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Criminal Forensic Psychiatry Principles and Practices Law of Crimes Forensic Questions Forensic Assessment Treatment Cou

Criminal Forensic Psychiatry Principles and Practices Law of Crimes Forensic Questions Forensic Assessment Treatment Court Movement San Mateo Pathways Program. Forensic Psychiatry. Answer legal questions in legal arena No duty to the client No “best interests”

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Criminal Forensic Psychiatry Principles and Practices Law of Crimes Forensic Questions Forensic Assessment Treatment Cou

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  1. Criminal Forensic Psychiatry Principles and Practices Law of Crimes Forensic Questions Forensic Assessment Treatment Court Movement San Mateo Pathways Program

  2. Forensic Psychiatry • Answer legal questions in legal arena • No duty to the client • No “best interests” • Need to know law as well as psychiatry • Ability to navigate an adversarial system • Always consider malingering • Good writing skills and good courtroom skills

  3. Percipient vs. Expert Testimony • Opinion evidence • Percipient • Expert • Admissibility vs. weight of evidence • Judicial gate keeper function • Fry • Daubert

  4. Principles • Honesty, objectivity, neutrality, abstinence, competence (legal and medical) • Duty is to patient replaced by duty to law • Best interest replaced by respect for autonomy • Special consent procedure • Address all evidence / challenge own opinions • Must explicate reasoning process

  5. Law of Crimes • Who is subject to punishment? • Penal Code • Misdemeanor vs. felony • Actus Reus plus men rea

  6. Typical Forensic Questions • Was the defendant mentally ill at time of crime? • If so, was he/she insane under California law? • Is the defendant mentally ill now? • If so, is he/she currently incompetent to stand trial • Did the illness impair ability to form requisite intent?

  7. Legal Reasoning • Question • Rule • Relevant facts • Reasoning process • Conclusion

  8. Competency to Stand Trial (1)U.S. vs. Dusky • "test must be whether he has sufficient present ability to • consult with his lawyer with a reasonable degree of rational understanding and • whether he has a rational as well as factual understanding of the proceedings against him.“ • If incompetent, remand to hospital for restoration of competency

  9. Competency to Stand Trial (2) SELL v. UNITED STATES • Permits involuntary use of antipsychotic drugs solely to restore competency to stand trial • Mentally ill defendant must be facing serious charges and drugs are necessary to • Treatment must be medically appropriate • Needed to restore competent to stand trial • Effects substantially unlikely to undermine fair trial • Is defendant dangerous

  10. Not Guilty by Reason of InsanityCalifornia Penal Code Section 27(b) • “… defense shall be found by the trier of fact only when the accused person proves by a preponderance of the evidence that he or she was • incapable of knowing or understanding the nature and quality of his or her act and [or] of • distinguishing right from wrong at the time of the commission of the offense.

  11. Link Between Mental Illness and Crime Judgment Impulse control Content of delusions or hallucinations Overwhelming emotion (overwhelms reason) Over reaction to perceived threat Anger Substance use m-TBI

  12. Treatment Court Movement • Law as first responder • Decrease jail time • Reduce risk to community • Evidence based therapeutic sentencing

  13. San Mateo “Pathways” Program • Joint Program – Court, Probation, Mental Health • Misdemeanor defendants who are SMI • Reduce recidivism / protect community • “Modify out to community treatment” • Therapeutic sentencing • Use of progressive sanctions • Special monitoring

  14. Therapeutic Sentencing Outpatient psychotherapy Residential treatment / supportive housing Dual diagnosis treatment AA, NA, CBT, anger management Med management Monitoring of substance use / social activities

  15. Forensic Experience Rotation • Pathways Program • Assess applicants for mental health court • Primary report to Pathways team • Secondary report for Stanford Program • Third Thursday of month • Maguire Jail or Probation Dept. Redwood City • Supervision by ACF forensic psychiatrist • Option to attend Pathways meeting and court

  16. Forensic Assessment • Know which “hat” you are wearing • Answer the legal question • Advocate for your opinion – not the client • Expose the limits of scientific certainty • Avoid too much jargon • Deal with disconfirming data • Consider malingering

  17. Forensic Report Writing • Identify referral source • State the forensic question and the relevant law • List and analyze documents reviewed • Informed consent • Clinical and forensic examination • Diagnosis • Forensic discussion – data, analysis, reasoning • Conclusion (reasonable medical certainty)

  18. Quick Links Seminar website: http://forensicpsychiatry.stanford.edu/Seminars/materials.htm Penal Code: http://www.leginfo.ca.gov/calaw.html

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