolve custody disputes and protect children from future harm. and protect children from future harm.

ObjectiveObjective Produce targeted medical-legal custody Produce targeted medical-legal custody evaluation, report, and testimony.evaluation, report, and testimony.

Standard of CareStandard of Care Apply forensic and practice guidelines Apply forensic and practice guidelines applicable to custody determinations. applicable to custody determinations.

CaveatCaveat Bias. Speculation. Conflict of interest. Bias. Speculation. Conflict of interest. Serving as expert for own patient.Serving as expert for own patient.

Uniform StandardsUniform Standards

LegalLegal Case Law Case Law California CodesCalifornia Codes

Fam. Code Fam. Code 3110,3110, 3011, 31183011, 3118

Rules of CourtRules of CourtRules 1257.3, 1257.4, 1257.7Rules 1257.3, 1257.4, 1257.7

PsychiatricPsychiatric CompetenceCompetence

Clinical, scientific, forensic, Clinical, scientific, forensic, specific additional areas of specific additional areas of training and experience.training and experience.

Standard of CareStandard of CarePractice Parameters for Child Practice Parameters for Child Custody Evaluation of Custody Evaluation of American Academy of Child American Academy of Child & Adolescent Psychiatry& Adolescent Psychiatry

Sexual Abuse & Abuse Allegations Sexual Abuse & Abuse Allegations

Sexual AbuseSexual Abuse Clinical impactClinical impact Legal impactLegal impact Factor in custody/visitation determinationFactor in custody/visitation determination Tactic in custody/visitation disputeTactic in custody/visitation dispute

Abuse AllegationsAbuse Allegations OverviewOverview Forensic assessmentForensic assessment Reporting dutyReporting duty Consequences of false allegationsConsequences of false allegations

The Special IssueThe Special Issue

Do you think a 40-hour week is a vacation?Do you think a 40-hour week is a vacation?

Do you think going to jail is a good way to relax? Do you think going to jail is a good way to relax?

Does your blood pressure equal your hourly rate?Does your blood pressure equal your hourly rate?

When your mate asks how you feel, do you say…When your mate asks how you feel, do you say…

STOP INTERROGATING ME !STOP INTERROGATING ME !

and is this the response you get?and is this the response you get?

Attorney StressAttorney Stress

Burnout Burnout Secondary Traumatic StressSecondary Traumatic Stress Impact on PracticeImpact on Practice PreventionPrevention TreatmentTreatment

People v. ArnoPeople v. Arno90 Cal App. 3d 505, FN 290 Cal App. 3d 505, FN 2

““We feel compelled by the nature of the attack in We feel compelled by the nature of the attack in the dissenting opinion to spell out a response:the dissenting opinion to spell out a response:

1.1. SSome answer is required to the dissent’s charges.ome answer is required to the dissent’s charges.

2.2. CCertainly we do not endorse “victimless crime.” ertainly we do not endorse “victimless crime.”

3.3. HHow that question is involved escapes us.ow that question is involved escapes us.

4.4. MMoreover, the constitutional issue is significant.oreover, the constitutional issue is significant.

5.5. UUltimately, it must be addressed in light of precedent.ltimately, it must be addressed in light of precedent.

6.6. CCertainly the course of precedent is clear.ertainly the course of precedent is clear.

7.7. KKnowing that, our result is compelled…”nowing that, our result is compelled…”

SummarySummary

Custody evaluation is a medical legal activity of Custody evaluation is a medical legal activity of utmost value to society. utmost value to society.

Experts need clinical expertise, familiarity with Experts need clinical expertise, familiarity with applicable law, and be able to perform consistent applicable law, and be able to perform consistent with the principles and practices of forensic mental with the principles and practices of forensic mental health assessment.health assessment.

Manage stress before stress manages you!Manage stress before stress manages you!