Forensic psychiatry is a specialized field where psychiatric expertise intersects with legal questions: competency to stand trial, criminal responsibility, civil commitment, fitness for duty, disability evaluations, custody assessments. The role differs fundamentally from clinical psychiatry, and conflating the two produces ethical and practical problems.
Role clarity at the start. The forensic evaluator is not the patient's clinician. Disclose this at the beginning: "I want to be clear about my role. I'm doing an evaluation, not providing treatment. What you tell me will go into a report that may be shared with the court, attorneys, or insurance. There's no doctor-patient confidentiality in this setting in the usual sense. Do you understand? Do you want to proceed?" The disclosure is informed consent for the forensic role.
Different documentation. Forensic reports follow specific structural formats — referral question, methodology used, sources of information, findings, opinion to a degree of psychiatric certainty. Stay within the scope of the question asked. Don't expand into clinical treatment recommendations beyond the question. Maintain professional language; avoid pejoratives. The report may be reviewed by attorneys, courts, opposing experts.
Don't mix forensic and clinical roles on the same case. The patient you've been treating shouldn't become your forensic evaluation subject. The forensic evaluation subject shouldn't become your treatment patient. Dual roles compromise both — the clinical alliance is contaminated by the forensic relationship, and the forensic objectivity is contaminated by the clinical investment. Refer to a different clinician when these would otherwise overlap.
When forensic evaluation reveals clinical need — say, the competency evaluation discloses active suicidality — arrange for clinical care separately. Notify the appropriate parties so treatment can be initiated by someone other than the forensic evaluator. The forensic role continues for your evaluation; the clinical role is filled by someone else.
Forensic practice requires specific training. The case-specific legal questions (Daubert standards, jurisdiction-specific competency criteria, expert witness practice) are learned through forensic fellowship or substantial mentored experience. Don't take forensic cases without adequate preparation.
Stay within scope. The question asked is what you answer. Resist the pull to opine on questions not asked. Specialty forensic psychiatrists who know their limits produce more useful work than generalists who overreach.