Frequently Asked Questions
What are forensic mental health experts?
Forensic mental health experts are people who may have training in psychiatry, psychology, social work or counseling and use this expertise in the context of the civil or criminal legal process. Forensic psychiatrists, forensic psychologists and forensic social workers apply their clinical knowledge and experience to various legal questions. They use their skills to gather and interpret information that has relevance both clinically and legally in order to assist courts of law and administrative bodies. When acting in this capacity, forensic mental health experts are not starting a therapeutic relationship or providing treatment; rather they are providing clinically informed opinions and sharing their expertise.
What does the forensic mental health consultation process entail?
The process varies depending on the kind of case, but generally, it involves clarification of the forensic question/desired role, information gathering, which may or may not include a clinical evaluation component, and formulation and communication of opinions pertaining to the forensic question. When clinicians with forensic mental health expertise act as confidential consultants to the legal team, their assistance is used to inform the legal strategy and no official report or testimony is provided. When forensic mental health consultants are named as experts, the opinions formed may be the basis of a forensic report and/or testimony in deposition or court. Sometimes after the communication of the opinion, the client may decide not to move forward with a report or testimony.
Do forensic mental health experts have to be board-certified in forensics?
Board certification is more commonly pursued by psychiatrists compared to psychologists. There is no board certification for forensics in social workers. It is possible for people to serve as forensic mental health experts, and do so well, without having board certification. Rather than going through a formal training program, these experts may have experience, supervision, and continuing education that aids in the development of the skills needed to serve as consultants. Unfortunately, some people may take forensic cases without having that additional training and/or supervision.
What training does a board-certified forensic psychiatrist have?
Psychiatrists are medical doctors who have graduated from medical or osteopathic school and then completed a 4-year residency training program in psychiatry. The specialty training in forensic psychiatry, known as a forensic psychiatry fellowship, is an additional 1-year program. Forensic psychiatry fellowship provides psychiatrists with advanced training in ethics, landmark legal cases, interfacing with the legal system, forensic report writing, testimony, and the role of forensic psychiatric consultants. Only psychiatrists who have completed general psychiatry residency, the forensic psychiatry fellowship, and passed their general psychiatry residency boards are eligible to take the forensic psychiatry board examination. Those who pass are board-certified forensic psychiatrists.
Forensic psychologists typically hold PhDs or PsyDs. While psychiatrists can perform some limited testing and may be familiar with clinical correlations of testing results, the range of psychological testing that forensic psychologists can administer is much broader. Forensic psychologists may learn forensic consultation skills during the internship or post-doc phases of their training. Additionally, they could learn about the discipline after completion of their formal training. There are some mental health consultation questions that can be addressed by either psychiatrists or psychologists. This can include but is not limited to legal questions pertaining to diagnosis, psychological impact, trauma, and treatment recommendations. Psychologists are better fits for cases that require the performance of psychological testing; whereas psychiatrists, by virtue of their medical training, may be better fits for cases that require expertise in psychopharmacology or the physical health-mental health interface.
Licensed social workers may have master’s or doctorate degrees in social work. Clinical social workers have expertise not only in the diagnosis and treatment of mental illness, but also in the evaluation and management of patients and families psychosocial needs. Forensic social workers can use this lens to address a variety of consultation questions. There is no such thing as board certification in forensic social work; however, forensic social work experts may have relevant clinical or practicum experiences during training or relevant work or supervision and educational experiences post-training.
In what ways can forensic mental health experts be helpful in administrative law cases?
Cases involving Social Security disability, workers’ compensation, Veterans Administration adjudication, security clearance revocations, and fitness for duty determinations may raise questions related to mental health functioning, diagnoses, and/or symptoms. In these cases, forensic psychiatrists, psychologists or social workers may act as consultants to the legal team, review relevant records and/or conduct independent medical evaluations or independent psychological evaluations. They may also write forensic reports that address mental health diagnosis, prognosis, impairments and residual functional capacity.
In what ways can forensic mental health experts be helpful in civil law cases?
Mental health related legal questions can be highly pertinent in a variety of civil law cases including but not limited to personal and/or psychic injury, class actions, products liability, malpractice claims, intentional infliction of emotional distress, civil rights violations (EEOC, etc.), contested wills and estates, and competency of an adult to manage financial or healthcare decisions. Depending on the legal question that is pertinent to a given case, forensic mental health experts may act as consultants to the legal team, review relevant records and/or conduct independent medical evaluations or independent psychological evaluations. They may also write forensic reports that address topics such as mental health diagnosis and impairments, causation of illness or symptomatology, prognosis, future treatment needs and costs, and the education or occupational impact of incidents.
In what ways are forensic mental health experts helpful in criminal law cases?
In criminal law, mental health experts can be helpful in cases involving but not limited to competency to stand trial, criminal responsibility, mitigating factors, aggravating factors, the impact of trauma on behaviors, competency for execution and competency to waive Miranda rights. They may also provide assistance in cases for which the court needs information regarding diagnostic clarity and treatment recommendations for persons with criminal justice and mental illness, a group that is grossly over-represented in the criminal justice system.
When acting in the role of forensic mental health experts, forensic psychiatrists, psychologists and social workers are not paid by medical insurance since the work does not actually involve treatment. The hiring party, which may be the person being evaluated, an attorney, the court or a family member is the client. Contingency fees are unethical for forensic mental health experts because these can lead to the evaluator starting the case with a desired outcome. A true, professional opinion should be based on the facts of the case and the information that is gathered. A forensic mental health expert should be paid for their time rather than a particular case outcome as doing so provides a greater likelihood of objectivity. For these reasons, forensic mental health experts are paid at an hourly rate, thus the total fee will depend on the extent of their involvement and the number of hours spent on a case.
While it can be tempting to call upon a clinician who already has familiarity with your client in need of forensic evaluation, doing so can have negative ramifications for your client and is ethically problematic for the clinician. Evaluation by an objective expert, with a limited role, who is gathering data with a specific forensic question in mind guards against the unnecessary exposure of sensitive and/or potentially harmful information about the evaluee. Using an expert in these cases also helps to preserve the evaluee’s existing treatment relationship with their clinician. Furthermore, clinicians who are providing treatment are ethically required and professionally inclined to put their patient’s interests first, setting the stage for advocacy rather than objectivity in the consultation process.
What is the relevance of cultural competence and structural competence in forensic mental health consultation?
There is rich scientific literature and growing awareness within the medical and mental healthcare system on the importance of cultural and structural issues on mental health and illness, treatment seeking behaviors and a myriad of life outcomes. Issues related to cultural and structural competence have relevance in personal interactions, decision-making and even the way certain mental illnesses look. These issues should also inform the lens through which medical or mental health treatment record review is conducted. In sum, cultural and and structural competence expertise is of the utmost importance for any mental health professional, whether they are acting in the role of clinician, confidential consultant or expert.
- Do you provide clinical care?
- What sort of populations do you serve?
- How often do you treat people from marginalized populations (e.g. racial minorities, people from lower SES)?
- When is the last time you treated or engaged in scholarship related to marginalized populations?
- Have you made any presentations or written articles that went through a peer-review process about cultural or structural issues in menta health ?
- What cultural or structural issues would you consider in this case?