Forensic psychiatric assessments

The purpose of a forensic psychiatric assessment is not treatment, but to answer a specific psychiatric question relevant to the proceedings. The person’s mental state, psychiatric history and the functional significance of these at the relevant time must be assessed in the context of the complete case file.

As part of my expert practice, I also undertake forensic psychiatric assessments with the involvement of a psychiatrist who holds the qualifications and expert competence required for the specific question. Where a minor is involved, a child and adolescent psychiatrist may also participate. 

What questions can we address professionally?

Below I summarise the most common questions that may arise during the forensic psychiatric assessment of an adult or a minor.

In what types of cases may a forensic psychiatric assessment be required?

Depending on the nature of the case, the assessment may address the person’s mental state at the time of the act, capacities relevant to criminal responsibility, decision-making capacity, mental state when making a legal declaration, capacity to participate effectively in proceedings, or the causal relationship between an event and a subsequent psychological condition.

Does a psychiatric diagnosis determine the capacity relevant to criminal responsibility?

No. A diagnosis alone is insufficient. The assessment must determine the extent to which a pathological mental state, at the time of the act, affected the person’s capacity to understand the consequences and to act in accordance with that understanding. The court determines criminal responsibility and its legal consequences.

Can mental state at the time of the act be assessed retrospectively?

In many cases, yes, provided that sufficient contemporaneous information is available. Medical records, documented behaviour, witness evidence and the findings of later examinations must be assessed together. If the case file is incomplete, the question may be answered only with limited certainty or not at all.

Can decision-making abilities be assessed in guardianship proceedings?

Yes. The assessment may examine whether a mental disorder is present and the extent to which it persistently or recurrently affects the person’s capacity to understand and manage their affairs in particular areas. The court decides whether legal capacity should be restricted.

Can it be established that an event caused a mental disorder?

Temporal sequence alone does not prove causation. The nature of the event, the onset and course of symptoms, the previous psychiatric condition and other possible causes must all be assessed. Depending on the evidence, the relationship may be established, considered probable, regarded as possible or not established.

Can it be determined whether the person examined is telling the truth?

The expert cannot determine factual truthfulness from a psychiatric examination. The expert may assess whether a psychiatric or cognitive condition affects perception, memory, recall or communication. Evaluating the credibility of testimony and establishing the facts of the case are not forensic medical tasks.

When is a personal examination required?

A personal examination is generally needed to assess current mental state, subject to the circumstances of the case. For a retrospective question, a document-based assessment may be possible in some cases, but its feasibility and degree of certainty depend on the contents of the records. The limitations of the assessment must be stated clearly in the expert opinion.

What documents are required?

In addition to the complete case file, relevant materials include records from general practitioners, psychiatrists and hospitals, medication data, previous expert opinions and, where appropriate, psychological, neurological or other specialist reports. A well-founded opinion usually cannot be based on a single isolated diagnosis or test result.

Child and adolescent psychiatric assessments

When assessing a minor, the child’s age, developmental level, communication needs and particular vulnerability must all be taken into account.

When should a child and adolescent psychiatrist be involved?

Their involvement is appropriate where the specialist question concerns the child’s psychological state, developmental characteristics, possible psychiatric disorder, the consequences of trauma or capacity to participate effectively in proceedings. The assessment method must always be adapted to the child’s age and condition.

Does a particular symptom in a child prove that abuse occurred?

No. The same psychological or behavioural symptom may have several causes. Its presence alone does not prove abuse, and its absence does not exclude it. Findings may be assessed for consistency with the reported event, taking account of the complete case file and the other evidence.