I started doing civil assessments on a small-scale from the time I commenced practice. I have been working almost exclusively as a civil assessment psychiatry for the past 20 years. One of my colleagues who had been working in the public sector has commenced doing full-time civil assessment with the explanation “it’s time I made some real money like you guys!” Do we do it for the money? That may be one of the reasons but what are the motivations for doing civil assessment psychiatry. I have asked this question of myself recently. This has occurred in the context of the almost total lack of support and validation from the Faculty of Forensic Psychiatry and the sense I get from colleagues especially those working in criminal justice psychiatry the work I and other civil assessment psychiatrists do is regarded as distasteful, a misuse of our expertise, that we are guns for hire and that we do not help people. This perception real or imaginary on my part is important.
There has been no interest expressed by anybody in the Faculty or the college to develop a training program in civil assessment psychiatry, attempts to establish a new section have been strongly resisted.
This has raised a question for me as to how do I justify what I do and how do I counter these perceptions. The facts are that we do not treat people, we do not have any ongoing commitment to patients, we do not work in hospitals, we appear to be paid well. How then can we justify our work ethically and morally.
There are some misconceptions, for example, that we are paid excessively. I now work 3 1/2 days a week. I do three assessment a day. The preliminary reading for each case may require me to read up to 1500 pages of documentation and sometimes more. Each interview takes me two hours. Preparation of the report takes another two hours. In all, for the average claim I spend 5 to 7 hours and at times up to 12 hours.. My hourly rate is about or less than the fee for a consultation up to 45 minutes. I do not regard that as excessive. Preparation of a report is challenging. I am always aware that I may be called to justify the report and my opinion in court. There is often a good deal of background reading required. It is common to me to be asked to refer to the professional literature when providing an opinion. The work is demanding and requires intense concentration.
Nevertheless the issue remains that we are in a profession that is meant to be a helping profession and that we have obligations to patients/clients to do no harm and be of help. There are of course limitations on this for us because the civil assessment psychiatrist must not be an advocate for either party and cannot be in a treating relationship with clients. Nevertheless I have found , over the years, that allowing people to tell their story over an extended period and, more importantly, have their story heard, is beneficial. Psychiatric assessments are also in integral part of any beneficial scheme for people who have been injured so the claim can be finalised and the legal matters resolved. Psychiatric input is essential for many claims and is likely to become more so in the future. For better or for worse this work is essential to assist in resolving a variety of issues for people so they can get on with their lives.
It is incumbent on us to behave ethically, for me, that means to do the required work before seeing the claimant, giving the claimant an adequate opportunity to inform me of their circumstances and treating the claimant respectfully. I am also required to prepare a report and an opinion that is, as far as possible, unbiased, fair and equitable. I believe that the work we do is of value to individuals and the community. I regret that some of our colleagues have a different view.