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Ethics guidelines recommend that forensic mental health professionals begin in-person assessments by explaining the nature and purpose of the examination. To learn whether evaluees have understood and can give consent, forensic practitioners may ask evaluees to paraphrase the explanation. This article explores how a forensic evaluee's disclosure response (DR) reveals substantive information relevant to the purposes of a forensic examination. We examined archival data from 255 reports on competence to stand trial (CST) that a Midwest public sector hospital had previously submitted to courts. We classified each evaluee's DR at one of three levels: DR = yes (accurate paraphrasing), DR = no (inability to paraphrase or provide a relevant response), or DR = other (an intermediate level implying a less-than-accurate response). None of the 28 DR = no evaluees was CST, and only 7 (17%) of the 48 DR = other evaluees were CST. Thus, a CST evaluee who cannot paraphrase an examiner's explanation is likely to be incompetent to stand trial, and an examiner would need to adduce a strong argument to support any opinion to the contrary., (© 2018 American Academy of Psychiatry and the Law.)

In 1982, Dr. Alan Stone raised a central dilemma in ethics for forensic psychiatry that has prompted significant and important discussion of the concerns about twisting justice, prostituting the profession, and operating without adequate ethics guidelines in the course of our work. In presidential addresses to the membership of the American Academy of Psychiatry and the Law (AAPL), Dr. Paul Appelbaum and Dr. Ezra Griffith have attempted to deal with Stone's challenges, the former by providing a theory of forensic ethics, the latter by advocating cultural formulation and narrative as the methodology of our work. In his present contribution, Dr. Griffith advances the idea of narrative to involve compassion for the subject of the evaluation. In so doing, he brings us to a far more satisfactory resolution of the dilemma described by Dr. Stone. The obligation to show compassion deserves to be at the core of any valuable statement of forensic ethics. The role of compassion in justice, as discussed, for example, by Simone Weil, warrants further interdisciplinary study.

Despite the growing attention to quality and quality improvement in health care in the United States, forensic psychiatry has yet to incorporate relevant developments and information and make quality an important item on the agenda. This article reviews the empirical research regarding the perceived quality of forensic evaluations, which has primarily examined criminal rather than civil forensic evaluations. Beyond the available research, many important policy and empirical questions must be addressed, including the definition of a quality forensic evaluation, the process used to access quality, the indicators and measures used, the methods that provide incentives for performing quality evaluations, the role of forensic psychiatry training programs, and the role of the American Academy of Psychiatry and the Law (AAPL) or other professional organizations in the quality improvement enterprise.

A pilot study of perceptions of different sources of expert bias, as well as of personal investment in case outcomes, was performed among attendees at a workshop at an annual meeting of the American Academy of Psychiatry and the Law. Participants were asked to rate hypothetical responses by experts to various case outcomes and the biasing potential of different kinds of situations for opposing or other experts. A factor analysis produced two factors. Factor 1 included questions about situations that were obviously biasing (such as working only for the defense). Factor 2 included questions assessing the potential of certain situations to cause bias in experts, or how likely experts thought other experts were to be biased. In general, experts identified only four areas to be overtly biasing. All occurred within situations in which experts worked only for one or the other side of civil or criminal cases. Experts otherwise thought other experts were reasonably bias free and well able to compensate for any bias when it occurred. The data suggest that experts may deal with bias by turning down cases that may cause them personal discomfort.

The aim of this article is to explore the boundaries of psychiatric testimony in criminal cases. In a series of vignettes, the author describes applications of psychiatric testimony in nontraditional areas. These are criminal cases in which the defendant-who was not mentally ill-acted in response to a situation that would tend to trigger violence in many persons: protection of self or others. In scenarios involving self-defense, duress, and passion/provocation, the dynamics involve interpersonal situations that give rise to behavior that may be entirely foreign to the defendant but that could not have been avoided. The law looks at these matters through a "reasonable person" standard: what the ordinary citizen would have done. In principle, there is often no need for expert testimony, because judges and jurors are presumed able to assess reasonableness, justification, or provocation. The trier of fact, however, could use a psychiatric explanation to assess culpability. The author discusses the cases in terms of application and admissibility.