ABPN Forensic Psychiatry cheat sheet

Dusky v. United States (1960): competency to stand trial requires factual understanding of proceedings and rational understanding plus ability to consult with counsel; not a fixed diagnosis test.

Jackson v. Indiana (1972): indefinite confinement solely for incompetency violates due process; commitment must be justified by progress toward competence or other lawful grounds.

McNaughten standard: acquittal requires defect of reason from disease of mind causing inability to know the nature/quality of the act or that it was wrong; 'wrong' is generally legal wrong.

Insanity standards vary by jurisdiction: McNaughten, ALI/Model Penal Code (volitional prong), and Durham product test; always identify the governing jurisdiction's standard.

Competency is a present-state functional inquiry; insanity is retrospective at the time of the offense; the two questions are legally distinct and assessed separately.

Civil commitment (Addington v. Texas) requires at least clear and convincing evidence; criminal commitment requires proof beyond a reasonable doubt.

Fitness-for-duty and disability evaluations must distinguish treating role from evaluative role; the evaluator's duty is to the retaining party, not the evaluee.

Risk assessment instruments (e.g., HCR-20, PCL-R, Static tools) inform but do not replace individualized clinical and legal judgment; base rates and population matter.

Forensic reports should state the referral question, sources reviewed, limits of confidentiality, methods, findings, and an opinion tied to the legal standard.

Informed consent for forensic evaluation differs from treatment consent: warn that the evaluation is not confidential and may be disclosed to the court or retaining party.

Tarásff duty-to-protect (Tarasoff v. Regents of the University of California) is a jurisdiction-specific duty; identify whether the state imposes a duty to warn, protect, or neither.

Forensic evaluators should avoid dual agency: treating clinician and forensic evaluator roles should be separated to preserve objectivity.

Record review and collateral sources (police reports, prior records, interviews) are standard components; reliance on self-report alone is inadequate.

Jail and correctional systems have distinct mental health standards (e.g., Estelle v. Gamble deliberate indifference); access to care and suicide risk screening are core obligations.

Juvenile forensic systems require developmental considerations; competency and culpability standards may differ from adult standards.

Expert testimony admissibility follows jurisdiction rules (Daubert or Frye); courts assess relevance, reliability, and fit to the legal question.

Core ethical principles: beneficence, nonmaleficence, autonomy, justice, and fidelity; forensic ethics prioritizes truth-seeking and the legal question.

Forensic psychiatrists owe duties to the retaining party and the court; the evaluee is not the patient, and a therapeutic relationship should not be implied.

Confidentiality is limited in forensic contexts; explain the absence of doctor-patient confidentiality and the potential for testimony and disclosure.

Boundary issues: avoid dual relationships, financial conflicts, and advocacy that compromises objectivity; disclose any potential conflicts of interest.

Competence and scope: opine only within one's expertise and the limits of the data; clearly distinguish clinical opinion from legal conclusion.

Informed consent and voluntariness: evaluees should understand the purpose, potential uses, and consequences of the evaluation before participation.

Honesty in testimony: experts must not misstate credentials, data, or the limits of instruments; correction of error is an ethical obligation.

Cultural and linguistic competence: use qualified interpreters and consider cultural factors in assessment, diagnosis, and risk formulation.