Report Writing for Treating Psychiatrists By Dr Andrew Carroll
Dr Andrew Carroll is a forensic psychiatrist who has worked in public mental health for over 25 years in both Australia and the UK. He has extensive experience working in both clinical and managerial roles in a range of forensic and general mental health services.
He has a busy private practice, which involves forensic assessment work for various agencies including Victoria Legal Aid, the Drug Court, the Office of Public Prosecutions, MACNI (the Multiple and Complex Needs Initiative), Department of Health and Human Services (Victoria) and the TAC. He regularly provides expert medicolegal opinions for private law firms, including opinions regarding ‘standard of care’ in the context of claims of negligence against mental health services.
Dr Carroll has published extensively in the field of risk assessment, forensic mental health service provision, clinical decision-making and violence. He previously held the role of Senior Lecturer in Forensic Psychiatry at Monash University and is now an Associate Professor (Adjunct) at the Centre for Forensic Behavioural Science at Swinburne University of Technology.
Always contact the person requesting the report and discuss their requirements. This will save you a lot of time in the long run and help you provide the most accurate information.
A report prepared by the subjects treating practitioner should be confined to information relevant to treatment provided to the subject (e.g., presenting signs and symptoms, diagnosis, clinical formulation, treatment response and treatment needs).
Treating psychiatrists may choose to limit any written reports for legal purposes to provision of information about diagnosis, treatment and prognosis.
Summary and Slides
Andrew introduces the webinar by discussing the different types of forensic report (civil and criminal), as well as the likely nature and sources of forensic report requests including criminal lawyers, civil claims lawyers, coroners, supervisors or TAC members.
He then explores the differences between the role of a treating psychiatrist versus that of a forensic psychiatrist. In a treatment role the psychiatrists duty is to their patient, opinions are asked about general psychiatric matters and report contents are limited to facts. In a forensic role the psychiatrist’s duty is to the court not the subject, reports are written on specific forensic matters.
Ten tips for best practice were then discussed, including the most recent clinical guidance from the Royal Australian & New Zealand College of Psychiatrists, and the AHPRA Medical Board of Australia. Some key strategies were then shared on how to complete reports quickly and accurately. Dr Andrew then describes the types of information to be included in a high-quality report (see below). He also explained the circumstances in which you should not agree to answer a question or complete a report, for example, when being asked about causality.
Sources of support and guidance were then discussed, including senior colleagues, forensic faculty members, your own indemnity insurer, as well as the practice guidance documents mentioned above. In the final part of the webinar Dr Andrew discusses the likelihood of having to attend court (which is very rare). He then explored additional support around coronials, advising viewers to consider the need for legal support from indemnity insurers or their own alternatives. He then discusses good practice guidance for patients in custody.
Take home messages:
- Your signature is very valuable and powerful – Use it wisely.
- A thoughtful and collaborative approach as well as maintenance of professional boundaries is key.
- Reports should always be completed within a reasonable and justifiable time frame.
- When being asked to write a report be co-operative but also be prepared to push back if you are being asked to comment on something outside of your comfort zone.
- Always be honest in your reports but stick to the facts and never give opinions beyond your sphere of competence.