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Soiling your point just yet to earn AKC hunting dogs Some representative rates: Patients who are more seriously ill, have made prior suicide attempts have been hospitalized, have not been adequately followed or treated, etc., have generally higher rates. Lower rates tend to be found patients who have never been hospitalized, who respond well to medication, and the like. The majority of the people any of these categories do not commit suicide, even over decades. Patients with depressive disorder have, speaking broadly, a 10% to 20% lifetime suicide risk. The U.S. general population has a lifetime risk of 1% or lower. These are large population rates which should not be confused with individual risk, and which vary each category with such things as gender, age, presence of psychosis, treatment offered, treatment response, and a number of other complex, often interrelated factors. Some more severely or acutely ill persons and those with certain important risk factors have greatly increased individual risk. Individual risk over periods is virtually impossible to predict with certainty. Short-term risk, especially relative risk, on the other hand, can and should be estimated clinical situations, and the risk managed appropriately. Clinical standards and knowledge of increased risk often create a special duty of care. Not all suicide is preventable. As the case of other bad outcomes, the mere presence of suicide does not necessarily imply malpractice. Troubled children and adolescents, particular, move from apparently non-suicidal depression to lethal behaviors rapidly, without much warning to parents or psychiatrists therapists. If you are a mental health professional or attorney and would like references for the above, send me email. Clinical experience is critical to most cases. The psychiatrist is hired primarily for his or her ability to clarify the psychological and medical issues of a case, not to interpret legal ones. This does not mean that the forensic psychiatrist must have a large clinical practice, but some contact with clinical care and or medical teaching is relevant to most cases. The forensic psychiatrist should be expected to understand the legal concepts and impact of the mental health issues a case, and to be able to convey his or her psychiatric findings language that the court can understand and use. Attorneys unfamiliar with mental health law or the potential effect of a psychiatric issue on their cases should be able to rely on the forensic psychiatrist's knowledge and experience to some extent, but the legal process itself is the province of lawyers and judges. Attorneys, clients, and courts should also expect that a professional offering expert psychiatric opinions has M.D. or D.O. degree, has completed approved specialty training, is appropriately licensed, has been certified by the American Board of Psychiatry and Neurology, is a member good standing of professional organizations with ethics codes, actively participates continuing education, is accepted by clinical patient-care peers and enjoys a good reputation within the profession. The potential expert's background should be free of factors which might diminish professional credibility General psychiatric training and clinical experience are sufficient for some forensic purposes. most, however, familiarity with highly specialized clinical issues and or forensic topics is required. Such expertise be demonstrated by additional training, relevant experience, special certification research, or publications related to the topic at hand. Return to Current Table of Contents. Should the Treating Clinician be Expert Witness? Plaintiffs and claimants forensic psychiatry matters have often been treated by a mental health professional and use information from such clinicians to support their cases. Triers should be made aware of some of the pitfalls inherent the testimony of treating psychiatrists, other physicians, and psychotherapists, especially when they are offered as expert witnesses. Although a common practice some jurisdictions, questions regarding conflict of interest, and admissibility of expert testimony from treating clinicians are not idle ones. a recent case, the treating psychiatrist for a patient had apparently billed her well over $100 for psychotherapy, and her lawyer over $100 for expert witness services. He testified that he would probably treat the patient for months or years the future as well. There are at least four reasons that such a dual relationship is not advisable. First, a treatment relationship clearly creates