Forensics refers to the application of scientific knowledge to legal problems, thus there are many forensic experts in many fields.  Most people are familiar with forensic pathology (from television shows) which is a study of dead bodies to understand the cause of death for legal purposes. 

Forensic Psychiatry is a sub-specialty of psychiatry which focuses on the interface between law and mental health.  It may involve criminal matters (such as insanity or competency to stand trial) or civil matters (such as emotional distress or fitness to work).  Forensic psychiatry may involve consultation with attorneys, clinical examinations of perpetrators, victims or plaintiffs.  Forensic Psychiatry usually involves writing detailed psychiatric reports, and less frequently, testimony in court.

A psychiatrist is a medical doctor (M.D. or D.O. in the U.S.) with specialized training during a 4-year residency following graduation from medical school in the evaluation, diagnosis and treatment (both psychotherapy and medications) of mental illness.  A forensic psychiatrist has additional training and experience in evaluating and communicating mental health issues in legal settings and has education in mental health law as it pertains to mental illness.

Forensic Psychiatry and Forensic Psychology are different but related fields and often collaborate to evaluate defendants, victims or plaintiffs.

A Forensic Psychiatrist is a medical doctor who has completed an undergraduate degree, medical school, four years of residency in psychiatry and additional training in legal psychiatry.  As a medical specialty, psychiatrists are trained in biological evaluations and treatments (lab testing, medication prescriptions), psychotherapy and other medical management techniques.

Forensic Psychologists are not physicians and do not attend medical school but are usually doctoral-level experts (Ph.D., Psy.D. or Ed.D.) with extensive training in psychology.  They often have expertise in areas not studied by psychiatrists such as psychological testing. Forensic Psychologists have additional training beyond their doctoral programs.  The difference in training between psychologists and psychiatrists often create a powerful, collaborative team to explain complex human behavior issues to a jury or judge in court.

Forensic Psychiatrists are expected to follow the general ethics of the medical profession (i.e. Hippocrates) and follow the state rules governing their licensure.  In addition, many Forensic Psychiatrists join the American Medical Association (AMA), the American Psychiatric Association (APA), and the American Academy of Psychiatry and the Law (AAPL).  Both the AMA and the APA have formal codes and ethics including sections on professional conduct of physicians who work in legal settings.  The AAPL Code of Ethics specifically focuses on forensic practice.  Ethical codes apply only to those Forensic Psychiatrists who join these organizations, thus it is common for attorneys to inquire of the Forensic Psychiatrist regarding membership in these organizations.

Forensic examinations can be diverse.  Criminal evaluations may involve insanity and competency, pre-trial capacity to waive Miranda, post-conviction psychiatric assessments, restoration of capacity examinations, capacity to be sentenced, capacity to be executed, and sex offender evaluations.  Civil forensic cases may include mental health commitment, medical malpractice, emotional distress related to workplace issues/harassment/violence, competency issues including guardianships, conservatorships and writing wills (testamentary capacity), fitness to work or fitness to be a parent.  Forensic Psychiatrists may work on any case or issue that may arise as a legal dispute involving psychological functioning requiring an expert opinion to assist the court in its decision making regarding the legal dispute.

Forensic Psychiatrists can work in a number of settings.  Most continue to provide general psychiatric services, and forensic work generally occupies less than 50% of their practice.  Thus, many Forensic Psychiatrists work in outpatient clinics or inpatient psychiatric units, academic settings such as universities (teaching and conducting new research), or in government settings such as jails or prisons. 

In general no.  Often the exam is ordered by a court or an exam is requested by a third party (like an employer seeking a fitness exam of an employee) or a defendant requesting an exam of a plaintiff alleging emotional distress that the plaintiff claims has been caused by the defendant.  In these cases, the party requesting the examination bears the cost of the examination.

It should not.  One of the ethical guidelines for Forensic Psychiatrists is to remain as objective as possible in the case analysis and formulation.  The forensic expert is paid for his or her time working on the case, not on the outcome of the case.  The forensic examiner’s role in the courtroom is to be a teacher, explaining the nature of mental illness and its relationship to the legal issue being addressed.  The Forensic Psychiatrist should strive to always be the best clinician in the courtroom, not the worst lawyer.  The forensic report should always be based on sound science and adhere to the diagnostic criteria accepted by psychiatry (DSM-IV or DSM-V beginning in May, 2013).  The conclusions of the forensic examiner should not be influenced by legal strategy or ignore data to adhere to a pre-conceived bias or opinion.

A forensic examination and a “regular” psychiatric evaluation are fundamentally different.  The goals of a forensic evaluation are to establish facts pertaining to a legal matter that required diagnosis and interpretation for the purposes of a fact finder, i.e. court, to make a determination regarding culpability or disposition of a person in court.  It does not imply that the Forensic Psychiatrist is providing ongoing care or treatment.  Usually there is not an established “special relationship” between the examiner and the examinee.  The elements of a forensic evaluation include review of all available records, interview of the individual, and completion of a report directed toward the questions regarding the legal matter.  In contrast, in a “regular psychiatric assessment”, the goal is for treatment of the individual.  A special relationship is established between the practitioner and the patient.  In that relationship, the assumption is that the patient is providing accurate information to the psychiatrist in order for the psychiatrist to formulate a diagnosis and a treatment plan.  The psychiatrist’s assumption is that the information is being provided accurately by the patient, and the doctor’s obligation is to provide appropriate treatment based on contemporary standards of care. 

The Forensic Psychiatrist, in contrast, makes no assumption about the veracity of the statements of the examinee but relies on all of the available data to formulate an opinion regarding a legal question.  While the interview process may be identical, the relationship is fundamentally different between the psychiatrist and the examinee.

The legal system is adversarial in nature.  Attorneys seek out experts to support their case.  Psychiatry is an art as well as a science, subject to changing opinions regarding psychiatric illness based on new research and discovery.  Psychiatry periodically reviews and revises its standard nomenclature and revises diagnostic criteria for mental illness.  This has been quantified in the DSM (Diagnostic and Statistical Manual of Mental Disorders), and the most recent revision is the DSM-V scheduled to be published in May, 2013.  Because of the overlap of criteria between disorders, the complexity of mental illness, the variable ways in which plaintiffs or defendants present themselves to the forensic examiner, and the set of data presented to the examiner, the end result may be genuine differences of opinion between experts.  Often the diagnosis is not in dispute but how the mental illness is conjoined to the legal question.  For example, in the case of insanity, it must be determined that a defendant, while mentally ill, was more likely than not (51%) to have been unable to appreciate the wrongfulness of his act at the time of its commission.  Both forensic experts may agree on the diagnosis but differ on the wrongfulness question.  One expert may conclude that yes, it is 51% likely, the other expert no, 49% likely, a very thin difference but one exploited in the adversarial court system, making it appear that the experts are radically different in their opinions.