Looking at the ‘Contents’ pages of this text, I recalled Rosner’s
discussion of definitions of ‘forensic psychiatry’ in his valuable Principles and Practice of Forensic
Psychiatry. Whereas in most countries it refers to the psychiatry of
the mentally disordered offender, in the United States it has come to have a
rather different scope.

What this book suggests is that there has been a dramatic change to the
roles adopted by psychiatrists working in forensic settings. A decade ago,
texts of forensic psychiatry mostly followed those of general psychiatry in
ranging over diagnosis, etiology, treatment and prognosis, additionally
emphasizing illegal and dangerous behaviors, and suggesting adaptations for
work in correctional and judicial settings. In stark contrast, this text has
little to say on clinical matters, and instead looks at the psychiatrists’ role
in connection with a wide range of legal processes: personal injury and
employment law; the provision of expert evidence in criminal and civil
proceedings; assessments of legal ‘fitness’, such as fitness to stand trial,
give evidence, assume custody of children, assume duty as a police officer, and
so on; and, working with law enforcement agencies. The emphasis throughout is
on evidence-based assessments and reports, and it is interesting to compare
this with the standard textbooks of forensic psychology, which are increasingly
focused on treatment.

Somewhat paradoxically, this rather unusual interpretation of ‘forensic
psychiatry’ adds to the value of the text because it does bring together a
number of topics which are otherwise scattered through the literature. For most
forensic mental health professionals in the United States this surely will
become a standard text, but they will need to turn to others for clinical
advice. It will not help them devise a treatment strategy for a serial fire
setter, or for a seriously mentally disordered offender with a dual diagnosis,
for example, but it is one of the few places where they can obtain well-founded
advice on preparing for the courtroom, assessing a person’s competency to enter
into a contract, evaluating an adolescent’s school threats, or on starting a
private forensic psychiatric practice. Because of its focus on the psychiatric
contribution to legal systems and processes, the book must have limited value
outside the systems for which it was written, i.e. the United States. The
exceptions to this are the couple of chapters (there are 23 in all), which
provide up-to-date summaries of largely system-neutral topics, namely the
chapters on forensic ethics, standards in psychological testing, and
understanding ‘prediction instruments’ (one has to marvel at psychiatrists’
persistence in representing their discipline as an exact science!)

This is a well constructed, detailed, copiously referenced handbook, in
which the various authors constantly refer to the exigencies of daily practice
and offer a generous supply of illustrative scenarios. Chapters end with a
summary of key points, a list of practice guidelines and suggested readings,
and there is a handy glossary of legal terms as an Appendix. The referencing is
exemplary, except for a disconcerting degree of parochialism which causes
authors to omit important non-American resources. By way of example, it is hard
to justify failing to refer to the detailed reports on the value of violent and
sexual offender assessment methods provided by Hazel Kemshall to the British
Home Office, and the Scottish Office, both of which are readily available via
the internet. Similarly, it is hard to understand why a chapter on adolescent
and child psychiatry fails to acknowledge the work of Susan Bailey (whose
authoritative textbook, with Mairead Dolan, on adolescent forensic psychiatry
appeared in 2002). These are the leading experts in the field, outside the
United States. All this adds to my suspicion that many American scholars still
think the information superhighway is a one-way street, and that they have
nothing to learn from researchers in other countries. Indeed, it is hard to
find many references here that are not of North American origin. Apart from hinting
€“ maybe unjustifiably €“ at a certain arrogance, I get the feeling that it means
that American authors in this field are reinventing wheels that turn quite
productively elsewhere!

For matters of clinical practice in forensic
settings, the familiar American texts edited by Rosner, and Landsberg &
Smiley, remain invaluable, whilst elsewhere the standard texts remain those of
Faulk, and Gunn et al. (new edition on its way!). Once we leave the
"psychiatry" tag behind, the competition hots up, and the well-known
texts by Hodgins et al., Gudjonssen, and Hollin, are all valuable resources.
Still, this will probably become the standard authority on the topics it
addresses, for as long as the changing legal and administrative context for
which it is written allows. I hope that when the second edition appears, its
contributors will think to look beyond the American coastline and learn from
the exciting work that is being done in forensic mental health around the
world.

© 2004 Colin A Holmes

Dr
Colin A Holmes, Professor, School of Nursing Sciences, James Cook University,
Townsville, Queensland, Australia

Categories: Ethics