Forensic psychiatry serves as an expert witness to courts and other governmental institutions. It also carries out essential procedures related with people who are under protection-treatment or the probation. Leading occupational topics of forensic psychiatry in recent years are as follows; criminal responsibility, legal capacity, employee disability, detection and management of substance use, impact of torture and trauma on survivors, degree of comprehension of moral evil among sexual crime victims, whether he/she could resist against perpetrator or not, whether he/she tells reasonable in the court or not, whether there is a need for postponement of execution of the prisoners or convicts, evaluation of malpractice lawsuits of psychiatrists, and etc ... Since the forensic psychiatric examinations are made within the framework of the laws and the boundaries of questions asked by the court, they have unique characteristics and are different from other psychiatric examinations. According to laws in Turkey, the mentaI state of a person is generally evaluated in three categories (may be for convenience of psysicians?) and arrangement of the reports based on these categories is required; (I-healthy, II-mild-moderate ill, III-severe ill):
I-Person was not ill during the event, in good health, criminal and full legal competence. For example, the borderline mental capacity, alcohol-substance abuse, personality disorders ...
II-Person had partial-mild illness during the event. For example, hypomania, mild mental retardation, organic personality disorder ...
III-Person was seriously ill during the event. For example, mania, schizophrenia and so on active state of psychosis, depression with psychotic features, moderate - severe mental retardation, dementia … Current difficulties of forensic psychiatry can be listed as follows:
1-Sometimes a detailed description of the criminal events may be absent in the judicial files. In the files, there may be either incomplete documents and reports or misleading reports and informations. Inconsistent information about the health of the perpetrator may be declared by different parties.
2-Scarcity of experienced psychiatrists, psychologists and other support staff who are sensitive to simulations and dissimulations, and existance of communication gaps between them, as well.
3-Mental status of the cases may show discrepancies between the criminal event and psychiatric evaluation. According to the results of our unpublished study, it has been shown that psychiatric examination and observation of the defendants is made 20.3 ± 29.5 months (2-192 months) after the date of crime in average and they have stayed under observation for 8.6 ± 5.7 days in the Department of Psychiatric Observation in Forensic Medicine Institute. As seen in this study, months even years may pass from the criminal event. In this process, psychiatric sypmtoms of the defendants may heal with medication or spontaneously. Less commonly, the defendant with especially chronic disease may be worse during psychiatric examination than the date of event. Arrangement of the reports by considering all of these variables are important.
4-Another topic is the discrepancy of the opinions among the physicians. In such a situation, minority of them write the dissenting opinion with the reasons. For example, different opinions occasionally may occur about the criminal responsibility during alcohol or drug induced psychotic states.
5-Establishing a causal relationship between criminal incident and disease is an another problematic topic. For example; If a person who had been previously hospitalized with the diagnosis of schizophrenia, frauds at his job, can he be assumed to be responsible for his crime? Can a person with the diagnosis of mild dementia or mild cognitive impairment, be kept responsible for the crime of making electric powermeter dysfunctional in his home and using illegal electricity? If a person, diagnosed with paranoid or antisocial personality disorder, commit a murder because of jealousy and sexual unfaithfulness then will he be additionally diagnosed with delusional disorder and will he be kept responsible for his crime? This issue may also raise discrepant opinions among the physicians.
6-Differences observed in the diagnoses appearing in the reports that are present in the forensic file: Complexity of psychiatric diagnoses, identification of comorbid situations and how to report them also may cause problems. Because, some traditions are present in forensic psychiatry practices. Different diseases are handled in different articles of law.
7-Different opinions about the upper and lower limits of being aware of the laws and the results of criminal behavior may appear. This problem is especially encountered during the evaluation of sexual behavior of children and adolescents.
8-Changes of the laws from time to time: For example, probation practices faced with obstruction currently. 95% of the people who benefited from the law of probation are cannabis users. Psychiatrists are reluctant to deal with people who are involved especially in substance use and related crimes. This situation causes huge amount of admissions and accumulation of the patients in alcohol-substance treatment unites like AMATEM, alcohol-substance rehabilitation unite in Bakirkoy Mental Health Training and Research Hospital (BMHH). Previously in BMHH, these people were clinically followed-up biweekly; however, now they are seen once in every three months due to this accumulation. Because, in this unit 200-250 people are serviced and examined each day.
9-Insufficiency of physical conditions and lack of staff are one of the major problems in the hospitals and institutions serving forensic psychiatric practices. As a result, we can say that current problems of forensic psychiatry can be reduced by training programs and meetings among experts and managers.