A criminal psychiatrist who assesses mentally ill offenders has revealed some elements of his job leave him with ‘a sense of hopelessness and frustration.’
Dr Soham Das, from London, regularly assesses offenders in prison, court, or in locked secure forensic psychiatric units – which are reserved for the most violent and dangerous mentally ill patients.
Some of the patients are heavily medicated to prevent them from being aggressive. agitated, or tortured by their terrifying symptoms – but it’s not all plain sailing for the expert.
‘The downside of this is that some of them are extremely overweight and heavily sedated,’ he explained. ‘It is hard to see them in zombie-like states, knowing this is because of our treatment – because of a machine that I am a cog in.’
Dr Das (pictured) from London, assesses offenders in prison, court, or in locked secure forensic psychiatric units
The criminal psychiatrist, who works part-time for the NHS in mental teams based in two criminal courts in London, says that one of the most rewarding aspects of his job is seeing patients gradually develop insight into their mental illness with treatment, medication and psychology session.
‘It’s gratifying to see very damaged and vulnerable patients turn their lives around,’ he explained.
‘But I would be lying if I said that, at times, some elements of my job don’t leave me with a sense of hopelessness and frustration. Many of my patients have had horrific childhoods.’
He added: ‘Some have suffered forms of abuse that you could not fathom and others have been exploited; for example women forced into prostitution or young men recruited by drug dealing gangs.’
‘Some have a number of current social issues, such as drug abuse, toxic families and homelessness.’
The majority of Soham’s patients are relatively stable and many are on their “best behaviour” – presumably because they want a favourable report from him to the Court.
However, there are a small but significant proportion who are agitated, disturbed or even violent; usually because they are psychotic, or angry at being detained.
‘My job involves assessing defendants’ mental states and sifting through evidence including witness statements, police interview transcripts, CCTV footage and medical records, which sometimes amount to hundreds of pages,’ he said.
‘I then extract all material related to mental illness, offer diagnoses if appropriate and then make recommendations or give advice to the judges to assist them in the case.’
A Consultant Forensic Psychiatrist working in prisons and criminal courts, assessing and rehabilitating mentally ill offenders has revealed exactly what his job entails
Typically, the issues that need an expert opinion include if the defendant is well enough to stand trial, if they need to be diverted to a locked psychiatric unit and if so, the level of security necessary to contain their risk of violence.
However, the forensic expert revealed that there’s a fine balance between justice and treatment, and some complex intertwined ethical issues.
‘I might opine that a defendant with a suspected mental illness wasn’t particularly unwell at the material time of an offence, and were in fact culpable for their actions,’ he explained.
‘I might therefore be instrumental in them going to prison, even though of course, it is ultimately the Judge’s decision.’
Dr Das went on to explain that if they have no mental illness and have done a horrible act, it isn’t too much of a moral burden. But the problem is that his world is full of grey areas.
‘I might well be assessing a woman who has significant depression and drug addiction who was caught shop-lifting,’ he said.
‘She might be genuinely unwell, suffering and vulnerable. Nevertheless, if her mental illness did not directly drive her offending, I have to explain this to the Court. She might therefore end up in prison as an indirect consequence of my evidence.’
He continued: ‘I know that treatment for basic mental health issues are available in custody, having run prison psychiatry clinics in a previous incarnation as a Consultant Forensic Psychiatrist.’
‘But I also know that it’s not the healthiest or safest environment for her. I could explain this to the Judge, but the priority of the Court, understandably, is justice, rather than treatment.’
As a part of his job, Dr Das is asked to ascertain the patient’s mental state at the time of the offence to see if there are any psychiatric defences available to them – and one of the more common types is “not guilty by reason of insanity.”
The forensic expert has been involved in high-profile cases, including giving evidence in murder cases at the Old Bailey.
‘Sometimes I am asked to opine on downgrading a murder charge to manslaughter, by diminished responsibility,’ he said.
‘This is another area with ethically murky connotations. I have a duty of care for the psychotic defendant in front of me. But in the back of my mind, I am aware of the need for justice for the children, spouse, or parents of somebody who has been killed. Some scenarios have no winners.’
Occasionally, if the Court has questions or doubts about his evidence, Dr Das is cross-examined by a barrister or a Judge, while the opposition barrister tries to trip him up and attack his credibility in court.
‘Psychotic disorders, like schizophrenia, are common within the people I assess,’ he explained. ‘A key feature for most sufferers is a lack of insight; not realising they are unwell.’
He continued: ‘For example, actually believing paranoid delusions about strangers wanting to kill them or believing that the voices they hear are real.’
Dr Das also sees a small but significant group of patients that will either not be discharged from their secure psychiatric hospital for decades, if ever.
‘These are patients who have such severe mental illness that even the strongest medication cannot cure them,’ he explained.
Speaking of hairy scenarios in his line of work, the forensic expert reveals he has been assaulted on two separate occasions in his career.
The forensic expert (pictured) says he manages to switch off by creative writing
‘I have been shouted at, threatened and faced racial abuse on numerous occasions,’ he explained.
‘Although these incidents have not particularly affected me emotionally, I know of some colleagues who have been attacked by patients, with lasting detrimental effects.’
Dr Das is often asked how he manages to switch off and resist becoming disturbed or depressed by what he sees.
‘I am good at not taking my work home with me, in terms of emotions, not in terms of paperwork,’ he explained.
‘The logical conclusion is that I have become hardened to violence over time, but the honest truth is, I don’t think I ever really have been very affected by hearing about the atrocities.’
‘It’s not that I don’t care; it’s just that I’m hyper-aware that it is not my role to judge or punish these people. In fact, it would be unethical of me to do so.’
‘If they are in the criminal justice systems and I have belief in the court process. I am always neutral and objective.’
‘I strictly focus only on my psychiatric opinions and recommendations and not how I feel about the defendant (even if they have committed a nasty offence, been screaming at me, or even tried to attack me).
And the expert’s newest hobby, writing articles and fiction, also proves a helpful distraction.
‘I spend time with my wife and two young sons every day, including doing some of the school pick-up and drop-offs,’ he explained. ‘I go to hip-hop and stand-up comedy gigs. I even go raving / to festivals occasionally.’
He added: ‘I am working on my debut novel; about the experience of a psychotic young woman who is detained in a medium-secure forensic psychiatry unit, after committing a horrendous offence,’ he explained.
‘It’s loosely based on an actual patient I treated several years ago. I cram in as much writing as I can every morning and weekend, then it’s back to assessing mentally disordered offenders, once again.’