Profile of defendants seen for pre-sentence psychiatric examination.

The recent forensic psychiatry literature has focused on such areas as compentency to stand trial and the insanity plea. Very little attention has been given to the pre-sentence psychiatric evaluation particularly from a research point of view. Such information as demographic data on the defendants examined and the role the psychiatric report plays in the sentencing process is both unclear and for the most part unknown. This is ironic in light of the view held by a certain segment of the forensic psychiatry community, that the only legitimate role ofthe mental health professional in the criminal proceeding should be after the determination of innocence or gUilt and in the pre-sentencing phase. Menninger,l for example, advocates the elimination of psychiatrists from the criminal courtroom because he considers guilt, competence, and responsibility to be moral questions, not medical ones. In his view, the psychiatrist may function in the post-trial situation as part of a multi-professional treatment tribunal. Also, Halleck2 suggests that the use of psychiatric testimony is likely to be increased in the sentencing process because of the current determinate sentencing laws and the need by some judges to receive advisement on mitigating circumstances. The recent Estelle v. Smith:l Supreme Court decision has focused on relevant aspects related to the pre-sentence psychiatric examination. Simon,4 in discussing the pre-sentence evaluation, raises some important ethical issues, among them the "ambiguity as to role relationshipsdoctor, patient, inquisitor, accused" that the psychiatrist finds himself in during the interview. To accurately assess the defendant's mental condition, details about the offense itself may have to be evaluated that, if obtained, could be potentially damaging when the question of guilt in the legal sense is reopened during an appeal. Although Sadoff' and other authorities in their writings attempt to sensitize practitioners to basic issues pertaining to forensic psychiatric interviews (for example, identifying oneself and the exact purpose of the examination), ethical uncertainties and role confusion persist.