Forensic issues

A range of forensic psychiatry issues frequently present themselves in correctional settings. Incompetency to stand trial is one such concern. In some states, defendants found incompetent to stand trial must be managed in jail. Litigation is another important issue. Psychiatrists working in correctional settings often have increased litigation risks regarding professional negligence and other forms of liability. Especially important is understanding whether their insurer covers correctional work. One common form of litigation is habeas corpus. For example, a habeas petition could be brought to seek medical interventions denied by the detaining institution, and as such, the medical staff could be named defendants. Many class actions have involved correctional mental health care. Often clinicians working in correctional settings welcome these litigations, as they focus the attention of the courts on deficiencies in care related to inadequate resources. While such lawsuits can be sensitive, especially in the earlier phases when the outcome is in doubt, correctional psychiatrists and other clinicians may also serve as sources of information for each party to the case and to the court. Another key topic is the correctional disciplinary process. Mental health input into the disciplinary process does not address issues of responsibility but is limited to identifying mitigating factors related to mental illness when present, dispositional recommendations when clinically appropriate, and competency-to-proceed issues in the context of the disciplinary hearing. This chapter reviews key issues of relevance to correctional psychiatrists, such as competency restoration, court collaboration, and litigation related concerns.