A day in the life of an Expert Psychiatric Witness

Dr Keith Rix, Consultant Psychiatrist

Exercise and current affairs 

My day usually begins with a run along the coast to get my daily newspaper, while listening to a podcast, or an hour on my exercise bike reading the newspaper. I need the exercise to remain healthy enough to continue as an expert for as long as my intellectual faculties last. I no more want to be accused of being out of touch with ‘real life’ than judges do and although there is more to real life than current affairs, it helps to keep up to date with the context in which my expert evidence is given, not least to be aware of public attitudes towards crime and experts (remember what Michael Gove said?) and the latest funding threats to the administration of justice. 

No couch, just a comfortable consulting room or a spartan prison visiting room 

Unless it is a report on papers, I am likely to spend nearly two hours consulting with the defendant or complainant in a criminal case or a claimant in a personal injury case. I begin by getting a full history from the subject, which includes their family history, birth, childhood and development, education, employment, relationships,  leisure pursuits, alcohol and substance use and personality as well as their medical history. How much of it is going to be relevant to the issues I have to address may not be clear to me until I prepare the report. It can be a harrowing experience especially for example in a ‘nervous shock’ or ‘secondary victim’ case when I have to ask a claimant to describe the last minutes and seconds of a loved one’s life or when taking a history from an accused person charged with the sexual abuse of infants the same age as my grandchildren. Then, although psychiatrists, as medically trained doctors, can and do conduct physical examinations, as a psychiatrist I apply the skill which others do not have; I examine the subject’s mental state. The history I have obtained is subjective so it may or may not be reliable and I will have to assist the court as to the subject’s clinical plausibility. But my examination of the mental state is objective and when supporting a diagnosis the objective can carry more weight than the subjective. This I noted from the reactions of a jury to my description of an accused’s hypervigilance and increased startle response. In the course of a consultation in which she sat with her back to a glass door that opened onto a corridor down which people walked backwards and forwards I noted her hypervigilance. She visibly jumped with an exaggerated startle response when the electronic fob I used to unlock the door into the public area of her solicitor’s offices made the door jolt noisily. My diagnosis of post-traumatic stress disorder was not challenged.  

Forensic fulfilment  

At some time during the day I may sit down at the computer and work on a report. My study looks out on a village green and with the tranquillity of rural life and some jazz playing in the background I am in the right frame of mind to start to turn the notes of my consultation, already typed into a report template, into a report for my PA to print and send out. But more exciting is a coronial or psychiatric negligence case where, having set out the substance of my instructions and the issues in the report template, I then start to construct my chronology of the case taking a page at a time in what are often quite disorganised bundles of medical records or haphazardly scanned documents. Until I have incorporated facts from the last page of the lever arch file, or got to the end of the files in the ‘bankers box’ or on the screen, I will not be in a position to start my analysis of the case identifying what, if anything, went wrong and at whose hands. In another life I would have been a spook or sleuth and if you paraphrase this quotation from a London Review of Books review of Jefferson Morley’s The Ghost: The Secret Life of CIA Spymaster James Jesus Angleton, you will appreciate the attraction for me of negligence cases: ‘A chronology is one of the basic tools of intelligence analysis, a listing of facts […] in chronological order. A serial is basically a file containing every bit of information on a given subject in the order it was received. Rigour is achieved in two ways: there is no scanting of detail and no quarrelling with the evidence. If the report says X showed up in place Y on day Z, in it goes, even if you know subject X had been buried in a distant city a month before. That report, as given, means something and you can never know what, for sure, until the end of time, if then.’ 

The retirement deception 

As I am now semi-retired (which my wife disputes), I’m not working on reports every day as I used to do. But I am still reading a lot of reports. Officially and unofficially I supervise or mentor other experts. It’s partly succession planning. I comment on their drafts and discuss them by phone. As a member of the Membership Committee of the EWI I also get to read reports by those applying for membership so I’m always learning about something new – ballistics, banking, facial recognition, etc. I have always wanted to share lessons I have learned as an expert so I may spend some time working on a paper or a book chapter and at present I am working hard to get the second edition of my Expert Psychiatric Evidence onto an edited and multi-author basis so that if I’m not up to doing the third edition, or not around, successors will be in post. And then there’s The Annual Grange Conference which started in 2001 as an inhouse CPD event for psychiatrists and psychologists doing medicolegal work and is now the leading medicolegal conference for mental health professionals. As I write this piece I am looking forward to next week when the Conference takes place in the idyllic Ripley Castle and, although trying to take a back seat, I’m already working on the 2019 conference programme. 

Having my day in court 

Every now and again I get to dress like a proper doctor because I am going to court. Few doctors these days wear ties and suits are uncommon. I get great satisfaction out of explaining my subject to the ordinary men and women on the jury. The prospect of cross-examination always fills me with apprehension and sometimes an appropriate and helpful level of anxiety. I always try hard to write my cross-examination into my opinion, which ‘the range of opinion’ encourages, but the clever solicitor or barrister will usually come up with something I have not anticipated. With luck I will get to discuss some aspect of psychiatry with a judge I first encountered when he or she was newly called to the Bar and I was a newly appointed consultant. But the ultimate satisfaction is going home in the belief that I have contributed to the delivery of justice. 

And so to bed? 

It’s not ‘all work and no play’ but I am a night owl who likes to work late and after switching off the PC I may not have been in bed long when the phone rings and I’ve a psychiatric emergency to attend. I’ve always enjoyed what medics describe as working at the coal-face so whether it’s someone with dementia who has run off from their care home, a suicidal person arrested by the police under section 136 of the Mental Health Act or someone with delirium tremens causing havoc in a surgical ward, I am in my element. It’s a good way of keeping my hand in and it exposes me to a cross-section of psychiatry from adolescence to old age. Then when counsel asks, ‘And when did you last see a case like this in your clinical practice’, I can answer, ‘At 3 a.m. this morning, My Lord’.