"Why did the defendant do it?"

Mental health professionals are asked to help courts answer this question. To serve justice, the law calls for evidence of the mental state at the time a crime is committed, of suicide intent in civil litigation, and of mental capacity in contract litigation. The law asks psychiatrists and psychologists to retrospectively determine mental states-a daunting task made even more difficult by the passage of time, the uncertain credibility of witnesses, the paucity of collateral sources of information, and often the death of the person in question.

This is the first book dedicated entirely to the retrospective assessment of mental states. This fascinating book explores the role of the psychiatrist and psychologist, as an expert witness in litigation, in rendering a retrospective judgment of an individual's mental state. Distinguished contributors apply their expertise in psychiatry, psychology, and the law to address the problems of retrospective assessment. With the goal of developing guidelines for more accurate retrospective assessment of mental states, they present topics such as • Guidelines for conducting retrospective assessments in children and adults • Guidelines for the retrospective assessment without benefit of direct examination • Assessments of suicide cases in both civil and criminal litigation• Psychological testing and interviewing techniques that may assist in retrospective assessment • Methods and analysis to help clinicians and attorneys critically evaluate the search for "truth" about the past.

This remarkable book will prove indispensable for helping clinicians, lawyers, and judges better understand the complex and difficult process of retrospective reconstruction of mental states.

The terrorist attacks on the World Trade Center in September 2001 turned PTSD into a household word. But posttraumatic stress disorder has been documented throughout history: For example, as long ago as 1666, Samuel Pepys wrote in his diary that he still had night terrors 6 months after the great fire of London. PTSD, officially recognized as a diagnosis by DSM-III in 1980, is only the most recent term used to describe the suffering of trauma victims.

Few could have foreseen its profound impact on litigation. Often dubbed the "black hole" of litigation-where allegations are relatively easy to assert but difficult to defend because the symptoms are subjective—PTSD has deeply influenced civil and criminal law in cases ranging from malpractice and personal injury to sexual harassment and child abuse. It is thus vital for all legal parties involved that forensic examiners perform credible psychiatric and psychological examinations of PTSD claimants.

Intended to add direction and discipline to the forensic assessment of PTSD litigants, this expanded second edition begins with an updated chapter on current and future trends for the role of PTSD in litigation. • Chapter 2 notes the increasing evidence that exposure to multiple events not only is more common than previously thought but also increases the risk for development of PTSD following the target event.• Chapter 3 details diagnostic criteria and guidelines for the forensic psychiatric examination of the PTSD claimant.• Most literature discusses PTSD in adults. Chapter 4 offers a rare perspective on PTSD in children and adolescents, including parental response to the trauma, developmental effects, and delayed onset symptoms.• Forensic assessment of PTSD claimants is presented in Chapter 5, followed by new chapters on disability determinants (how PTSD impairs occupational functioning) and PTSD in the workplace, where the causal relationship between employment stress and a resulting mental or emotional disorder must be determined.• Chapter 8 covers guidelines for malingering in PTSD, where the claimant may be motivated by financial gain or by a reduced charge resulting from an insanity defense.• A new chapter on forensic laboratory testing in PTSD presents the tantalizing potential of psychophysiologic measurement to redeem the PTSD diagnosis from its daunting subjectivity.

This essential collection by 13 U.S. experts sheds important new light on forensic guidelines for effective assessment and diagnosis and determination of disability, serving both plaintiffs and defendants in litigation involving PTSD claims. Mental health and legal professionals, third-party payers, and interested laypersons will welcome this balanced approach to a complex and difficult field.

Updates to this edition: • Clinical and legal issues in the use of clozapine in treatment of schizophrenia• Clinical information and new cases involving tardive dyskinesia• Changes in civil and criminal law regarding right to refuse treatment• An update of clinical guidelines and legal regulations of ECT• An update on suicide risk assessment and new legal cases involving suicide• An update on violence risk assessment and new legal cases involving the duty to protect endangered third parties• New statutes and criminal sanctions regarding sexual misconduct • New statutes limiting the liability of therapists toward third parties who are injured or killed by patients• Changes in the relationship between psychiatrists and nonmedical therapists• Regulatory developments regarding physician impairment• Numerous tables and an updated glossary of legal terms• New section on common terms and abbreviations in legal citations

Evaluating and treating patients with violent ideations and behaviors can be frustrating, anxiety-provoking, and even dangerous, as errors in judgment can lead to disastrous consequences. Fortunately, there is the Textbook of Violence Assessment and Management, the first and only comprehensive textbook on assessing the potentially violent patient for mental health clinicians on the front lines of patient care.

Uniquely qualified to produce this comprehensive volume, the editors have assembled a distinguished roster of contributors who, in 28 practical chapters, combine evidence-based medicine with expert opinion to address the topic of patient violence in all its diversity of presentation and expression. Dr. Simon is Director of the Program in Psychiatry and Law at Georgetown University School of Medicine, as well as the author or co-author of more than two dozen books. Dr. Tardiff, Professor of Psychiatry and Public Health at the Payne Whitney Clinic, The New York Hospital-Cornell Medical Center, is the author of The Concise Guide to Assessment and Management of Violent Patients, an introduction to aggression management now in its second edition.

Violence is both endemic to our society and epidemic in our age. Skilled assessment and management of violence is therefore critical for mental health professionals involved in patient care. The Textbook of Violence Assessment and Management includes many features designed to instruct and support these clinicians. For example: • It is the first comprehensive textbook to take the mental health professional from evaluation and assessment to treatment and management of patients who are or may become violent. • The 28 chapters address the diversity of clinical settings, patient demographics, psychopathology and treatment modalities, making this work useful as both a textbook and a reference that clinicians can consult as needed for particular cases.• End-of-chapter "Key Points" highlight the most important concepts and conclusions, allowing students to review and consolidate their learning and practicing professionals to locate critical information quickly.• Clinical case examples abound, providing rich and nuanced perspectives on patient behavior, evaluation and management.• The textbook includes a separate chapter on evaluating patients from different cultures, a competency that becomes more crucial as patient populations become more diverse.

Increasing numbers of veterans are diagnosed with PTSD and traumatic brain injury. Campus tragedies such as Virginia Tech are fresh in our collective memory. This text is both timely and necessary—not just for mental health professionals and their patients, but for the families and communities whose safety depends upon competent professional judgment.

