Forensic Reproductive Psychiatry: Practice Guidelines Review
Drs. Susan Hatters Friedman, Renée Sorrentino, Jacqueline Landess, Joseph Penn, and Patricia Westmoreland described the proposed practice resource document on reproductive psychiatry/women’s mental health in forensic psychiatry practice, that is currently available for comment for AAPL members.
The presenters identified the importance of understanding women’s mental health to combat gender bias and provide accurate forensic evaluations and appropriate psychiatric care. They explained the epidemiology of mental health diagnoses in various female populations — e.g., women in correctional facilities have higher rates of mental health symptoms compared with men in correctional facilities or women in the community. Reproductive-related diagnoses were reviewed, including pseudocyesis, delusional pregnancy, and denial and concealment of pregnancy.
A variety of considerations for evaluations were highlighted. The lower rates of violence among women were juxtaposed with the low predictive validity for women of some of the common violence risk assessment tools, but also psychiatrists’ tendency to underestimate violence risk for women. Relevant criminal evaluations were described, including neonaticide, infanticide, filicide, child abuse, and kidnapping by cesarean; and civil evaluations including parenting evaluations and risk assessments in the postpartum period.
For treatment, the presenters noted that psychiatrists should recognize the importance of understanding mental illness in pregnancy and postpartum, lactation, mother-baby units, and forced separation/custody loss.
