A proper forensic evaluation is a complex, in-depth process that requires multiple interviews, extensive review of previous assessments with attention to the variation and consistency of reports, and the thoughtful collection of data from relevant collateral and corroborative sources via interviews review of appropriate legal, academic, medical and histories, other expert witness reports, and psychological testing. Recommendations about interventions should be based on a detailed knowledge of evidence-based outcomes.
The evaluation must be conducted by someone with extensive training and experience in questioning witnesses who may embellish, exxagerate, diminish, mislead or attempt to hid details or truths, due to conscious or unconscious motivations, or due to mental, emotional or cognitive issues that must be well-understood by the examiner.
A developmentally and scientifically informed psychiatrist who has expertise in clinical and forensic practice and who is skilled in developing an alliance even from the reluctant or hostile subject will allow for the most informed, accurate, and just assessment.
Forensic psychiatric consultations are NOT clinical, and should not be conducted by a psychiatrist who is also providing clinical care to the client. The forensic evaluation requires additional skill, training, and microanalysis, and so it generally costs between $250 and$500 an hour. The forensic psychiatrist will typically bill for review of records, examinations and interviews, preparation of reports, travel time, and court time, so a forensic psychiatric assessment can be expensive. At times, it may not be clear that the benefits of a psychiatric evaluation are worth the expense; an initial review of the case by a forensic psychiatrist may help an attorney decide whether an extensive evaluation is warranted. A psychiatrist will generally request a retainer in order to commence with a forensic evaluation. The American Academy of Psychiatry and the Law has guidelines for forensic psychiatric practice, and this includes ethical guidelines which prohibit a psychiatrist from accepting a contingency fee for a psychiatric evaluation.
Too often, I have seen well-intended attorneys and judges, who are penny-wise and pound foolish; they pay an agreed-upon fee for a “complete forensic evaluation”. Typically these are brief evaluations conducted by examiners who complete a fairly simple interview and who do not get into the mulitdimensional and complex details that each legal situation presents. The conclusions lack a synthesis of the real data, and are often based on overall “impressions” after a short assessment that may even lack the details of an initial clinical assessment. I have seen the negative outcomes of such assessment: adoptions have been disrupted with potentially catastrophic outcomes, important childhood attachments have been interrupted without consideration for the child’s development, mentally ill youth and young adults have been placed in punitive settings, or in “wilderness programs” that have no evidence of efficacy. I have never been involved in a case in which my recommendations were not implemented when 1)no other forensic consultant has been asked to consult 2)the other consultant has failed to conduct a proper evaluation. Thus, the import of an expert who can provide a rich, complex, and detailed synthesis of the finest details of the situation can provide the most ethical and just outcome possible for legal matters.