Perhaps never before has an objective, evidence-based review of the intersection between gun violence and mental illness been more sorely needed or more timely. Gun Violence and Mental Illness, written by a multidisciplinary roster of authors who are leaders in the fields of mental health, public health, and public policy, is a practical guide to the issues surrounding the relation between firearms deaths and mental illness. Tragic mass shootings that capture headlines reinforce the mistaken beliefs that people with mental illness are violent and responsible for much of the gun violence in the United States. This misconception stigmatizes individuals with mental illness and distracts us from the awareness that approximately 65% of all firearm deaths each year are suicides. This book is an apolitical exploration of the misperceptions and realities that attend gun violence and mental illness. The authors frame both pressing social issues as public health problems subject to a variety of interventions on individual and collective levels, including utilization of a novel perspective: evidence-based interventions focusing on assessments and indicators of dangerousness, with or without indications of mental illness.

Reader-friendly, well-structured, and accessible to professional and lay audiences, the book: • Reviews the epidemiology of gun violence and its relationship to mental illness, exploring what we know about those who perpetrate mass shootings and school shootings. • Examines the current legal provisions for prohibiting access to firearms for those with mental illness and whether these provisions and new mandated reporting interventions are effective or whether they reinforce negative stereotypes associated with mental illness. • Discusses the issues raised in accessing mental health treatment in regard to diminished treatment resources, barriers to access, and involuntary commitment.• Explores novel interventions for addressing these issues from a multilevel and multidisciplinary public health perspective that does not stigmatize people with mental illness. This includes reviews of suicide risk assessment; increasing treatment engagement; legal, social, and psychiatric means of restricting access to firearms when people are in crisis; and, when appropriate, restoration of firearm rights.

Mental health clinicians and trainees will especially appreciate the risk assessment strategies presented here, and mental health, public health, and public policy researchers will find Gun Violence and Mental Illness a thoughtful and thought-provoking volume that eschews sensationalism and embraces serious scholarship.

In their latest collaboration, Clinical Manual of Psychiatry and Law, noted forensic psychiatrist Dr. Robert Simon and legal scholar Daniel Shuman, both recipients of the Guttmacher Award, have created a unique, practical reference to enable psychiatrists to transform the impact of the law on their clinical practices from an adversary to a working partner. In lieu of scare tactics or horror stories, Dr. Simon and Professor Shuman clearly explain not only what the law requires and why but how best to integrate its requirements to enhance clinical practice and reduce the risk of successful tort claims. They have written a clear, comprehensible, and accessible volume that will guide practitioners through the thickets of the law and benefit their clinical practices.

This volume covers a wide range of topics, from confidentiality, privilege, informed consent and the right to refuse treatment to treatment boundaries, involuntary hospitalization, seclusion and restraint, management of violent as well as suicidal patients, and the additional requirements which apply to the treatment and evaluation of minors or persons with mental disabilities. It also includes the tort (i.e., negligence, intentional harm) claims that arise from a breach of the law''s expectations. The content reflects the latest legal precedents concerning such topics as: • Establishment of the doctor-patient relationship and liability for damages caused by its breach, including new rulings governing confidentiality and testimonial privileges• Case law regarding informed consent -- especially the issue of competency when dealing with minors or persons with mental disabilities• New rules and regulations restricting the use of seclusion and restraint• Guides to the most recent laws regarding involuntary hospitalization and emergency commitment• Insights into recent state court decisions concerning disclosures by therapists of threats of harm by patients against others, including such issues as conflicts between the duty to maintain confidentiality and the duty to protect• Reviews of recent legislation proscribing sexual misconduct or prosecuting sexual exploitation of patients under existing rape or sexual assault laws

Clinicians will find this wealth of knowledge immediately practical and lawyers will appreciate its in-depth treatment of complex psychiatric issues. With extensive references and a glossary of legal terms, Clinical Manual of Psychiatry and Law deserves a place among the top legal references for mental health professionals.

Patient suicide is an unavoidable occupational hazard of psychiatric practice. Indeed, it is the rare clinician who does not struggle, even agonize, over the complex task of assessing and managing the risk of suicide in patients. Patient suicides account for the greatest number of malpractice suits filed against psychiatrists and for the greatest number of settlements and verdicts covered by professional liability insurers.

In this book, written by a clinician for clinicians, Dr. Simon, an established expert in psychiatry and law, offers • A solid, easy-to-understand review of how medical malpractice law applies to patient suicides. He discusses the standards of care physicians must meet, the conditions associated with malpractice liability, and how best to minimize risks of litigation. • Extensive references to peer-reviewed literature on suicide and recent malpractice cases, including those triggered by patient suicides, which give insight into the latest developments in both the scientific community and the courts. • Much-needed practical advice, including advice on working with suicide risk assessments and suicide prevention contracts, on treating suicidal patients in various settings (outpatient, inpatient, collaborative, and emergency), and on coping with issues arising in the aftermath of a patient''s suicide (documentation, confidentiality, and survivor care). • Clearly defined risk management guidelines that will help clinicians avoid litigation or establish a sound legal defense if sued for malpractice. • Numerous case examples that make the theoretical discussions and clinically based risk management guidelines that follow come alive.

Rich in advice that draws on the author''s more than 40 years of clinical experience, this book serves as an essential aid to clinicians.

The terrorist attacks on the World Trade Center in September 2001 turned PTSD into a household word. But posttraumatic stress disorder has been documented throughout history: For example, as long ago as 1666, Samuel Pepys wrote in his diary that he still had night terrors 6 months after the great fire of London. PTSD, officially recognized as a diagnosis by DSM-III in 1980, is only the most recent term used to describe the suffering of trauma victims.

Few could have foreseen its profound impact on litigation. Often dubbed the "black hole" of litigation -- where allegations are relatively easy to assert but difficult to defend because the symptoms are subjective -- PTSD has deeply influenced civil and criminal law in cases ranging from malpractice and personal injury to sexual harassment and child abuse. It is thus vital for all legal parties involved that forensic examiners perform credible psychiatric and psychological examinations of PTSD claimants.

