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Complaint no affidavit been helping people love boost probabilities talks do some of these things even though you know better? Do you think managed care has changed the standard of care the U.S.? Remember that you, not the clinic administrator or insurance company, are responsible for the quality of your care and for meeting the relevant standard of care when working with patients. Return to Current Table of Contents. Child Custody Evaluations: There Are Rules! I am amazed at the way mental health professionals and some courts address one of the most important kinds of litigation we have, that which determines the development and safety of children when their parents divorce or separate. Family court judges and family lawyers should know that there are at least three fundamental requirements for a child custody evaluation: This usually means a fully-trained, forensically-experienced child psychiatrist or child psychologist. Family counselors, ordinary psychotherapists, and general psychiatrists and psychologists simply have not had the years of special child and adolescent training and experience necessary to understand children's issues, family interactions, and the child custody process. Although Dad's or Mom's therapist, the children's counselor, or a family psychiatrist-friend offer fact testimony, each has indelible bias, has often not received all the relevant information, almost always has a conflict of interest, and usually doesn't understand the forensic process and its implications. Courts should not rely on his or her report or testimony for expert opinions When one or more family members is truly unavailable for interview, that fact should be highlighted any report or testimony and the possible effect on the expert opinion should be explained. After allowing for lack of knowledge about what makes adequate evaluation money is probably the most common reason for breaking these rules. Complete evaluations by qualified professionals routinely cost thousands of dollars. They take time. Courts and litigants have to look outside their communities for specialists who meet both clinical and forensic criteria. Tough. The child's interests are the point here, not the parent's, court's or state's pocketbook, feelings, or convenience. To act otherwise is to put children danger of suffering even more than they must when their parents separate or divorce. A recent article by Stephen P. Herman, M.D., a New forensic child psychiatrist, provides excellent summary of one of these fundamentals, evaluators who 't assess all parties Issues of the can often be found medical libraries or through Dr. Herman's website is at Return to Current Table of Contents. Suicide Risk: Stop Prematurely Discharging Suicidal Patients This is editorial vignette It is based on clinical and forensic experience with which, I believe, the professional literature agrees. I have seen a great clinical cases and malpractice lawsuits during the past several years that call out to psychiatrists on inpatient units: When a patient is admitted to a psychiatric hospital with serious suicide potential, do not discharge him or her after just a few days unless either that risk is substantially lessened or some other adequate measure has been taken to protect the patient. Before you say to yourself, I already do that, please read on. Given a patient who has recently made a serious suicide attempt or has been judged to be acutely suicidal, it makes no sense to move that patient prematurely from a relatively safe environment of almost constant professional observation and treatment to one which virtually all protections are removed, there is no continuous monitoring, and the stimuli and stressors associated with the earlier self-harm are still present. Yet that's exactly what happens hospitals. Each situation is unique, of course, and these comments are not meant to apply to every eventuality, but even step-down partial hospitalization and intensive outpatient programs leave the patient on his own most of the