|Year : 2015 | Volume
| Issue : 1 | Page : 61-67
Chinese Forensic Psychiatry: History, Development and Challenges
Li Xue1, Yan-Wei Shi1, James L Knoll2, Hu Zhao1
1 Faculty of Forensic Medicine, Zhongshan School of Medicine, Sun Yat Sen University, Guangzhou, Guangdong, China
2 Department of Psychiatry, State University of New York (SUNY) Upstate Medical University, Syracuse, New York, USA
|Date of Web Publication||29-May-2015|
Forensic Psychiatry Program, Faculty of Forensic Medicine, Zhongshan School of Medicine, Sun Yat Sen University, Guangzhou 510080, Guangdong
Source of Support: None, Conflict of Interest: None
China has a long history of forensic psychiatry, which can be traced even back to Zhou dynasty (11 th century B.C.). However, modern forensic psychiatry has not been set up in China until the 1970s. After the interruption of Cultural Revolution of 1966-1976, there was a period of rapid development. In the past five years, a series of judicial identification system reforms have been taking place. In 2010, China had 225 forensic psychiatry agencies, 2,090 forensic psychiatry experts and 40,822 cases. The experts are organized within the separate agencies of psychiatric hospitals, universities, the Institute of Forensic Sciences of the Ministry of Justice and other forensic agencies. Apart from criminal forensic psychiatry, the experts are often asked to evaluate civil competency for the clients involved in civil litigation. Chinese forensic psychiatry has developed rapidly during the past 30 years, and formed the characteristics of its own under the special legal system. However, there is still much work for Chinese forensic psychiatrists to do for the future.
Keywords: Chinese, forensic psychiatry, history
|How to cite this article:|
Xue L, Shi YW, Knoll JL, Zhao H. Chinese Forensic Psychiatry: History, Development and Challenges. J Forensic Sci Med 2015;1:61-7
| Introduction|| |
Forensic psychiatry is a subspecialty of psychiatry in which scientific and clinical expertise is applied to legal issues in legal contexts embracing criminal, civil, correctional or legislative matters. Forensic psychiatry should be practiced in accordance with guidelines and ethical principles enunciated by the profession of psychiatry. The number of specific psychiatric-legal issues to consider is itself large. Criminal forensic psychiatry including, at minimum, competence to stand trial, competence to enter a plea, testimonial capacity, voluntariness of confessions, insanity defense (s), diminished capacity, sentencing considerations, release of persons who have been acquitted by reason of insanity. Civil forensic psychiatry including, at minimum, conservators and guardianships, child custody determinations, parental competence, termination of parental rights, child abuse, child neglect, psychiatric disability determinations (e.g. for social security, workers' compensation, private insurance coverage), testamentary capacity, psychiatric negligence and malpractice, personal injury litigation issues. Legal regulation of psychiatry including, at minimum, civil involuntary commitment, voluntary hospitalization, confidentiality, right to treatment, right to refuse treatment, informed consent, professional liability, ethical guidelines.
Chinese forensic medicine has a long history traced back to the Warring States Period (457-421 B.C.). The State of Chhin has been regarded as its birthplace.  The first systematic book of forensic is the Xi Yuan Lu written by Song Ci (1186-1249), who is honored as the greatest figure in the history of Chinese forensic medicine.  Interestingly, ancient forensic psychiatry appeared much earlier, but modern forensic psychiatry has not been established until the 1970s. Meanwhile, because of special legal and social system, dramatic history and development of forensic psychiatry have been experienced by China in the past.
| History of Forensic Psychiatry|| |
The establishment of forensic psychiatry has a long historical process in China. In 11 th century B.C., the chapter Si Chi (Criminal Officials) of document entitled Zhou Li (Laws of Zhou dynasty) stipulated definitely that criminal officials were in charge of San Chi (inflicting punishment), San You (mitigating punishment) and San She (remitting punishment). Three provisions of mitigating punishment included "be disable to recognize", "negligence" and "forgotten or amnesia". The criminals should be granted remitting punishment if they were children, elders and ill or stupidity. The above descriptions are the earliest legal rules of ancient China about criminal responsibility of the accused who may be mentally patient. In West Han Dynasty (206-25 B.C.), Biography entitled "Han-Dong Fang Shuo" reported that drunken murder case was not free from punishment. There existed descriptions about mentally cases involved in violence in many books and documents after the Han Dynasty and Tang Dynasty, but the lawful rules of how to dispose the criminals with mental disorder were rarely explicit. Until the 1930s, Professor Lin Ji (1897-1951), pioneer of modern forensic medicine of China, first established the department of forensic medicine at the Peking University, and introduced forensic psychiatry of Germany and Japan in the chapter "Psychiatric evaluation" of his textbook entitled Lecture of Forensic Medicine. In those years, the relevant rules began to appear for the disposal of mentally patients in the civil, criminal, security and administrative regulations. However, the development of forensic psychiatry was limited because of war and the unstable political situation in China from 1911 to 1949.
