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To provide practical guidance for the performance of forensic psychiatric assessments.
To provide information for clinicians and trainees.
To improve resources for teaching and training.
To create a template to improve consistency of assessments.
To help identify future research directions.
Before conducting an assessment, the expert must: Determine whether there is any conflict of interest.
Determine whether there are limitations to objectivity.
Identify limitations regarding licensure.
Determine what expertise is necessary.
Estimate the time and resources needed to respond to the referring agent.
Understand the role of the expert in the case.
The retainer letter might include: The specific psycholegal question.
The role of expert.
The time frame, with any deadline.
An estimation of the time needed for the assessment (when appropriate).
The fee structure (where appropriate).
Evaluees must be informed of: The limits of confidentiality, including:
That the evaluation will be sent to retaining party.
That the evaluation is not for treatment.
Legal matters, including:
The mandatory and permissible reporting requirements.
The possibility of disclosure in open court.
The right to decline to answer questions.
Collateral information is obtained from: Written records collected from various sources.
Medical and psychiatric records.
Interviews with various sources who are familiar with the patient.
Personal records: Past and present mental health treatments
Substance abuse treatment
Medical history and treatments
Psychological testing results
Expert declarations and prior forensic reports
Educational history
Occupational history
Military history
Arrest history
Histories of detention and incarceration
Personal notes
Diaries
Computer files
Cellular telephone records and text messages
Criminal assessments: Police reports
Grand jury minutes
Investigation reports
Witness interviews
Police interrogation tapes and interview transcripts
Tapes of jail conversations
Civil assessments: Job description
Work investigations and employment hearings
Educational history
Depositions of the plaintiff, treatment providers, and other relevant parties
History of lawsuits
Undercover investigation reports or videotapes
Financial institution records
Collateral information to assess criminal responsibility: Police reports
Witness statements
Contemporaneous medical and psychiatric records
Collateral sources
Ensure safety of evaluator and evaluee.
Establish entry and exit strategies.
Ensure maximum privacy.
Consider and negotiate the presence of third parties.
In general, open-ended questions
Neutral attitude
Forensic empathy
Awareness of countertransference
Repeated interviews, if necessary
Take careful notes.
Consider audio- or video-recording the interview.
Notify evaluee of the recording.
Retain all materials, as per jurisdiction.
Civil Criminal Psychic trauma
Medical malpractice
Disability, fitness for duty, or worker's compensation
Child custody
Civil commitment
Psychological autopsy
Competence
Testamentary capacity
Competence to make health care decisions
Competence to manage financial affairs
Competence to enter into a contract
Guardianship assessmentsCompetence or fitness to stand trial
Insanity/not criminally responsible due to mental disorder
Competence to waive Miranda rights
Aid in sentencing
Sexually violent predator (United States)
Dangerous or long-term offender (Canada)Neurological illnesses
Head injuries and sequelae
Endocrine diseases
Chronic diseases or chronic pain
Hospitalizations
Relevant medications
Duration and amount of exposure to trauma
Evaluee's perception of the event
Impact of the trauma
Immediate
Medium-term
Long-term
Treatment provided
Factors that aggravate or relieve symptoms
Social activities
Activities of daily living
Relationships
Other social stressors
Detailed occupational history
Current work and income
Previous work and income
Problems encountered in the workplace
Attempts to return to work
Perceived barriers to return to work
Appearance, attitude, and behavior
Mood and affect
Speech and thought form
Speech and thought content
Perception
Cognition
Insight and judgment
Georgia Court Competency Test–Mississippi State Hospital version109
The Competence Assessment for Standing Trial for Defendants with Mental Retardation110,111
Interdisciplinary Fitness Interview–Revised112
MacArthur Competence Assessment Tool–Criminal Adjudication113
Fitness Interview Test (Revised Edition)114
Evaluation of Competency to Stand Trial–Revised (ECST-R)115
The METFORS Fitness Questionnaire (MFQ)116
Forensic assessment instruments
Psychological testing
Actuarial tests and structured professional judgment guides
Physical examination and investigation
Neuroimaging and electroencephalogram
Penile plethysmography and visual reaction time
Preexisting conditions
Personality disorders
Malingering
Somatization
Genetic predisposition
Effects of litigation
Causality
Link between the mental disorder and occupational impairment
Etiology of the mental disorder
Restrictions
Limitations
Prognosis
Adequacy of treatment
Secondary gain/malingering
Accuracy of history
Contemporaneous record (notes, recordings)
Referral for treatment
Prevention of possible violence
Congenital aphasia
Neurologically acquired aphasia
Catatonia
Conversion disorder
Selective
Malingering
Informed consent or assent
Observation by third parties
Avoidance of leading questions in interviews
Published standards for sexual abuse or custody
An intellectual disabilities (ID) were a developmental impairment that results in cognitive ability and adaptive functioning that are substandard to a significant degree. More specifically, ID is defined by a combination of three factors:
Deficits in intellectual functioning confirmed by both clinical assessment and individualized standardized intelligence testing.
Deficits in adaptive functioning in one or more of the following adaptive skills areas:
Communication
Social participation
Independent living
Onset during the developmental period.
Unlike the the DSM-IV-TR, the DSM-5 rates severity of ID by severity of adaptive functioning, not by IQ score.
Choose an appropriate location.
Have family and caregivers present.
Obtain a reliable history.
Ensure informed consent.
Use a team approach.
Use direct observation in a familiar environment.
Diagnosis
Identification of relevant cultural factors
Consideration of evaluee's distinctiveness
Avoidance of stereotyping
Validation of testing
Consideration of the meaning of language
Respect for and knowledge of cultures
Marked inconsistencies and contradictions
Improbable psychiatric symptoms
Mixed symptom profile: endorsement of depressive symptoms while mood is euphoric
Overly dramatic behavior
Extremely unusual responses to questions about improbable situations
Evasiveness or noncooperation
Excessively guarded or hesitant responses
Frequent repetition of questions
Frequent declaration of ignorance (“I don't know”) in response to simple questions
Hostile, intimidating behavior, seeking to control or refusing to participate in the interview
Overemphasis of positive symptoms of schizophrenia
Review psychiatric records.
Review all relevant sources of collateral information.
Identify plausible external incentives to malinger.
Conduct forensic psychiatric assessment(s) (may require several sessions and/or extended length).
Conduct behavioral observations (especially over time and/or on inpatient unit).
Determine specific period for which evaluee may be attempting to malinger symptoms (e.g., currently, at time of offense, or both).
Carefully analyze all clinical indicators of malingering.
Apply model criteria for the assessment of malingering in defendants (Summary 10.6).
Obtain psychological testing if necessary (e.g., MMPI-2, SIRS-2, M-FAST, PAI, TOMM).
Support conclusion of malingering with multiple factual bases.
