Court reports (criminal and civil)
Psychiatric legal reports are reports prepared by an instructed expert witness to give his independent opinion regarding a case in a court. The purpose of the psychiatric report is to communicate the expert’s opinion so as to assist the court in reaching conclusions on matters in issue and to enable it to do so justly. Psychiatric reports are of great value in a number of legal areas such as personal injury, immigration, criminal law and family law.
Personal Injuries are ‘any disease and any impairment of a person’s physical or mental condition’. In relation to psychiatry, in order for a personal injury case to be relevant it must be proven that the claimant has sustained a ‘recognisable psychiatric illness’. A recognisable psychiatric illness is not shock, grief, distress or some other emotion, but a positive illness ‘recognised as such by a specialist in psychiatry’. Our centre has experience in the following areas relating to personal injury psychiatric reports:
- Road traffic or workplace accidents
- Fitness to work
- Depression, Anxiety
- Work related stress
Psychiatric reports used in criminal proceedings can be commissioned by the defence, the prosecuting side and by the by the court itself. Pre-trial and preliminary issues may include bail, fitness to be interviewed/reliability, fitness to plead and stand trial, and vulnerable defendants. Trial issues may include diminished responsibility, insanity, automatism, loss of control, duress and coercion amongst others. Our centre also has expertise in violence risk assessments. Our centre can prepare psychiatric reports for child and family law cases. Some of the areas covered are:
- Parental Assessments
- Child Care Proceedings
- Child Contact Issues
- Child Safety
- Child Assessments including ADHD and Aspergers
- Child Abuse : Physical / Emotional / Sexual
Mental capacity assessment
Capacity is the ability to make decisions for oneself. A person may lack capacity due to a disability such as intellectual disability, dementia, brain injury or mental illness. A person may lack capacity temporarily, such as during a coma following an accident. The person may be able to make some decisions but not others.
Legal capacity and all the rights that go with it remain in effect until death, unless a court of law determines that a person can no longer manage personal affairs in his own best interest and court intervention is necessary to protect the person. People are assumed to have capacity to make their own decisions unless it can be demonstrated that they lack capacity.
Clinical evaluation by a specialist in psychiatry is sometimes necessary in order to assess whether a person can give informed consent to medical investigations and treatment. Likewise, a clinical evaluation of the person’s ability to conduct major legal and business transactions may be needed before a lawyer or accountant can proceed with transactions.
Expert witness in Court
An expert witness is someone who is recognized by a court as an authority on a topic who has knowledge beyond that accessible to the average person. Rather than testifying on legal matters, expert witnesses provide factual information and analysis, which may be beneficial to a case. Expert witnesses may have experience, training, skills, or education which are not common to the general public. A doctor is usually treated as an expert witness on the stand because not everyone has the benefit of a medical education and experience in practice as a doctor.
We also provide assessment, management and counseling of mental health issues including:
Mood and anxiety disorders
Mood disorders include Depression, Bipolar Affect Disorder, and Mania. Mood disorders can occur in anyone, including children. The cause of mood disorders is not fully understood, but an imbalance in brain chemicals known as neurotransmitters is likely to play a role. Symptoms of mood disorders include feelings of sadness, hopelessness, helplessness or inadequacy that do not go away; guilt; suicidal thoughts; fatigue; changes in appetite; irritability; difficulty concentrating; and trouble engaging in daily tasks and relationships. Mood disorders can also cause an elevated mood (mania) that is accompanied by feelings of grandiosity, extreme energy, and heightened arousal. These feelings are stronger and last longer than normal, and interfere with day-to-day life.
There are many types of anxiety disorders that include panic disorder, obsessive compulsive disorder, post-traumatic stress disorder, social anxiety disorder, specific phobias, and generalized anxiety disorder. Anxiety is a normal human emotion that everyone experiences at times. Anxiety disorders, however, are different. They can cause such distress that it interferes with a person’s ability to lead a normal life. For people with anxiety disorders, worry and fear are constant and overwhelming, and can be crippling. Treatment for mood and anxiety disorders depends on the evaluation of a medical professional. Medication, cognitive therapy, behavioral therapy, and lifestyle modification may all be used. It is important to get early treatment for these mental health problems to reduce the severity of symptoms and manage any complications.
Psychosis means abnormal condition of the mind, and is a generic psychiatric term for a mental state often described as involving a “loss of contact with reality”. People experiencing psychosis may report hallucinations or delusional beliefs, and may exhibit personality changes as well as thought disorder. Depending on its severity, this may be accompanied by unusual or bizarre behavior, and also difficulty with social interaction and impairment in carrying out the daily life activities. Causes of symptoms of mental illness were customarily classified as “organic” or “functional”. Organic conditions are primarily medical or pathophysiological, whereas, functional conditions are primarily psychiatric or psychological. These include dementia, drug abuse, schizophrenia, and mood disorders. The treatment of psychosis depends on the cause or diagnosis or diagnoses. The first line treatment for many psychotic disorders is antipsychotic medication (oral or intramuscular injection), and sometimes hospitalization is needed.