After the People's Republic of China was founded in 1949, the Institute of Forensic Medicine (now the Institute of Forensic Sciences) attached to the Ministry of Justice, trained more than 200 medical students for work in forensic medicine during the 1950s. Then, former Soviet Union had important influences on the forensic psychiatry of China in the early period (1949-1966), and the idea 'sick equal to innocent' was popular in the forensic practice. Some psychiatric doctors attended the special training and courses in Nanjing, Beijing, Shanghai, Changsha, Chengdu and other places, and then carried out medical evaluation of mental disorders to meet the needs of juridical department. Unfortunately, these developments came to a standstill during the Cultural Revolution took place from 1966 to 1976. Despite the mistakes it had made, China has thoroughly changed originally wrong policies and has garnered worldwide attention for its rapid economic development in the past thirty years, especially the 20 th century. There were 144 forensic psychiatry agencies in 2002 across the mainland China.  But, this number increased to 225 with 2,090 forensic psychiatry experts and 40,822 cases in 2010.
China firstly enacted Criminal Law (1979) and Criminal Procedures Act (1979), then General Principles of Civil Law (1986), Civil Procedures Act (1991) and Administrative Penalties for Public Security (1987) and other laws and regulations. Forensic Psychiatric Evaluation Temporary Regulation (1989) was issued jointly also by the Supreme People's Court, the Supreme People's Procuratorate, Ministry of Public Security, Ministry of Justice, Ministry of Public Health, which become the code of conduct of Chinese forensic psychiatrists, played an important role for the healthy development of Chinese forensic psychiatry.  The Revised Criminal Procedures Act (1996) and the Revised Criminal Law (1997) were successively passed by National People's Congress (NPC), which clearly defined that forensic psychiatry evaluation has to be carried out in the legal agencies proposed by the provincial government, and added limited criminal responsibility into the grading standards of criminal responsibility. These laws and regulations provided the legal basis for forensic psychiatry in China. From then on, modern Chinese forensic psychiatry had been set up. The experts may not only make medical diagnosis, and also provided the opinions about the criminal responsibility or civil competency for mentally patients. In addition, although national mental health legislation has not been enacted, the some local mental health acts have been taken into force in such districts as Shanghai, Beijing and Ninbo. Mental Health Ordinance issued by Shanghai on Dec. 2001, was the first local rule of mental health of China. Recently, another notable progress is the promulgation and implementation of Mental Health Legislation. The draft released in June 2011, approved by the standing committee of the National People's Congress on October 26, 2012, and finally implemented formally on May 1, 2013. The legislation formulated the procedure of compulsory medical treatment and involuntary hospitalization for the first time, provided legal basis for forensic psychiatry.
The first rapid development in Chinese forensic psychiatry began in 1979, when the departments and sections of forensic psychiatry were rebuilt and restored in the medical universities and psychiatric hospitals across the country. Three key medical colleges (Sun Yat-Sen, West China, and China Medical University) began to enrol undergraduate students majoring in forensic medicine and psychiatry. During the 1980s, five more medical colleges established the forensic psychiatry program or department. As a result, the numbers of forensic psychiatry experts were restored and then expanded in the psychiatric hospitals and medical colleges.
