Criminal Responsibility

In order for a person to be found guilty of a crime, they must not only have committed a “forbidden act,” but also have had a “guilty intent” at the time of the alleged offense. There are jurisdictional variations in the types of criminal responsibility evaluations that a forensic psychiatrist may be asked to complete. For example, in California, criminal responsibility evaluations include those for not guilty by reason of insanity (NGRI) and diminished actuality defenses. Other types of criminal responsibility evaluations include diminished capacity and extreme emotional disturbance.

The standards for criminal responsibility defenses also vary depending on the jurisdiction. For example, in some states, an individual may be found not guilty by reason of insanity if, as a result of a mental illness, they did not know the nature and quality and/or the wrongfulness of the alleged offense. Other states’ sanity statutes include a consideration of whether the individual’s actions were within their volitional control.

Criminal Competencies

Competence is the quality or condition of being legally qualified to perform an act and/or make decisions. Being “competent” usually requires the ability to understand a body of knowledge and rationally apply that knowledge to a decision-making process. A forensic psychiatrist may be consulted in criminal cases if a defendant’s competence to perform a particular task related to the legal proceedings is called into question. Examples of types of criminal competence evaluations include competence to stand trial, competence to waive Miranda rights, competence to proceed pro se (i.e., to represent oneself), competence to testify, competence to plead guilty, and competence to refuse an insanity defense.

Risk Assessment

Forensic psychiatrists may be asked to evaluate a defendant’s risk of general or sexual violence using a combination of clinical judgment and psychological assessment instruments.

Malingering assessment

Malingering is defined by the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) as the intentional production of false or grossly exaggerated physical or psychological problems for an external incentive. Individuals may malinger a variety of different psychiatric symptoms and conditions including psychosis, memory impairment, low intelligence, depression, and post-traumatic stress disorder (PTSD). There are a number of reasons why individuals may malinger. For example, defendants may feign psychiatric symptoms in order to be found not guilty by reason of insanity, and plaintiffs may malinger in order to obtain damages for an alleged psychiatric injury. Forensic psychiatrists may be asked to evaluate whether an individual is malingering.

Psychiatric Malpractice and Deliberate indifference

Physicians have a duty to their patients to use the degrees of knowledge, skill, and care that are ordinarily possessed and expected of other members of his or her profession in similar circumstances. When a psychiatrist breaches this duty and their breach directly harms a patient, they may be sued for malpractice. In correctional settings, suits may be brought when deliberately indifferent (i.e., subjectively reckless) treatment or management directly harms an inmate.

Common types of psychiatric malpractice cases include those related to incorrect treatment or diagnosis, suicide or attempted suicide, drug reactions, inadequate informed consent, breach of confidentiality, and inappropriate management of risk (e.g., unnecessary involuntary commitment). Forensic psychiatrists may be consulted in malpractice cases to help determine whether the treatment or management in question fell below the standard of care, as well as whether the negligent care was causally related to the damages.

Psychic harm and worker’s compensation

When one individual’s actions harm another, the injured party may be compensated. This compensation may be in the form of tort law, worker’s compensation, social security, or other disability benefits. A forensic psychiatrist may be consulted to determine whether a person’s conduct caused another individual to develop emotional distress or a psychiatric disorder.

Civil Competencies

Competence is the quality or condition of being legally qualified to perform an act and/or make decisions. Being “competent” usually requires the ability to understand a body of knowledge and rationally apply that knowledge to a decision-making process. In a civil setting, a forensic psychiatrist may be asked to determine whether an individual has the capacity to write a will (i.e., testamentary capacity), to make financial decisions, or to enter into a contract. They may also be asked to assess an individual’s capacity to make medical decisions as well as whether the individual needs a guardian or a conservator.

Other Issues Related to Employment

Forensic psychiatrists may be consulted on a number of issues related to employment. As mentioned above, they may be asked to evaluate worker’s compensation and sexual harassment claims. In addition, if an employer becomes concerned that their employee is disruptive and/or violent, a psychiatrist may conduct a fitness for duty evaluation to determine whether the employee is able to perform his or her essential job functions safely. This includes the evaluation of impaired professionals, including physicians and police officers.

Forensic psychiatrists may also be asked to conduct disability assessments. “Disability” is defined differently by different agencies, so the forensic psychiatrist must tailor his or her evaluation to the specific definition being used. Types of disability evaluations include those done for worker’s compensation, the veterans’ administration, the social security administration, and private insurance companies.

Forensic psychiatrists may also be consulted to evaluate Americans with Disabilities Act (ADA) claims. The ADA prohibits discrimination against individuals with disabilities in employment settings. It requires employers to provide reasonable accommodations to individuals with disabilities in order to help them to perform their essential job functions.