The reference list is a resource for further reading. A sexual history should include an assessment of gender identity, sexual orientation, and sexual dysfunctions. With any approach, it is important to avoid leading questions and to ensure that the evaluee can convey his story without suggestion. In 2010, Griffith and colleagues4 conceptualized the forensic psychiatric report as a performative narrative. During the clinical assessment, explore the advantage of including family members or familiar staff in some situations. Distress may manifest in culturally specific ways in individuals with different life histories.179, Religion, culture, and race may affect a psychiatrist's worldview, causing bias (or the appearance of bias). Instruments are valid only if the individual resembles the group for which the scale was developed. Additional records are commonly requested and may be useful (see the list in Summary 5.3B). Military history and juvenile and adult legal histories are especially helpful in assessing risk of violence, which is often a facet of fitness-for-duty assessments. Specific trauma inventories are less helpful, since they are more transparent. Certain matters must be addressed well in advance of proceeding with video-recording of an interview. Courts are likely to take a skeptical view of an evaluee's description of a positive response to treatment, especially if the offense or claim seems to be related to substance use. Social networking sites and other Internet social forums may contain information about the evaluee that conflicts with data provided by the evaluee or others, warranting further examination to contextualize this apparent conflict. Occupational history can provide insight into the evaluee's personality, including attitude toward authority. Another facet of death penalty cases involves a jury's deciding whether the sentence is warranted after it has found the defendant guilty of a capital felony. For example, a mother who had been involved in a traumatic car accident as a child might be overprotective in her relationships with her children, and this information would be significant (although not dispositive) in a custody assessment. There is a debate over recording interviews. Regardless of its subtlety, coercion is inappropriate, and the evaluee or any collateral source should be free to decline to answer any or all questions.60 However, the evaluator must also give the evaluee appropriate notice that refusal to participate in some or all of the assessment may be noted in the report in a court-ordered assessment.46, Collateral sources of information, when available, are usually an important element of the forensic assessment. The forensic psychiatric examination of competence follows the general principles of other assessments and includes a thorough psychiatric assessment, with an interview and a mental status examination, if possible, and an examination of collateral information. Self-report measures of sexual behavior and attitudes provide another window into the mind of the evaluee.240 Other investigations include sexual preference testing by PPG and VRT (see Section 8.6, Penile Plethysmography and Visual Reaction Time Screening). The records may also indicate illnesses, injuries, or treatment related to substance use. Also, fundamental rights may not be waived by anyone other than the person who holds them, even if that person is a minor (e.g., a parent cannot waive a minor's right to avoid self-incrimination). State evaluators investigating an abuse or neglect report do not need consent in most jurisdictions. Although the informed consent of the evaluee is not necessary for some types of assessments (e.g., court-ordered assessments for competence to stand trial or involuntary commitment), the evaluator must avoid coercion in the interview. At the start of the interviews, participants should be warned about the limits of confidentiality, and the purpose of the interview should be explained. The approach, then, must include ongoing hypothesis testing until conclusions can be reached. Persons with ID have difficulty providing a history, and their reliability as reporters may be compromised. 18, p 44) to allow their voices and concerns to be aired in the assessment process. Transference and countertransference may require additional attention in cross-cultural contexts; self-examination of bias regarding ethnicity and belief systems should be conducted.178 The psychiatrist should also be aware that attitudes toward mental illness and the stigma that it carries differ across groups. /Flags 34 Most people believe that the legal system is fair, but some disagree46 and may have complex sociocultural reasons for their belief.175 Even personal concepts of wrongfulness may be steeped in cultural and social definitions, and these concepts may be taken into consideration in certain situations, such as evaluations for mitigating factors in sentencing.164, Aggarwal163 and Kirmayer174 both argued that situating behavior in its cultural context often provides insight and clarification into an individual's reasoning process. One study,15 for instance, noted poor agreement on such basic points as the presence of a mental disorder and the psychiatric diagnoses submitted by opposing experts. Therefore, questions about the adequacy of treatment are usually posed. Examples of trauma that may be relevant to a case include physical or sexual abuse or neglect; natural disaster, motor vehicle accident, fire, or other dangerous event; and military combat or violent events. Access to an exit door should