Forensic Psychiatry Relation With Law
Forensic Psychiatry Relation With Law
Forensic Psychiatry Relation With Law
Legal Context
Psychological Evaluations for the Courts:
A Handbook for Mental Health Professionals
and Lawyers (Melton et al, 2007)
During the process, they must keep in mind that the system for
which they are working (i.e., judicial) denies a fundamental
theoretical premise of much of psychiatry (i.e., that all behavior is
influenced by unconscious forces beyond the control of the actor and
is thus, to some extent, involuntary and predetermined).
DSM-IV Cautionary Statement
It is to be understood that inclusion [in DSM-IV], for clinical
and research purposes, of a diagnostic category such as
Pathological Gambling or Pedophilia does not imply that
the condition meets legal or other non-medical criteria for
what constitutes mental disease, mental disorder, or
mental disability.
Economic Context
Texas Mental Health Budget Could Be Cut
By as Much as 40% (KHOU-TV, 2011)
Type % Type %
Psychiatry/Psychology 29 Sociology 8
Medical/Health 20 Pharmacology 4
Chemistry 13 Statistics 4
Toxicology 10 Engineering/Physics 3
Economic 9 Epidemiology 1
Mental States, Motivations, and Behaviors
During Past Events
Adapted from Heilbrun, Grisso, & Goldstein (2009)
For all those reasons, even once their general cognitive abilities
approximate those of adults, juveniles are less capable than adults of
mature judgment, and more likely to engage in risky, even criminal,
behavior as a result of that immaturity.
Graham v. Florida, 2010 (Vote: 6-3)
It is so ordered.
DISSENT: “The [trial] court ordered the premature release of
approximately 46,000 criminals—the equivalent of three
Army divisions...
90
80
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40
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20
10
0
Low Moderate High
Psychiatric and Psychological Research for
Evidence-Based Law Making
Outpatient Commitment in New York
• Increased medication adherence
• Reduced inpatient hospital admission
• Reduced inpatient hospital days
• Reduced arrest rate
• No differences with the comparison group in
perceived coercion, working alliance, or
treatment satisfaction
• Statute renewed for 5 years.
Interventions Used by Colleges to Respond
to Student Mental Health Crises
Monahan, Bonnie, Davis, & Flynn, Psychiatric Services, in press.
Public 11,117 6
Private 2,800 11
Community 0 0
Care Accessed at the CC: Suicidal Ideation
and Ideation of Violence to Others
Mean % at CC w Mean % at CC w Ideation
Suicidal Ideation of Violence to Others
Public 15 4
Private 12 1
Involuntary Medical Withdrawal
“[The College] reserves the right to require a
medical withdrawal if the student:
Presents an ongoing, clear and present danger to
self and/or others; [or]
Shows potential for presenting a clear and present
danger, and refuses to cooperate with treatment
recommendations.”
91% of private colleges—but only 47% of public
colleges— have involuntary medical withdrawal.
Psychiatrist/Psychologist Recommendation
for Reenrollment at the University of Virginia
“DSM-IV diagnosis; # of times patient was seen by you since
withdrawal; prescribed medications and dosages
Issues addressed in treatment
Functional difficulties which need to be addressed in
continued treatment or which may pose difficulties in
relation to student’s reenrollment [including homicidal or
suicidal ideation/intent]
Your recommendation: patient is/is not ready to return
Recommended treatment plan if patient returns:
continued treatment is/is not necessary.”
August 24, 2010
A new [computer] prompt each fall will ask that students
disclose relevant criminal arrests or convictions [i.e., all
arrests/convictions except minor traffic violations] and will
also remind them of their continuing duty to do so within
72 hours of any future such incident.