What Lockdowns Mean to Psychiatry and the Legal Profession

As we emerge from the cold dark nights, as daffodils begin to emerge from the soil and winter seems to be parting company. It is a time to reflect on what has happened in the last twelve months in the trends surrounding the medico legal world of psychiatric reports. It has been almost a year since the first lockdowns were announced and for many, the world has changed. For some loved ones are no longer with us; others have become accustomed to being more distant from colleagues, working from home and for now, we are left with memories of socialising with friends and family. As the lockdowns subside, some things will return to as they were and others will not. The lockdowns certainly have left an indelible mark on many aspects of business life in the legal and mental health areas and in this article I would like to explore some trends that may effect us all.

The Use of Video Technology

Many of our consultant psychiatrists up until 12 months ago most definitely preferred to see patients in person. After all when you are in the physical presence of someone the assessment is far easier due to picking up different cues.   Some of our suppliers became very busy providing specialised video links to prisons and other institutions for psychiatric court reports because of high demand. Internally many of our meetings were conducted on Zoom with many of our consultant psychiatrists and psychologists operating from home taking advantage of the now popular technology.

There are some concerns in legal circles about the use of video technology in trials because potentially vulnerable people do not have the reassurance of having a legal representative present. Whilst management cases are fine by video link many have concerns about more complex cases.  

It still remains to be seen if psychiatrists will form a consensus about merits and demerits of video technology, the fact of the matter is that video technology has been widely adopted and it saves both professional time and cost of travel. Many will continue to use this technology whilst others will have reservations and judge appropriateness on a case by case basis.

The Court System

Many of the psychiatric reports that we produce are used in courts, for fitness to plead as an example. The lockdowns have severely hampered an already overwhelmed justice system. According to a Law Society Report

“Prior to the pandemic, the justice system was already facing an overwhelming number of cases waiting to proceed. Years of financial cuts and court closures have created an escalating backlog of cases which has only worsened during the months since lockdown. HMCTS data shows that during the pandemic outstanding cases in criminal courts rose from 446,460 to 568,678 at the end of July (an increase of 27%), while those in family courts rose from 54,600 to 65,429 (a 20% increase).”   Law under lockdown: the impact of COVID-19 measures on access to justice and vulnerable people.

In the same report, some lawyers have complained about long delays in hearings leaving their client’s legal limbo for long periods of time, which is  especially daunting if they are youngsters

“The delay in listing cases has caused my 14-year-old defendant’s trial to be moved from June 20 to February 2021. He is currently detained in a secure detention centre and he will have been held on remand for over 14 months of his life by the time his trial has concluded […] This is likely to cause him all manner of issues for his social and personal development. If he is found not guilty then he will have served what would be a 2.5 year prison sentence without actually having committed a crime and that is totally unacceptable.” Law under lockdown: the impact of COVID-19 measures on access to justice and vulnerable people.

Whilst the government has introduced “Nightingale” courts to clear backlogs it is clear that some well thought out changes will be required to the court system for it to function in an efficient manner to deal with backlogs as time proceeds.

Legal Firms

Many of those instructing psychiatric court reports are legal firms. According to the Law Gazette solicitors were allowed to meet up with clients during the second lockdown but were told that they should work from home wherever possible. Some of our smaller clients have operated in different ways with one of them having staff on a rotating furlough basis. It is clear that much of the work has been put on a slower track than it normally would be due to delays in the court system and generally activity being curtailed by the lockdown.

In the first lockdown, solicitors, barristers, paralegals and legal executives involved with court cases and tribunals were interestingly classified as key workers. Many however worked from home as per the guidelines.

According to the Law Gazette , many smaller solicitors firms may be facing collapse.

“The finding is extrapolated from a survey of nearly 8,000 small firms conducted in March and April, to which 10% of practices responded. One in five said they were already feeling the squeeze on cashflow and fee income. Some 63% of sole practitioners and 71% of firms with four partners or fewer said such pressures could put them out of business by the autumn. As a worst-case scenario that would equate to over 5,000 firms ceasing to trade, if the 774 respondents are a representative sample of the sector.”

Although this may have been a pessimistic forecast there is no doubt that small firms will feel the squeeze and will need to adapt to the changing environment.

General Public Mental Health

Mental health issues in the general population were increasingly prevalent prior to the crisis. There is evidence to suggest that lockdowns have exacerbated the situation. Early during the lockdown according to the Royal College of Psychiatrists

“The researchers found that from 21 March to 20 April, 8,000 out of 44,000 people reported thoughts of self-harm or suicide, and 5% of those (2,174 people) deliberately harmed themselves at least once since the start of the UK’s lockdown.

Overall, 9% (4,121) experienced psychological or physical abuse. Around half of those respondents had thoughts of suicide or self-harm, while a quarter had engaged in self-harm behaviours during the past week.

Only 42% of those thinking about self-harming or suicide and 57% of people who self-harmed had accessed mental health services.”

The Office for National Statistics which is responsible for compiling suicide statistics will not be able to release any data for long period as the verdict of suicide has to be announced by a coroner’s court after an inquest and typically takes 5 or 6 months until the cause of death as suicide is recorded.

The impact of lockdowns on children’s mental health is also expected to be high. According to the Telegraph children’s mental health referrals have soared and the number of children being referred for serious mental health issues to the NHS has reached a record high.

What’s on the Horizon

Whilst no one has the ability to predict the future. The trends discussed in this article give us a base point to start from. We do expect that once the lockdowns are lifted there will be an increasing requirement of expert medico legal psychiatric reports. There is the pent up demand in a constrained court system where many different types of expert reports will be required. Additionally many in the legal profession may have kicked cases into the long grass due to lengthy waits for trial dates.

We anticipate there will be many issues with housing law that require expert psychiatric reports as well as in the criminal justice sector. The effect on family law, child custody, court of protection matters and employment of the lockdown remains to be seen.

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