Forensic Psychiatry: Expertise In Legal And Clinical Contexts

Many people have a basic idea of forensic science because of how it is represented in popular crime investigation shows, where we can watch the characters figure out who committed a crime and how it was done. As in television shows, forensic science is used in real life in courts and other legal situations, usually as a means of gathering evidence for use in criminal cases. Forensic science combines many scientific disciplines, including physics, chemistry, and biology.

Two other branches of forensic science are forensic psychology and forensic psychiatry. Each of these disciplines relates to the human mind within the context of the judicial system, using principles from the behavioral sciences to address various legal concerns. However, there are some important differences between them.

Forensic psychiatry vs. psychology

In addition to finishing medical school, a professional typically must complete a residency training program and a fellowship—in which they receive on-the-job training in a forensic setting—prior to practicing. They may acquire additional qualifications through board certification, which can signal to employers that the professional has gained the skills and knowledge required to practice forensic psychiatry. Additionally, psychiatrists can further specialize in areas like forensic child and adolescent psychiatry or forensic geriatric psychiatry. 

Once they’re licensed to practice, forensic psychiatrists can work in various legal contexts. A forensic psychiatrist may be called in to assist with a case that involves a plea of insanity, or they may testify about an individual’s competency to stand trial or to manage their own affairs. 

 Forensic psychiatry: Key players in mental health assessment and legal proceedings

A forensic psychologist has a doctorate in psychology (either Ph.D. or Psy.D.) rather than a medical degree. Their specialty may include administering psychological tests and providing related expertise. A forensic psychologist typically works in criminal detention centers, medical facilities, or police stations. They often spend their time conducting research, interviewing clients, and providing counseling. They may also provide services advocating for one of the parties to a legal case, or they may give expert testimony at trial about any matters where one or the other party’s psychological state might be a concern. 

Forensic psychiatrists and psychologists are paid in various ways. Sometimes, a court or other public agency contracts them for their services. Alternatively, they may be paid an hourly fee by one of the parties in the case.

What forensic psychiatrists and psychologists do

Forensic psychiatrists and psychologists play an important role in civil and criminal law, conducting relevant consultation in legal matters and providing expert testimony. Forensic mental health professionals may work in a prison system, law enforcement agency, court system, or a variety of other settings. Below is a discussion of some of the ways a forensic psychiatrist or psychologist might contribute to a court case.

Family law intersecting with forensic psychiatry: Court and legal assessments

Family law is one of the major areas in which a forensic psychologist might be called in to help. They can have an important impact on the way family legal situations are resolved. A forensic psychologist might evaluate parents to see whether they're fit and capable of having physical or legal custody of their child after a divorce. A psychiatrist—particularly one experienced in both forensic and child and adolescent psychiatry—may perform similar duties during family disputes. 

These types of evaluations might be conducted when one parent accuses the other of being unstable or unfit. Another reason why one or both of the parties might call in a forensic psychologist is when they have been unable to resolve custody issues themselves and the case may be going to trial. The psychologist might be hired by one or the other parties to the custody case, or they might be appointed by the judge or magistrate who is overseeing the case.

Forensic psychiatrists in civil law and mental health

Civil cases involve disputes between two parties (e.g., people or businesses)—unlike cases in the criminal justice system, which typically involve action being taken by a government against a person accused of committing a crime. Many lawsuits include claims of mental and emotional distress. When the court recognizes that mental or emotional damages have happened and should be compensated for, the awards can be substantial. In order for the court to reach a fair decision, experts often testify to assess what damages were done and what impact those damages are likely to have in the future. A forensic psychiatrist may conduct an evaluation or refute the conclusions of psychiatrists on the opposing side.

If someone has been severely injured or has mental health challenges that make day-to-day decisions about things like finances difficult for them, they may need a guardian. A forensic psychiatrist may help by evaluating their need for such services. The forensic psychiatrist can also determine if others are unduly influencing a person with such injuries or conditions in legal matters.

Discrimination cases also sometimes require the expertise of a forensic psychiatrist. If an employer or other entity is accused of discrimination, a forensic psychiatrist may be called on to determine the mental or emotional damages that resulted from the discrimination. Such damages can include depression, anxiety, or a relapse into previously diagnosed mental health conditions. The goal is typically to provide the court with evidence from an impartial expert witness so that a fair judgment can be reached.

Ability to work and mental health

Often, the courts need to determine if someone can work. This can be important for:

• getting disability payments
• getting worker’s compensation payments and treatment
• getting safety afforded by the Americans with Disabilities Act
• getting compensation for mental damages due to personal injury, harassment, or discrimination

Evaluations in disability cases may be conducted by a forensic psychologist or by a forensic psychiatrist. These experts typically make their assessments by conducting a face-to-face interview with the claimant in most cases, as well as conducting psychometric testing and reviewing depositions and information gained through investigations.

They may need to give an opinion on:

• whether the person can work in any occupation
• whether the person can work in a specific occupation
• whether the person can work as long as specific accommodations are made for them
• whether their inability to work was caused by an injury or event or was a preexisting condition

Undue influence

Adults have the right to make their own decisions without undue influence from others. The right to make decisions can be especially important with regard to making a will or a trust or making valuable gifts. In some cases, a person being coerced may have difficulty making their own decisions because of physical or mental health conditions or because they have become involved with a cult. Such situations may make them vulnerable to exploitation by others. If a forensic mental health professional finds that an individual’s testamentary capacity was impaired, a will or trust may not be valid. A forensic psychiatrist or psychologist may help determine whether the testator has been coerced to create their will or trust either to unduly favor certain people or to deny them an inheritance.

