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The evolution of U.S. civil commitment law needs to be understood within the context of changes in psychiatry and medicine, as well as larger social policy and economic changes. American civil commitment law has reflected the swinging... more
The evolution of U.S. civil commitment law needs to be understood within the context of changes in psychiatry and medicine, as well as larger social policy and economic changes. American civil commitment law has reflected the swinging pendulum of social attitudes towards civil commitment, oscillating between more and less restriction for both procedural and substantive standards. These standards have evolved from a "need for treatment" approach to a "dangerousness" rationale, and now may be moving to a position in which these justifications are combined, particularly in the context of involuntary outpatient commitment. Civil commitment in the United States has been shaped by multiple factors, including sensitivity to civil rights, public perception of psychiatry, availability of resources, and larger economic pressures. We suggest that current American commitment practice is influenced more by economic factors and social perceptions of mental illness than by changing legal standards.
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Research Interests: Psychiatry and Medicine
Fitness-for-duty examinations are a common type of psychiatric disability evaluation. These evaluations are typically best performed by the independent (nontreating) psychiatrist with forensic training or expertise in these examinations.... more
Fitness-for-duty examinations are a common type of psychiatric disability evaluation. These evaluations are typically best performed by the independent (nontreating) psychiatrist with forensic training or expertise in these examinations. A comprehensive evaluation requires careful definition of the referral questions and consideration of the terms of the referral; review of relevant job-specific documentation and medical records; the collection of collateral information from relevant third-party informants; a thorough clinical psychiatric examination; and possibly additional testing. The examination report needs to be comprehensive, address the specific questions in clear language understandable to the non-mental health clinician, and use all available data to substantiate the logical conclusions in a fair, accurate, and objective manner.
Research Interests: Documentation, Mental Health, Expert testimony, Forensic psychiatry, Vocational Rehabilitation, and 12 moreMedicine, Humans, Duty, United States, Mental Disorders, Psychiatric Clinics of North America, Disability Evaluation, Psychology and Cognitive Sciences, Physician impairment, Medical and Health Sciences, Referral and consultation, and Referral
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Over the next few decades, there will likely be an increase in the frequency of will challenges related to testamentary capacity and undue influence, given a U.S. elderly population with a disproportionate amount of wealth. Psychiatric... more
Over the next few decades, there will likely be an increase in the frequency of will challenges related to testamentary capacity and undue influence, given a U.S. elderly population with a disproportionate amount of wealth. Psychiatric clinicians are likely to be called upon to advise the courts about a person’s capacity to make a will or susceptibility to undue influence. This chapter reviews the important legal and psychiatric issues involved in determinations of testamentary capacity and undue influence. It also touches on the policy considerations of promoting liberty and autonomy which set a low threshold for testamentary capacity while allowing for the doctrine of undue influence as a mechanism to protect those who are vulnerable. The complex interplay between cognition, a potentially conflictual milieu, and the extent of the assets at stake is also discussed. This chapter also provides guidance with respect to some of the challenges faced by clinicians conducting a contemporaneous versus retrospective assessment. Finally, mechanisms to avoid estate litigation, such as power of attorney and estate planning, are also discussed.
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This chapter explores the question of payment barriers and economic challenges for psychiatric service delivery within the medical setting. We first summarize how payments for psychiatric services developed and are treated differently... more
This chapter explores the question of payment barriers and economic challenges for psychiatric service delivery within the medical setting. We first summarize how payments for psychiatric services developed and are treated differently than other medical services. Integrated care and patient-centered medical homes are shifting American health care from a fee-for-service model to a complex model of global payment, risk sharing, and incentives for quality and coordinated care. Psychiatry and behavioral health will play an essential role in consultation, care management, and coordination with primary care partners. Integrated behavioral health care models can be safer, better, and ultimately less expensive. We provide suggestions on how to address the challenge of convincing the health care system to integrate the payment for psychiatric and other behavioral services.
