Writing for Court: Do you know how?

“I want to make a difference in the world and in people’s lives. I am a social worker; I am an advocate.” Jackie articulated these words in response to the question, “What motivates you?” This sentiment introduced the first article series on Writing for Court entitled, Effective Writing for Court: 7 Reasons Why.  There I explained that Jackie subsequently went to work with attorneys and the Court, writing mitigation reports and advocating for justice involved individuals with mental illness.  As, Ken Hoge, MD, my mentor, once told me, “The future of mental health is forensic mental health.”  I believed it then, and I believe it now.  And every day, as I see patients in different settings, this belief gets reinforced.

So, why is it important for clinicians to learn the new strategies for writing court evaluations?  Is this required for every clinician?  Is this a transferrable skill?  The initial steps to answering these questions require that you

(1) first consider how you feel about working with justice involved individuals, and

(2) reflect on how you engage in conversations to learn more about your patients and clients who may be justice involved.

Below is a series of questions designed for self-assessment, asking you to think about your work, as it relates to individuals who are justice-involved:

• How many of your patients and clients are justice involved?

• How do you know this information?

• How often do you ask your patients and clients about their legal history?

• How often do you ask your patients and clients about their arrest and incarceration experience?

• How do you frame these questions; what are your intentions for asking; how do you respond to the answers; and what do you do next?

When I train clinicians and others in healthcare on Social Determinants of Health, I remind the audience that only 10% of our health and wellness are dependent on receiving medical care from the doctor, and the remaining 90% depend on the conditions in which we were born, raised, work, and live.  One way of addressing these social determinants is to first ask about them.  Once you ask, more than likely, you will be surprised by the answers you will get.  The same is true for our justice involved patients and clients.  If you work in a setting that primarily serves justice involved individuals, this alone may facilitate open talk about their legal history and experience.  The setting also makes you, as a clinician, more primed and likely to ask.  However, this is not the case in the vast majority of mental health settings; yet, an increasing number of the patient population is justice involved, though patients and clients are hardly comfortable disclosing this important history, and the clinicians don’t ask or know how to best ask.

I sit on the board that oversees a significant government project; we are tasked with developing solutions to best provide integrated primary care to justice involved individuals.  During a needs assessment and preliminary discussions for this noble endeavor, one question raised addressed whether clinicians ought to ask patients and clients if they are involved in the criminal justice system.  As you might expect, my answer was, “It depends on our intent in asking this question, how we ask, and what we do with this answer.”

 It all starts with examining our own biases and understanding how we feel about serving the justice involved individuals.  With this, the answer to this question may become less complicated than it seems to be.  As I always tell clinicians, “Know what you are doing, know why you are doing it, and know what you are most comfortable with and why.”  The main point here is for us to determine how we really feel about working with those involved in the criminal justice system.  Once you are able to respond to this question, without judgment, fully aware of potential bias, any subsequent decisions related to your work with them will emanate from there.

What is obvious is that as long as an aspect of the lives of our patients and clients remains unknown, we will not be able to address it, and failure to address it results in a treatment plan that is far from comprehensive.  It also means the inability to conduct an accurate risk assessment, including a suicide, violence, and recidivism risk assessment.  All of this impacts how we approach writing mitigation reports for Court.

“I want to make a difference in the world and in people’s lives. I am a social worker; I am an advocate.” Jackie articulated these words in response to the question, “What motivates you?”

What motivates you?

Do you know how to effectively write for court, on behalf of your patients and clients?

Do you want to be a clinician advocate, and do you want to continuously arm yourself to make a difference in the lives of your patients and clients?

References:

1. Butler-Sloss E, Hall A. Expert witnesses, courts and the law. J R Soc Med 2002; 95:431–4.

2. MASSACHUSETTS DEPARTMENT OF MENTAL HEALTH FORENSIC SERVICES M.G.L. c. 123, s.15 (a) Report Writing Guidelines.

3. J Clin Psychol. 2006 Jan;62 (1):59-72. Forensic report writing. Ackerman MJ.

4. J Am Acad Psychiatry Law. 2010;38 (1):43-5. Commentary: the art of forensic report writing. Appelbaum KL.

5. Grisso, Thomas, “Guidance for Improving Forensic Reports: A Review of Common Errors” (2010). Psychiatry Publications and Presentation. Arch Dis Child 1998; 79:205–6.