The judicial system of my country, asks me (a psychiatrist in the national health care system) to evaluate parents for their capacity as parents.

[Iparksiako]

Apparently I am not in U.S. as most of you are. However, I would like your opinion on this matter because it is quite confusing to my mind.

The public prosecutor of the judicial system sometimes asks me to "psychiatrically evaluate and assess their parental capacity (present psychopathology, personality disorders)." Usually it is the ex-wife or ex-husband that I have to assess one, but only one of the two. They usually have a child and and wanting custody is in the middle.

Now I am a bit confused by what they ask me, considering the I am not sure how to proceed and what I should qualify as -capable of being a parent.

When they come to me they are usually very defensive, accusatory of their ex-partner and usually deny any history of psychiatric pathology.

The most recent case is a woman I have to assess, who she is accursing her husband of -repeatedly- cutting the hair of their small child - which is quite stressful for it. The husband says he has no involvement on that, doesn't accuse the mother but leaves open the possibility to be a relative of the mother. The prosecutor asked me to assess the mother.

Another example is a couple that the father is asking full custory of the child. Is accussing the ex-wife. He had a past depressive episode years ago. He is evidently stressed and I get a feeling he is obsessed with the ex-wife, voice recording their phone calls, accursing her trying to brainwash the child against him. His whole day seems to revolve around it - which is apparently not placing him in a very good mental state as of now. His MMPI came back negative - but was defensive in his answers and tried to show a good profile, which makes it useless.

I usually go over:

MMSE
MINI psychiatric interview
MMPI (when I have suspicion of personality disorder)
and a period of assessment of around 4-6 months with variable frequency.

But after a while I hit a wall, as I do not want to act as an interrogator and try to cross-check facts in order to see if they are answering truthfully. I also do not want to fall into the -therapy- category and give support to someone who is there without his will.

Am I overthinking it? Is it wiser to just report as -parentally incapable- very dysfunctional disorders like overt psychosis, psychopathic p.d. etc? How would you proceed yourself?

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[Merovinge]

This is absolutely wild to me that these cases are just handed to you so thank you for enhancing my awareness of psychiatry in other cultures. I am surprised you A) are trained in psychometric testing as a psychiatrist B) that your healthcare system wants you spending your time as a doctor doing that work and C) that they ask someone who is not forensically trained to do forensic work.

Typically child custody evals in the US go as follows (very brief outline):
Eval by child psychiatrist with forensics training or child psychologist with forensic training
Patient is interviewed alone, with parent 1 and separately with parent 2. This can occur over a period of time and on discrete occasions.
All notes of previous interactions with child and healthcare system reviewed.
Expert opines to best custody arrangement to support child's mental health. Notably each side will typically retain their own expert who will only make it to trial if they have an opposing viewpoint.

Most doctors avoid this work in the US like the plague as they are notorious for having high rates of malpractice lawsuits, you are almost invariably going to have someone that wishes ill will or even physical harm upon you for each and every case. I have met only a small handful of child psychiatrists who enjoy this work.

 

[whopper]

Due to you being in a different country the legal landscape could be very very different. E.g. I lived in England for a few months. Due to their NHS I was told the malpractice going on there was almost non-existent. (I haven't researched it myself but this was what I was told). Due to the law being a very important component and we don't even know the country aside from even the laws hard to give you advice.

 

[Fan_of_Meehl]

Apparently I am not in U.S. as most of you are. However, I would like your opinion on this matter because it is quite confusing to my mind.

The public prosecutor of the judicial system sometimes asks me to "psychiatrically evaluate and assess their parental capacity (present psychopathology, personality disorders)." Usually it is the ex-wife or ex-husband that I have to assess one, but only one of the two. They usually have a child and and wanting custody is in the middle.

Now I am a bit confused by what they ask me, considering the I am not sure how to proceed and what I should qualify as -capable of being a parent.

When they come to me they are usually very defensive, accusatory of their ex-partner and usually deny any history of psychiatric pathology.

The most recent case is a woman I have to assess, who she is accursing her husband of -repeatedly- cutting the hair of their small child - which is quite stressful for it. The husband says he has no involvement on that, doesn't accuse the mother but leaves open the possibility to be a relative of the mother. The prosecutor asked me to assess the mother.

Another example is a couple that the father is asking full custory of the child. Is accussing the ex-wife. He had a past depressive episode years ago. He is evidently stressed and I get a feeling he is obsessed with the ex-wife, voice recording their phone calls, accursing her trying to brainwash the child against him. His whole day seems to revolve around it - which is apparently not placing him in a very good mental state as of now. His MMPI came back negative - but was defensive in his answers and tried to show a good profile, which makes it useless.

I usually go over:

MMSE
MINI psychiatric interview
MMPI (when I have suspicion of personality disorder)
and a period of assessment of around 4-6 months with variable frequency.

But after a while I hit a wall, as I do not want to act as an interrogator and try to cross-check facts in order to see if they are answering truthfully. I also do not want to fall into the -therapy- category and give support to someone who is there without his will.

Am I overthinking it? Is it wiser to just report as -parentally incapable- very dysfunctional disorders like overt psychosis, psychopathic p.d. etc? How would you proceed yourself?

I think there's the likelihood of a dangerous confusion/conflation of values and facts inherent in this sort of evaluation. It's something that--as a mental health provider in the US--I've been increasingly concerned about. What I mean specifically is the identification of 'licensed mental health providers' as some sort of new priesthood invested with the powers of the state to decide such things as 'who gets custody of the kid.' I would definitely touch base with colleagues and see if there is any published literature on how to scientifically and validly assess the relevant constructs (and what those constructs actually are, i.e., are they cognitive/emotional capacities, per se, that can be reliably and validly assessed or are they sociopolitical and ideological constructs that are watery/murky and heavily laden with a sociocultural/political value system). Questions such as 'who is your client?' 'what (specifically) is your role?' 'to whom (which parties) do you owe specific 'duties' to as a professional, etc.' loom large. Especially considering that--from your description--often only one party (wife or husband) is being 'examined' for 'lacking parental fitness/capacity' I'd be really concerned about being brought in as a 'hit man' to take out one specific party due to non-relevant factors (e.g., who knows whom or who owes whom a political favor or the friend-of-a-friend a political favor). I'd be concerned about fairness and due process and the potential for the arbitrary lack thereof. Good luck.

 

[allantois]

This is interesting because most judicial systems around the world are not adversarial so the court may only appoint one set of expert witnesses (as opposed to the US where you get two from each side).. so I would imagine the process may be quite different than it is here. But I would agree that lawyers can figure these issues out themselves without involving the mental health establishment

 

[whopper]

What I mean specifically is the identification of 'licensed mental health providers' as some sort of new priesthood invested with the powers of the state to decide such things as 'who gets custody of the kid.'

This is an exact reason why I thought my late PD, Doug Mossman, was so great. He was one of the first people in Forensic Psychiatry to point out that the so called expert might not have objective proof to back up their expert-opinion. I've seen forensic psychiatrists get on the stand, push an opinion and there was no science backing it up. Mossman also researched and came up with several approaches to add more objective evidenced-based methods for forensic psychiatrists and psychologists.

There is a large load of cases where a mental health expert pushed an opinion with no science to back up their claims and despite this the judge took the expert-witness's testimony as good science. I've seen professors in current forensic programs push very unobjective opinions in court. While I was a 4th year resident I did a forensic rotation and the forensic psychiatrist openly told me he had no science to back up his claims.