The compleat forensic psychiatrist

Clinical guidelines for management of patients under Lieutenant Governor's Warrants

This paper examines three categories of mentally abnormal offenders who are held under Lieutenant Governor's Warrants. It explores the psychiatric-legal issues in cases of pre-trial (not fit to stand trial) and post-trial (not guilty by reason of insanity) L.G.W.'s. An attempt is made to provide a structure for such psychiatric-legal evaluations. Clinical guidelines are offered about the objectives, the assumptions and the criteria which form the basis of such evaluations. Suggestions are made for collection of relevant data which should inform psychiatric and legal judgement-making in this area. The role of the psychotropic medication in N.G.I. cases is discussed. It is recommended that whenever medically feasible, a controlled drug-free trial should be carried out in N.G.I. cases prior to their final release, in order to unambiguously establish their need for medication.

Pre-trial evaluation of court referrals

This paper examines the current Canadian laws and psychiatric practice relating to the pre-trial evaluation of court referrals in a mental hospital. The purpose of evaluation is briefly discussed. The issue of fitness to stand trial is examined in detail and psychiatric criteria of unfitness reviewed and illustrated with brief descriptions of clinical cases. It is contended that motivation for defence may be crucial in determining the fitness or unfitness of the accused. Under the present laws a finding of unfitness leads to legal and psychiatric consequences which contain elements of potential injustice to the patient. The recommendations of the Chalke Committee to modify the legal procedure and to remove some of these difficulties are underlined. The paper concludes with a description of the actual process of assessment in the hospital, the writing and submission of psychiatric reports, the fate of such reports and problems commonly encountered in the pre-trial evaluation.