Intended to add direction and discipline to the forensic assessment of PTSD litigants, this expanded second edition begins with an updated chapter on current and future trends for the role of PTSD in litigation. • Chapter 2 notes the increasing evidence that exposure to multiple events not only is more common than previously thought but also increases the risk for development of PTSD following the target event.• Chapter 3 details diagnostic criteria and guidelines for the forensic psychiatric examination of the PTSD claimant.• Most literature discusses PTSD in adults. Chapter 4 offers a rare perspective on PTSD in children and adolescents, including parental response to the trauma, developmental effects, and delayed onset symptoms.• Forensic assessment of PTSD claimants is presented in Chapter 5, followed by new chapters on disability determinants (how PTSD impairs occupational functioning) and PTSD in the workplace, where the causal relationship between employment stress and a resulting mental or emotional disorder must be determined.• Chapter 8 covers guidelines for malingering in PTSD, where the claimant may be motivated by financial gain or by a reduced charge resulting from an insanity defense.• A new chapter on forensic laboratory testing in PTSD presents the tantalizing potential of psychophysiologic measurement to redeem the PTSD diagnosis from its daunting subjectivity.

This essential collection by 13 U.S. experts sheds important new light on forensic guidelines for effective assessment and diagnosis and determination of disability, serving both plaintiffs and defendants in litigation involving PTSD claims. Mental health and legal professionals, third-party payers, and interested laypersons will welcome this balanced approach to a complex and difficult field.

"Why did the defendant do it?"

Mental health professionals are asked to help courts answer this question. To serve justice, the law calls for evidence of the mental state at the time a crime is committed, of suicide intent in civil litigation, and of mental capacity in contract litigation. The law asks psychiatrists and psychologists to retrospectively determine mental states -- a daunting task made even more difficult by the passage of time, the uncertain credibility of witnesses, the paucity of collateral sources of information, and often the death of the person in question.

This is the first book dedicated entirely to the retrospective assessment of mental states. This fascinating book explores the role of the psychiatrist and psychologist, as an expert witness in litigation, in rendering a retrospective judgment of an individual''s mental state. Distinguished contributors apply their expertise in psychiatry, psychology, and the law to address the problems of retrospective assessment. With the goal of developing guidelines for more accurate retrospective assessment of mental states, they present topics such as • Guidelines for conducting retrospective assessments in children and adults • Guidelines for the retrospective assessment without benefit of direct examination • Assessments of suicide cases in both civil and criminal litigation• Psychological testing and interviewing techniques that may assist in retrospective assessment • Methods and analysis to help clinicians and attorneys critically evaluate the search for "truth" about the past.

This remarkable book will prove indispensable for helping clinicians, lawyers, and judges better understand the complex and difficult process of retrospective reconstruction of mental states.

Evaluating and treating patients with violent ideations and behaviors can be frustrating, anxiety-provoking, and even dangerous, as errors in judgment can lead to disastrous consequences. Fortunately, there is the Textbook of Violence Assessment and Management, the first and only comprehensive textbook on assessing the potentially violent patient for mental health clinicians on the front lines of patient care.

Uniquely qualified to produce this comprehensive volume, the editors have assembled a distinguished roster of contributors who, in 28 practical chapters, combine evidence-based medicine with expert opinion to address the topic of patient violence in all its diversity of presentation and expression. Dr. Simon is Director of the Program in Psychiatry and Law at Georgetown University School of Medicine, as well as the author or co-author of more than two dozen books. Dr. Tardiff, Professor of Psychiatry and Public Health at the Payne Whitney Clinic, The New York Hospital -- Cornell Medical Center, is the author of The Concise Guide to Assessment and Management of Violent Patients, an introduction to aggression management now in its second edition.

Violence is both endemic to our society and epidemic in our age. Skilled assessment and management of violence is therefore critical for mental health professionals involved in patient care. The Textbook of Violence Assessment and Management includes many features designed to instruct and support these clinicians. For example: • It is the first comprehensive textbook to take the mental health professional from evaluation and assessment to treatment and management of patients who are or may become violent. • The 28 chapters address the diversity of clinical settings, patient demographics, psychopathology and treatment modalities, making this work useful as both a textbook and a reference that clinicians can consult as needed for particular cases.• End-of-chapter "Key Points" highlight the most important concepts and conclusions, allowing students to review and consolidate their learning and practicing professionals to locate critical information quickly.• Clinical case examples abound, providing rich and nuanced perspectives on patient behavior, evaluation and management.• The textbook includes a separate chapter on evaluating patients from different cultures, a competency that becomes more crucial as patient populations become more diverse.

Increasing numbers of veterans are diagnosed with PTSD and traumatic brain injury. Campus tragedies such as Virginia Tech are fresh in our collective memory. This text is both timely and necessary -- not just for mental health professionals and their patients, but for the families and communities whose safety depends upon competent professional judgment.

Robert Simon''s Bad Men Do What Good Men Dream: A Forensic Psychiatrist Illuminates the Darker Side of Human Behavior is that rare title that is both essential reading for the mental health professional and accessible in style and content to the fascinated lay reader. In twelve powerful and provocative chapters, the author introduces readers to a psychological perspective on evil, character and destiny, as well as the making of good men and women. Simon also illuminates the psychology of psychopaths, serial killers, rapists and all manner of evil characters who appall and challenge us by their very existence. He rejects the common belief that his subjects are "monsters" with nothing in common with the more "normal" among us. Simon posits that if we deny our dark side, it can only obscure our understanding of violent offenders and impede our ability to both know ourselves and control our own, at times, unacceptable impulses.

The author is among the foremost experts in forensic psychiatry. He is Director of the Program in Psychiatry and Law at Georgetown University School of Medicine. Author or co-author of more than two dozen books and editions, including the foundational Textbook of Forensic Psychiatry, Simon has made important contributions to the field of forensic psychiatry for more than 30 years. He is also an eloquent writer with a dramatic, yet nuanced, narrative style that takes the reader inside the mind of the evildoer.

The first edition of this groundbreaking work garnered uniformly superlative reviews and was translated into several languages. This updated version retains Simon''s engrossing portrayals and keen insight, while offering a number of key enhancements. The highlights include: • Explorations of the Internet and violence, "corporate" psychopaths, cyberstalkers, perpetrators of school violence, and a new cast of serial killers, terrorists, and other evildoers.• A psychological perspective on evil, serial killers, and us.• Updates on the neuroscience and genetics of deviant behaviors.• Reflections on empathy, character, and destiny: the making of good men and women.• A new foreword by Thomas G. Gutheil, M.D., Professor of Psychiatry and Co-Founder, Program in Psychiatry and the Law at Harvard Medical School, that illuminates Simon''s thesis and grounds it in historical context.

