Civil and Criminal Forensic Psychiatry
The civil and criminal domains test whether you can keep the legal question separate from the clinical question and match the right evaluation product to the right proceeding. In civil matters, know the standards for competence to consent to treatment, informed consent, competence to make medical/financial decisions, testamentary capacity (capacity at the moment of execution, not the day of the exam), fitness for duty, ADA/FMLA concepts, personal injury and disability, and child custody (best-interests standard, parenting plans). Malpractice questions hinge on the duty–breach–causation–damage elements and on the standard of care. In criminal matters, distinguish competence to stand trial (Dusky: factual and rational understanding of proceedings and ability to assist counsel) from competence to plead, waive counsel, and waive Miranda; distinguish insanity/mental state at the time of the offense (M'Naghten, irresistible impulse, ALI/Model Penal Code, and the federal standard) from mens rea and from competence. Know voluntariness of confessions and the risk of false confessions, risk of violence, sex offender civil commitment, and diminished capacity.
Traps: confusing present mental state (competence) with past mental state (insanity); treating a diagnosis as a legal conclusion; assuming a person incompetent because mentally ill; forgetting that competence is task- and time-specific; using "insanity" colloquially. Also watch for questions where the examiner asks for the legal standard, not the clinical opinion.
Rule of thumb: name the legal question first, then the legal standard, then the clinical data that bear on it. Worked example: a defendant with untreated psychosis is unable to understand the charges - this is a competence question (present ability), not an insanity question, and the proper opinion addresses restoration and treatment, not guilt.