According to the American Academy of Psychiatry and the Law, it is defined as "a subspecialty of psychiatry in which scientific and clinical expertise is applied in legal contexts involving civil, criminal, correctional, regulatory, or legislative matters, and in specialized clinical consultations in areas such as risk assessment or employment.
The two major areas of criminal evaluations in forensic psychiatry are competency to stand trial (CST) and mental state at the time of the offense (MSO).
CST, sometimes referred to as adjudicative competency, serves three purposes: "preserving the dignity of the criminal process, reducing the risk of erroneous convictions, and protecting defendants' decision-making autonomy".
[3] In 1960, the Supreme Court of the United States in Dusky v. United States established the standard for federal courts, ruling that "the test must be whether the defendant has sufficient present ability to consult with his attorney with a reasonable degree of rational understanding and a rational as well as factual understanding of proceedings against him."
As such, prominent leaders in the field of forensic psychiatry, from Thomas Gutheil[4] to Robert Simon and Liza Gold[5] and others[6] have identified teaching as a critical dimension in the role of expert witness.
Much of forensic psychiatry is guided by significant court rulings or laws that bear on this area which include these three standards:[7] "Not guilty by reason of insanity" (NGRI) is one potential outcome in this type of trial.
Risk assessment and management is a growth area in the forensic field, with much Canadian academic work being done in Ontario and British Columbia.
More recently, use is being made also of "dynamic" risk factors, such as attitudes, impulsivity, mental state, family and social circumstances, substance use, and the availability and acceptance of support, to make a "structured professional judgment."
This may entail monitoring, treatment, rehabilitation, supervision, and victim safety planning and depends on the availability of funding and legal powers.
Risk management in forensic psychiatry is often done using standardised tests called structured professional judgement tools.
In the UK, most forensic psychiatrists work for the National Health Service, in specialist secure units caring for mentally ill offenders (as well as people whose behaviour has made them impossible to manage in other hospitals).
[citation needed] These workers play an important role in combating the phenomenon of "double revolving doors" between hospitals and prisons.
[citation needed] Mental Health Acts specify the circumstances under which individuals may be brought against their will to a psychiatric facility for examination or assessment and possible admission.
It can be initiated by a physician for psychiatric assessment of the person or examination of the person ordered by a judge, magistrate or justice of the peace [16] Concerns have been expressed [citation needed] that the Canadian criminal justice system discriminates based on DSM IV diagnosis within the context of Part XX of the Criminal Code.
[17] This part sets out provisions for, among other things, court ordered attempts at "treatment" before individuals receive a trial as described in section 672.58 of the Criminal Code.
The position of the Canadian Psychiatric Association holds, "in recent years, serious incursions have been made by governments, powerful commercial interests, law enforcement agencies, and the courts on the rights of persons to their privacy."
This may seem unusual given that a result of a verdict of "Not Criminally Responsible by reason of Mental Disorder" is often portrayed as desirable to the defence, similar to the insanity defense in the United States.
[citation needed] Some Internet references address treatment/assessment conflict as it relates to various justice systems, particularly civil litigation in other jurisdictions.
[24][25] The American Academy Of Psychiatry and the Law states in its ethics guidelines, "when a treatment relationship exists, such as in correctional settings, the usual physician-patient duties apply", which may be seen as contradiction.
[26] In South Africa, patients are referred for observation for a period of 30 days by the courts if questions exist as to CST and MSO.
Forensic psychiatrists typically have additional training that is relevant to the job they hold (such as a focus in child/adolescent, geriatric, or addiction).
In the United States, one-year fellowships are offered in this field to psychiatrists who have completed their general psychiatry training.