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Disability evaluations for public or private insurance claims are among the most frequently requested psychiatric evaluations for non-treatment purposes. This chapter provides an overview and framework for independent medical examination... more
Disability evaluations for public or private insurance claims are among the most frequently requested psychiatric evaluations for non-treatment purposes. This chapter provides an overview and framework for independent medical examination (IME) providers, which are particularly relevant for evaluations in private long-term disability claims. These evaluations are typically best performed by an independent (non-treating) clinician with forensic training or expertise in these examinations. IME providers should be familiar with the referral context, expectations, and careful definition of the referral questions. Clinicians performing independent examinations should provide a comprehensive evaluation and detailed report; address the specific questions in clear language understandable to the non-mental health clinician; and use all available data to substantiate the logical conclusions in a fair, accurate, and objective manner.
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<p>Over the next few decades, there will likely be an increase in the frequency of will challenges related to testamentary capacity and undue influence, given a U.S. elderly population with a disproportionate amount of wealth.... more
<p>Over the next few decades, there will likely be an increase in the frequency of will challenges related to testamentary capacity and undue influence, given a U.S. elderly population with a disproportionate amount of wealth. Psychiatric clinicians are likely to be called upon to advise the courts about a person's capacity to make a will or susceptibility to undue influence. This chapter reviews the important legal and psychiatric issues involved in determinations of testamentary capacity and undue influence. It also touches on the policy considerations of promoting liberty and autonomy which set a low threshold for testamentary capacity while allowing for the doctrine of undue influence as a mechanism to protect those who are vulnerable. The complex interplay between cognition, a potentially conflictual milieu, and the extent of the assets at stake is also discussed. This chapter also provides guidance with respect to some of the challenges faced by clinicians conducting a contemporaneous versus retrospective assessment. Finally, mechanisms to avoid estate litigation, such as power of attorney and estate planning, are also discussed.</p>
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Edited by Ezra E. H. Griffith, Michael A. Norko, Alec Buchanan, Madelon V. Baranoski, Howard V. Zonana. Boca Raton, FL: CRC Press, 2017. 408 pp. $79.95 paperback. This is a thoughtful and ambitious effort, edited by leaders of the Law and... more
Edited by Ezra E. H. Griffith, Michael A. Norko, Alec Buchanan, Madelon V. Baranoski, Howard V. Zonana. Boca Raton, FL: CRC Press, 2017. 408 pp. $79.95 paperback. This is a thoughtful and ambitious effort, edited by leaders of the Law and Psychiatry program at Yale University School of Medicine. (
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In 1991, I was a first-year psychiatry resident in Massachusetts, beginning my interest in law and ethics in psychiatry. The news was full of reports about Dr. Jack Kevorkian, a Michigan pathologist who advocated physician-assisted... more
In 1991, I was a first-year psychiatry resident in Massachusetts, beginning my interest in law and ethics in psychiatry. The news was full of reports about Dr. Jack Kevorkian, a Michigan pathologist who advocated physician-assisted suicide and euthanasia. Michigan revoked his medical license, but his activities continued. Other physicians took a less dramatic and extreme position, arguing for the role of physicians to support their terminally ill patients in actively taking control of their dying process. In 1991, Dr. Timothy Quill, a palliative care specialist in Rochester, NY, published a seminal article in The New England Journal of Medicine. He described his assistance to “Diane,” a 45-year-old leukemia patient whom he provided with a lethal prescription of barbiturates that she self-administered. His actions stirred great debate and controversy, although no legal charges or indictments were brought against Quill. In 1993, I helped organize a resident forum in Boston about physi...
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Full Document: Anfang SA, Gold LH, Meyer DJ: AAPL practice resource for the forensic evaluation of psychiatric disability. Journal of the American Academy of Psychiatry and the Law Online Supplement 2018, 46 (1). Available at:... more
Full Document: Anfang SA, Gold LH, Meyer DJ: AAPL practice resource for the forensic evaluation of psychiatric disability. Journal of the American Academy of Psychiatry and the Law Online Supplement 2018, 46 (1). Available at: http://www.jaapl.org/content/46/1_Supplement.
