AAPL Practice Guideline for the Forensic Assessment

1 AAPL Practice Guideline for theForensic Assessment *1. Statement of IntentThis document is intended as a review of legal andpsychiatric factors to offer practical guidance in theperformance of Forensic evaluations. It is a guidelinedeveloped through the participation of Forensic psy-chiatrists who routinely conduct a variety of forensicassessments and who have expertise in conductingthese evaluations in a variety of Practice settings. Thedevelopmental process incorporated a thorough re-view that integrated feedback and revisions into thefinal draft. The final version was reviewed and ap-proved by the Council of the American Academy ofPsychiatry and the Law on October 26, 2014. Thus,the Guideline reflects a consensus among membersand experts about the principles and practices appli-cable to the conduct of Forensic assessments.

2 How-ever, it should not be construed as dictating the stan-dard for Forensic evaluations. While it is intended toinform Practice , it does not present all currently ac-ceptable ways of performing Forensic evaluations,and following its recommendations does not lead toa guaranteed outcome. Differing facts, clinical fac-tors, relevant statutes, administrative and case law,and the psychiatrist s judgment determine how toproceed in any individual Forensic Guideline is for psychiatrists and other clini-cians working in a Forensic role who conduct evalu-ations and provide opinions in legal and regulatorymatters. Any clinician who agrees to perform forensicassessments in any domain is expected to have thequalifications necessary to meet the professionalstandards in the relevant jurisdiction and to completethe evaluation at IntroductionForensic Assessment is one of the basic buildingblocks that form the foundation of the Practice ofpsychiatry and the law, in addition to report -writingand giving testimony in court.

3 Similar to any foun-dation, the integrity of the process depends on howwell each brick is laid upon the other. In psychiatryand the law, the quality of the final product dependson the quality of the Assessment , regardless of thepractitioner s report -writing psychiatrists are often called on to act asconsultants to the courts, lawyers, regulatory agen-cies, or other third parties. The referring agent has aspecific psycholegal question that requires an expertopinion, generally to advance a legal requirement. Torespond to that question, Forensic psychiatrists gen-erally conduct an Guideline is the product of a consensus basedon the available literature and knowledge in a broadrange of Forensic assessments. The field of psychiatryand the law, along with the rest of medicine, is in-creasinglyusing an evidence-based medicine is defined by Sackett et the conscientious, explicit, and judicious use ofcurrent best evidence in making decisions about thecare of individuals (Ref.)

4 2, p 2). Sackett and collab-orators made the point that all clinical assessmentsare, to a certain extent, individualized, based on theunique factors of each recommendations in the Guideline do not seta standard of Practice and are not a substitute for* The AAPL Task Force on a Forensic Assessment Guideline consisted of:Graham D. Glancy, MBChB, FRCP(C) (Chair); Peter Ash, MD; Erica PJBath, MD; Alec Buchanan, PhD, MD; Paul Fedoroff, MD; Richard , MD; Victoria L. Harris, MD; Susan J. Hatters Friedman, MD;Mark J. Hauser, MD; James Knoll, MD; Mike Norko, MD; DebraPinals, MD; Marilyn Price, MD, CM; Patricia Recupero, MD, JD;Charles L. Scott, MD; and Howard V. Zonana, following members of the Task Force composed a Steering Com-mittee for development of the Guideline : Drs.

5 Glancy, Buchanan,Norko, Pinals, and : The authors thank the following for their assis-tance and advice in preparing this Guideline : Jacquelyn Coleman,Elizabeth Ferris, Stefan Treffers, Dylan Glancy, and Kirsten of financial or other potential conflicts of interest: 2 Objectives of the Guideline To provide practical guidance for the performance of forensicpsychiatric assessments. To provide information for clinicians and trainees. To improve resources for teaching and training. To create a template to improve consistency of assessments. To help identify future research 43, Number 2, 2015 Supplementknowledge-seeking, experience, or training amongpractitioners. It is the individual responsibility ofeach clinician to make appropriate decisions andjudgments that are based on the circumstances ofeach case.

