Competence to stand trial is a legal construct used to identify those criminal defendants who have the requisite mental capacity to understand the nature and objective of the proceedings against them and to participate rationally in preparing their defense. This Practice Guideline has described how psychiatrists should evaluate individuals concerning their competence to stand trial. The Guideline describes acceptable forensic psychiatric practice for such evaluations. Where possible, it specifies standards of practice and principles of ethics and also emphasizes the importance of analyzing an individual defendant's case in the context of statutes and case law applicable in the jurisdiction where the evaluation takes place. The recommendations in the Guideline both reflect and are limited by evolving case law, statutory requirements, legal publications, and the current state of psychiatric knowledge. The authors have taken note of nationally applicable case law, federal constitutional standards, statutory language, and federal and state interpretations of the rights or statutes, recognizing that jurisdictions may differ in their specific interpretation or application of statutes or general constitutional standards. The review of cases concerning specific psychiatric diagnoses illustrates general U.S. trends, and psychiatrists must remain cognizant of their jurisdictions' interpretations of statutes or constitutional requirements. By surveying a variety of practices and approaches to data gathering and case analysis, the authors believe that this Guideline will stimulate additional collegial discussion about what is necessary and sufficient for adequate evaluations of adjudicative competence. The notion that psychiatrists should apply expertise to competence assessments stems from the principal that, before allowing a defendant to face criminal prosecution and possible punishment, courts need reasonable assurance--based, if necessary, on a careful, individualized evaluation--that the defendant has adequate mental capacity to make a defense. At a minimum, a psychiatrist's opinion about adjudicative competence should reflect an understanding of the jurisdictional standard and of how the defendant's mental condition affects competence as defined with the jurisdiction. The psychiatrist's report should clearly describe the opinion and the reasoning that leads to it. Psychiatrists who provide mental health expertise concerning adjudicative competence give trial courts information needed to assure that defendants can appropriately protect themselves and that criminal proceedings will be accurate, dignified,and just.

https://aapl.org/docs/pdf/Competence%20to%20Stand%20Trial.pdf

AAPL Practice Guideline for the Forensic Psychiatric Evaluation of Competence to Stand Trial

Law, Psychiatry and psychology : a selection of constitutional, medico-legal and liability issues

This guideline is intended as a review of legal and psychiatric factors to give practical guidance and assistance in the performance of insanity defense evaluations. It was developed through the participation of forensic psychiatrists who routinely conduct evaluations of competence to stand trial and have expertise in this area. Some contributors are actively involved in related academic endeavors. The process of developing the guideline incorporated a thorough review that integrated feedback and revisions into the final draft. This guideline was reviewed and approved by the Council of the American Academy of Psychiatry and the Law (AAPL) on May 19, 2013. Thus, it reflects a consensus among members and experts about the principles and practice applicable to the conduct of insanity defense evaluations. This practice guideline should not be construed as dictating the standard for this type of evaluation. Rather, it is intended to inform practice in this area. This guideline does not present all acceptable current ways of performing these forensic evaluations, and following it does not lead to a guaranteed outcome. Differing fact patterns, clinical factors, relevant statutes, administrative and case law, and the psychiatrist’s judgment determine how to proceed in any individual forensic evaluation. Adherence to the approaches and methods set forth in this document will not ensure an accurate assessment of a defendant’s mental state at the time of the instant offense. These parameters are not intended to represent all acceptable, current, or future methods of evaluating defendants for and drawing conclusions about the insanity defense. The fact situation, relevant law, and the judgment of the forensic psychiatrist determine the ultimate conduct of each insanity defense evaluation. The guideline is directed toward psychiatrists and other clinicians who are working in a forensic role in conducting evaluations and providing opinions related to the insanity defense. It is expected that any clinician who agrees to perform forensic evaluations in this domain has appropriate qualifications.

