Willamette Cross Cultural Psychiatry Services

What is forensic psychiatry?
Forensic psychiatry is a branch of medicine which focuses on the interface of law and mental health. It may include psychiatric consultation in a wide variety of legal matters, expert testimony, as well as clinical work with perpetrators and victims.

What is a forensic psychiatrist?
A psychiatrist is a medical doctor (M.D. or D.O. in the U.S.) who has completed several years of additional training in the understanding, diagnosis, and treatment of mental disorders. A forensic psychiatrist is a psychiatrist who has additional training and/or experience related to the various interfaces of mental health (or mental illness) with the law. Most forensic psychiatrist may also have a solo clinical practice, and when acting in the capacity of forensic expert, he or she is not providing therapy or medical care to alleviate the patient's suffering, but an objective evaluation for use by the retaining institution, attorney, or court.

What is a forensic child psychiatrist?
A forensic child psychiatrist is a forensic psychiatrist who has an additional year or two of residency or graduate school to cultivate the knowledgeable of normal growth and development, and child psychopathology; and the experience related to the various interfaces with the law and their role in family and juvenile court, child custody evaluations, and physician malpractice evaluations among others.   Although the courts sometimes allow general psychiatrists, psychologists, or counselors to do such an evaluation, most good psychiatrists agree that such work is so specialized, and so important to the children, that a child specialist is required.  The forensic child psychiatrist

Is a forensic psychiatrist the same thing as a forensic psychologist?
No. Psychiatrists are physicians with specialty training in the understanding, diagnosis, and treatment of mental disorders. This includes biological evaluations and treatments (such as laboratory tests and medications), psychotherapy, and family & social issues. Doctoral-level (such as Ph.D., Psy.D., or Ed.D.) psychologists do not go to medical school, but are professionals in their own right, and may have special expertise in topics not usually studied in detail by psychiatrists (such as psychological testing).

Why not use the treating psychiatrist in place of a forensic psychiatrist in civil and criminal case?
The treating clinician or psychiatrist may turn out to be biased against the defendant merely by the act the defendant has committed. As physicians, psychiatrist trained in medical school to "first, do no harm” and may become so preoccupied with the harm done to the victim or to society as to lose sight of the harm being done to the client/defendant.  Also, some treating psychiatrist provide therapy in addition to medications; in those cases, the psychiatrist will engage in an empathic exploration of the patient's subjective point of view, which entails a degree of emotional identification. A forensic psychiatrist, by contrast, undertakes an objective investigation of cause-and-effect relationships, using multiple perspectives and information sources. The two roles are so incompatible that the American Academy of Psychiatry and the Law considers it unethical to combine them when the alternative of a forensic psychiatrist who is not the treating psychiatrist is available.

What kind of determinations does a forensic psychiatrist make in civil proceedings?

Forensic psychiatrists are involved in; competency determinations (including the competence to make wills, dispose of property, or refuse medical treatment), in child custody disputes, in cases of alleged emotional harm and Post-Traumatic Stress Disorder (PTSD), workers' compensation, supervisory negligence, disability discrimination, sexual harassment, and in cases of medical malpractice, including the accusations of sexual exploitation of patients by health professionals.

How does a forensic psychiatrist go about conducting an evaluation?
A properly conducted forensic evaluation is an extended and in-depth process. It entails multiple interviews, detailed review and comparison of what the examinee has communicated on different occasions, microanalysis of the data and nonverbal behavior, and corroborating with collateral data (interviews with relevant others, police and medical records, other expert witness reports, and psychological testing).

How are forensic psychiatrists paid?
In most cases, forensic psychiatrists charge an hourly fee for work with attorneys or courts. Occasionally, they work by contract to a court or other public agency. Flat fees or pre-set numbers of hours, while not unethical per se, are sometimes discouraged, since they may inappropriately limit the depth of one’s involvement in a case and lead to insufficient information for accurate opinions. Fees or reimbursement which are tied to the outcome of a case (e.g., contingency fees) are strictly unethical in our profession.

What does a forensic psychiatric consultation cost?
Since a forensic psychiatric consultation/evaluation is a nonclinical procedure requiring additional training and skill, it carries a higher fee than general psychiatry. Time billed generally includes review, examination, preparation, travel, and testimony. Attorney’s or agency considering this service must evaluate whether, in a particular case, the benefit is worth the additional cost.

Will a forensic psychiatrist accept a contingency fee?
Not if the psychiatrist is practicing according to the ethical guidelines published by the American Academy of Psychiatry and the Law. Contingency fees are ruled out because they compromise the objectivity of the evaluation. Attorneys who pressure an expert witness to work on a contingency basis are, in effect, asking the expert to engage in unprofessional and unethical conduct.

Are forensic psychiatrists’ "advocates" for one side or the other in legal matters?
Usually not. Ethical forensic psychiatrists try to avoid bias. They focus on the data or evidence within their areas of expertise, and comment objectively on the information as they see it. Although we have some familiarity with the law, we are not attorneys or judges. We are often consultants to advocates (lawyers) or courts, and at other times we may participate in advocacy strategy, but we consider it unethical to combine our expert opinions (testimony, reports, or affidavits, for example) with advocacy per se. Ethical forensic psychiatrists do not accept contingency fees or otherwise conduct themselves in ways that may interfere with, or imply, a lack of professional objectivity.

Doesn’t the expert have an incentive to agree with the lawyer, so he or she can testify and make money?
Preferably, no. Ethical experts are paid for their time, not their testimony. Since the time spent forming the opinion usually far exceeds time spent testifying, most payment is received regardless of whether or not the expert testifies. Forensic psychiatrists are like most other professionals in their respect for their work and their clients.