Principles and Practice of Child and Adolescent Forensic Mental Health

Child psychiatrists meet the mental health needs of children and adolescents by using developmentally sensitive assessment and treatment interventions. The U.S. legal system, as well, is cognizant of the unique status of minors. There are special courts, legal language, and laws to meet the needs of youths. In the 21st century, the following areas of interest to child mental health professionals have been addressed by U.S. governmental and court systems: education rights of juveniles, the release of mental health information by schools to emergency health care providers, gay and lesbian parenting and adoption, rehabilitation of juveniles in detention and corrections facilities, miranda warnings, the death penalty for juvenile offenders, and life without parole for juveniles.

The rapidly changing climate of child forensic mental health has suggested the need for an updated version of Principles and Practice of Child and Adolescent Forensic Psychiatry, the Guttmacher Award-winning text edited by longtime collaborators Diane Schetky and Elissa Benedek. Yet, the field has not grown enough to warrant a revised text of that volume. Benedek's solution was to introduce cutting-edge topics in juvenile forensic psychiatry into the book, while expanding the book's audience to include mental health professionals of various disciplines, including forensic psychiatrists. She recruited two leaders in the field of child and adolescent forensic psychiatry, Peter Ash, MD, and Charles L. Scott, MD, to collaborate with her on the project. The resulting book, Principles and Practice of Child and Adolescent Forensic Mental Health, is an accessible 21st century resource that should be on the short list of references for children's mental health professionals who are seeking to expand their libraries.

The text is divided into seven sections and 33 chapters. Each chapter contains a discussion of legal issues, illustrative case examples, and a key points section that summarizes important concepts. The book is written in a clear and concise style that works well for early career and more experienced mental health professionals. At times, however, the content struggles to meet the needs of the editors' intended audience. For example, “Ethics of Child and Adolescent Forensic Psychiatry” is specifically geared toward psychiatrists. The chapter does not examine ethics in other mental health professions, and there is no appendix that refers readers to other resources for guidance. A similar concern applies to Chapter 30, “Malpractice and Professional Liability.”

The “Basics” section of the book contains timely discussions of “Forensic Telepsychiatry” and cultural competence. “Introduction to Forensic Evaluations” contains an editorial error on page 30. The text reads “Abuse or neglect cases usually have clear and convincing evidence as the standard.” In fact, preponderance of the evidence is the standard in most jurisdictions for child abuse and neglect cases. The legal standard for termination of parental rights in most jurisdictions is clear and convincing evidence.¹ Otherwise, the chapter, provides a concise review of fundamental concepts and is a pleasure to read.

The second section of the book contains two chapters that describe the “Legal Regulation of Psychiatric Practice.” Although I enjoyed the thoughtful discussion of intellectual disability and the law, it seems better suited to an adult forensic mental health text. The chapter did not address matters in a developmentally sensitive fashion that would benefit professionals who work with minors. For example, youths who have intellectual disabilities are less likely to have their cases transferred to criminal court. However, they are at risk of exploitation and warehousing in residential facilities and community-based programs. These concerns should be addressed by the courts with input from mental health professionals.

The book includes a timely discussion of “Special Issues in Transcultural, Transracial, and Gay and Lesbian Adoption.” This chapter should be essential reading for child custody evaluators as well as mental health and social services professionals who seek to obtain a more objective understanding of these controversial topics.

Child abuse and neglect are important concepts for mental health clinicians and forensic mental health professionals. The book contains a section that addresses the fundamentals of interviewing suspected victims of sexual abuse, suggestibility of children's statements, and Munchausen syndrome by proxy. Although these chapters may be suitable for trainees in child psychiatry and other mental health professionals, they seem relatively limited, given the body of literature in this area. In a book of this scope, however, editorial decisions must be made to balance the content. Fortunately, the references in these chapters serve as a springboard for additional reading about these topics.

“Youth Violence” is one of the stronger sections of the book. “Taxonomy and Neurobiology of Aggression” contains a concise summary of genetic studies, as well as case examples to illustrate proactive and reactive aggression for readers who are seeking to deepen their knowledge of these subjects. Discussions about violence risk assessment and prevention and school violence are well articulated. The review of juvenile stalkers, however, could have been more detailed. Some of these youths have mental disorders for which treatment may improve receptivity to clinical intervention, although it may not alter recidivism rates. Also, a discussion of the timely topic of “sexting” would be welcome in a future edition.

Notably, a discussion of forensic mental health evaluation and treatment in juvenile detention and correctional settings was not included, despite the ongoing controversy about these facilities being primary or de facto mental health care systems for juveniles. Readers need to be aware of this problem, especially since suicide rates are higher in residential juvenile justice settings than in the community. Perhaps the editors will consider including in a future edition these topics as well as discussions about rehabilitating children and adolescents who engage in sex offenses. The latter topic is one that I am frequently asked about by child psychiatry residents.

Overall, the editors have made a laudable effort to provide a basic academic text in forensic mental health that meets the needs of various disciplines. The book is a valuable resource for mental health professionals who want to understand the forensic impact of everyday concerns in children's mental health.

• © 2011 American Academy of Psychiatry and the Law