Legal Implications/ Responsibilities for a Psychiatrist/ Mental health professional By Dr.Jagadeesh.N MBBS, MD, DNB, LLB, PGDMLE *Professor of Forensic Medicine Vydehi Institute of Medical Sciences Bangalore, Karnataka *Hon. Consultant, CEHAT, Mumbai

Editorial of Journal of the American Academy of Child and Adolescent Psychiatry No problem in child and adolescent psychiatry stirs up more heated discussion than does child sexual abuse 2

Psychiatrist/ Mental health professional Therapist Forensic evaluator Public policy educator 3

Legal Implications/ Responsibilities Criminal cases Civil cases Departmental enquires 4

Psychic injury Short term effects V Long term effects? With and Without associated Physical injuries? Summit’s - Child Sexual Abuse Accomodation syndrome Finkelhor & Browne’s – Traumatogenic model DSM-III-R Diagnostic model of PTSD – Post Traumatic Stress Disorder Terr’s – Type I & II Childhood Psychic Traumas 5

Child Sexual Abuse Accomodation syndrome Secrecy Helplessness Entrapment & Accommodation Delayed, Conflicted, Unconvincing Disclosure Retraction 6

Traumatogenic model Traumatic Sexualization Betrayal Stigmatization Powerlessness 7

PTSD 50% of cases found Different in Child v Adult But doesnot explain all the symptoms seen in victims Age / developmental level/ length & type of abuse/ relationship with the offender 8

Childhood Psychic Traumas Type – I – single blow traumas full detailed memories, misperceptions Type – II – longstanding repetitive traumas denial & psychic numbing, self hypnosis, dissociation, rage 9

False Allegations Subsequent retraction by child Inconsistencies in report Failure of others to corroborate the abuse Absence of medical evidence Custody of child cases Parental alienation syndrome 10

Improper Investigatory techniques Lack of Professional resources & Training Lack of Investigatory Independence Improper Interview techniques Inadequate data base Contamination by External influences 11

Admissibility of Expert’s evidence Refutation of defense Counsel’s claims Common characteristics of Sexually abused children General veracity of children alleging sexual abuse Veracity of particular Child witness Matching general characteristics of sexually abused children with those of Child Witness 12

Admissibility of Expert’s evidence Common characteristics of child sexual Abusers Expert testimony identifying the defendant as the Abuser 13

Competency of Minors to testify Is there a mental disease or defect? Does this directly impair the functions relevant to being a witness?? 14

Forensic Interviewing? Helping the child to disclose abuse OR Efforts in fact finding or credibility assessment? 4 stage interview Rapport building skills Competency testing Obtaining details of abuse Closing the interview 15

Forensic Interviewing? Role definition – forensic V therapist Clear communication Confidentiality Problem of bias – healer v objective assessment Awareness of limitations Degrees of certainty Beyond reasonable doubt v degree of preponderance -51% 16

Liability of Psychiatrists /MHP Ethical Deficiency of service Medical Negligence 17

American Academy of Child and Adolescent Psychiatry Guidelines for the Clinical Evaluation for Child and Adolescent Sexual Abuse …………………… Practice Parameters for the Forensic Evaluation of Children and Adolescents Who May Have Been Physically or Sexually Abused ………. ………. 18

In future in INDIA…………. Guidelines – Therapeutic / Forensic? Documentation of Counselor notes Research evidence into therapeutic benefits Court appearance & adjudication on these skills 19