Journal of the American Academy of Psychiatry and the Law Online published ahead of print

Options for the Forensic Mental Health Evaluator When Retaining Counsel Is Impaired

Brodsky, S. L., Coffey, C. A., Drogin, E. Y., Gutheil, T. — 2026-05-07T08:03:57-07:00

When forensic mental health professionals find themselves working with seemingly impaired attorneys, a substantial dilemma is presented. The forensic professional must consider how, if at all, to respond to legal performance deficits that may reflect dementia, a substance use disorder, a mood disorder, or some other identifiable psychiatric condition. Two de-identified cases are presented that highlight the difficulty of providing expert witness and consultation services under such circumstances. Codified ethics guidance for attorneys, psychiatrists, and psychologists offers relevant, albeit rather limited, direction. Several overlapping options are proposed, including discreet inquiry, frank discussion, treatment referral, and withdrawal from participation.

Legal and Forensic Perspectives on Civil Litigation Capacity

Khalsa, P. R., Glancy, G. — 2026-04-22T09:16:51-07:00

Although forensic psychiatric assessments of fitness to stand trial are well established in criminal law, the analogous question of civil litigation capacity, particularly the ability to commence or continue legal proceedings, receives far less attention. In this article, we examine the statutory frameworks and case law governing litigation capacity in Canada and the United States. Focusing on decisions such as Carmichael v. GlaxoSmithKline Inc. and In re Mirapex Products Liability Litigation, we analyze the legal criteria used to toll limitation periods, evaluate how courts distinguish functional incapacity from psychiatric diagnosis, and highlight the presumption of capacity as a core principle. We also consider comparative standards, emerging rights-based approaches under the United Nations Convention on the Rights of Persons with Disabilities (CRPD), and the implications for forensic psychiatric practice. Emphasis is placed on the importance of functional assessment and supported decision-making models, offering forensic clinicians practical guidance aligned with contemporary legal values.

The Pendulum Swings from Deinstitutionalization to Expanded Civil Commitment

Huselid, A. N., Zare, A., Griffiths, J., Fisher, K. — 2026-03-30T05:19:50-07:00

Over time, U.S. civil commitment laws have evolved from broad, paternalistic statutes to more narrowly defined legal standards that emphasize individual liberty, least-restrictive treatment, and due process. This shift contributed to deinstitutionalization as state hospital beds decreased and the number of those meeting the new involuntary commitment standards diminished. Subsequent analyses found that, as states narrowed their criteria for involuntary commitment and as community mental health systems strained to absorb the gap, homelessness and criminal justice involvement among people with mental illness increased. Recently, some states and localities have begun to examine their civil commitment frameworks, aiming to broaden eligibility to address complex social and public safety concerns. This article examines these nationwide occurrences and trends through the lens of New York, California, and Minnesota, analyzing their legal reforms and exploring the ethics tensions they raise. These developments reflect a recurring tension between respect for individual autonomy and society’s obligations to provide care and ensure public safety, a dynamic that continues to shape modern civil commitment frameworks.

A Pilot Curriculum for Teaching Social Justice in Forensic Psychiatry Fellowships

Burke, C., Kapoor, R., Dike, C., Bryant, P., Parke, S., Prabhu, M. — 2026-03-30T05:13:49-07:00

Medical schools and residency programs vary widely in the depth and breadth of training offered within their social justice curricula, creating an uneven knowledge base for incoming forensic psychiatry fellows. To address this disparity, a core faculty group in a forensic psychiatry fellowship designed a novel social justice curriculum to ensure that all fellows possess the knowledge needed for competent forensic evaluation and treatment. The course begins with an introduction to the ethics of practicing within an unjust system and utilizes a three-tiered model that explores the social determinants of outcomes within the legal system, bias in forensic evaluation, and special population considerations. The curriculum is designed to provide a space for fellows to discuss the influence of identity on legal and forensic mental health outcomes, enhance their knowledge of social justice, recognize and reduce their biases, and understand the lived experiences of those whom they evaluate and treat. This course provides a potential solution for training inequities and offers a national model to ensure that all fellows, regardless of previous educational experiences, receive training that is vital to competent practice in forensic psychiatry.

Examining Contributors to Burnout and Well-Being in U.S. Forensic Psychiatrists

Wilkie, T., Jones, R. M., Maheandiran, M., Ramshaw, L., Chatterjee, S. — 2026-03-20T09:00:19-07:00

Burnout and well being in forensic psychiatrists have been insufficiently examined, with most research focusing on vicarious trauma, compassion fatigue, or posttraumatic stress disorder among forensic mental health professionals. Previous research in Canada from 2023 highlighted a high prevalence of burnout among forensic psychiatrists, particularly among early-career psychiatrists, those whose values were misaligned with their institution, and those who had a low perceived control over their workload. Building upon this, the current study provides an assessment of the U.S. workforce in forensic psychiatry, identifying aspects of practice that contribute to, or mitigate, burnout and enhance professional fulfillment. Survey results of American Academy of Psychiatry and the Law (AAPL) members (response rate 11%) indicated that those experiencing burnout were younger, female, perceived to have had less control over their workload, spent more time on the electronic medical record (EMR), and felt their values were misaligned with leadership and colleagues. Factors predicting professional fulfillment were overall job satisfaction, value alignment with colleagues, and mentoring others. The findings of this survey will help to identify interventions at institutional and systems levels to address contributors to burnout, promote professional fulfillment and well being, and enhance recruitment and retention in the field of forensic psychiatry.

Forensic Policy Considerations of Childhood Lead Toxicity

Zhang, R., Herger, M. — 2026-03-16T09:25:15-07:00

Childhood lead toxicity remains a nationwide problem, despite significant progress in reducing exposure sources in the United States since the 1970s. Neurodevelopmental sequelae of lead exposures often persist into adulthood, with limited reversibility. These include long-lasting deficits in intelligence, impulse control, and emotional and behavioral regulation, which can increase one’s propensity for aggression and criminality. Yet, despite the strong association between lead poisoning and criminality, there is little agreement thus far among U.S. jurisdictions about how to apply such knowledge to criminal legal proceedings. Here, we explore forensic considerations of childhood lead toxicity for evaluation, sentencing, and staff support in the criminal justice system. We cite both clinical science and case law in navigating this complex intersection of forensic psychiatry, public health, and the environment. We aim to provide preliminary guidance on how forensic psychiatrists can approach and refer to lead toxicity in their medicolegal work. This article may hopefully inspire further forensic research on the topic and the eventual creation of standardized, lead-related guidelines for criminal legal proceedings.

The Journal of the American Academy of Psychiatry and the Law

2021-05-05T11:25:13-07:00