This Practice Resource describes salient concerns within reproductive psychiatry (also known as women’s mental health) for the practice of forensic psychiatry. Understanding is essential and can help combat gender bias in such evaluations. Forensic psychiatric evaluations in the criminal realm, including evaluations related to neonaticide, infanticide, filicide, child abuse, and kidnapping by Cesarean, require an understanding of reproductive psychiatry. Civil forensic evaluations requiring knowledge about reproductive psychiatry include parenting evaluations and risk assessments in the postpartum. Similarly, forensic psychiatrists performing a treatment role within corrections or forensic hospitals should recognize the importance of understanding mental illness in pregnancy and postpartum, lactation, mother-baby units, and forced separation or custody loss. In addition to menstruation, pregnancy, and postpartum, specific concerns that bear consideration within reproductive forensic psychiatry include the periods of girlhood and menstruation. Finally, eating disorders and substance misuse bear additional attention in this group.
The Council of the American Academy of Psychiatry and the Law (AAPL) approved a task force to develop this document in the autumn of 2020. The AAPL Council approved the version posted online on June 1, 2024.
This Practice Resource reviews the literature and gives expert opinion to guide and assist in evaluating and treating women across life stages in forensic psychiatry. The process of developing this document incorporated a thorough review that integrated feedback and revisions from AAPL members into the final draft. It reflects a consensus among members and experts about the principles and practice of reproductive psychiatry and women’s mental health with specific relevance to the practice of forensic psychiatry. Although recommendations are sometimes articulated when supported by research evidence, ethics standards, or expert opinion, this document should not be construed as a practice guideline or as dictating the standard of care. Rather, it is intended to inform practice in this area.
The AAPL Practice Resource for Reproductive Psychiatry and Women’s Mental Health in Forensic Psychiatry Practice is organized in the following way. The Introduction describes the document and reviews: mental illness and pregnancy; miscarriage and elective termination and their relationship to mental health; pseudocyesis and delusional pregnancy; and the converse, denial and concealment of pregnancy. The second section describes gender bias in both forensic evaluations and the criminal justice system. Next, the document focuses on criminal forensic psychiatry, including justice-involved female youth, menstruation, and specific criminal evaluations in postpartum and parenting. Then, the document turns to reproductive concerns within correctional facilities and forensic hospitals, including pregnancy, postpartum and parenting, menopause, and addiction among reproductive age women. Next, civil forensic evaluations are considered, including in pregnancy, postpartum, eating disorders, and abuse of elderly women. The document concludes by summarizing the importance of an understanding of women’s reproductive mental health being essential for forensic psychiatrists in civil, criminal, and correctional work.
This document is intended to educate students, psychiatry residents, and forensic psychiatry fellows; to be a resource for those currently providing psychiatric care for women and girls; and to identify gaps in the existing knowledge base and current practices that present opportunities for research and policy development.
Footnotes
Disclosures of financial or other potential conflicts of interest: None.
- © 2024 American Academy of Psychiatry and the Law