Psychiatrists determine fitness for duty

In nearly all occupations, a certain level of competence is required to perform the duties required. If an employee can't meet the competency requirements, they may need to be removed from their position, given treatment, or transferred to a position they can reasonably manage.

A forensic psychiatrist may help to determine whether they're fit for duty, and if so, whether they need to be given special considerations and accommodations. This may be done through consultation between a company representative and a forensic psychiatrist. Other cases may go to court, where a forensic psychiatrist may give testimony as an expert witness so that a judge or jury can make a determination.

Violent crimes and forensic mental health in criminal investigations

Forensic psychiatry and psychology often play a part in the investigation of murders, arson, rapes, and the criminal cases that result from them. A forensic psychiatrist or psychologist can work either for the prosecution or for the defendant. An expert’s input may be valuable in determining things such as whether the defendant is fit to stand trial and able to cooperate with their defense team. Forensic mental health professionals may also conduct a criminal responsibility evaluation so that they can testify to the defendant’s mental state when the crime was taking place. 

Translating scientific and clinical expertise to legal settings

Providing psychiatric and psychological services in legal contexts can be difficult at times. A common challenge is translating mental health diagnoses to legal definitions. For example, the term insanity is generally out of use in mental health settings. However, in legal or correctional settings, it often needs to be defined. In some cases, legal teams using the insanity defense may be seeking to prove that a defendant did not have “substantial capacity” to understand or moderate their behavior due to a “mental disease or defect”. If a professional finds that the defendant meets this threshold, they may not be held criminally responsible. 

Additionally, mental health professionals in the forensic field often need to stay apprised of noteworthy legal and legislative matters, which can be hard given their complexity. For example, in 2020 the US Supreme Court upheld Kansas’ abolition of the insanity defense, a ruling that significantly impacts forensic psychiatrists and psychologists in that state. Because such legal issues can be difficult to analyze, forensic mental health professionals typically have to develop a robust understanding of the machinations and terminology of the legal system. 

Additionally, psychiatrists and psychologists may be subject to aggression when assessing individuals. Research suggests that violence is more common in forensic psychiatric departments than general psychiatric wards. According to researchers, “Violent behavior includes verbal and physical threats and aggression that may lead to serious injury or death”. Many experts believe, though, that greater involvement in the treatment process may lead to decreased violence—as well as decreased likelihood that a patient will refuse treatment. 

Professional ethics in forensic mental health

Working at the intersection of psychology or psychiatry and the law can lead to challenging ethical situations. Forensic psychiatrists and psychologists are typically held to high standards of professional ethics. They must follow the general ethics of their profession and must meet the requirements laid out by their state licensing agency.

If a forensic psychiatrist or psychologist is associated with a professional organization such as the American Psychiatric Association or the American Medical Association, they must adhere to that association’s codes of ethics as well. The American Academy of Psychiatry and the Law is an organization that specifically addresses the field of forensic psychiatry, and it has its own code of ethics. Forensic psychologists may be part of the American Psychological Association, which has its own standards for the practice of forensic psychology. 

The role of forensic psychiatry in investigating mental health disorders

Forensic psychiatrists are expected to remain objective so that they can come to the truth of whatever matter they're investigating. Experts in forensic psychiatry typically use a combination of observation and knowledge of medicine and human psychology to make determinations about matters like liability, trial competency, and the possible effects of mental illnesses on one or the other party to a case. Because they have training in both psychiatry and medicine, they can assess both mental states and brain disorders and injuries. Forensic psychiatric specialists look at the evidence and form their conclusions based on the facts of the case.

Psychological evaluation and assessment

Forensic psychologists operate in a similar way, although they are not qualified to make medical determinations. Forensic psychologists typically interview the relevant parties to a case and review any other evidence. They use that evidence and their knowledge of psychology to present expert testimony or make any recommendations the court might need.

Could a forensic psychiatrist help me?

Typically, forensic psychiatrists and psychologists don't work with people outside of court situations. They usually don't follow patients through a course of mental health treatment unless it is needed to gain information for the courts, attorneys, employers, or others with a legal interest in the case. If you need to talk to a psychiatrist about a personal mental health concern that’s not connected to any legal proceedings, you may wish to find a general psychiatrist or one who specializes in your type of mental health condition. If you are involved in litigation, you may wish to consult with your attorney about whether a forensic psychiatrist or psychologist might be helpful to your case.

If you are experiencing mental health concerns that are not related to litigation, you may not need to see a psychiatrist. A qualified licensed therapist may be able to provide the care you might need, although if medication might help you, you will need to get a prescription from a psychiatrist or other medical doctor.

If you’d like to speak with a therapist but feel hesitant about traditional in-office therapy, you might benefit from online therapy, which research shows to be effective for a variety of mental health conditions. One study from 2017 found that online therapy is effective for anxiety, depression, phobias, obsessive-compulsive disorder, and substance use disorder, among other conditions.

With online therapy at BetterHelp, you can be matched with a therapist who has experience treating whatever specific concerns you’re facing. You can communicate with your therapist via phone, video, or live chat at a time that works for you. You can also write to your therapist at any time via in-app messaging, and they’ll respond as soon as they can.