The difference between a psychiatric evaluation, psychological assessments and psychosocial reports
Preamble Against the background of ever increasing number of clients presenting at court with mental health problems and disabilities and other psychological disorders, the need for determining precisely what the mental health or disability issue is for your client has become even more critical. The use of reports from other fields of expertise often guides your presentation of a case and also provides a vehicle for the presentation of information in an admissible form before the court. In order to achieve the best outcome for your client it is imperative that you have the best and most appropriate type of report. Different circumstances will dictate what type of report will best assist your client. This document provides guidelines and practical tips designed to assist solicitors to determine what type of report will best suit their client’s situation. Solicitors also need to be mindful regarding the cost involved of obtaining reports externally, and the need to be as cost-efficient as possible.
Psychiatric Reports Psychiatric evaluations are the only way to determine whether a mental illness or psychiatric illness is present. Broadly speaking a psychiatrist (if he/she is not the client’s treating doctor) will see the client on only one occasion to make this medical diagnosis. Reports by psychiatrists do not usually canvass or discuss community services, treatment options or alternatives to a custodial sentence. If your client fits any of the criteria below then you may wish to consider arranging a psychiatric evaluation. Has a current or recent history of ongoing psychiatric treatment Displays or reports obsessive-compulsive behaviours Displays unusual behaviours; is psychotic and hears voices or has delusional or paranoid thoughts Has attempted suicide on one or more occasions Has a repeated history of sexual offending Discloses taking anti-psychotic medication over an extended period Displays significantly violent or aggressive behaviours Has a history of depression whether treated or not
Remember If you are considering arranging for a psychiatric evaluation ask your client the following questions: 1. Who is their doctor? 2. Have they ever been involved with a local community health team? 3. Have they ever been involved with a local mental health team? 4. Have they ever had a caseworker? 5. Have they ever seen a counsellor? 6. Have they ever had a financial case manager? (protective office) 7. Do they take tablets or medicine or receive an injection? 8. Who first prescribed them medication? 9. Have they ever been put in hospital for hearing voices or because other people thought they were behaving oddly? One of these professionals may already have a psychiatric evaluation & diagnosis on file. They may also be able to provide a comprehensive or recent client history. Securing this information will provide a useful history of the client’s mental health problem. If you need to establish whether the client was mentally ill at the time of the offence then you may still need to get a psychiatric assessment. Clinical Psychologists Psychological assessments are the only accepted way to determine the presence and extent of an intellectual disability, developmental delay, psychological disorder or abnormal psychological functioning. Clinical psychologists rely on a range of psycho-metric tests to assess personality and a person’s level of functioning. In assessing for an intellectual disability for example they will determine what a person may or may not understand, and describe what they can or cannot accomplish. These tests are commonly referred to as cognitive, intellectual and adaptive functioning. These assessments will only include discussion of community services or alternative non-custodial programs for clients if they are specifically requested by the referring solicitor. It is important to recognise that some clinical psychologists have particular expertise in specific areas. For example they may specialise in anxiety disorders, depressive conditions, attachment issues (as they relate to young children), eating disorders, substance abuse disorder, obsessive-compulsive disorders or personality disorders such as sociopathy. If your client meets some of the criteria below then you may wish to consider arranging a psychological assessment. If your client: Attended special classes at school Attended a special school
Uses very simplistic or child like language Cannot focus or stay attentive during the interview Does not seem to understand why they are at the Legal Aid Commission Do not seem to comprehend the court process or likely consequences of their arrest Show no or flat affect during the interview (eg: lack expression & respond without voice inflection) Routinely answering "Yes" as they may not want to give the impression they don't understand Difficulty with making decisions Is a poor historian Has difficulty focusing on the issue at hand Over-reacts emotionally and irrationally Remember When arranging a psychological assessment please remember to ask the psychologist to also conduct an ‘adaptive functioning test’ and to include the raw scores for all tests. This information is essential when organising referrals to Ageing & Disability for disability case management. If you are considering arranging a psychological assessment remember to ask your client the following questions. 1. Have they ever seen a psychologist before? 2. Have they ever seen a counsellor? 3. Have they ever had a caseworker? 4. Have they ever been involved with Ageing and Disability? 5. Did they attend a special school or special classes at school? 6. Who is the main person they go to for help or advice? One of these professionals may already have a psychological assessment handy so you won’t need to seek another one. Psychosocial Reports Psychosocial reports are prepared by social workers. Psychosocial reports present a comprehensive social history/background, and explain how this has impacted both socially and psychologically on the individual. Psychosocial reports make links between issues such as child abuse, sexual abuse, witnessing domestic violence (and other trauma), cultural dislocation, poverty, intellectual disability, and their connection with substance abuse & relapse, mental illness, offending behaviour, decision making processes, responses to stress and other patterns of behaviour. Such experiences are known to impact negatively on emotional and psychosocial development. Significant events in early life can also determine responses to stress, intimacy, conflict and grief: all of which can be mitigating circumstances. Psychosocial reports also comment, if requested, on alternatives to custodial sentences and discuss what relevant community services may be available to assist the client. Clients will generally be referred to the most appropriate
service so that issues raised in the assessment can be addressed. The assessment generally involves discussions with other significant parties, for example family members, and other professionals in the client’s life. If your aboriginal client is to be sentenced utilising the principles under Fernando then the preparation of a psychosocial report will prove invaluable. A report in this instance will document the social, cultural, demographic and personal circumstances of the client. It will include a detailed assessment of community and cultural breakdown prevalent in particularly disenfranchised indigenous communities.