According to findings from research conducted by Brunel University in conjunction with the West London NHS Trust, the COVID-19 pandemic had a “substantial impact” on forensic mental health service provisions across the UK. Incidents of violence were significantly more frequent during the third national lockdown (January – March 2021) and an increased use of restrictive interventions were apparent in psychiatric facilities. Beyond this, challenging conditions brought about by the pandemic amongst the prison population, such as confined living spaces and poor physical health, contributed to the declining mental health amongst prisoners.
This has resulted in an increase in demand for forensic psychiatrists to assist with both civil and criminal matters within the criminal justice system. We sat down with our experts to discuss the trials and tribulations of working as a forensic psychiatrist, and here we share some of the key responsibilities and challenges related to their work.
What does a forensic psychiatrist do?
“First of all, it’s important to clarify what’s meant by a forensic psychiatrist. In terms of medicolegal practice, it’s a forensic psychiatrist that will carry out the work. Within our profession, forensic psychiatrists undertake six years of postgraduate training to specialise in this branch of psychiatry.
“In short, forensic psychiatry is the application of psychiatry to legal issues within legal contexts, including civil, criminal, correctional or legislative situations. Within clinical practices, psychiatrists are not limited to dealing with individuals in relation to the Criminal Justice System.”
When did psychiatry enter the field of forensics?
“Prior to the nineteenth century, it would not have been a common occurrence to summon a physician to court to comment on the mental state of an offender.
“The Criminal Lunatics Act (1800) handed down indefinite imprisonment to mentally-incapacitated offenders who were tried for serious crimes. However, this ultimately paved the way for the insanity defence we see today. It also enabled clinicians to enter the courtroom to testify on the mental condition of defendants.”
How and when are psychiatric assessments used in forensic investigations?
“Many of the instructions that forensic psychiatrists receive are from solicitors or barristers, however, sometimes the order for a psychiatric assessment may come from the judge directly.
“A forensic psychiatrist may intervene anytime from the point of arrest. On occasion they are called to a police station to assess a detained individual, and by doing so, that individual may be diverted to either a hospital or psychiatric ward as opposed to staying or being remanded in custody.
“It also depends on the issues that the legal representatives or the court want to address. It could be a case of the court wanting to find out about the defendant’s mental health at the time of an offence. A forensic psychiatrist’s involvement could also be warranted if a defendant is on remand, but the prison officers have found that their mental health is of concern. They will then inform the solicitor of this, who will in turn instruct a psychiatrist.
“Sometimes the court will want to know the impact of mental health on the offence that has occurred, and the court often seek assistance regarding sentencing. For relatively low-grade offences, the court may want advice on whether a community sentence is appropriate – and if so, whether the offender needs to be subject to mental health treatment requirements as part of a community order.”
What are the most common requests from a criminal defence perspective?
“Mostly fitness to plead and fitness to stand trial, as well as the defendant’s mental state at the time of the offence. Judges usually take this into consideration when deciding the length and terms of a sentence when there are concerns over mental health. Defence on the grounds of mental disorders e.g., the insanity defence, is another common request from solicitors when instructing forensic psychiatrists. This is especially true for the most serious cases including homicide, i.e. could it be a case of diminished responsibility or manslaughter instead of murder? The defence often looks to get some advice on this and judges often want to be informed too. These are very serious cases, so they want to be sure.
“A forensic psychiatrist looks to ascertain whether there is a link between the offence and the mental state of the offender. Advice about disposal is another important role. Even if the offence is so serious that a prison sentence is the one that’s most appropriate, the judge would like to know whether the offender would benefit from treatment while incarcerated.
“An offender can also enter a psychiatric facility as an alternative to prison – this involves sentencing to a psychiatric hospital. If, at the time of sentencing, there’s evidence of serious mental health issues with the offender, the judge can decide to sentence the person to hospital. In this case, two psychiatrists will need to be involved.”
How has the impact of COVID-19 effected your work?
“When it comes to medical legal practice, seeing patients face-to-face during the pandemic has been very, very limited. Forensic psychiatrists have attended prison a few times to see defendants for various reasons, but it has mostly taken place via video consultations.
“In terms of the volume of work, there has been an increase in the number of instructions that forensic psychiatrists are receiving. The pandemic has certainly led to an increase in mental health issues. People in their forties or fifties who have never experienced mental health problems have developed them because of stress caused by the pandemic. Stress can trigger mental health issues, whether that’s the result of a direct COVID-19 infection or factors such as job uncertainty and the impact of lockdowns.
“There has also been an increase in solicitors wanting access to forensic psychiatrists. This is due to the court being heavily impacted by the new guidelines for sentencing offenders with mental, developmental and neurological disorders.”
What information is required when instructing a forensic psychiatrist with Forensic Access?
For psychiatry casework we require the following information:
- Name of the persons involved in the case (defendant, co-defendant, complainant) as well as the deceased if applicable
- Trial date and court name/deadline for the report
- Case summary, counsel’s advice or specific questions for the expert to address
- Copies of any prosecution statements
- Confirmation of how the case is funded (LAA/Private)
- Volume of medical records, if available
- Location of the client – can they attend via video link
- Client’s date of birth
- Whether the client has previous mental health issues.
Forensic Psychiatry Expertise
As part of our industry-leading team of forensic scientists, Forensic Access boasts some of the leading forensic psychiatry experts, with all forensic work carried out to the highest quality standards.
Our dedicated casework managers support the defence solicitors and barristers by providing end-to-end assistance and coordination. Direct access to our team of scientists helps the legal team prepare a more effective defence strategy, and all expert witness reports are thoroughly written and quality checked.