be unimpeded for both the clinician and the evaluee. The personal history obtained in the course of a forensic assessment is similar to that obtained in clinical settings, although some aspects may warrant extra attention. In disability or fitness-for-duty assessments, sufficient information about functioning in the current job should be gathered to relate an impairment to a specific job responsibility. This Guideline has set the groundwork for forensic assessments, which form the basis for reports and court testimony. Methods useful in managing countertransference include consultation with a colleague, clinical case conferences, ethics training, and training in managing aggressive behavior. This process requires that the treatment team disclose sufficient information to the evaluee.97. Through careful assessment, the forensic psychiatrist's role in exploration of the cultural contexts of behavior may also help explain the behavior.176, In addition to the forensic psychiatrist's duty to provide culturally informed assessments, cultural concerns arise in other forensic settings. For disability determinations, opinions should address the link between signs and symptoms, if any, of a mental illness and occupational impairment.139 In workplace-related disability claims, the assessment is conducted to answer one of the following concerns: [w]hether the employee has a psychiatric diagnosis, and if so, its duration, symptoms, and prognosis; the etiology or causation of the disorder and, specifically, its relationship to work; and whether the disorder has resulted in a work-related impairment (Ref. /Subtype /Type1C Two examples of tests with embedded validity scales are the MMPI-2 and the Personality Assessment Inventory.198 The MMPI-2 has multiple validity scales, some of which are particularly useful in detecting feigned mental disorder.213 Rogers et al.198 outlined some useful points, as well as numerous pitfalls to avoid, in the use of this instrument. Assessments of children and adolescents for civil suits often involve observations of the parentchild relationship and sometimes a childsibling relationship. In risk assessment, a psychiatric opinion can affect the evaluee's interests. Officers may be surprised to receive a cold call from a forensic evaluator and may not be willing to speak. If the individual has actual symptoms, but consciously exaggerates them, it is called partial malingering. If paranoid, they may withhold information from the evaluator that would be crucial to formulating the forensic opinion. Manuscripts are welcomed that deal with the interfaces of psychiatry and the legal system and the theory and practice of forensic psychiatry. The nature of Forensic Psychiatry Process the questions asked to the expert, the timeline when an assessment can be or- The legal background and legal proceed- dered, and the legal consequences for ings are the basis of the forensic practice. Particular care is necessary in addressing several aspects of mental status that are important in a criminal forensic assessment. Evaluations fork competency to stand trial are distinguished since other areas of forensic consultation by their long history of standardized assessment beginning with the 1970s. As with psychiatric assessments, forensic assessments include an exploration of previous trauma and coping mechanisms. Mode of death is classified into four typesnatural, accidental, suicide, or homicideand is directly relevant to civil litigation involving insurance policies, which do not provide coverage for suicide-related deaths, and to investigations into whether a third party or a product caused the death. There should be an inquiry about the family of origin, including parents and siblings. Some states have special capital defense units as part of the public defender's office; other states assign private attorneys who may never have handled a capital case. /CharSet Arrangements must be made in advance to secure entry into the facility and to ensure that the evaluator is allowed to bring appropriate recording materials such as paper, writing instruments, a computer or tablet, and audio or video equipment. This strategy enables a neutral exploration of the evaluee's narrative, state of mind, and style of presentation.7,64 Open-ended questions can help the individual to become comfortable with talking to the evaluator and enable the examiner to establish a rapport with the evaluee before moving to more difficult material about the forensic matter at hand.36,45 Closed questions, which demand a yes-or-no answer, may have their place in specific matters, but, as part of the strategy for seeking objectivity and honesty, the evaluator should guard against leading questions or questions that limit responsiveness from the evaluee. However, in most cases, requests for information or collateral interviews generally should be made through the retaining attorney. The evaluator's opinion may be that the employee is temporarily unfit for duty, but that the impairments are expected to resolve with treatment. >> School and vocational records and, in the United States, Individualized Education Plans (IEPs), should be obtained. However, while the psychiatrist should be prepared to address the content of the report, team members who have gathered or generated information may also, although rarely, have to testify. Since questions about symptoms by their very nature are leading questions, endorsement of new symptoms at this stage should merit careful consideration and due explanation.
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