Transcript PTSD UPDATE - Stanford University

Criminal Forensic Psychiatry
Principles and Practices
Law of Crimes
Forensic Questions
Forensic Assessment
Treatment Court Movement
San Mateo Pathways Program
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Forensic Psychiatry
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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
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Percipient vs. Expert Testimony
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Opinion evidence
Percipient
Expert
Admissibility vs. weight of evidence
Judicial gate keeper function
 Fry
 Daubert
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Principles
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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
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Law of Crimes
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Who is subject to punishment?
Penal Code
Misdemeanor vs. felony
Actus Reus plus men rea
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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?
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Legal Reasoning
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Question
Rule
Relevant facts
Reasoning process
Conclusion
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Competency to Stand Trial (1)
U.S. vs. Dusky
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"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
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Competency to Stand Trial (2)
SELL v. UNITED STATES
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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
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Treatment must be medically appropriate
Needed to restore competent to stand trial
Effects substantially unlikely to undermine fair trial
Is defendant dangerous
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Not Guilty by Reason of Insanity
California Penal Code Section 27(b)
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“… 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.
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Link Between Mental Illness and Crime
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Judgment
Impulse control
Content of delusions or hallucinations
Overwhelming emotion (overwhelms reason)
Over reaction to perceived threat
Anger
Substance use
m-TBI
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Treatment Court Movement
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Law as first responder
Decrease jail time
Reduce risk to community
Evidence based therapeutic sentencing
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San Mateo “Pathways” Program
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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
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Therapeutic Sentencing
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Outpatient psychotherapy
Residential treatment / supportive housing
Dual diagnosis treatment
AA, NA, CBT, anger management
Med management
Monitoring of substance use / social activities
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Forensic Experience Rotation
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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
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Forensic Assessment
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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
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Forensic Report Writing
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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)
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Quick Links
Seminar website:
http://forensicpsychiatry.stanford.edu/Seminars/materials.htm
Penal Code:
http://www.leginfo.ca.gov/calaw.html
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