11 Forensic psychiatry11.2 Psychiatry and the criminal justice system
11.2.1 Psychiatric assessment across the criminal process
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Written by Resident Doctor Committee · Published
Stages of assessment
Stage | Clinical question | Decided by |
|---|---|---|
Police custody | Safety, fitness for interview, need for diversion | Custody officer, advised by healthcare |
Pre-trial | Fitness to plead, effect of treatment | Court |
Pre-sentence | Diagnosis, risk, treatment, disposal | Sentencing court |
Police custody
Assess physical safety first, because intoxication, withdrawal and head injury can mimic or hide psychiatric symptoms.
Fitness for interview is a current, changeable judgement under the Police and Criminal Evidence Act (PACE) Code C, whereas fitness to plead is a legal test for trial.
PACE Code C requires an appropriate adult for under-18s and vulnerable adults, who supports communication but does not replace a solicitor.
Liaison and diversion teams in custody suites and courts link people with mental disorder to care, as the Bradley Report (2009) recommended.
Mental Health Act powers
Section | Power |
|---|---|
136 | Police remove someone who appears mentally disordered and needs immediate care, but not from a private dwelling |
135 | Warrant to enter and remove |
35 | Remand to hospital for a report |
36 | Remand to hospital for treatment |
Place-of-safety detention lasts up to 24 hours, extendable by 12 by a doctor, and police stations are barred for under-18s.
Disposal after conviction
Hospital disposals require appropriate medical treatment to be available, aiming to alleviate the disorder or stop it worsening, without guaranteed success.
The psychiatrist recommends the least restrictive disposal, and diagnosis alone does not decide disposal or security level.
Malingering
Malingering is the conscious production of symptoms for an external incentive, such as legal gain for a defendant facing trial.
It is suggested when symptoms appear under assessment and vanish when unobserved, and it differs from unconscious or sick-role conditions.
Sexual offending
Penile plethysmography (phallometry) is an objective physiological measure of male genital arousal to stimuli of differing age and sex.
It is used within a wider sexological assessment of men who have sexually offended, particularly against children.
The expert's role
Before assessing, the psychiatrist explains who instructed the report and that confidentiality is limited.
An expert's overriding duty is to assist the court impartially, whoever pays.