AAPL Practice Resource for the Forensic Evaluation of Psychiatric Disability.

(Reprinted with permission from The Journal of the American Academy of Psychiatry and the Law).

AAPL Practice Resource for the Forensic Evaluation of Psychiatric Disability.

Full Document: Anfang SA, Gold LH, Meyer DJ: AAPL practice resource for the forensic evaluation of psychiatric disability. Journal of the American Academy of Psychiatry and the Law Online Supplement 2018, 46 (1). Available at: http://www.jaapl.org/content/46/1_Supplement.

Commentary: Disability evaluations--are the evaluators able?

Disability assessments of patients are among the most common nontherapeutic evaluations requested of treating psychiatrists. Yet, there has been relatively little empirical analysis of how psychiatrists approach these evaluations in real clinical practice. Treating psychiatrists, those both with and without forensic expertise, struggle with the challenge of dual agency and overlapping therapeutic and forensic roles. Making the different roles clear to the patient can allow for more therapeutic exploration and alliance around further treatment goals, expectations, and interventions. Given the high prevalence of psychiatric disability and requested evaluations, psychiatric trainees would benefit from formal teaching, and it should be considered an important area for psychiatric continuing education.

Psychiatric fitness-for-duty evaluations.

Fitness-for-duty examinations are a common type of psychiatric disability evaluation. These evaluations are typically best performed by the independent (nontreating) psychiatrist with forensic training or expertise in these examinations. A comprehensive evaluation requires careful definition of the referral questions and consideration of the terms of the referral; review of relevant job-specific documentation and medical records; the collection of collateral information from relevant third-party informants; a thorough clinical psychiatric examination; and possibly additional testing. The examination report needs to be comprehensive, address the specific questions in clear language understandable to the non-mental health clinician, and use all available data to substantiate the logical conclusions in a fair, accurate, and objective manner.

Civil commitment--the American experience.

The evolution of U.S. civil commitment law needs to be understood within the context of changes in psychiatry and medicine, as well as larger social policy and economic changes. American civil commitment law has reflected the swinging pendulum of social attitudes towards civil commitment, oscillating between more and less restriction for both procedural and substantive standards. These standards have evolved from a "need for treatment" approach to a "dangerousness" rationale, and now may be moving to a position in which these justifications are combined, particularly in the context of involuntary outpatient commitment. Civil commitment in the United States has been shaped by multiple factors, including sensitivity to civil rights, public perception of psychiatry, availability of resources, and larger economic pressures. We suggest that current American commitment practice is influenced more by economic factors and social perceptions of mental illness than by changing legal standards.

The American Psychiatric Association's resource document on guidelines for psychiatric fitness-for-duty evaluations of physicians.

The psychiatric evaluation of a physician's fitness for duty is an undertaking that is both important to patients' well-being and to the physician-subject of the evaluation. It is necessary that psychiatrists who agree to perform such evaluations proceed in a careful and thorough manner. This document was developed to provide general guidance to the psychiatric evaluators in these situations. It was prepared by the American Psychiatric Association (APA) Council on Psychiatry and Law and Corresponding Committee on Physician Health, Illness, and Impairment, of which the authors are members. The Resource Document was approved by the APA Joint Reference Committee in June 2004. APA Resource Documents do not represent official policy of the American Psychiatric Association. This Resource Document was edited to conform to Journal style and has therefore been modified slightly from the original document approved by the APA.