Graphic but never sensational, unsparing but never cold, Simon''s writing transcends the theoretical and achieves that most difficult of aims: leading readers to discover, contain, and transform the darkness within us all, to the betterment of our human condition.

Today's psychiatrists practice in an environment that poses difficult challenges. Both treatment time and duration are limited by insurance requirements; many facilities are understaffed; split treatment arrangements are typical; and high-risk, acutely suicidal patients are admitted to inpatient units for short lengths of stay. In addition, law now plays a pervasive role in the practice of psychiatry. The doctor-patient relationship is no longer defined solely by the involved parties. Clinicians must juggle these requirements and limitations while providing the very best care to their patients, especially those at high risk.

Preventing Patient Suicide: Clinical Assessment and Management provides the wisdom of Dr. Robert I. Simon's vast clinical experience, combined with the latest insights from the evidence-based psychiatric literature, to offer a cutting-edge survey of suicide prevention and management techniques. The author: • Addresses sudden improvement in high-risk suicidal patients, a phenomenon both common and perilous, with techniques for determining whether the improvement is real or feigned.• Explores in depth the misuse of suicide risk assessment forms, with emphasis on their inherent limitations.• Examines the many entrenched myths and traditions about suicide, exposing them to the critical light of evidence-based medicine, including the concept of "imminent suicide risk" and the myth of "passive suicide ideation".• Discusses the continuum of chronic and acute high-risk suicidal patients, the fluidity with which one can become the other, and the difficulty in assessing these patients.• Explores how the law and psychiatry interact in frequently occurring clinical situations, and the importance of therapeutic risk management.

In addition, the book contains a variety of features that illuminate the subject and enhance the reader's understanding, including: • Inclusion of illustrative case studies, combined with commentary on commonly occurring but complex clinical situations. • Key points at the end of each chapter that identify critical information. • A Suicide Risk Assessment Self-Test, a teaching instrument that consists of fifty questions designed to enhance clinician suicide risk assessment by incorporating evidence-based risk and protective factors.

Dr. Simon provides a nuanced, empathic, yet pragmatic perspective on identifying, assessing, and managing the suicidal patient while successfully navigating a complex legal and clinical environment that poses its own risks to the practitioner.

Today''s psychiatrists practice in an environment that poses difficult challenges. Both treatment time and duration are limited by insurance requirements; many facilities are understaffed; split treatment arrangements are typical; and high-risk, acutely suicidal patients are admitted to inpatient units for short lengths of stay. In addition, law now plays a pervasive role in the practice of psychiatry. The doctor-patient relationship is no longer defined solely by the involved parties. Clinicians must juggle these requirements and limitations while providing the very best care to their patients, especially those at high risk.

Preventing Patient Suicide: Clinical Assessment and Management provides the wisdom of Dr. Robert I. Simon''s vast clinical experience, combined with the latest insights from the evidence-based psychiatric literature, to offer a cutting-edge survey of suicide prevention and management techniques. The author: • Addresses sudden improvement in high-risk suicidal patients, a phenomenon both common and perilous, with techniques for determining whether the improvement is real or feigned.• Explores in depth the misuse of suicide risk assessment forms, with emphasis on their inherent limitations.• Examines the many entrenched myths and traditions about suicide, exposing them to the critical light of evidence-based medicine, including the concept of "imminent suicide risk" and the myth of "passive suicide ideation".• Discusses the continuum of chronic and acute high-risk suicidal patients, the fluidity with which one can become the other, and the difficulty in assessing these patients.• Explores how the law and psychiatry interact in frequently occurring clinical situations, and the importance of therapeutic risk management.

In addition, the book contains a variety of features that illuminate the subject and enhance the reader''s understanding, including: • Inclusion of illustrative case studies, combined with commentary on commonly occurring but complex clinical situations. • Key points at the end of each chapter that identify critical information. • A Suicide Risk Assessment Self-Test, a teaching instrument that consists of fifty questions designed to enhance clinician suicide risk assessment by incorporating evidence-based risk and protective factors.

Dr. Simon provides a nuanced, empathic, yet pragmatic perspective on identifying, assessing, and managing the suicidal patient while successfully navigating a complex legal and clinical environment that poses its own risks to the practitioner.

Perhaps never before has an objective, evidence-based review of the intersection between gun violence and mental illness been more sorely needed or more timely. Gun Violence and Mental Illness, written by a multidisciplinary roster of authors who are leaders in the fields of mental health, public health, and public policy, is a practical guide to the issues surrounding the relation between firearms deaths and mental illness. Tragic mass shootings that capture headlines reinforce the mistaken beliefs that people with mental illness are violent and responsible for much of the gun violence in the United States. This misconception stigmatizes individuals with mental illness and distracts us from the awareness that approximately 65% of all firearm deaths each year are suicides. This book is an apolitical exploration of the misperceptions and realities that attend gun violence and mental illness. The authors frame both pressing social issues as public health problems subject to a variety of interventions on individual and collective levels, including utilization of a novel perspective: evidence-based interventions focusing on assessments and indicators of dangerousness, with or without indications of mental illness.

Reader-friendly, well-structured, and accessible to professional and lay audiences, the book: • Reviews the epidemiology of gun violence and its relationship to mental illness, exploring what we know about those who perpetrate mass shootings and school shootings. • Examines the current legal provisions for prohibiting access to firearms for those with mental illness and whether these provisions and new mandated reporting interventions are effective or whether they reinforce negative stereotypes associated with mental illness. • Discusses the issues raised in accessing mental health treatment in regard to diminished treatment resources, barriers to access, and involuntary commitment.• Explores novel interventions for addressing these issues from a multilevel and multidisciplinary public health perspective that does not stigmatize people with mental illness. This includes reviews of suicide risk assessment; increasing treatment engagement; legal, social, and psychiatric means of restricting access to firearms when people are in crisis; and, when appropriate, restoration of firearm rights.

Mental health clinicians and trainees will especially appreciate the risk assessment strategies presented here, and mental health, public health, and public policy researchers will find Gun Violence and Mental Illness a thoughtful and thought-provoking volume that eschews sensationalism and embraces serious scholarship.