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Since the Tarasoff decision by the California Supreme Court in 1974, mental health clinicians have struggled to balance their duty of confidentiality to their patients against the duty to protect third parties from potential violence.... more
Since the Tarasoff decision by the California Supreme Court in 1974, mental health clinicians have struggled to balance their duty of confidentiality to their patients against the duty to protect third parties from potential violence. This article explores the development of this issue over the last 20 years, with a focus on ways that Tarasoff has and has not affected clinical practice. Reviewing the evolution of case and statutory law, we discuss appropriate clinical responses for the mental health practitioner who faces a potential &quot;duty to protect&quot; situation.
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Thesis (A.B., Honors)--Harvard University, 1986. Includes bibliographical references (leaves 86-98).
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... Libby Zion needed what every patient needs: an experienceddoctor who would give her full attention and take full re¬ sponsibilityfor her welfare. Natalie Rob¬ ins challenges us to figure out how to do that in the teaching environment.... more
... Libby Zion needed what every patient needs: an experienceddoctor who would give her full attention and take full re¬ sponsibilityfor her welfare. Natalie Rob¬ ins challenges us to figure out how to do that in the teaching environment. ...
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Disability assessments of patients are among the most common nontherapeutic evaluations requested of treating psychiatrists. Yet, there has been relatively little empirical analysis of how psychiatrists approach these evaluations in real... more
Disability assessments of patients are among the most common nontherapeutic evaluations requested of treating psychiatrists. Yet, there has been relatively little empirical analysis of how psychiatrists approach these evaluations in real clinical practice. Treating psychiatrists, those both with and without forensic expertise, struggle with the challenge of dual agency and overlapping therapeutic and forensic roles. Making the different roles clear to the patient can allow for more therapeutic exploration and alliance around further treatment goals, expectations, and interventions. Given the high prevalence of psychiatric disability and requested evaluations, psychiatric trainees would benefit from formal teaching, and it should be considered an important area for psychiatric continuing education.
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The evolution of U.S. civil commitment law needs to be understood within the context of changes in psychiatry and medicine, as well as larger social policy and economic changes. American civil commitment law has reflected the swinging... more
The evolution of U.S. civil commitment law needs to be understood within the context of changes in psychiatry and medicine, as well as larger social policy and economic changes. American civil commitment law has reflected the swinging pendulum of social attitudes towards civil commitment, oscillating between more and less restriction for both procedural and substantive standards. These standards have evolved from a "need for treatment" approach to a "dangerousness" rationale, and now may be moving to a position in which these justifications are combined, particularly in the context of involuntary outpatient commitment. Civil commitment in the United States has been shaped by multiple factors, including sensitivity to civil rights, public perception of psychiatry, availability of resources, and larger economic pressures. We suggest that current American commitment practice is influenced more by economic factors and social perceptions of mental illness than by chan...
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Research Interests: Law, Criminal Law, Psychiatry, Expert testimony, Forensic psychiatry, and 17 moreIntellectual Disability, Scientific Societies, Capital Punishment, Law Enforcement, Mental Retardation, Humans, United States, Physicians, The, Mental Disorders, Organizational Policy, Adult, State government, Supreme Court Decisions, Public Policy, Mental Competency, and Disability Evaluation
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Fitness-for-duty examinations are a common type of psychiatric disability evaluation. These evaluations are typically best performed by the independent (nontreating) psychiatrist with forensic training or expertise in these examinations.... more
Fitness-for-duty examinations are a common type of psychiatric disability evaluation. These evaluations are typically best performed by the independent (nontreating) psychiatrist with forensic training or expertise in these examinations. A comprehensive evaluation requires careful definition of the referral questions and consideration of the terms of the referral; review of relevant job-specific documentation and medical records; the collection of collateral information from relevant third-party informants; a thorough clinical psychiatric examination; and possibly additional testing. The examination report needs to be comprehensive, address the specific questions in clear language understandable to the non-mental health clinician, and use all available data to substantiate the logical conclusions in a fair, accurate, and objective manner.
