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Preparing a forensic mental health report

Watch this video to learn how a forensic mental health report is prepared for the court.
I’m Dr. Danny Sullivan, the executive director of clinical services at Forensicare, which is the Victorian Institute of Forensic Mental Health. I’m a consultant, forensic psychiatrist by training. When a request is made for expert evidence, it typically comes in the form of a letter from the briefing solicitor. That letter will set out the background of the matter and provide information about what is required of the expert. That might include the statutory tests or particular questions to be answered for the court. The letter is discoverable at law. It’s an important part of the information provided to the expert.
And it really sets the situation so that the expert knows that they’re within their scope of practice, that it is within their expertise, and that they can meet the terms, including deadlines and costs.
When provided with the brief of evidence, I’m looking at a range of materials, and I’ll be seeking evidence in there that I can infer the presence of mental disorder from, that can include witness statements indicating that a person’s behaviour was unusual, such as their mode of dress, their verbal statements or their behaviour. They may show a preoccupation with a supernatural event. They may appear to be experiencing auditory hallucinations or communicating with spirits. In any event, lay witnesses can provide a valuable real time insight at the time of the offending, into the mental state of the offender. Many people with a mental disorder have a limited recollection of what happened at the time of an offense.
And so it’s important to be able to cross-reference not only their own recollection, but also statements made by other people. The most critical of those statements tend to be those of clinicians, such as doctors or other health care workers who observe a person either before or after or during a period of offending. The reason for that is that their clinical assessment from a position of expertise is really helpful to explore what the mental state was at the time of the offending. I can form my own opinion about the mental state retrospectively. But it’s important to take into account the expert views of those who were present at the time.
In many cases, a person taken into custody may be assessed by a doctor soon after their remand. And this gives a valuable opportunity if the doctor has taken adequate notes to determine whether or not a mental disorder appeared to be present. When I’m asked to provide a psychiatric report in one of these issues, insanity or unfitness to be tried, the report generally has the same standard and layout. It begins with a description of who I am so that the court can satisfy itself of my expertise, and if necessary, that can undergo a challenge by one of the sides or parties in the case.
So my expertise needs to determine that I am a doctor, that I have clinical experience in the field, that I’m up to date with the literature, and that I’m practicing a body of medical knowledge, which is acceptable and not simply outlandish or idiosyncratic. In addition, I will set out the question that I’ve been asked to answer and the assumptions that I might base my questions and answers upon. I will set out the materials that I’ve had reference to, and I’ll point out any materials that I would have liked to have seen but did not have the capacity to do so.
I will also set out the circumstances of my assessment where it took place, how long it was, whether there were other people present, and whether they participated willingly or not. I might also set out whether there are any conflicts of interest, that is, whether I have relationships with any other party in the matter or whether there is any reason that people might question why I am doing that report. The report then sets out some basic information about the person, much of which may be relevant to the establishment of a diagnosis of mental disorder. That is, I want to reflect upon their family history and determine whether there are illnesses that run in the family.
I want to focus a little on who the person is, where they’ve gone to school and for how long, what sort of work they’ve done. There are inferences that can be drawn about a person from all of this information. I’ll certainly set out their medical history and their psychiatric history to determine whether there are pre-existing matters which should be taken into account or which might be relevant to my eventual opinion. I’ll always set out a substance use history, even a negative substance use history by simply listing what I’ve asked for and what information I have about any form of drug or alcohol use.
Then I want to set out what the person reports of the offense or what they understand their offense involved. This can sometimes be a tenuous area to explore, because I have to be careful not to prejudice the court case. I have to be careful that the information I provide in my report doesn’t disclose information which should not be before the trier of fact, such as the previous criminal history or information which might prejudice a jury.
I’ll set out the information separately. The information obtained from the person and the information obtained from the materials so that the basis of my opinion is clear, things that I’ve assumed, facts that I’ve been informed of, and opinions that I’ve formed myself through my clinical experience. I will set out what’s called a mental state examination, which is a shorthand way used internationally by doctors to describe a person’s mental state- behaviour, appearance, speech, mood, thought, cognition and insight. It’s a a shorthand way using medical terminology. That means that when I read someone else’s mental state examination, I have a good clinical picture of what the person presented like at that time. And then I’ll set out my opinion.
When I set out my opinion, I want to set out the diagnosis that I have made or the diagnoses. And I want to set out the reason that I’ve made that diagnosis. In some cases, I will also set out differential diagnoses, that is diagnoses that I’ve considered and thought less likely or excluded. If I’m uncertain about a diagnosis, I need to express the certainty with which I hold my opinion, that is, am I definite. Do I think it’s most likely? Do I think it’s probable? There are a range of different words can express where the probability is not quite so certain, or whether there may be two possibilities which remain to be seen in the future.
Once I’ve set out the diagnosis, I then want to explore how it is that it affects the person’s behaviour. So the diagnosis is the beginning of the inquiry. The diagnosis sets the scene for an exploration of what elements of that diagnosis were involved in the behaviour which is of interest to the court. For instance, if a person has a diagnosis of schizophrenia, I want to explain what symptoms they experience so that the court can understand how it might be to be that person. And then I might reflect upon how those symptoms interacted with other people at the time of the offending behaviour. I want to set out any uncertainties in my opinion here.
I want to set out whether, in fact, it might not be the case, whether the person might be malingering, whether the person might have alternative explanations for their behaviour. So, in other words, I want to lay out the basis of my thinking so that the trier of fact can understand how it is that I’ve reached my opinion without simply having to regard that as a doctor, what I say must be true. That, of course, is not the case in a court of law. All of my opinions must be subject to scrutiny, open to examination and cross examination, and open to the judge or the jury to make up their own mind about the veracity of what I’m saying.

Is there a standard assessment tool that is used for competence evaluations? If yes, what does the assessment include?

In doing these assessments, what are the collateral sources of information that are interviewed or looked at by the mental health expert?

What happens if there is inconclusive or insufficient information to make a conclusive assessment?

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Forensic Mental Health and Criminal Justice

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