Why Complex Legal Cases Demand Psychiatric Assessment Expertise

In the area of personal injury, and particularly historical abuse matters, complexity is the norm rather than the exception.

In contrast to matters involving a physical injury either compensable by a third party such as WorkCover, or a personal liability matter, historical abuse matters can affect so many facets of a person’s life and identity. People are often assessed years after the abuse occurred, following life circumstances and incidents that may also impact on their presentation in the present day.

Psychiatrists are trained to develop a sophisticated understanding of their patients, particularly when engaging them in long-term psychotherapy. For me, it was indeed one of the most rewarding parts of being a clinical psychiatrist—developing and maintaining a safe place for my patients to peel away layers to get to the core of the issue, the wound or the moment that their sense of self was impacted. Being able to then communicate those moments and discoveries in the form of a psychodynamic formulation was also a skill to master and maintain.

I was reflecting in supervision yesterday about the value and uniqueness that psychiatrists can bring to these cases. In order to examine people undergoing claims for compensation in historical abuse matters, we also need to have superior rapport-building skills to facilitate the rapid process of disclosure in a time-limited frame, establishing trust when we must ask questions that we would pose over many sessions in a clinical process. We must be aware of the potential for risk in these delicate settings, which can also be vexed as we are not responsible for the ongoing care and safety of the person we are examining.

All of these skills, developed over time and with many patients who entrust us with their care, contribute to our ability to perform complex medicolegal assessments that provide more than percentages of impairment according to rigid tables better utilised for physical injuries.

Psychiatrists have a sophisticated understanding of the impact of different experiences and traumas on a broad range of factors, including a person’s sense of self, their ability to engage in meaningful work, and their capacity to have longstanding and fulfilling interpersonal relationships. We can also derive the impact of these experiences from the patient’s narrative by carefully listening to not just what is said but how it is stated by the person we are examining. These further skills enable us to make considered conclusions about the impact of historical abuse compared to other significant and distressing events that a person may have experienced over the years.

Our demand for examination of historical abuse matters is growing as more victims come forward for claims for compensation. Our abilities to meet the challenges of working with these cases that are emotionally laden, complex and historical will ensure our role and value will sustain for years to come. Our ability to upskill, learn and refine our practice will also benefit our clients as well as provide the valuable contribution and excellence this field of medicolegal practice deserves.