On the other hand, with the establishment of laws and regulations, the forensic psychiatry workgroup was set up under the consultative committee of mental health organized by the Ministry of Public Health in 1985. The nationwide academic society of forensic psychiatry, China Association of Forensic Psychiatry (CAFP), was founded in 1986 and been held every 2 years in different cities. At the same time, within the Forensic Medicine Association of China (FMAC) founded in 1985, forensic psychiatry is one of eight academic committees for the different branches of forensic medicine. And many related research papers were published on some general journals of psychiatry or forensic medicine, such as Chinese Journal of Psychiatry, Chinese Journal of Clinical Psychology, Journal of Forensic Medicine, Chinese Journal of Forensic Medicine, Shanghai Archives of Psychiatry and Journal of Clinical Psychiatry. According to statistical data, 231 papers related to forensic psychiatry were published in 10 national psychiatric journals issued from 1976 to 1995. The number of papers published from 1991 to 1995 was 1.29 times more than that of those from 1976 to 1990.  Meanwhile, some high-quality monographs and textbooks of forensic psychiatry were published in Chinese. Meanwhile, under the support of China government, some students or scholars are often sent abroad to study or make cooperative research in forensic psychiatry program from 1990. Chinese forensic psychiatrists began to attend some of the important international academic conferences held outside China. The delegations of experts from WHO, the United States, British and other countries have visited China. Especially in mental health legislation, the academic communication is most active under the support of WHO.
The second rapid development in Chinese forensic psychiatry is from 2000 to 2010. A series of judicial identification system reforms have been taking place in both law and forensic science. Decision of the Standing Committee of the National People's Congress on the Administration of Judicial Identification come into force since 2005, which specifies all the forensic agencies and services must be supervised under the Ministry of Justice, the Department of Justice for each province, the Bureau of Justice for each municipality, and the Bureau of Justice for each county. The forensic agency must also be an independent organization in the legal status, and certified by China Metrology Accreditation (CMA) under law. Some forensic agencies also actively took part in and pass the Proficiency and Management Capacity Tests accredited by China National Accreditation Service for Conformity Assessment (CNAS). At the same time, the Registration and Administrative Regulations of Forensic Experts was enacted by Ministry of Justice in 2005, which further defined the detailed requirements of qualified forensic psychiatrists in registration, right and legal obligation, and supervisory perspective. In such a situation, forensic psychiatry agencies or programs, like forensic pathology and DNA disciplines, should pass the Proficiency and Management Capacity Tests as well.
| Legal System, Commission and Identification|| |
China (except for Hong Kong and Macao), as a statute law society, has been carrying out the law made by the highest legislature (NPC). The judicial system is made up of Ministry of Public Security, Supreme People's Procurator's Office, Supreme People's Court and Ministry of Justice. In fact, it is a counterbalance structure of judicial system among investigation, prosecution, trial and punishment.
The police service is called the "Public Security Service" in China and has a hierarchy of four levels: The Ministry of Public Security, the Department of Public Security for each province, the Bureau of Public Security for each municipality, and the Bureau of Public Security for each county. Attached to the bureaus at the municipal and county level are basic operational units such as sub-bureaus and police stations. The courts have an organizational hierarchy of four levels, including the Supreme People's Court, the High People's Court for each province, the Intermediate People's Court for each municipality, and the People's Court for each county. The people's Procurator's Offices refer to as 'state organs for legal supervision', which have exercising and supervising prosecutorial authority at all state and local levels. As with the courts, the procurator's offices also have an organizational hierarchy of four levels from the Supreme People's Procurator's Office down to a procurator's office for each county. Procurators are in charge of examining cases scheduled for investigation by public security agencies to decide whether a suspect should be arrested or not, and whether a case should be prosecuted or not. In addition, the justice system also poses a similar hierarchy, including the Ministry of Justice, the Department of Justice for each province, the Bureau of Justice for each municipality, and the Bureau of Justice for each county. All the forensic services, forensic experts, lawyers, jails and prisons are supervised by the justice system. Apart from justice system, the police, procurator's offices, courts have their own experts in forensic medicine, but not forensic psychiatry. One of their main tasks is commissioning the cases to forensic psychiatry agencies, and reviewing the forensic reports submitted by forensic psychiatrist during the investigation, prosecution, trial. The defendant or plaintiff has to first send their application to judicial system according to enforced procedures, if they need forensic psychiatry expertise. In recent years, in some personal injury or workplace compensation cases, defendant or plaintiff and their attorneys directly select and ask some forensic agencies to do evaluation without the permission of the court before trial, just to know in advance how many per cent chance they win the trial. These kinds of forensic reports may fit some interest of one side, but the value and power of evidence is limited in the courtroom.
