CR193: a framework of knowledge and support for expert witnesses

Summary

The Royal College of Psychiatrists’ report CR193 details the responsibilities of psychiatrists who provide expert evidence to courts and tribunals. This brief commentary describes the rewards and challenges of expert witness work, the author's role as the College's Lead for Expert Witnesses, and importance of CR193 for expert psychiatric witnesses.

Working as an expert witness can be rewarding and challenging in equal measure. Although a doctor's expertise is largely valued by the court, the experience can be draining, difficult and hazardous, particularly if things go wrong. The Royal College of Psychiatrists’ (RCPsych's) report CR193 provides a bedrock of guidance and advice for psychiatric expert witnesses, helping them understand and negotiate the icebergs that invariably lie ahead in wait (Rix 2023). The sea may look calm ahead but rarely is.

I am a consultant in child and adolescent forensic psychiatry and have given expert evidence in a variety of court settings. This work, for me, has always been the most interesting, challenging and engaging aspect of my career. It can sometimes be a very difficult experience, especially under an aggressive cross-examination or, worse still, being criticised by the judge. But I have learnt from every experience, good and bad.

Training, support and empowerment for experts across the RCPsych

I was recently appointed as College Lead for Expert Witnesses at the RCPsych, and a key objective of my role over the next few years is to provide a framework of training and support for experts across the College's faculties. It goes without saying that our contribution as psychiatrists to the court must fall in line with College standards and values, as well as adhering to General Medical Council (GMC) guidelines and principles (General Medical Council, 2023). CR193 is a go-to document that enables an expert to examine and consider their own practice and standards, both in accepting instructions and carrying out the work.

Another key objective in my role is to encourage and empower consultant colleagues from faculties outside of forensic to consider expert witness work. There simply are not enough psychiatric experts giving evidence in court, and a particular example is a lack of child and adolescent consultant psychiatrists providing evidence in the family courts. Forensic psychiatry trainees are usually provided with training and support for expert witness work, and a robust understanding of the interface between health and justice is a core tenet of their training and careers. Not so with other specialties, such as child and adolescent mental health, where there is usually no training for court work, and indeed such work is actively discouraged.

The privilege and benefits of court work

As well as detailing the responsibilities of psychiatrists who provide expert evidence to courts, CR193 is also written with tribunals in mind. I have found it to be a highlight and privilege to be instructed by one of His Majesty's coroners to provide expert evidence for a tribunal, and of all my expert work, this has been the most important for my National Health Service (NHS) role. All psychiatrists can be summoned to a coroner's court, either to give expert factual evidence about a patient of whom they have personal knowledge, or to give independent expert evidence at the request of the coroner or one of the interested parties. Although this experience always carries a heavy weight of responsibility, a doctor walking out of a tribunal is invariably a stronger more careful doctor than the one who walked in.

We may shy away from court work, and I am sure we all have busy NHS jobs with little time or energy to spare; but in my view, experience as an expert witness, in either a court or tribunal, adds a richness to our expertise that simply cannot be found elsewhere. Such work is difficult, no doubt, and may be the most professionally scrutinised a psychiatrist will feel – but it is an unparalleled training that sharpens the mind, hones our thinking under pressure, and makes us carefully consider the subtle nuances of our clinical opinions and recommendations.

Acquiring the confidence give expert testimony

CR193 is thoughtfully constructed to provide comprehensive guidance to experts so that they might operate in court and tribunal settings with confidence, adhering to the highest professional and ethical standards required of them. CR193 is essential reading for any psychiatric expert and should be carefully digested before an instruction is even accepted. In criminal cases in England and Wales, there is a requirement for the expert to declare that they have acted in accordance with the code of practice or guidance for their discipline and to name it. Although CR193 is not named as such, it represents the code of practice for experts in psychiatry, and psychiatric experts can expect to be asked about their knowledge of, or familiarity with, it. The document provides pragmatic guidance and advice for psychiatric experts, helping them assist the courts in a wide variety of medico-legal matters. It provides examples of cases and case law that equip an expert with the knowledge and confidence to seek up-to-date judgments and to operate in a variety of court settings.

Giving evidence in court can feel like a very lonely occupation. It might be a fine line of difference between you and a colleague instructed by the adverse party with regard to clinical diagnosis, but that difference might have a massive impact on the decision of a judge or jury. Such work needs to be discussed in peer groups and it must form part of our appraisal and revalidation, with structured feedback (e.g. via the Multi-Source Assessment of Expert Practice (MAEP) system: www.rcpsych.ac.uk/improving-care/ccqi/multi-source-feedback/maep). Each and every case will form part of our inner scaffolding as psychiatrists, to be carried with us for the rest of our careers.

In my view, this work changes us fundamentally, for the better. In a world that feels increasingly chaotic and incomprehensible, there is even more of a need for doctors to fulfil their duty to assist in the administration of justice with their knowledge and/or experience, so as to enable the court to understand matters that are otherwise beyond its comprehension.