Psychiatric reports for court: duty, content and disposal

What is a psychiatric report for court?

It's an expert's written opinion on a defendant's mental condition. It helps the court decide a specific question: fitness to plead, a defence such as insanity or diminished responsibility, or sentence.

When Part 3 is in play, the court isn't asking for a general report. It wants advice on whether to divert the person from prison by a hospital order or hospital direction. The other option is a community order with a mental health treatment requirement (Code 22.9).

Before a custodial sentence, other than one fixed by law, the court must get a medical report on anyone who is or appears mentally disordered. The court can skip it only if it thinks a report unnecessary, and the report must come from a s12 approved doctor (Sentencing Code s232).

Your duty is to the court

Under Part 19 of the Criminal Procedure Rules 2025, your opinion must be objective, unbiased and within your expertise. That duty overrides any obligation to whoever instructed or paid you (r19.2).

Define your expertise in the report and in the witness box, and flag any question outside it. If your opinion changes, tell the parties and the court (r19.2(3)).

What a psychiatric court report must include

• Your qualifications, relevant experience and accreditation.
• What you relied on, including records and any literature.
• The facts, making clear which are within your own knowledge.
• The range of opinion, if there is one, and your reasons for yours.
• Any qualification to your opinion.
• A summary of your conclusions.
• A declaration that you understand your duty to the court and have complied with it, and the same declaration of truth as a witness statement (r19.4).

The Code adds that a report should show how the material relates to your opinion, any other trial issue it bears on, and risk factors. If you recommend admission, say what treatment or security is needed, and whether your service can provide it (Code 22.19).

Preparing for the assessment

1. Pin down the question from your instructions: fitness, a defence, or sentence.
2. Ask for the case papers, any pre-sentence report, prison medical records and previous psychiatric reports. If something isn't available, say so in the report (Code 22.10).
3. Get independent history from GP records, past treatment and previous convictions (Code 22.12).
4. At the start, say who you are, who asked for the report, and the limits of confidentiality. What they tell you could affect a punitive sentence or its length, not just a hospital disposal (Code 22.10).

Answer the question asked

• Fitness to plead. Take each Pritchard limb in turn, and say what would help them take part. The Code expects every report to assess fitness to plead (Code 22.20).
• Insanity or diminished responsibility. Keep your present findings separate from your view of their state at the time, and explain how the condition bears on each limb of the legal test.
• Sentence. Address culpability. Did the disorder impair their judgement, their ability to make rational choices, or their understanding of the consequences? Culpability falls only with a sufficient connection to the offence (guideline paras 11, 15).
• Guilt. Don't speculate about guilt or innocence (Code 22.20).

A court commissioning a report may ask for more (guideline, annex B). How does the condition relate to the offences? What was the impairment then, and what is it now? What's driving any non-compliance, how long will treatment take, and is an intermediary needed?

Recommending a disposal

• The criteria. Say whether the disorder makes hospital treatment appropriate, whether appropriate treatment is available, and which section fits.
• A bed, and when. A hospital order or s45A needs evidence of admission within 28 days, from the AC who'd be in charge or someone for the managers. If you can't offer a bed, refer to someone who can (Code 22.11).
• Restrictions. A s41 restriction order needs at least one doctor to give oral evidence (s41(2)). The decision is the court's, and it isn't bound by your view.
• Named unit. If restrictions are likely, say whether the order should name a unit or level of security (Code 22.23, 22.26).
• The longer term. Explain how release works under s37/41 and under s45A. Once the order is made, the release route can't be changed (guideline, annex C).
• Not sure yet? Consider a s38 interim hospital order: up to 12 weeks, renewable by 28 days at a time, to a maximum of 12 months (Code 22.15).

Hospital or prison? Vowles and the guideline

Two psychiatrists recommending a s37/41 is never enough on its own (Vowles, 2015). The judge weighs how far the person needs treatment, how far the offending is down to the disorder, how much punishment is needed, and public protection, including the release regime.

Vowles set an order of thinking: a s45A direction first, then a hospital order if that's the most suitable method, then whether a s47 transfer would do. The 2020 guideline adds that no order should be assumed to be better, or more protective, than another.

Vowles also said a s37/41 is more likely to suit a severe mental illness, such as psychosis or an organic brain disorder, than a personality disorder.

Give your opinion, then let the court decide

Say what you think, and how the condition bears on each legal test. Fitness, insanity and diminished responsibility are for the judge or jury, and the sentencer makes their own assessment of culpability. Sentencers must consider expert evidence but aren't bound by it, if there are compelling reasons to set it aside. If they don't follow it, they must say why (guideline paras 13, 14).

Giving evidence

• You may be called. For most Part 3 orders the court can act on written medical evidence, but it can require you to attend (s54(2A)). A s41 order needs at least one doctor in person (s41(2)).
• Experts' discussions. The court can direct experts to meet and set out where they agree and disagree (CrimPR r19.6). In Keal, four psychiatrists' joint report framed the jury's question.
• Your limits. If a question goes beyond your expertise, say so (r19.2(3)).
• After sentence. If prison follows, the court should send your report on to the prison (guideline para 7).

How to get a psychiatric report for court

If you're a defendant or a family member, ask the solicitor. In a criminal case they usually instruct an expert, often through legal aid, and the court can also commission a report (Code 22.13, 22.17). Someone remanded to hospital under s35 or s36 can get their own independent report to challenge the remand (Code 22.16). See remand to hospital.

Mistakes to avoid

• A general report. The court wants answers to its question, not a life history (Code 22.9).
• An undeliverable plan. Don't recommend a bed you haven't secured.
• Mixing then and now. Keep present findings apart from your view of their state at the offence.
• Hiding the gaps. Say what you couldn't get, and how it limits your opinion (Code 22.10).
• Taking sides. Your duty is to the court, whoever pays you (r19.2(2)).