"Why did the defendant do it?"

Mental health professionals are asked to help courts answer this question. To serve justice, the law calls for evidence of the mental state at the time a crime is committed, of suicide intent in civil litigation, and of mental capacity in contract litigation. The law asks psychiatrists and psychologists to retrospectively determine mental states-a daunting task made even more difficult by the passage of time, the uncertain credibility of witnesses, the paucity of collateral sources of information, and often the death of the person in question.

This is the first book dedicated entirely to the retrospective assessment of mental states. This fascinating book explores the role of the psychiatrist and psychologist, as an expert witness in litigation, in rendering a retrospective judgment of an individual's mental state. Distinguished contributors apply their expertise in psychiatry, psychology, and the law to address the problems of retrospective assessment. With the goal of developing guidelines for more accurate retrospective assessment of mental states, they present topics such as • Guidelines for conducting retrospective assessments in children and adults • Guidelines for the retrospective assessment without benefit of direct examination • Assessments of suicide cases in both civil and criminal litigation• Psychological testing and interviewing techniques that may assist in retrospective assessment • Methods and analysis to help clinicians and attorneys critically evaluate the search for "truth" about the past.

This remarkable book will prove indispensable for helping clinicians, lawyers, and judges better understand the complex and difficult process of retrospective reconstruction of mental states.

The terrorist attacks on the World Trade Center in September 2001 turned PTSD into a household word. But posttraumatic stress disorder has been documented throughout history: For example, as long ago as 1666, Samuel Pepys wrote in his diary that he still had night terrors 6 months after the great fire of London. PTSD, officially recognized as a diagnosis by DSM-III in 1980, is only the most recent term used to describe the suffering of trauma victims.

Few could have foreseen its profound impact on litigation. Often dubbed the "black hole" of litigation-where allegations are relatively easy to assert but difficult to defend because the symptoms are subjective—PTSD has deeply influenced civil and criminal law in cases ranging from malpractice and personal injury to sexual harassment and child abuse. It is thus vital for all legal parties involved that forensic examiners perform credible psychiatric and psychological examinations of PTSD claimants.

Intended to add direction and discipline to the forensic assessment of PTSD litigants, this expanded second edition begins with an updated chapter on current and future trends for the role of PTSD in litigation. • Chapter 2 notes the increasing evidence that exposure to multiple events not only is more common than previously thought but also increases the risk for development of PTSD following the target event.• Chapter 3 details diagnostic criteria and guidelines for the forensic psychiatric examination of the PTSD claimant.• Most literature discusses PTSD in adults. Chapter 4 offers a rare perspective on PTSD in children and adolescents, including parental response to the trauma, developmental effects, and delayed onset symptoms.• Forensic assessment of PTSD claimants is presented in Chapter 5, followed by new chapters on disability determinants (how PTSD impairs occupational functioning) and PTSD in the workplace, where the causal relationship between employment stress and a resulting mental or emotional disorder must be determined.• Chapter 8 covers guidelines for malingering in PTSD, where the claimant may be motivated by financial gain or by a reduced charge resulting from an insanity defense.• A new chapter on forensic laboratory testing in PTSD presents the tantalizing potential of psychophysiologic measurement to redeem the PTSD diagnosis from its daunting subjectivity.

This essential collection by 13 U.S. experts sheds important new light on forensic guidelines for effective assessment and diagnosis and determination of disability, serving both plaintiffs and defendants in litigation involving PTSD claims. Mental health and legal professionals, third-party payers, and interested laypersons will welcome this balanced approach to a complex and difficult field.

Updates to this edition: • Clinical and legal issues in the use of clozapine in treatment of schizophrenia• Clinical information and new cases involving tardive dyskinesia• Changes in civil and criminal law regarding right to refuse treatment• An update of clinical guidelines and legal regulations of ECT• An update on suicide risk assessment and new legal cases involving suicide• An update on violence risk assessment and new legal cases involving the duty to protect endangered third parties• New statutes and criminal sanctions regarding sexual misconduct • New statutes limiting the liability of therapists toward third parties who are injured or killed by patients• Changes in the relationship between psychiatrists and nonmedical therapists• Regulatory developments regarding physician impairment• Numerous tables and an updated glossary of legal terms• New section on common terms and abbreviations in legal citations

Evaluating and treating patients with violent ideations and behaviors can be frustrating, anxiety-provoking, and even dangerous, as errors in judgment can lead to disastrous consequences. Fortunately, there is the Textbook of Violence Assessment and Management, the first and only comprehensive textbook on assessing the potentially violent patient for mental health clinicians on the front lines of patient care.

Uniquely qualified to produce this comprehensive volume, the editors have assembled a distinguished roster of contributors who, in 28 practical chapters, combine evidence-based medicine with expert opinion to address the topic of patient violence in all its diversity of presentation and expression. Dr. Simon is Director of the Program in Psychiatry and Law at Georgetown University School of Medicine, as well as the author or co-author of more than two dozen books. Dr. Tardiff, Professor of Psychiatry and Public Health at the Payne Whitney Clinic, The New York Hospital-Cornell Medical Center, is the author of The Concise Guide to Assessment and Management of Violent Patients, an introduction to aggression management now in its second edition.

Violence is both endemic to our society and epidemic in our age. Skilled assessment and management of violence is therefore critical for mental health professionals involved in patient care. The Textbook of Violence Assessment and Management includes many features designed to instruct and support these clinicians. For example: • It is the first comprehensive textbook to take the mental health professional from evaluation and assessment to treatment and management of patients who are or may become violent. • The 28 chapters address the diversity of clinical settings, patient demographics, psychopathology and treatment modalities, making this work useful as both a textbook and a reference that clinicians can consult as needed for particular cases.• End-of-chapter "Key Points" highlight the most important concepts and conclusions, allowing students to review and consolidate their learning and practicing professionals to locate critical information quickly.• Clinical case examples abound, providing rich and nuanced perspectives on patient behavior, evaluation and management.• The textbook includes a separate chapter on evaluating patients from different cultures, a competency that becomes more crucial as patient populations become more diverse.

Increasing numbers of veterans are diagnosed with PTSD and traumatic brain injury. Campus tragedies such as Virginia Tech are fresh in our collective memory. This text is both timely and necessary—not just for mental health professionals and their patients, but for the families and communities whose safety depends upon competent professional judgment.

