Has Anyone Had An Assessment With A Forensic Psychiatrist?

[Pencil]

I'll be back later to explain what I think is about to happen. Nothing to get neurotic about - just that they will naturally go for a win lose outcome in their favour. If they didn't, they would have been bankrupt by now. It is all 'normal'. But you have to approach this in flow-chart manner. If I say this, then it might be yes, or if I say the same thing, it might be no - which will lead you to the next step. You MUST know all the possible outcomes. It is not about 'winning' - it is about not setting yourself up for loss of another kind later (e.g. if they agree to dropping charges if I agree to xyz, it might look fine right now, but it might mean not being eligible for abc later). You have to know all the avenues, all the options, all the possible outcomes so that you can weigh your options.

 

[Laura 2]

@Pencil - I like you way of thinking about this. For them though, it can become all about winning so you have to take that into account at every step...as you say, you have to know all the avenues, which is where a good lawyer comes in.

Also, the trade-off business - the lawyers are very sensible about this and invariably recommend that you appear very reasonable and willing to negotiate (though that doesn't necessarily mean you have to give ground).

One ray of sunshine as I read this history is that the person I knew in a very similar situation (and had behaved very dangerously) was treated very fairly and even kindly by the police/CPS.

 

[Maggiemay]

From a sufferer of borderline just wanted to say hugs and it's not as scary as it sounds x

 

[Sandstone]

But I just don't believe it.My daughter asked today why everything had changed since I last saw them a week and half ago, when they were talking about how to start CBT safely - or so she says - I don't remember the appointment at all.

I keep looking at the descriptors and seeing how little they fit.

But as I said originally, it's the forensic Psych that really bothers me.

 

[Lucycat]

Just remember that 'forensic' psychiatrists are just normal psychiatrists who choose to take on forensic work. The psychiatrist I have seen also does forensic work when required. He is not a special or different person, just on those days he is answerable to the legal system.

I really don't think you have anything to worry about. They are trying to show - legally- that you were not well when a crime was committed. I see this as a very positive and supportive move.

My fear is some of the advice you are receiving here is not specific to the UK where our legal and health care systems are very different. Here, of course, we do not sue readily.

 

[Hashi]

Here, of course, we do not sue readily.

I agree, and nor do we get sued readily by the authorities. The likelihood of that is quite small.

The likelihood of a bureaucratic process that requires forms to be filled in by a forensic psychiatrist in order for nothing to happen - that's much more likely I think.

In this country forensic psychology and psychiatry have two main focusses - risk assessment and preventing recurrence. @stenni I would imagine that these are the main reasons in your case too. I can't know for sure, of course, but that's what I imagine is the case here.

 

[Pencil]

why everything had changed since I last saw them a week and half ago, when they were talking about how to start CBT safely - or so she says - I don't remember the appointment at all.

Could you elaborate? How has everything changed? Did she go with you?

 

[Pencil]

Once again: my take on this could be wrong, but perhaps it isn't. Instead of telling you that all will be fine, I would rather tell you to be well prepared so that if I'm totally wrong, you'll still have nothing to lose.

The purpose of forensic psychiatry is largely to establish criminal capacity, plain and simple. There are two issues here:

1) Can you be held accountable for smashing your car into the entrance that day or not? (according to the law, that is) If yes, there are certain implications (legal). If not, there are certain implications (psychiatric)
2) If you were not, can it be shown that you were not due to negligence on the part of the NHS? (which seems to be the case judging by your first post in the thread where you were losing your mind about their lack of response to you.)

Please note: I'm not being alarmist and saying 'they' want to be horrible to you. See this in the same light as, say, bankruptcy. If you go bankrupt you get out of your debt. Wonderful. But there are consequences that may in the long run have a more negative financial impact on your life than paying off the debt. The debt counsellor and all the other people involved in the process may be the nicest people around, but that is entirely irrelevant. In this case you may be held responsible for acting like a loon and smashing their front door and the consequences may be crap - such as paying damages. Or, it may be determined that you had reduced criminal capacity due to x, y, and z, but that will have other consequences. This process is wholly impersonal.

