Forensic psychiatry in India .

Psychiatry

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Forensic psychiatry in India
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This article has been written by Nivrati Gupta, a student of the Institute of Law, Nirma University, Ahmedabad. This article briefly discusses the scope of Forensic Psychiatry in India, Its scope ahead and career development options.

Table of Contents

The understanding of humanity in a nation can be judged by the way its judicial system treats its socially and economically disadvantaged groups. The areas of forensic psychiatry include conflict with criminal laws, marriage issues, sexual abuses, eligibility to work, testamentary capacity and ethical issues. In India, forensic psychiatry is still in its easy stages. It is one of the very important yet a misinterpreted and neglected subject. Recognition of mentally disordered offenders of the economically backward groups is still unsatisfactory as according to the National Human Rights Commission report 2012.

Legislation plays an important role in building a firm base for the recognition of this study and the implementation of Mental Health Care. Judicial and legislative bodies must understand the passive connection between mental illness, offenders, treatment of mental illness and law. Effective mental health legislation provides a healthy environment for patients by providing them with integrated health services to overcome discrimination and ill-treatment. When a mentally ill person is not given the proper medication they often turn into regular offenders. Not providing proper infrastructure for these special people who need specific care is like bargaining with the public tranquillity and peace of the nation. Forensic psychiatry should be practised by following guidelines and ethical principles articulated by the profession of Psychiatry.

Forensic psychiatry is defined as a sub-branch of psychiatry. It deals with patients and issues at the interface of the legal and psychiatric systems applied to legal issues in context to legislative matters. The word ‘forensic’ originated from the Latin word forum which gradually shifted to forensics which means in open court or public in Latin. Forensic psychiatry deals with the study of offences committed by the offenders in prison, their treatment and mental health problems of offenders.

This field helps draw a mature understanding by linking law and the mental health of the offenders. With time the objective of Forensic psychiatry has changed from only being limited to understanding criminal nature to modern forensic psychiatry which has evolved into a medical-legal relationship. This modern method of understanding helped to form a better framework between criminality and mental illness. Forensic psychiatry includes legal tests to draw a clear distinction between legal insanity and insanity, new methodologies for the treatment of mental conditions, understanding public behaviour and their perspectives about the criminal mind and mental conditions. Internationally the distinctions in the practice of forensic psychiatry go far beyond mere legal differences.

In India, there is very limited infrastructure and training for forensic psychiatry. There is a structured training program for psychiatry, which is a 3‑year training program. In this course only 2 weeks is allotted for training in the area of forensic psychiatry. Most of the psychiatric units do not have a well versed forensic psychiatry ward/unit. Many forensic evaluations are directed by the treating psychiatrist who themselves have not undergone sufficient training in forensic psychiatry training. When compared to the other developed and developing countries like the UK and Australia Forensic Psychiatry has a full-fledged 3-year course after which 3 years of training is also required. A large part of private and government medical institutions the psychiatry units do not hold much susceptibility and exposure to Forensic Psychiatry.

Teaching and training in Forensic Psychiatry are not adequate for the postgraduates of Psychiatry throughout the country. Some medical colleges post their postgraduates to some state-run hospitals forensic units for a short period of training. Many practising psychiatrists especially the budding researcher‘s find it challenging to handle cases related to psychiatry and law. But every coin has two sides though we are lagging behind many western countries in this subject area there are institutions like NIMHANS who have marked a stepping stone by creating an active workforce in this field. The Indian Psychiatry Society has also formed a separate section in forensic psychiatry. At present, the scenario of forensic psychiatry is continuously changing. India, compared to many other SAARC countries and other developing countries, has picked up a strong pace in this subject. Mental health care legislations are much progressive, client-oriented, and more aware of the rights of the people suffering from a mental well being.

Mental health legislation came into the picture in India in 1858. Based on the two Acts of 1853, the law relating to custody of neurotics and administration of their estates was introduced in India through three separate Acts. The Lunacy Act, 1858 concerning judicial trial as to lunacy in presidency towns, The Lunacy Act, 1858 concerning proceedings outside the presidency towns, and The Lunatic Asylum Act 1858 which was relating the custody of lunatics in the asylums. The Acts of 1853 after amendments were succeeded by the Lunacy Act, 1890 and revised by the Act of 1891. Later The Indian Lunacy Bill, 1911 was brought which was enacted within a year as the Indian Lunacy Act, (Act IV of 1912) to amend and assimilate the law relating to custody of lunatics. India became independent in 1947. Indian Psychiatric Society, the national organization of psychiatrists in this country, was founded in 1947. The Mental Health Bill, 1986 was adopted by the Rajya Sabha by the Lok Sabha in 1987. After various discussions and amendments, the parliament after 9 years received the assent of the President on May 22, 1987, to be called as the Mental Health Act, 1987.

Forensic psychiatry differs from country to another. Reason being different historical structure and different base of legal systems and mental health. There are few legislations related to psychiatry and law directly or diffusely. Mental Health Act 1987, the National Trust Act, Persons with Disability Act, Protection of Children from Sexual Offences Act, Juvenile Justice Act and acts related to marriage and divorce. These legislations can be divided into civil laws and criminal laws. There are separate laws to handle the care of mentally ill patients, which is not yet there in any other pharmaceutical speciality branch. Forensic psychiatry has several goals mainly-

  • treatment assurance of mentally ill people who become the perpetrator;
  • giving evidence to courts in cases where the offender’s mental stability is in question
  • competency evaluations;
  • working effectively to understand and upgrade the connection of the law and psychiatry;
  • working with additional clinical and non-clinical experts in the field;
  • preventing a delay in the treatment of offenders with a mental disorder.

