The prevailing standard for psychiatric commitment requires a finding that the examinee be dangerous to self or to others in order to be hospitalized against one’s will. Depending on the state, “dangerous’ may include a passive danger to oneself through profound neglect. Some factors may increase the likelihood of the future risk of dangerousness, as determined by available research, but otherwise do not definitively establish a person’s imminent dangerousness.
Involuntary commitment questions engage particularly sensitive areas of liberty and control over one’s own body. It isn’t always so obvious when a person is dangerous. Conflicting psychiatric history, informants with agendas, and the exploiting of a psychiatric commitment laws may land someone in a locked psychiatry ward who should not be there. Alternatively, an intransigent if quietly incendiary individual with a vague psychiatry history may challenge well-founded efforts to keep him or her secure.
Medication over objection may be instrumental to restoring a defendant to competency, or an individual to the community. A violation of an individual’s rights? What does he or she understand? What risk does he or she present? Does the medication make a difference? How? Have alternatives been explored? Patients may be disorganized and obviously impaired in court. Nevertheless, a psychiatrist must establish that a patient continues to represent a danger to self or to others, even in a protective hospital setting for medication to be ordered by the court. Furthermore, the testifying psychiatrist must impress the court that the medication recommended specifically targets the psychiatric symptoms that perpetuate that dangerousness.
Part of a court’s decision to allow treatment over objection is driven by the examining psychiatrist’s ability to prove that a patient lacks capacity to give informed consent. In reality, many who refuse treatment but need psychotropic medicines retain capacity to give informed consent – yet would remain dangerous if he or she refused medicines. Increasing respect for the rights of the individual mandates that treatment may be administered only after informed consent is obtained. Included in a forensic psychiatry evaluation of a person’s capacity to refuse or even accept treatment, therefore, is the capacity to provide informed consent in the first place. The psychiatrist verifies the patient’s ability to understand the very reason for treatment, the actual treatment, the alternatives, the risks, the benefits and side effects of each, as well as the risks of no intervention at all.
The Forensic Panel is comprised of world-class expert clinical psychiatrists who are used to dealing with these issues every day in a hospital or forensic setting. We are well-acquainted with the forensic subtleties of competency to give informed consent, as well as the assessment of acute danger among the incarcerated.
Sometimes, resolution of such cases is made more difficult by how vested some parties are for unrelated reasons. In such instances, The Forensic Panel’s forensic peer review imbues the examination with the critical oversight to cut through bias and to arrive at evidence-based conclusions that reflect complete and independent review of available history and informants.