Research Interests:
Since the Tarasoff decision by the California Supreme Court in 1974, mental health clinicians have struggled to balance their duty of confidentiality to their patients against the duty to protect third parties from potential violence.... more
Since the Tarasoff decision by the California Supreme Court in 1974, mental health clinicians have struggled to balance their duty of confidentiality to their patients against the duty to protect third parties from potential violence. This article explores the development of this issue over the last 20 years, with a focus on ways that Tarasoff has and has not affected clinical practice. Reviewing the evolution of case and statutory law, we discuss appropriate clinical responses for the mental health practitioner who faces a potential &quot;duty to protect&quot; situation.
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ABSTRACT We evaluated retrospectively the efficacy of long-term fluoxetine treatment in 19 consecutive outpatients with bulimia nervosa (18 females and 1 male; mean age: 29.5 + 6.6 years) who had been treated with fluoxetine for more than... more
ABSTRACT We evaluated retrospectively the efficacy of long-term fluoxetine treatment in 19 consecutive outpatients with bulimia nervosa (18 females and 1 male; mean age: 29.5 + 6.6 years) who had been treated with fluoxetine for more than 3 months (43.5 + 18.1 weeks) following an apparent initial positive response, defined as a clearcut improvement of bulimic symptoms with a reduction in frequency of binges and purges in the first 6 to 8 weeks. Their mean duration of illness was 9.7 + 5.8 years. Data were gathered retrospectively in reference to three distinct periods: immediately prior to the onset of treatment with fluoxetine (Baseline), 6 to 8 weeks into treatment (Weeks 6 to 8), and at the end of treatment if fluoxetine had been discontinued or at the time of data collection if the patient had still been on it (Follow-up). At Baseline 13, patients met criteria for either major depression or dysthymia or both. At Follow-up, 13 of 19 patients were still on fluoxetine whereas 6 patients had discontinued it. Frequency of binges per week decreased significantly (p &lt; 0.0001, paired t test) during fluoxetine treatment in all patients (N = 19) from a mean of 6.1 (+3.4) at baseline to a mean of 1.7 (+1.7) at Weeks 6 to 8 and a mean of 1.4 (+2.8) at Follow-up. It was also observed that the frequency of purges per week was significantly reduced (p &lt; 0.0001, paired t test) from a mean of 6.1 (+ 3.4) at Baseline to a mean of 1.6 (+1.7) at Weeks 6 to 8 and a mean of 1.3 (+2.8) at Follow-up. Clinician Global Impression Severity Scale (CGI-S) scores also significantly decreased (p &lt; 0.0001, paired f test) from a mean of 4.0 (+0.5) at Baseline to a mean of 2.5 (+0.9) at Weeks 6 to 8 and a mean of 2.2 (+1.0) at Follow-up. Overall, it appears that the significant improvement in frequency of binges, purges, and in CGI-S score seen after 6 to 8 weeks of treatment with fluoxetine in our bulimics was maintained at Follow-up.
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The psychiatric evaluation of a physician's fitness for duty is an undertaking that is both important to patients' well-being and to the physician-subject of the evaluation. It is necessary that psychiatrists who agree to perform... more
The psychiatric evaluation of a physician's fitness for duty is an undertaking that is both important to patients' well-being and to the physician-subject of the evaluation. It is necessary that psychiatrists who agree to perform such evaluations proceed in a careful and thorough manner. This document was developed to provide general guidance to the psychiatric evaluators in these situations. It was prepared by the American Psychiatric Association (APA) Council on Psychiatry and Law and Corresponding Committee on Physician Health, Illness, and Impairment, of which the authors are members. The Resource Document was approved by the APA Joint Reference Committee in June 2004. APA Resource Documents do not represent official policy of the American Psychiatric Association. This Resource Document was edited to conform to Journal style and has therefore been modified slightly from the original document approved by the APA.