Drug or alcohol related disorders
Drug addiction is a complex illness characterized by intense and, at times, uncontrollable drug craving, along with compulsive drug seeking and use that persist even in the face of devastating consequences. While the path to drug addiction begins with the voluntary act of taking drugs, over time seeking and consuming the drug becomes compulsive. This behavior results mainly from the effects of prolonged drug exposure on brain functioning. Addiction is a brain disease that affects multiple brain circuits, including those involved in reward and motivation, learning and memory, and inhibitory control over behavior.
The most popular substance used worldwide is alcohol, which is a central nervous system depressant, meaning that it slows down the functioning of the brain and in turn, the body. Other depressants include tranquillizers, hypnotics and opioids. Stimulants have the opposite effect as they speed up the functioning of the central nervous system. Common drugs in this category are cocaine, crack and amphetamines (diet pills). There are other types of psychoactive drugs, which are being commonly abused including hallucinogens, cannabis and ketamine.
Drug abuse and addiction have so many dimensions and disrupt so many aspects of an individual’s life, treatment is not simple. Effective treatment programs typically incorporate many components, each directed to a particular aspect of the illness and its consequences. Addiction treatment must help the individual stop using drugs, maintain a drug-free lifestyle, and achieve productive functioning in the family, at work, and in society. Because addiction is typically a chronic disease, people cannot simply stop using drugs for a few days and be cured. Most patients require long-term or repeated episodes of care to achieve the ultimate goal of sustained abstinence and recovery of their lives.
Dementia and related psychological and behavioural symptoms
Dementia is a term that describes a collection of symptoms that include decreased intellectual functioning which interferes with normal life functions. These symptoms include impairment or lost of major life functions such as memory, language, perception, judgment or reasoning; the person may lose emotional and behavioural control, develop personality changes and have problem solving abilities reduced or lost. Alzheimer’s disease is the most common cause of dementia in people over age 65. Almost all brain functions, including memory, movement, language, judgment, behavior, and abstract thinking, are eventually affected.
Vascular dementia is the second most common cause of dementia caused by brain damage from cerebrovascular or cardiovascular problems (strokes) or other problems that inhibit vascular function; symptoms similar to Alzheimer’s disease but personality and emotions effected only late in the disease.
While treatments to reverse or stop the disease progression are not available for most of the dementias, patients can benefit to some extent from treatment with available medications and other measures, such as cognitive training. Drugs to specifically treat Alzheimer’s disease and some other progressive dementias are now available. These drugs do not stop the disease or reverse existing brain damage, but they can improve symptoms and slow the progression of the disease.
Personality disorder is characterised by a chronic, inflexible, and maladaptive pattern of relating to the world. This maladaptive pattern is evident in the way a person thinks, feels, and behaves. There are many specific types of personality disorders. In general, those suffering from personality disorders will experience significant problems and limitations in relationships, social encounters, work and school. Studies on the prevalence of personality disorders performed in different countries and amongst different populations suggest that roughly 10% of adults can be diagnosed with a personality disorder. The treatment will depend on the particular type of personality disorder, its severity and the patient’s life situation. Often, a holistic approach is appropriate to make sure the psychiatric, medical and social needs are met. Because personality disorders tend to be chronic and can sometimes last much of one’s adult life, long-term treatment may be needed. Psychotherapy is the main way to treat personality disorders. Using the insight and knowledge gain in psychotherapy, healthy ways can be learnt to manage the symptoms. There are no medications specifically approved to treat personality disorders. However, several types of psychiatric medications may help with various personality disorder symptoms.
Mental Retardation and related psychological and behavioural symptoms
Mental retardation is a condition that is usually diagnosed before the age of 18. The person has a below-average general intellectual function and a lack of the skills necessary for daily living.
Mental retardation affects about 1 – 3% of the population. There are many causes of mental retardation, but doctors find a specific reason in only 25% of cases. A family may suspect mental retardation if the child’s motor skills, language skills, and self-help skills do not seem to be developing, or are developing at a far slower rate than the child’s peers. Failure to adapt (adjust to new situations) normally and grow intellectually may become apparent early in a child’s life. In the case of mild retardation, these failures may not become recognizable until school age or later. The degree of impairment from mental retardation varies widely, from profoundly impaired to mild or borderline retardation.
The primary goal of treatment is to develop the person’s potential to the fullest. Special education and training may begin as early as infancy. This includes social skills to help the person function as normally as possible. It is important for a specialist to evaluate the person for other affective disorders as well as behavioural difficulties. These problems need to be treated and at times, medications will be indicated.