Forensic service is set up with the approval of Justice Department. Forensic psychiatry evaluations have to be provided by qualified experts with forensic psychiatrist license. Experts can't be allowed to make any forensic evaluation across other forensic agencies. Besides, the law and related regulation clearly stipulate that psychiatrist must give forensic services in a group or team which consist of at least 2 experts. Interestingly, clinical psychologists work often with forensic psychiatrists, and join same case at same time. Forensic psychiatrists think that psychological testing is very helpful in many aspects. At present, forensic psychology is still on the early stage of its development in China, and only few forensic psychologists are asked to be expert witness on the court. Naturally, the conclusions in forensic reports are made only through the collective discussion of all the experts of group. The different viewpoints and important differences should be recorded respectively in the final report if agreement cannot be reached at last. Though the experts do not need to testify for every case in the courtroom, they have the legal obligation to do so as expert witness if necessary. As the matter of fact, these evaluations are rather easier to be accepted by the court because collective conclusions have more authority than individual opinion. The experts' conclusion may become one of the lawsuit evidences only after authentication of the court in accordance with the law. Sometimes the court may decide to make supplementary appraise or appraise again while having doubtful points or need further examination. Generally experts cannot refuse the entrustment of any case which the courts order, if without warrant. In case of some interest conflicts in specific situation or insufficient information of patient, they may have the right to not accept it.
| Performence of Forensic Evaluations|| |
Although the basis of forensic psychiatry is the clinical psychiatry, their thinking mode is very distinct. In clinical psychiatry, the doctor-patient relationship between psychiatrists and the patients is harmonious. In such a relationship, the ultimate goal of psychiatrists and patients are consistent, that is to make the patients get rid of the pain as soon as possible. Because of this, the medical staff generally do not doubt the patients' complaints and signs they reported, thus in clinical psychiatry, the thinking mode is "presumption of sick". However, in forensic psychiatry, the goal of the forensic psychiatrist is not to provide beneficial treatment but to acquire and communicate information. Unlike the doctor-patient relationship, it is the duty of the forensic psychiatrist to gather and communicate accurate, relevant information to the court, even if it will cause harm to a litigant. Meanwhile, in order to escape punishment or secure high compensation, litigants may take various measures to exaggerate their signs. Therefore, forensic psychiatrists should first assume that the litigant is heath, and then make the judgement after careful professional examination. This is the thinking mode of "presumption of heath".
Another thinking mode of forensic psychiatry is "presumption of innocence", meaning that anybody is assumed innocence before judge sentence. This principle is a basic human right of international convention, as well as one of the minimum standards of the United Nations in the field of criminal justice.
| Criminal Forensic Psychiatry|| |
Insanity defence and criminal responsibility
Criminal responsibility is the most important legal competency for the mental disorder patients. Recognition and understanding of it is different overtime in China. During the early period, the idea 'sick equal to innocent' was popular in experts due to the marked influences of former Soviet Union. After the Culture Revolution, many theories and standards of forensic psychiatry had been introduced from western world, including McNaughten Rule (McNaughten's case 1843),  Durham rule (Durham v. United State 1954),  Modern Penal Code (American Law Institute 1955)  and the ensuing debate about legal insanity in the wake of Hinckley. ,, McNaughten Rule and Modern Penal Code are conceived and used currently by most of Chinese forensic psychiatrists.
The article 15 of Criminal Law (1979) classified criminal responsibility into full responsibility and irresponsibility. However, there are many transition states between full responsibility and irresponsibility in practice. The article 18 of Revised Criminal Law (1996) divided criminal responsibility into three levels: Full responsibility, limited responsibility and irresponsibility. Interestingly, both substantial capacity to appreciate the nature and consequence of conduct and capacity of impulse control are regarded as one of the two prerequisites of responsibility in law. CAFP specified two standards of criminal responsibility, including medical standard and legal standard. An accused is not responsible for criminal conduct if at the time of such conduct, as a result of mental disease or defect (medical standard), he or she lack substantial capacity to appreciate the nature and consequence of his or her conduct (legal standard 1), or present seriously impaired impulsive behavioural control (legal standard 2). In fact, it is similar to the standard of Modern Penal Code about 'not guilty by reason of insanity' (NGRI) from American Law Institute. At the same time, Jia (2006), a senior forensic psychiatrists, also made detailed evaluating guideline of criminal responsibility for various kinds of mental disorders. , Cai (2006) believed that limited responsibility should be classified into three levels, including mostly, partial, and less because there is a broad spectrum in limited responsibility in the practice. , At present, the role of impaired impulse control is still a controversial issue because some experts think what extent of it is not easy to determinate.
