The emerging and urgent need for forensic mental health

A study in the early 2000s that looked at over 60 surveys on the prevalence of mental disorders amongst the prison population revealed shocking statistics. Of the 22,790 prisoners, approximately 10% had major depression, 65% had a personality disorder and around 4% had psychotic illnesses. The study also found that prisoners were several times more likely to have psychosis and major depression, and about ten times more likely to have an antisocial personality disorder, than the general population. [1]

Despite these statistics, there is an unchecked and overwhelming increase in the prevalence of mental disorders within the prison population. In order to address this, it is crucial to learn about the relevance of mental health issues within the criminal justice system and the role of forensic psychiatry in equipping the system to be able to institute fair procedures and provide support, treatment and care to the prison population.

Forensic psychiatry is a subspecialty of psychiatry that deals with the interface between medical and legal aspects of psychiatry training and practice. The practise of forensic psychiatry differs from one country to another due to different historical developments, different legal systems and different mental health systems. However, there are certain shared goals, like giving evidence to courts in cases when the offender’s mental responsibility is in question, assurance of treatment to and preventing relapse of prisoners with mental disorders.[2][3]

One of the greatest challenges in the development of forensic psychiatry lies in its relationship with general psychiatry. Some argue that this specialization may lead to the loss of some skills in general psychiatry. Consequently, practitioners may have the tendency to lean towards ‘forensification’ of people who would previously have been treated as general psychiatry patients.[2] It must be said that forensic psychiatry faces a different issue in India. Unlike many countries in the Global North, Indian psychiatrists generally wear two hats – that of a “treating psychiatrist” as well as of a “forensic expert”. This is due to a lack of resources devoted to forensic psychiatry and its evolution. Thus, the onus of learning and understanding the nuances of laws associated with medical and mental health rests on the fraternity.[3] While ‘forensification’ may not be a concern in India, the real concern here is developing expertise in forensic psychiatry, adopting standardized procedures for assessment and evaluation and knowledge of the legal implications of forensic psychiatric practice.

The ever-rising voices of human rights, ethics in clinical practice and the changes in law related to mental health has made this field more important than ever. [3] As expert witnesses in criminal law, psychiatrists perform a professional role in cases of the insanity defense, fitness to stand trial, and sentencing considerations in a criminal trial. In order to better understand the role of a forensic mental health expert, it is essential to learn about the interface of mental health and law, the relationship between the expert, the defense, the prosecution and the court.

References:

[1] Seena Fazel, John Danesh, Serious mental disorder in 23 000 prisoners: a systematic review of 62 surveys, The Lancet, Vol. 359, Issue 9306, 2002, 545-550 [2] Norbert Nedopil,The role of forensic psychiatry in mental health systems in Europe, CBMH, Vol. 19, Issue 4, 224-234 [3] Naik, S, Damodharan, D, Kumar, C, Bada Math, S. Forensic Psychiatry in India – Interface of Indian Laws and Mental Health, NIMHANS Publications, (2021)