Mental illnesses caused by physical illness or brain injury
An organic mental disorder is a form of decreased mental function due to a medical or physical disease, rather than a psychiatric illness. It may be caused by inherited physiology, injury, or disease affecting brain tissues, chemical or hormonal abnormalities, exposure to toxic materials, neurological impairment, or abnormal changes associated with aging. While mental or behavioral abnormalities related to the dysfunction can be permanent, treating the medical disease may prevent permanent damage in addition to fully restoring mental functions.
Symptoms can differ based on the disease. In general, organic brain syndromes cause agitation, confusion, long-term loss of brain function (dementia), and severe, short-term loss of brain function (delirium).
Treatment depends on the disorder. Many of the disorders are treated mainly with rehabilitation and supportive care to assist the person in areas where brain function is lost. Medications may be needed to reduce aggressive behaviors that can occur with some of the conditions.
Most people, at some time in the lives, will experience trouble sleeping properly. Sleep disorder is characterized by the sleep problems being a regular occurrence and interfere with daily life. Sleep disorders cause more than just sleepiness. Poor quality sleep can have a negative impact on energy level, emotional balance, and health.
Insomnia is the most common type of sleep disorder. It is the inability to get the amount of sleep you need to wake up feeling rested and refreshed. Insomnia is often a symptom of another problem, such as stress, anxiety, depression, or an underlying health condition. It can also be caused by lifestyle choices, including the medications you take, lack of exercise, jet lag, or even the amount of coffee you drink.
Regardless of the sleep problems, a consistent sleep routine and improved sleep habits will translate into better sleep over the long term. When taken for a brief period of time and under the supervision of a doctor, sleeping pills may also help sleep problems. In general, sleeping pills and sleep medications are most effective when used sparingly for short-term.
An eating disorder is an illness that causes serious disturbances to your everyday diet, such as eating extremely small amounts of food or severely overeating. A person with an eating disorder may have started out just eating smaller or larger amounts of food, but at some point, the urge to eat less or more spiraled out of control. Severe distress or concern about body weight or shape may also characterize an eating disorder. Eating disorders frequently appear during the teen years or young adulthood. The most common eating disorders include anorexia nervosa, bulimia nervosa, and binge-eating disorder. Eating disorders are treatable medical illnesses. They frequently coexist with other illnesses such as depression, substance abuse, or anxiety disorders.
Adequate nutrition, reducing excessive exercise, and stopping purging behaviors are the foundations of treatment. Specific forms of psychotherapy and medication are effective for many eating disorders. Treatment plans often are tailored to individual needs and may include one or more of the following:
• Individual, group, and/or family psychotherapy
• Medical care and monitoring
• Nutritional counseling
Some patients may also need to be hospitalized to treat problems caused by mal-nutrition or to ensure they eat enough if they are very underweight.
Pre- / Postnatal Mental Disorders
Most women experience the transition to motherhood as a time of emotional change and challenge. External changes in a woman’s physical shape, in her occupational status, and in her relationship with her partner may be mirrored by internal changes in her sense of self-esteem and self-efficacy. Although these changes may be positive and a source of happiness, many women across a wide range of cultures experience transient periods of low mood during pregnancy or after a baby’s birth, including feelings of loneliness, increased anxiety and unhappiness. For most women these feeling are relatively mild and would not lead to a clinical diagnosis of mental disorder if help were sought. They tend to resolve as a woman adjusts to her new maternal role. For a minority of women, however, this low mood has a significant impact and may amount to a clinically diagnosable mental disorder.
Mental disorders during the antenatal and postnatal period take many forms. Current thinking distinguishes the following perinatal mental disorders: baby blues, depression, anxiety, and psychosis.
Having a baby may trigger a further episode of serious mental illness for women with a history of severe mental health problems. Where a woman is identified as being at high risk of serious mental illness, a care plan should be drawn up in early pregnancy. Because of the risks associated with psychotropic medication during pregnancy and breast-feeding, self-help strategies and psychological therapies may be used in the first instance. However for women with moderate to severe symptoms, or her symptoms do not respond to psychological therapy, psychotropic medication or hospitalization may be indicated.
Child and Adolescent mental health problems
Child and adolescent mental health disorders are surprisingly common. They affect 10-20% of children and young people. Common mental health disorders and difficulties encountered during childhood and the teenage years include: ADHD (attention deficit hyperactivity disorder); anxiety and a range of related anxiety disorders ranging from simple phobias to social anxiety, generalised anxiety disorder and PTSD (post-traumatic stress disorder); autism and Asperger syndrome (the Autism Spectrum Disorders, or ASD); behavioural problems; bullying; depression; eating disorders (including anorexia nervosa and bulimia); obsessive compulsive disorder (OCD); psychotic disorders – and in particular schizophrenia; and substance abuse. For the management and treatment of these disorders, apart from mental health professionals, input from other agencies such as education and social services is also important. Treatment approaches usually include psychotherapy such as individual as well as family therapy, or at times, it may be necessary to start the child on medication.