Perhaps never before has an objective, evidence-based review of the intersection between gun violence and mental illness been more sorely needed or more timely. Gun Violence and Mental Illness, written by a multidisciplinary roster of authors who are leaders in the fields of mental health, public health, and public policy, is a practical guide to the issues surrounding the relation between firearms deaths and mental illness. Tragic mass shootings that capture headlines reinforce the mistaken beliefs that people with mental illness are violent and responsible for much of the gun violence in the United States. This misconception stigmatizes individuals with mental illness and distracts us from the awareness that approximately 65% of all firearm deaths each year are suicides. This book is an apolitical exploration of the misperceptions and realities that attend gun violence and mental illness. The authors frame both pressing social issues as public health problems subject to a variety of interventions on individual and collective levels, including utilization of a novel perspective: evidence-based interventions focusing on assessments and indicators of dangerousness, with or without indications of mental illness.

Reader-friendly, well-structured, and accessible to professional and lay audiences, the book: • Reviews the epidemiology of gun violence and its relationship to mental illness, exploring what we know about those who perpetrate mass shootings and school shootings. • Examines the current legal provisions for prohibiting access to firearms for those with mental illness and whether these provisions and new mandated reporting interventions are effective or whether they reinforce negative stereotypes associated with mental illness. • Discusses the issues raised in accessing mental health treatment in regard to diminished treatment resources, barriers to access, and involuntary commitment.• Explores novel interventions for addressing these issues from a multilevel and multidisciplinary public health perspective that does not stigmatize people with mental illness. This includes reviews of suicide risk assessment; increasing treatment engagement; legal, social, and psychiatric means of restricting access to firearms when people are in crisis; and, when appropriate, restoration of firearm rights.

Mental health clinicians and trainees will especially appreciate the risk assessment strategies presented here, and mental health, public health, and public policy researchers will find Gun Violence and Mental Illness a thoughtful and thought-provoking volume that eschews sensationalism and embraces serious scholarship.

In their latest collaboration, Clinical Manual of Psychiatry and Law, noted forensic psychiatrist Dr. Robert Simon and legal scholar Daniel Shuman, both recipients of the Guttmacher Award, have created a unique, practical reference to enable psychiatrists to transform the impact of the law on their clinical practices from an adversary to a working partner. In lieu of scare tactics or horror stories, Dr. Simon and Professor Shuman clearly explain not only what the law requires and why but how best to integrate its requirements to enhance clinical practice and reduce the risk of successful tort claims. They have written a clear, comprehensible, and accessible volume that will guide practitioners through the thickets of the law and benefit their clinical practices.

This volume covers a wide range of topics, from confidentiality, privilege, informed consent and the right to refuse treatment to treatment boundaries, involuntary hospitalization, seclusion and restraint, management of violent as well as suicidal patients, and the additional requirements which apply to the treatment and evaluation of minors or persons with mental disabilities. It also includes the tort (i.e., negligence, intentional harm) claims that arise from a breach of the law''s expectations. The content reflects the latest legal precedents concerning such topics as: • Establishment of the doctor-patient relationship and liability for damages caused by its breach, including new rulings governing confidentiality and testimonial privileges• Case law regarding informed consent -- especially the issue of competency when dealing with minors or persons with mental disabilities• New rules and regulations restricting the use of seclusion and restraint• Guides to the most recent laws regarding involuntary hospitalization and emergency commitment• Insights into recent state court decisions concerning disclosures by therapists of threats of harm by patients against others, including such issues as conflicts between the duty to maintain confidentiality and the duty to protect• Reviews of recent legislation proscribing sexual misconduct or prosecuting sexual exploitation of patients under existing rape or sexual assault laws

Clinicians will find this wealth of knowledge immediately practical and lawyers will appreciate its in-depth treatment of complex psychiatric issues. With extensive references and a glossary of legal terms, Clinical Manual of Psychiatry and Law deserves a place among the top legal references for mental health professionals.

Patient suicide is an unavoidable occupational hazard of psychiatric practice. Indeed, it is the rare clinician who does not struggle, even agonize, over the complex task of assessing and managing the risk of suicide in patients. Patient suicides account for the greatest number of malpractice suits filed against psychiatrists and for the greatest number of settlements and verdicts covered by professional liability insurers.

In this book, written by a clinician for clinicians, Dr. Simon, an established expert in psychiatry and law, offers • A solid, easy-to-understand review of how medical malpractice law applies to patient suicides. He discusses the standards of care physicians must meet, the conditions associated with malpractice liability, and how best to minimize risks of litigation. • Extensive references to peer-reviewed literature on suicide and recent malpractice cases, including those triggered by patient suicides, which give insight into the latest developments in both the scientific community and the courts. • Much-needed practical advice, including advice on working with suicide risk assessments and suicide prevention contracts, on treating suicidal patients in various settings (outpatient, inpatient, collaborative, and emergency), and on coping with issues arising in the aftermath of a patient''s suicide (documentation, confidentiality, and survivor care). • Clearly defined risk management guidelines that will help clinicians avoid litigation or establish a sound legal defense if sued for malpractice. • Numerous case examples that make the theoretical discussions and clinically based risk management guidelines that follow come alive.

Rich in advice that draws on the author''s more than 40 years of clinical experience, this book serves as an essential aid to clinicians.

The terrorist attacks on the World Trade Center in September 2001 turned PTSD into a household word. But posttraumatic stress disorder has been documented throughout history: For example, as long ago as 1666, Samuel Pepys wrote in his diary that he still had night terrors 6 months after the great fire of London. PTSD, officially recognized as a diagnosis by DSM-III in 1980, is only the most recent term used to describe the suffering of trauma victims.

Few could have foreseen its profound impact on litigation. Often dubbed the "black hole" of litigation -- where allegations are relatively easy to assert but difficult to defend because the symptoms are subjective -- PTSD has deeply influenced civil and criminal law in cases ranging from malpractice and personal injury to sexual harassment and child abuse. It is thus vital for all legal parties involved that forensic examiners perform credible psychiatric and psychological examinations of PTSD claimants.

