Preparation of reports

Whilst the content and purposes of psychiatric reports may vary considerably, the essential qualities of a good report will apply generally. Reports should aspire to be relevant, thorough, objective, clear, and well reasoned. The structure and format of individual reports will vary in different cases, and sometimes instructing lawyers will advise on the conventions that should be followed in particular types of case. The structure discussed below is offered as a guideline rather than a framework for rigid adherence.

Formal reports for court proceedings should generally only be done following receipt of instructions from legal representatives or courts. Sometimes lawyers or others (e.g. court probation officers) will write requesting reports on behalf of the court. Occasionally it may be appropriate for a psychiatrist to convey information or an opinion to a court on his or her initiative, preferably with the consent of the defendant concerned and his or her legal representatives. For example, it may be appropriate to notify a court about recently recognized mental illness in a defendant. Unsolicited reports of this kind should normally be brief and deal with immediate practical issues.

Instructions to prepare a report should make clear the nature of the legal proceedings, the purpose for which the report is requested, and the particular issues to be addressed. When instructions are minimal further clarification and detail may need to be requested. Detailed instructions may be particularly necessary in civil cases, and complex criminal cases.

The assessing psychiatrist should try to ensure that he or she has access to all the relevant background material. In criminal cases it is usually essential to see the prosecution written evidence, and this should be requested if it is not provided. If the defendant is seen in prison permission should be sought from the defendant and the senior medical officer to see the prison medical records.

When arrangements are made to interview the person to be assessed, sufficient time must be allowed to carry out a full assessment and to cover the relevant issues. At the outset it is important to ensure that the interviewee understands the purpose of the assessment, the potential uses of the report, and to whom it will be disclosed. If the person does not consent to the assessment it would normally not be right to proceed further.

The written court report should begin with an introduction, summarizing the sources and purposes of the report. The sources will normally include the psychiatric interview(s) and the documentation supplied to the writer, which should be listed. The report may then give a description of the individual's personal, medical, and psychiatric history. There may also need to be reference to relevant aspects of the additional information supplied to the assessing clinician. The report should include an account of the psychiatric interview and findings on clinical examination.

The final part of the report, giving the psychiatric opinion and conclusions is likely to receive most attention, and should be prepared with particular thoroughness and care. Its purpose is to summarize the relevant psychiatric information and findings, and to apply them to the specific legal questions at issue. It is important to give full reasons for the conclusions reached, including negative conclusions. For example, in a pre-sentence report, if it is thought that a medical disposal such as a hospital order is not appropriate, the reasons for this opinion, and not just the conclusion, should be fully specified.

The task of considering how psychiatric findings apply to statutory criteria can be difficult, and the advice of the instructing lawyers may need to be sought about the meaning and interpretation of particular statutory formulations. Finally, if practical recommendations are made, for example, concerning an individual's clinical treatment and management, it is important that the proposals will be seen as credible and realistic by the court. For example, it would normally not be appropriate in a serious criminal case to recommend a disposal which the court will regard as wholly inconsistent with requirements of public safety.

The level of confidence with which an opinion can be given may vary. For example, a clinician may be able to give an opinion about diagnosis with a high level of confidence, but an opinion about an individual's potential risk to others may be less certain. In compiling a report the psychiatrist should make it explicit if a particular opinion is provisional, or carries a significant degree of uncertainty. The written opinion must accurately reflect how sure or unsure the writer is about the conclusions.

Reports need to be clearly written and reasoned. Technical terms should either be avoided, or, if used, they should be defined so as to be understood by the lay reader. It should be remembered that any report may be examined and cross-examined in court with rigour and in every detail, and the writer needs to be confident that everything that is said in the report can be well defended.

After a report has been submitted, the instructing lawyers may occasionally request corrections and changes to the text. For example, they may indicate that it would be helpful if opinions could be expressed with a higher level of certainty. If faced with such requests the clinician should be willing to make corrections of fact, clarify parts of the text that are obscure, and remove any material that must not be disclosed or referred to. However, requests to amend opinions and conclusions should be resisted if this would distort, misrepresent, or unbalance the clinician's objective appraisal of the case. The clinician should not be drawn into making statements which he or she could not fully substantiate or defend.

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Funny Wiring Autism

Autism is a developmental disorder that manifests itself in early childhood and affects the functioning of the brain, primarily in the areas of social interaction and communication. Children with autism look like other children but do not play or behave like other children. They must struggle daily to cope and connect with the world around them.

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