Criminal Forensic PsychiatryACGME Requirement

Treatment CourtCompetency to Stand Trial

Forensic Report

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Quick Links

Forensic experience materials:http://forensicpsychiatry.stanford.edu/Seminars/materials.htm

California Penal Code:http://www.leginfo.ca.gov/calaw.html

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Law of Crimes

Protective purpose Restrain, rehabilitate, deter, vindicate law Penal Code Crime is union of actus reus and mens rea

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Link Between Mental Illness and Crime

Impaired executive functions Delusions and hallucinations Overwhelming emotion Overreaction to “threat” Substance abuse TBI Personality disorder

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The Forensic Psychiatrist Answer legal question in legal arena No “best interests” No “do no harm” Need to know law as well as psychiatry Must understand legal reasoning Must consider malingering in every case Need good writing skills Need to adapt to adversarial system

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Ethics Honesty, objectivity, neutrality, competence Duty to law and to truth Must respect patient’s “personhood” Consent and non-disclosure statement Consider all evidence Explicate reasoning process

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Percipient vs. Expert Testimony

Evidence must be relevant, probative Judge decides admissibility Jury decides weight to be given Percipient vs. expert witness Rule against admissibility of junk science

Frye: special expertise, general acceptance Daubert: special expertise, general acceptance, focus on

methodology (peer reviewed, known error rates, etc.)

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Forensic Questions

Is defendant mentally ill now? If so, is he currently incompetent to stand trial?

Was defendant mentally ill at time of crime? If so, was he insane under California law?

Did illness impair ability to form legal intent? What are the treatment options? What is risk to community if not incarcerated?

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Forensic Assessment

Fact heavy Answer legal question Consider all the evidence plus malingering Write for legal as well as medical audience Explicate scientific and legal reasoning Expose limits of certainty

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Reasoning Process

Scientific Scientific question Focus on methodology Empirical Quantitative Reproducible Statistical reliability

Legal Legal question Legal rule Relevant facts Reasoning process

Major premise Minor premise

Logical conclusion

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Treatment Court Movement

Decrease jail time / cost Law as first responder Therapeutic sentencing Reduce risk to community Drug, mental health, veterans courts

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Forensic Experience Rotation

Pathways Program Assess applicants for mental health court Prepare report to Pathways team

Third Thursday of month Maguire Jail or Probation Dept., Redwood City Supervision by ACF forensic psychiatrist Write report Meet with supervisor

Other opportunities

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San Mateo “Pathways” Program

Joint Program – Probation and Mental Health Misdemeanor defendants who are Axis I SMI Reduce recidivism / protect community Modify sentence to community treatment Progressive sanctions Therapeutic sentencing

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Pathways Forensic Questions

Is the defendant seriously mentally ill? Is there a link between illness and crime? Is there community treatment? Would sentence modification to community

treatment decrease the likelihood of reoffending without exposing the community to undue risk of harm?

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Therapeutic Sentencing

Outpatient psychotherapy Medication management / psychotherapy Residential care / supportive housing AA, NA, CBT, anger management Monitoring substance use, med compliance Rehabilitation / reintegration programs Intensive case management

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Generic Forensic Report Identify referral source Identify forensic question and relevant law Consent / statement of non-confidentiality Case facts Identify and analyze relevant documents Clinical and forensic examination Diagnosis Diagnostic and forensic discussion Medical and Legal Conclusions

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The Forensic Report for Pathways

Two parts: The mental health court report The competency to stand trial report

The online report template

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Competency to Stand Trial (1)

Fundamental fairness – 5th, 6th, 14th Amendments

Defined at Cal Penal Code Section 1367 Principle case law – Dusky and Sell Critical phases of trial:

confess, waive Miranda, plead guilty, testify, represent self, be executed

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Competency to Stand Trial (2)Dusky vs. US

“whether he has sufficient present ability to consult with lawyer with a reasonable degree of

rational understanding and whether he has a rational as well as factual

understanding of the proceedings against him.“ If incompetent, remand to hospital for

restoration of competency

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Competency to Stand Trial (3) Sell vs. US

Involuntary drugs to restore competency Defendant must be facing serious charge Drug must be medically appropriate Side effects unlikely to undermine fair trial

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Competency to Stand Trial (4) Assessment

Mental status examination Case related motivation / knowledge Quality of relating to attorney Capacity to engage legal needs at all critical

points in the case

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