Legal Implications/ Responsibilities for a

Psychiatrist/ Mental health professional

By

Dr.Jagadeesh.NMBBS, MD, DNB, LLB, PGDMLE

*Professor of Forensic MedicineVydehi Institute of Medical Sciences

Bangalore, Karnataka*Hon. Consultant, CEHAT, Mumbai

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Editorial of Journal of the American Academy of Child and Adolescent Psychiatry

No problem in child and adolescent psychiatry stirs up more heated discussion than does child sexual abuse

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Psychiatrist/ Mental health professional

• Therapist • Forensic evaluator• Public policy educator

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Legal Implications/ Responsibilities

• Criminal cases• Civil cases• Departmental enquires

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Psychic injury

• Short term effects V Long term effects?• With and Without associated Physical injuries?• Summit’s - Child Sexual Abuse Accomodation

syndrome• Finkelhor & Browne’s – Traumatogenic model• DSM-III-R Diagnostic model of PTSD

– Post Traumatic Stress Disorder

• Terr’s – Type I & II Childhood Psychic Traumas

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Child Sexual Abuse Accomodation syndrome

• Secrecy• Helplessness• Entrapment & Accommodation• Delayed, Conflicted, Unconvincing Disclosure• Retraction

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Traumatogenic model

• Traumatic Sexualization• Betrayal• Stigmatization• Powerlessness

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PTSD

• 50% of cases found• Different in Child v Adult• But doesnot explain all the symptoms seen in

victims• Age / developmental level/ length & type of

abuse/ relationship with the offender

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Childhood Psychic Traumas

• Type – I – single blow traumasfull detailed memories, misperceptions

• Type – II – longstanding repetitive traumasdenial & psychic numbing, self hypnosis,

dissociation, rage

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False Allegations

• Subsequent retraction by child• Inconsistencies in report• Failure of others to corroborate the abuse• Absence of medical evidence

• Custody of child casesParental alienation syndrome

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Improper Investigatory techniques

• Lack of Professional resources & Training• Lack of Investigatory Independence• Improper Interview techniques• Inadequate data base• Contamination by External influences

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Admissibility of Expert’s evidence

• Refutation of defense Counsel’s claims• Common characteristics of Sexually abused

children• General veracity of children alleging sexual

abuse• Veracity of particular Child witness• Matching general characteristics of sexually

abused children with those of Child Witness

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Admissibility of Expert’s evidence

• Common characteristics of child sexual Abusers

• Expert testimony identifying the defendant as the Abuser

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Competency of Minors to testify

• Is there a mental disease or defect?

• Does this directly impair the functions relevant to being a witness??

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Forensic Interviewing?

• Helping the child to disclose abuse OR• Efforts in fact finding or credibility assessment?

4 stage interview• Rapport building skills• Competency testing• Obtaining details of abuse• Closing the interview

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Forensic Interviewing?

• Role definition – forensic V therapist• Clear communication• Confidentiality• Problem of bias – healer v objective assessment• Awareness of limitations• Degrees of certainty• Beyond reasonable doubt v degree of

preponderance -51%

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Liability of Psychiatrists /MHP

• Ethical • Deficiency of service• Medical Negligence

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American Academy of Child and Adolescent Psychiatry

• Guidelines for the Clinical Evaluation for Child and Adolescent Sexual Abuse …………

• Practice Parameters for the Forensic Evaluation of Children and Adolescents Who May Have Been Physically or Sexually Abused ……….

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In future in INDIA………….

• Guidelines – Therapeutic / Forensic?

• Documentation of Counselor notes

• Research evidence into therapeutic benefits

• Court appearance & adjudication on these skills