Psychiatric reports criminal

Court reports should be written in non-technical language, as they will be used by lawyers and other lay persons. All technical words, even those commonplace to psychiatrists, such as 'schizophrenia', should be explained.

Before beginning work, the wise psychiatrist obtains the written agreement of the person requesting the report to pay his fee, as this work is not part of NHS practice. A proper letter of instruction is essential. This must set out the points on which the psychiatrist is to report. A general request for 'a report' is not adequate.

The commonest type of report relates to a patient for whom the psychiatrist provides NHS care. In this case, the report has clearly arisen out of NHS practice, and only a modest fee would be appropriate. For example, the patient concerned may be one with an existing mental disorder who has been arrested for a minor public order offence. Here the need is for an expeditious and brief report. Two A4 sheets are ample for most such cases.

Reports are frequently requested by courts, and by defence lawyers. It is crucial to establish clearly the question behind the request; for example, is the court asking about fitness to plead or advice about sentencing? The following scheme is appropriate:

PSYCHIATRIC REPORTS: CRIMINAL

• name, age, address, occupation, and marital status

• sources of information: when and where the psychiatrist interviewed the defendant, other informants interviewed, and documents consulted

• index offence

• forensic history

• medical and psychiatric history,

• personal background, including

• present social circumstances

• substance use

• circumstances of index offence, including opinion on mental state at the time of offending

• present mental state

• opinion, including advice on specific points raised by the person requesting the report

• advice as to disposal. This is traditionally phrased in appropriate language, recognizing that the authority rests with the court; for example, 'I respectfully offer the Court the following suggestions as to disposal, for its consideration.'

Case example

An unemployed man aged 38 presented himself to casualty with the complaint of 'hearing voices'. He admitted to recent drug use, and the likely diagnosis seemed drug-induced psychosis. He was admitted to a psychiatric ward informally, and rapidly improved with oral antipsychotic medication, but discharged himself before a full assessment had been made. He including history of present illness (if any) family history did not attend follow-up, but presented again with similar symptoms shortly afterward. On this occasion, no beds were available, and he was sent home with medication. Two weeks later, his consultant was surprised to receive a request from the local magistrates' court for a psychiatric report 'to assist in sentencing for a number of motoring offences'.

After old notes had been consulted, it emerged that this man had been brought up in a large and chaotic family, of long-standing criminal tendencies, and had been subject to a mixture of neglect and abuse. He had spent his life taking, selling, repairing, and even living in cars, and had multiple convictions for vehicle offences; none of a variety of sentences had influenced this behaviour. His only psychiatric history was the complaint of hearing voices during his last term of imprisonment; he had been transferred to hospital, only to abscond shortly afterward. His probation officer indicated to the psychiatrist that the court was very keen for him to be taken on for medical treatment, as it felt that other disposals would be ineffective.

At interview, residual psychotic symptoms were still apparent, but resolving. The man was frank about his drug use, and also about his intentions to continue with his offending behaviour.

The psychiatrist's report indicated that his personality appeared to have been damaged by his unsatisfactory upbringing, and that he continued to have a psychotic illness, partly due to illicit drug use and partly due to the stress of impending imprisonment.

The court accepted the psychiatrist's recommendation of a community disposal, with the condition of psychiatric treatment. It also imposed a suspended prison sentence. The patient accepted depot antipsychotic medication, which seemed to help the psychosis, but he continued to offend. He therefore breached the terms of his suspended sentence, and was imprisoned.

In respect of more serious offences and civil litigation (personal injury, employment tribunal, family courts, etc.) or insurance claims, reports will be more extensive. They will need to summarize other documents (for example, GP notes) and proceed by reasoned argument to a conclusion. Here, the psychiatrist may be practising as an expert witness, and his primary duty is not to those instructing him, but to the court (http://www.dca.gov.uk/civil/procrules_fin/ contents/parts/part35.htm).

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