6 It is also recognized that policies and pro-cedures change with the passage of time and fromone setting to writing of Forensic psychiatric reports is be-yond the scope of this Guideline . report -writing is avast topic in itself that has been covered in severalother 9 The text provides an overview that is applicable tovarious types of assessments: for criminal cases (com-petence to stand trial and culpability); for risk ordangerousness (of violence, sexual violence, or crim-inal recidivism); and for civil proceedings (disability,fitness for duty, testamentary capacity, guardianship,child custody, malpractice, and civil commitment).It is intended to complement, not replace, existingpractice guidelines published by the American Acad-emy of Psychiatry and the Law (AAPL) that focus inmore depth on particular areas of Quality Improvement in ForensicPracticeSeveral studies and articles have assessed the qual-ity of Forensic psychology and psychiatry 16A review of the literature concluded thatthe level of Practice falls short of professional aspira-tions for the field, although there have been incre-mental improvements during the stud-ies to date have observed Forensic psychiatricinterviews, although some, mainly in the field of psy-chology and the law, have looked at the content offorensic reports.

7 In particular, these have examinedthe psychological tests used in criminal Forensic eval-uations,13emotional injury cases,14child custody as-sessments,17and neuropsychological results demonstrated significant inconsistenciesand variable standards. One study,15for instance, notedpoor agreement on such basic points as the presence ofa mental disorder and the psychiatric diagnoses submit-ted by opposing experts. Given these findings, it is im-portant to enhance the potential for consistent practicesthat can inform Forensic 2010, Griffith and colleagues4conceptualizedthe Forensic psychiatric report as a performative nar-rative. Although their article concentrated on thewritten report , it suggested that psychiatrists lis-tened hard to the voices they heard (Ref.)

8 4, p 42).The authors also drew attention to aspects of theinterpersonal relationships between parties, whichmay be significant. Kenneth Appelbaum,18com-menting on the article, cautioned mental health ex-perts to ensure the accuracy and veracity of theirassessments. Mossman and colleagues19attemptedto measure the accuracy of assessments in a quanti-tative manner. They compared multiple ratings perevaluee and concluded that evaluators are very accu-rate. However, recent research has examined thequality of Forensic reports and rated them as medio-cre, noting that there was fair agreement between theevaluators conclusions and court struck an optimistic note, stating, inthe long-term future, we expect that quality improve-ment at a more sophisticated level will transcend any-thing discussed heretofore (Ref.

9 11, p 172). Thisview built on his previous work with Simon,21in whichthey described general guidelines, shaped by the ethicsprinciples of general and Forensic psychiatry, as well ascase law and statutes. Such guidance was intended tohelp practitioners maintain the integrity of Forensic psy-chiatric consultation and Ethics FoundationThe American Medical Association s Code of Eth-ics states that physicians have an obligation to assistin the administration of justice. 22 Forensic psychi-atrists are physicians who are trained to diagnose andtreat patients within the ethics principles embeddedin the doctor patient relationship. However, as PaulAppelbaum23has stated, the role of the Forensic psy-chiatrist in assisting court and other agents some-times demands that the psychiatrist step outside ofthe doctor patient relationship.

10 The psychiatrist isprimarily serving the interests or needs of the court,the retaining attorney, or another third party, buttheir interests may or may not serve those of , in this context, the forensicpractitioner strives for objectivity in seeking to an-swer a psycholegal ethical Practice of Forensic psychiatry hastherefore been a subject of significant discussion inthe psychiatric literature, with competing, comple-mentary, and sometimes conflicting models of ethi-cal Practice ,25 36 Stone37has stated thatthe role of the Forensic psychiatrist is so framed thatthe formulation of ethics guidelines is view was countered by Paul Appelbaum,23whoattested that the primary value of Forensic psychiatryPractice Guideline : The Forensic AssessmentS4 The Journal of the American Academy of Psychiatry and the Lawis to advance the interests of justice.