Some more typically performed functions by forensic psychologists include Suggesting recommendations, Trial consultants to help with jury selection, Evaluating the risk of reoffending, Child custody evaluations, Academic research on criminality, Consult with law enforcement, treatment of criminal offenders, Providing psychological services to patients and offenders, Testimony as an expert witness, preparation of the witness and legal strategies to design correctional programs. To achieve these goals the requirement of special knowledge and skills must be developed. Essentially in the management of violence, sexual deviance, risk and treatment of these behaviours many incorporating techniques are yet to be developed in surrounding disciplines. One of the greatest concerns in the development of forensic psychiatry lies in the relationship of forensic psychiatry with general psychiatry.

Doctors who have completed their MBBS and are eligible for specialization in forensic psychiatry there are mainly two options-

  1. A post-graduation in psychiatry
  2. A diploma in psychiatry

Post Graduation course in Psychiatry takes 3 years to complete. The diploma takes 2 years. There are various institutions offering these diploma, masters and PhD courses in psychiatry.

Besides the MD(diploma) and the DPM, there is also another facility- The National Board of Examinations (NBE) conducts a programme called Diploma of National Board Exam (DNB). The DNB is considered to be equivalent to an MD degree. The academic curriculum for the MD programme includes anatomy, psychology, the biochemistry of the brain, physiology, physiologic neurology and neurosurgery. Special aspects of psychology such as child, social and forensic psychiatry, psychiatry, community psychiatry, and preventive psychiatry are also taught in these programs The course also includes practical training at mental institutes and hospitals. Everyone who practices and is a to-be psychiatrist and postgraduate should have a better understanding of the relationship between psychiatry and law.

They should know the many aspects of psycho and criminology that also include the relationship between mental illness and crimes, criminal responsibility and others. Knowledge of civil issues such as the role of mental illness in estimating testamentary potential, civil issues include marriage, witness mental fitness, entry and transfer of a mentally ill person’s property, the right to vote and the right to stand for election, and mental health and Indian laws. Mental health professionals, PGs in psychiatry, lawyers, police officers, and judicial officers are all expected to know the basic mental health legislation in India. The psychiatrist needs to be very well versed with the law of the land regarding mental illness and its treatment as he might be called upon for the evaluation of the mental standing of a person anytime in his career as a psychiatrist.

The path to becoming a forensic psychiatrist is a prolonged one. One has to attend medical school and then complete a residency course in psychiatry and then move further to complete a fellowship in forensic psychiatry. Though a hard one but this field has witnessed dramatic growth in recent years, as many students have become interested in this branch of law and medical science and thus holds a very good scope in the research field.

It is important to understand that forensic psychiatry is much more than what is portrayed in television, movies, and books. Forensic psychiatry is not a mainstream degree option, yet more and more schools are offering it as a speciality reason being the growing awareness and need of understanding mental illness and law. The growing demand of this field has led to a vast addition in the course curriculum of master’s forensic psychology degrees. Additional to this Doctoral level study in forensic psychology mainly focuses on topics including research methods, ethical and legal issues, personality examination, cognitive science, psychology and the law assessment, and treatment of the ill.

Any person interested in continuing his future career option as a forensic psychologist can take the following courses focusing on topics such as:

  • Parental competency evaluations
  • Abnormal behaviour
  • Law and psychiatry
  • Psychiatric disability evaluation for worker’s compensation or personal injury cases
  • Criminal justice
  • Psychiatric malpractice and negligence evaluation
  • Perception
  • Assessment of acquittal for the insanity plea
  • Cognitive therapy
  • Evaluation of individual mental fitness for conservatorships
  • Abnormal behaviour
  • Drugs and psychopharmacology

Today forensic psychiatry is no longer considered as it once was, only between psychiatrists and the patients. In the practice of psychiatry, the law is omnipotent. For psychiatrists, now, becoming legally knowledgeable isn’t optional. Legally informed psychiatry and good clinical psychiatry do not happen spontaneously; they require specialized knowledge and a thorough understanding of the subject.

We haven’t even touched on the forensic aspects of many additional less common issues like shoplifting, arson, stalking, and juvenile crimes. All of these are dealt predominantly by the legal system, many of them, who actually need treatment, are completely ignored because of our lack of knowledge. Presently the Indian education system does not support the Indian psychiatrists to be adequately trained even in civil matters such as the assessment of testamentary capacity, fitness to give witness, contracting and transfer of mentally ill property, the right to vote or stand for election by mentally ill, marriage and mental health. Postgraduate psychiatry courses should be modified to an extent that proper forensic psychiatry training, and if not available in the centres. Then the posting should be done in a higher centre like NIMHANS Bengaluru, where structured courses with a better framework are available.

There are very little Continuing medical education programs occurring in forensic psychiatry that can be improved by Indian psychiatric associations. India being on the tracks of becoming from a developing to a developed country, we lag behind from many underdeveloped countries in this subject of the legal and healthcare policy. It is high time that we start thinking and modify the ways we are running our academic institutions for the betterment of society and nation.


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