Intended to add direction and discipline to the forensic assessment of PTSD litigants, this expanded second edition begins with an updated chapter on current and future trends for the role of PTSD in litigation. • Chapter 2 notes the increasing evidence that exposure to multiple events not only is more common than previously thought but also increases the risk for development of PTSD following the target event.• Chapter 3 details diagnostic criteria and guidelines for the forensic psychiatric examination of the PTSD claimant.• Most literature discusses PTSD in adults. Chapter 4 offers a rare perspective on PTSD in children and adolescents, including parental response to the trauma, developmental effects, and delayed onset symptoms.• Forensic assessment of PTSD claimants is presented in Chapter 5, followed by new chapters on disability determinants (how PTSD impairs occupational functioning) and PTSD in the workplace, where the causal relationship between employment stress and a resulting mental or emotional disorder must be determined.• Chapter 8 covers guidelines for malingering in PTSD, where the claimant may be motivated by financial gain or by a reduced charge resulting from an insanity defense.• A new chapter on forensic laboratory testing in PTSD presents the tantalizing potential of psychophysiologic measurement to redeem the PTSD diagnosis from its daunting subjectivity.

This essential collection by 13 U.S. experts sheds important new light on forensic guidelines for effective assessment and diagnosis and determination of disability, serving both plaintiffs and defendants in litigation involving PTSD claims. Mental health and legal professionals, third-party payers, and interested laypersons will welcome this balanced approach to a complex and difficult field.

"Why did the defendant do it?"

Mental health professionals are asked to help courts answer this question. To serve justice, the law calls for evidence of the mental state at the time a crime is committed, of suicide intent in civil litigation, and of mental capacity in contract litigation. The law asks psychiatrists and psychologists to retrospectively determine mental states -- a daunting task made even more difficult by the passage of time, the uncertain credibility of witnesses, the paucity of collateral sources of information, and often the death of the person in question.

This is the first book dedicated entirely to the retrospective assessment of mental states. This fascinating book explores the role of the psychiatrist and psychologist, as an expert witness in litigation, in rendering a retrospective judgment of an individual''s mental state. Distinguished contributors apply their expertise in psychiatry, psychology, and the law to address the problems of retrospective assessment. With the goal of developing guidelines for more accurate retrospective assessment of mental states, they present topics such as • Guidelines for conducting retrospective assessments in children and adults • Guidelines for the retrospective assessment without benefit of direct examination • Assessments of suicide cases in both civil and criminal litigation• Psychological testing and interviewing techniques that may assist in retrospective assessment • Methods and analysis to help clinicians and attorneys critically evaluate the search for "truth" about the past.

This remarkable book will prove indispensable for helping clinicians, lawyers, and judges better understand the complex and difficult process of retrospective reconstruction of mental states.

Evaluating and treating patients with violent ideations and behaviors can be frustrating, anxiety-provoking, and even dangerous, as errors in judgment can lead to disastrous consequences. Fortunately, there is the Textbook of Violence Assessment and Management, the first and only comprehensive textbook on assessing the potentially violent patient for mental health clinicians on the front lines of patient care.

Uniquely qualified to produce this comprehensive volume, the editors have assembled a distinguished roster of contributors who, in 28 practical chapters, combine evidence-based medicine with expert opinion to address the topic of patient violence in all its diversity of presentation and expression. Dr. Simon is Director of the Program in Psychiatry and Law at Georgetown University School of Medicine, as well as the author or co-author of more than two dozen books. Dr. Tardiff, Professor of Psychiatry and Public Health at the Payne Whitney Clinic, The New York Hospital -- Cornell Medical Center, is the author of The Concise Guide to Assessment and Management of Violent Patients, an introduction to aggression management now in its second edition.

Violence is both endemic to our society and epidemic in our age. Skilled assessment and management of violence is therefore critical for mental health professionals involved in patient care. The Textbook of Violence Assessment and Management includes many features designed to instruct and support these clinicians. For example: • It is the first comprehensive textbook to take the mental health professional from evaluation and assessment to treatment and management of patients who are or may become violent. • The 28 chapters address the diversity of clinical settings, patient demographics, psychopathology and treatment modalities, making this work useful as both a textbook and a reference that clinicians can consult as needed for particular cases.• End-of-chapter "Key Points" highlight the most important concepts and conclusions, allowing students to review and consolidate their learning and practicing professionals to locate critical information quickly.• Clinical case examples abound, providing rich and nuanced perspectives on patient behavior, evaluation and management.• The textbook includes a separate chapter on evaluating patients from different cultures, a competency that becomes more crucial as patient populations become more diverse.

Increasing numbers of veterans are diagnosed with PTSD and traumatic brain injury. Campus tragedies such as Virginia Tech are fresh in our collective memory. This text is both timely and necessary -- not just for mental health professionals and their patients, but for the families and communities whose safety depends upon competent professional judgment.

Robert Simon''s Bad Men Do What Good Men Dream: A Forensic Psychiatrist Illuminates the Darker Side of Human Behavior is that rare title that is both essential reading for the mental health professional and accessible in style and content to the fascinated lay reader. In twelve powerful and provocative chapters, the author introduces readers to a psychological perspective on evil, character and destiny, as well as the making of good men and women. Simon also illuminates the psychology of psychopaths, serial killers, rapists and all manner of evil characters who appall and challenge us by their very existence. He rejects the common belief that his subjects are "monsters" with nothing in common with the more "normal" among us. Simon posits that if we deny our dark side, it can only obscure our understanding of violent offenders and impede our ability to both know ourselves and control our own, at times, unacceptable impulses.

The author is among the foremost experts in forensic psychiatry. He is Director of the Program in Psychiatry and Law at Georgetown University School of Medicine. Author or co-author of more than two dozen books and editions, including the foundational Textbook of Forensic Psychiatry, Simon has made important contributions to the field of forensic psychiatry for more than 30 years. He is also an eloquent writer with a dramatic, yet nuanced, narrative style that takes the reader inside the mind of the evildoer.

The first edition of this groundbreaking work garnered uniformly superlative reviews and was translated into several languages. This updated version retains Simon''s engrossing portrayals and keen insight, while offering a number of key enhancements. The highlights include: • Explorations of the Internet and violence, "corporate" psychopaths, cyberstalkers, perpetrators of school violence, and a new cast of serial killers, terrorists, and other evildoers.• A psychological perspective on evil, serial killers, and us.• Updates on the neuroscience and genetics of deviant behaviors.• Reflections on empathy, character, and destiny: the making of good men and women.• A new foreword by Thomas G. Gutheil, M.D., Professor of Psychiatry and Co-Founder, Program in Psychiatry and the Law at Harvard Medical School, that illuminates Simon''s thesis and grounds it in historical context.