All I'm trying to say is that I don't want you to go into this process like a lamb to the slaughter. I want you to be able to see where the NHS is going with this before the process starts. That is what being a responsible citizen and individual is all about.

 

[Pencil]

And yes, as Hashi said, it has to do with risk management, i.e. 'What is the likelihood, given the dx we're now giving Stenni, of her doing this again?' If there is no risk, wonderful. If there is a big risk, what do we have to do to reduce that risk?' And this is what I was referring to in an earlier post = you have to be careful not to go for the 'reduced capacity' and end up a 'case'.

 

[Hashi]

The purpose of forensic psychiatry is largely to establish criminal capacity, plain and simple.

Pencil, please would you reference this statement, in terms of how forensic psychiatry is practised in the UK?

Since the discussion is in the context of the NHS and the UK, I think the following links help explain the focus. These agree with my experience of working in the UK criminal justice sector.

http://www.nhscareers.nhs.uk/explor...s-in-medicine/psychiatry/forensic-psychiatry/

http://www.rcpsych.ac.uk/workinpsychiatry/faculties/forensic.aspx

When you say "establish criminal capacity" I think that is to do with establishing risk, and the reduction of that risk. The focus being not litigation, but avoidance of harm through assessment and treatment planning.

Where litigation is an issue, criminal charges come first and forensic psychiatric evaluation follows. Not the other way round.

 

[Laura 2]

Pencil, please would you reference this statement, in terms of how forensic psychiatry is practised in the UK?

When you say "establish criminal capacity" I think that is to do with establishing risk, and the reduction of that risk. The focus being not litigation, but avoidance of harm through assessment and treatment planning.

Where litigation is an issue, criminal charges come first and forensic psychiatric evaluation follows. Not the other way round.

@Hashi - good Qs and points.

I wonder could you clarify what you mean by 'litigation'? I'm not understanding its relevance in final or previous sentence (litigation being a civil law, tort process).

Also, would it be more accurate to 'establish criminal liability'?The law does not countenance speculation of a defendant's 'capacity' to commit criminal acts except in rare charges such as inchoate offences. Though only a Court can establish criminal liability via trial.

Which suggests that we're back into the area of assessing risk of future episodes of loss of control due to the illness/disorder which may lead to further behaviours that result in criminal damage and/or injuries to bystanders. (It's a fine distinction I know, but that's how the legal system operates: 'It depends on what the meaning of the word 'is' is...' etc etc!)

 

[Sandstone]

Could you elaborate? How has everything changed? Did she go with you?

It's hard for me to elaborate much as I have next to no recollection of the appointment, having taken a number of pills the day before. My family say I was in and out of sleep all that day and the next.

The appointment was with a Psychiatrist from the Crisis Team, and a clutch of others - I think a trainee doctor???, a nurse from the Crisis Team, and possibly the Care Coordinator. My husband and daughter were with me and it's their account I rely on. His was very sketchy, but he is way out of his comfort zone dealing with all of this. When I asked my daughter about it I was more concerned with whether I'd said things that would have revealed to her too much about the past.

The only part I recall is everyone wanting me to agree to something, and me saying to my husband "You have some say on this too, if it all goes wrong you are the one who would come home and find the body"

It seems that they wanted me to agree that the way forward was to start CBT. I presume I was saying, again, what I keep asking for - CBT is what I want but I need to be assured that it would start with the stabilisation stage because that is the bit that everyone keeps missing out.

So something has changed between then and now, when they are no longer talking about CBT, and seem to want to change the diagnosis.

Looking at it in the most positive light, they also asked my husband which admitted treatments he had been researching, so it's just possible that against all the odds they will go ahead with that and just want to be assured that the level of risk is low.