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The New Therapist
with Anthony D. Smith, LMHC

Forensic Psychology Careers: Court Clinicians

As readers are learning, forensic psychology has many avenues. The past two posts examined correctional facility mental health clinicians. Today, we begin exploring the role of “house” psychology professionals within the courts. Chances are, in one of your favorite crime TV shows, you’ve seen a psychologist being cross-examined on the stand. Such is the life of expert witnesses and private evaluators hired by attorneys hoping for specific outcomes. However, did you know that most courts have in-house psychological evaluation services? This is usually termed the Court Clinic and consists of psychologists, master’s level clinicians, and sometimes psychiatrists. They provide a vital role in day-to-day proceedings in both adult and juvenile courts.

In adult courts, the work is primarily that of psychologists or psychiatrists performing a few different types of evaluations:

Competency to stand trial evaluations:

Here, the clinician evaluates a defendant’s ability to understand the charges against them and the proceedings of the court. Competence is important because the person needs to be an informed participant in their defense. If an attorney or judge believes a defendant may have psychological illness or defects inhibiting their ability to understand proceedings, they will request an evaluation. Court psychologists may attend to the individual in a court-based office, or, if they are detained, visit the individual at a facility.

Jurisdictional criteria and case law set criteria for competence. In Massachusetts, competence is defined as:

Whether the defendant has sufficient present ability to consult with his lawyer with a reasonable degree of rational understanding and whether he has a rational as well as factual understanding of the proceedings against him.

To decide competency versus incompetency, court clinicians examine not only mental status, but explore many judicial items with the defendant. These include processing and reasoning abilities around items such as the nature of a charge or what it could mean to accept a guilty plea versus going to trial. If competent, the defendant reappears in court and proceedings continue, unless defense counsel requests a second opinion. If they are found incompetent the cases are put on hold until competency is restored. This may require both stabilization of acute symptoms and educating the individual about proceedings. Some states have programs for the latter, while others rely on attorneys to do the work. However a person is found, the clinician may be required to provide testimony, but that is not a given, like in the next evaluations.

Criminal responsibility evaluations:

Some court clinic evaluations pertain to criminal responsibility. This evaluation concerns determining whether an accused individual was influenced by a mental defect such that:

  • They were unable to appreciate the wrongfulness of the unlawful activity, or
  • They were unable to make themselves behave lawfully

As you can imagine, depending on the gravity of the charges, a lot is at stake and there may be a push to use an insanity defense. It must be remembered, however, that just because someone has a mental illness does not mean they are unable to tell right from wrong. Examiners may spend a lot of time determining if someone is malingering.

If motive, intent and planning can be established, a not guilty by reason of insanity, or NGRI, defense is usually moot. In fact, a survey of NGRI statistics tends to show that less than one percent of NGRI defenses are successful. It becomes interesting in some cases, for example, where motive, intent and planning are established, but were entirely influenced by significant delusions.

Emergency substance abuse and psychiatric crisis evaluations:

With the cresting of the opiate epidemic, some states saw an increase in petitioning for involuntary commitment to substance abuse treatment. In Massachusetts, the number of filings nearly doubled between 2010 and 2018. Since such commitment requires a court petition, it makes sense that Court Clinic personnel perform the evaluation. In Massachusetts a qualified examiner for to perform these evaluations must be a psychologist, psychiatrist, or licensed clinical social worker.

While this is a civil matter, if the individual refuses to come to court, an arrest warrant can be issued given the potential danger the person is in and the need for intervention. In order to be committed, an examiner must find the person dangerous to themselves and/or others because of the effects of the substance. Attorneys can challenge findings and examiners may find themselves badgered on the stand like any expert witness. In the end, it is not the examiner’s role to make sure the person gets committed or not. They are simply explaining to the court their professional opinion, and it is ultimately up to the judge. This is the case in both adult and juvenile courts.

Psychiatric crisis evaluations are performed when someone presents acute mental health problems in the court. This could be active hallucinations or mania, to suicidal or homicidal ideation thoughts or actions. A risk assessment is performed by a court clinician, and if deemed at risk, just like in a community setting, a bed search is performed. Since a court is not a treatment facility, if beds are not available, the person can be sent to a local emergency room for ongoing evaluation until a bed is found, or they stabilize.


Just as treatment providers encounter an unending array of presentations that keep their work interesting, so, too, do forensic evaluators. Evaluations are often complex, and have the additional component of legal considerations. If you are in a doctoral or psychiatry program and the above piques your interest, seeking internships or post-doctoral fellowships in courthouses will lay a good foundation.

If you’re a master’s level practitioner and want to work in a court clinic, don’t fret! Tomorrow, we’ll compare adult and juvenile court clinicians’ work.

References:

Massachusetts Government. (2020). Section 15.  https://malegislature.gov/Laws/GeneralLaws/PartI/TitleXVII/Chapter123/Section15#

Massachusetts Government. (2020). Section 35: the process. https://www.mass.gov/service-details/section-35-the-process#

 

Forensic Psychology Careers: Court Clinicians


Anthony Smith, LMHC

Anthony Smith is a licensed mental health counselor in Massachusetts with 20 years of experience. He has worked in facilities and in private practice performing therapy and diagnostic evaluations across a wide array of populations both demographically and clinically. This includes 17 years in the forensic arena, where he currently provides assessments for the juvenile courts. Aside from interest in the intersection of psychology and law, Anthony is particularly in interested differential diagnosis and supervision of new practitioners. He regularly teaches abnormal psychology and creates courses on the lived experience of people with mental illness, along with supervising graduate student counselling practicums at a local university. When not providing clinical services, teaching or blogging, Anthony can be found hiking and fly-fishing around the Northeast and American West.

 


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APA Reference
Smith, A. (2020). Forensic Psychology Careers: Court Clinicians. Psych Central. Retrieved on September 19, 2020, from https://pro.psychcentral.com/new-therapist/2020/08/forensic-psychology-careers-court-clinicians/