Graphic but never sensational, unsparing but never cold, Simon''s writing transcends the theoretical and achieves that most difficult of aims: leading readers to discover, contain, and transform the darkness within us all, to the betterment of our human condition.

Today's psychiatrists practice in an environment that poses difficult challenges. Both treatment time and duration are limited by insurance requirements; many facilities are understaffed; split treatment arrangements are typical; and high-risk, acutely suicidal patients are admitted to inpatient units for short lengths of stay. In addition, law now plays a pervasive role in the practice of psychiatry. The doctor-patient relationship is no longer defined solely by the involved parties. Clinicians must juggle these requirements and limitations while providing the very best care to their patients, especially those at high risk.

Preventing Patient Suicide: Clinical Assessment and Management provides the wisdom of Dr. Robert I. Simon's vast clinical experience, combined with the latest insights from the evidence-based psychiatric literature, to offer a cutting-edge survey of suicide prevention and management techniques. The author: • Addresses sudden improvement in high-risk suicidal patients, a phenomenon both common and perilous, with techniques for determining whether the improvement is real or feigned.• Explores in depth the misuse of suicide risk assessment forms, with emphasis on their inherent limitations.• Examines the many entrenched myths and traditions about suicide, exposing them to the critical light of evidence-based medicine, including the concept of "imminent suicide risk" and the myth of "passive suicide ideation".• Discusses the continuum of chronic and acute high-risk suicidal patients, the fluidity with which one can become the other, and the difficulty in assessing these patients.• Explores how the law and psychiatry interact in frequently occurring clinical situations, and the importance of therapeutic risk management.

In addition, the book contains a variety of features that illuminate the subject and enhance the reader's understanding, including: • Inclusion of illustrative case studies, combined with commentary on commonly occurring but complex clinical situations. • Key points at the end of each chapter that identify critical information. • A Suicide Risk Assessment Self-Test, a teaching instrument that consists of fifty questions designed to enhance clinician suicide risk assessment by incorporating evidence-based risk and protective factors.

Dr. Simon provides a nuanced, empathic, yet pragmatic perspective on identifying, assessing, and managing the suicidal patient while successfully navigating a complex legal and clinical environment that poses its own risks to the practitioner.

Today''s psychiatrists practice in an environment that poses difficult challenges. Both treatment time and duration are limited by insurance requirements; many facilities are understaffed; split treatment arrangements are typical; and high-risk, acutely suicidal patients are admitted to inpatient units for short lengths of stay. In addition, law now plays a pervasive role in the practice of psychiatry. The doctor-patient relationship is no longer defined solely by the involved parties. Clinicians must juggle these requirements and limitations while providing the very best care to their patients, especially those at high risk.

Preventing Patient Suicide: Clinical Assessment and Management provides the wisdom of Dr. Robert I. Simon''s vast clinical experience, combined with the latest insights from the evidence-based psychiatric literature, to offer a cutting-edge survey of suicide prevention and management techniques. The author: • Addresses sudden improvement in high-risk suicidal patients, a phenomenon both common and perilous, with techniques for determining whether the improvement is real or feigned.• Explores in depth the misuse of suicide risk assessment forms, with emphasis on their inherent limitations.• Examines the many entrenched myths and traditions about suicide, exposing them to the critical light of evidence-based medicine, including the concept of "imminent suicide risk" and the myth of "passive suicide ideation".• Discusses the continuum of chronic and acute high-risk suicidal patients, the fluidity with which one can become the other, and the difficulty in assessing these patients.• Explores how the law and psychiatry interact in frequently occurring clinical situations, and the importance of therapeutic risk management.

In addition, the book contains a variety of features that illuminate the subject and enhance the reader''s understanding, including: • Inclusion of illustrative case studies, combined with commentary on commonly occurring but complex clinical situations. • Key points at the end of each chapter that identify critical information. • A Suicide Risk Assessment Self-Test, a teaching instrument that consists of fifty questions designed to enhance clinician suicide risk assessment by incorporating evidence-based risk and protective factors.

Dr. Simon provides a nuanced, empathic, yet pragmatic perspective on identifying, assessing, and managing the suicidal patient while successfully navigating a complex legal and clinical environment that poses its own risks to the practitioner.

Perhaps never before has an objective, evidence-based review of the intersection between gun violence and mental illness been more sorely needed or more timely. Gun Violence and Mental Illness, written by a multidisciplinary roster of authors who are leaders in the fields of mental health, public health, and public policy, is a practical guide to the issues surrounding the relation between firearms deaths and mental illness. Tragic mass shootings that capture headlines reinforce the mistaken beliefs that people with mental illness are violent and responsible for much of the gun violence in the United States. This misconception stigmatizes individuals with mental illness and distracts us from the awareness that approximately 65% of all firearm deaths each year are suicides. This book is an apolitical exploration of the misperceptions and realities that attend gun violence and mental illness. The authors frame both pressing social issues as public health problems subject to a variety of interventions on individual and collective levels, including utilization of a novel perspective: evidence-based interventions focusing on assessments and indicators of dangerousness, with or without indications of mental illness.

Reader-friendly, well-structured, and accessible to professional and lay audiences, the book: • Reviews the epidemiology of gun violence and its relationship to mental illness, exploring what we know about those who perpetrate mass shootings and school shootings. • Examines the current legal provisions for prohibiting access to firearms for those with mental illness and whether these provisions and new mandated reporting interventions are effective or whether they reinforce negative stereotypes associated with mental illness. • Discusses the issues raised in accessing mental health treatment in regard to diminished treatment resources, barriers to access, and involuntary commitment.• Explores novel interventions for addressing these issues from a multilevel and multidisciplinary public health perspective that does not stigmatize people with mental illness. This includes reviews of suicide risk assessment; increasing treatment engagement; legal, social, and psychiatric means of restricting access to firearms when people are in crisis; and, when appropriate, restoration of firearm rights.

Mental health clinicians and trainees will especially appreciate the risk assessment strategies presented here, and mental health, public health, and public policy researchers will find Gun Violence and Mental Illness a thoughtful and thought-provoking volume that eschews sensationalism and embraces serious scholarship.