AAPL practice guideline for forensic psychiatric evaluation of defendants raising the insanity defense

Invoquer la defense culturelle est devenue une strategie judiciaire populaire bien que controversee. Expliquant dans un premier temps que la portee de la defense culturelle est plus vaste que generalement comprise et qu'elle sert aussi bien a attenuer des sentences, a creer des exceptions a des politiques etablies qu'a augmenter les montants de dommage et interets accordes, j'identifie ensuite les principes normatifs qui justifient ce type de defense. Meme si elle peut etre appuyee fonde sur des principes, si la defense culturelle a une chance d'etre adoptee 
formellement, des politiques doivent etre etablies pour prevenir des abus. Je propose des criteres d'application de la defense culturelle qui sont illustres par quelques cas. La presentation d'exemples ou la defense culturelle est appropriee est suivie d'une demonstration des abus potentiels, a partir de cas particuliers dans lesquels les arguments culturels avances ne remplissaient pas les criteres du test propose. L'article se termine sur des recommandations pour assister les tribunaux a trouver les experts qui peuvent authentifier les requetes culturelles. 
Invoking a cultural defense has become a popular but controversial legal strategy. After explaining that the scope of the cultural defense is broader than is often understood and that it is used to mitigate punishment, create exemptions from policies, and increase the size of damage awards, I identify the normative principles that justify such a defense. Although it may be defended as a matter of principle, if this defense has any chance of being formally adopted, policies must be established to prevent its misuse. I propose a cultural defense test and show how it could be applied appropriately in a few cases. Following the analysis of its proper use, I demonstrate the potential for abuse by showing how in particular cases cultural arguments failed to meet the requirements of the cultural defense test I propose. Finally I recommend ways to assist courts in finding cultural experts who can authenticate the cultural claims.

/pdf/the-use-and-abuse-of-the-cultural-defense-5aacbupvxu.pdf

The Use and Abuse of the Cultural Defense

Objective: The aim of this paper is to provide an update of principles of forensic report writing, to guide and assist registrars, junior consultants and psychiatrists considering working within the forensic arena.Method: The literature was reviewed for information on principles of report writing from a variety of jurisdictions. Additionally, literature on medical ethics was examined.Result: Writing reports is a professional activity that most psychiatrists undertake at some point in their careers. The report represents the psychiatrist's professional opinion. It is important that information is accurate, relevant and ethical. In writing medico-legal reports, psychiatry deviates from traditional medical ethics.Conclusion: It is important that psychiatrists who write reports have a good understanding of the process and behave ethically and competently.

General Principles of Forensic Report Writing

In the Middle Ages and the Renaissance, it was easy to know the public perception of every rank and occupation of society. The Dance of Death was a popular art form that showed in a series of cartoons each person, from king to peasant, from merchant to beggar, from judge to robber in the final rendezvous with Death, with his or her frailties, dishonesty, and hypocrisies mercilessly exposed. The most famous series is that of Holbein published in 1538.' Holbein portrays the physician as impotent and helpless to cure the effects of age. "He holds out his hand to receive, for inspection, a urinal which Death presents to him, and which contains the water of a decrepit old man whom he introduces, and seems to say to the physician, 'Canst thou cure this man who is already in my p~wer?'"~ The lawyer is portrayed thus: "The rich client is putting a fee into the hands

http://jaapl.org/content/jaapl/20/2/119.full.pdf

The forensic psychiatrist: consultant versus activist in legal doctrine.

The treating psychiatrist can change his initial clinical impression as a result of his ongoing relationship with the patient and his evaluation of response to treatment. Such monitoring is difficult. if not impossible, in the usual practice of forensic psychiatry. Also, the legal consequences of judicial decisions based on psychiatric opinion may be quite serious. If the psychiatric opinion is to be influential in determining the final decision, it should be offered with as high a level of confidence as possible.

/pdf/reasonable-medical-certainty-diagnostic-thresholds-and-l71g746xau.pdf

Bernard L. Diamond

Papers

The forensic psychiatrist: consultant versus activist in legal doctrine.

Reasonable medical certainty, diagnostic thresholds, and definitions of mental illness in the legal context.

Social and cultural factors as a diminished capacity defense in criminal law.