Lawyer Monthly Magazine - July 2019 Edition

between them. My first associate continues to work with me to this day. Civil cases In civil cases, my defendant/ claimant split is approximately 30/70. My cases are generally large complex medical negligence cases where experts from several disciplines are required. There may be a pre-existing history of mental health issues so that I need to tease out the question of what was already in evidence from the impact of subsequent medical events or there may be a sequence of separate traumatic events such that working out causation becomes a real puzzle. I have a particular interest in chronic pain cases. Pain and depression are the most prevalent physical and psychological symptom-based disorders, respectively, and there is a close relationship between the two conditions. Pain is a risk factor for depression and vice versa. Various childhood risk factors are related to depression and chronic pain later in life. Parental mental health, childhood history of sexual abuse, childhood functional limitations and family functioning are all related to co-morbid depression and chronic pain conditions. The combination of both of these disorders is associated with worse clinical outcomes than either condition alone. A psychological assessment has much to offer in relation to treatment planning and prognosis in chronic pain cases. Family Cases In family cases where the Local Authority is involved due to child protection concerns, I have been instructed to provide a psychological assessment of parents or carers to determine if there are psychological issues relevant to decision- making about the placement of the children. Instructions include cognitive assessment of learning disability, psychological assessment of mental health and personality, dynamics in the relationship between people sharing caring roles, insight into Local Authority concerns, capacity to engage with professionals, capacity to meet children’s needs, capacity for change, treatment or support needs and evidence of change. However, sadly, due to cuts in legal aid, these types of cases are less often brought to an expert now, as compared to when I first started this work and as a result, I wonder about the quality of decision-making for these troubled families. Criminal Cases I have assessed several defendants facing charges of fraud where there is a question of fitness to stand trial for the criminal Courts and I very much enjoy the challenges of these cases. The accused is considered to be fit if he or she can plead to the indictment, understand the course of proceedings, instruct a solicitor, challenge a juror and understand the evidence. Mental health issues can interfere with a person’s capacity to manage these demands but equally, the possibility of malingering must also be considered. A psychologist should always consider the possibility that the defendant may not be truthful in any report for the Court, but this becomes a particularly acute issue in cases where the defendant is charged with fraud. With other types of crime, dishonesty is not necessarily an integral part of the offence, whereas fraud is by definition a crime of dishonesty. A multi- method approach is essential and the psychologist should never rely on an interview alone. Psychometric data complements the interview and a thorough review of documentation pertaining to the alleged offence and to the person’s medical history. Although psychologists cannot claim to have a “litmus test” for lying, there are well-established techniques, supported by a considerable body of peer-reviewed research, for assessing the reliability of the defendant’s self report. In large fraud cases, trials are likely to be lengthy and require attention to detailed financial transactions, with a considerable information processing demand on the participants. The psychologist needs to integrate the results from the assessment with the specific demands that the defendant would face if the case goes to trial in order to reach an opinion about how this individual would cope in that situation and consider whether any special measures might ameliorate any potential deficits and render the person fit. The Importance of Medical Records Psychological assessment “ Pain and depression are the most prevalent physical and psychological symptom-based disorders, respectively, and there is a close relationship between the two conditions. JUL 2019 43 Expert Witness www. lawyer-monthly .com