In order to improve the reliability of evaluation, some rating tools have been introduced or developed in China. Hu (1997) translated Rogers Criminal Responsibility Assessment scale (RCRAS) into Chinese version and tested the reliability and validity of it in 281 defendants.  Xie (2002) developed Criminal Responsibility Rating Scale for Violence Offenders (CRRSV), and found it has good validity and reliability in forensic application.  In addition, Zhou (2003) tried to develop the Diminished Responsibility Scale for Mentally Ill Offenders (DRS). They found 16 items of scale have good correlation to the total score, and 6 factors to be favourable criteria to judge the diminished responsibility. 
Competency of stand trial
Currently there is not any legal standard of competency to stand trial (CST) in China, but the article 11 of Criminal Procedure Act stipulates that the defendants have the right to plead for their cases, and the people's courts, people's procuratorates and public security organs have legal obligation to guarantee the defendants to get legal litigation right. This is why there is a very small proportion that the evaluation about CST accounts for in forensic practice, compared to criminal responsibility. Nonetheless, sometimes the people's prosecution or court may want the experts make the evaluation if necessary.
It is considered generally that CST should be identified from medicine standard and legal standard. Li (1992), another senior forensic psychiatrist, suggested 5 basic elements of CST: The defendant understand the nature and objectives of the court proceedings; ability to assist his or her attorney in the defence; possess sufficient understanding of all the questions and ability to give a rational, consistent responses in the court; the capacity to make coherent account of the offence and mental state; the consistency of both the competency to stand trial and the severity of mental symptoms.  Zhang (2004) established rating criteria of CST for mental ill offenders, then developed Rating Scale of Competency to Stand Trial, according to China's legal system and some similar tools from other countries.  Yang (2005) also investigated 170 criminal defendants′ CST before trial, and the results indicated that thought disturbance factor and agitation factor of Brief Psychiatric Rating Scale (BPRS) and P score of Positive and Negative Syndrome Scale (PANSS) have significant impacts on CST. 
Competency to serve sentence
The legal basis of assessing competency to serve sentence (CSS) is the article 214 of Criminal Procedure Law, which stipulates that the prisoners or convicted with serious diseases may remain out of custody to gain the medical treatment. CSS is defined as the capacity to understand the sentencing procedure and to appreciate the diversity and nature of all possible sentences once guilt has been established. CSS is classified into full CSS and non-CSS. Of the prison sentencing system of China, its main objective is to punish, awe and educate the criminal. Therefore, it will be skimble-skamble for the convicted to continue the sentencing if they have lost CSS due to serious mental disorder.
There may be the need of evaluating CSS at different times during a judicial event: From the end of the trial to sentencing, or from sentencing to the end of the sentence. However, in the practice, most of patients were referred for the evaluation of CSS from the prisons, seldom from the courts and procuratorates in China. The courts and procuratorates usually think that the convicted with limited responsibility has not CSS as well, or there is not any necessity to reconsider CSS for the accused with irresponsibility.
In order to explore the influencing factors of CSS, Huang (2000) developed Scale of Adaptability to Punishment Circumstance and used it to investigate 102 prisoners who were interviewed for the evaluation of CSS from 1993 to 1998. Their results showed that the patients with psychotic disorders or with the history of mental disorders, have a relatively high rate of non-CSS, and that they usually cannot adapt themselves to the punishment circumstance.  In his another study,  Huang (2005) tried to develop Competency to Serve Sentence Rating scale (CSSRS) on the basis of China Criminal Law, related regulations and legal elements of CSS, then used it to identify CSS of 56 cases retrospectively. Their results suggested that CSSRS is a reliable tool in the evaluating CSS of mental ill prisoners.
Disposal of mental disorder offender and prison psychiatry
Before or during the trial, the court agree the postponement of the trial until the accused recovers from mental disorder, if found losing CST. What kind of necessary treatment and time limit depend on the concrete situation and article 18 and 214 of the Criminal Procedure Act. If the offender fails to attend the psychiatrist or refuses treatment then he or she can be taken back for the court to reconsider the case. In case the patient's condition does not improve, the question of fitness to plead or a hospital order have to be considered by the court.
At present there are many special psychiatric hospitals designed for the accused patients of NGRI supervised under the provincial public security departments all over the country. The court's order can be used to move someone to the hospital in an emergency if immediate transfer is needed. These high-security hospitals provide medical treatment and custody to the severely mentally ill offenders. For the convicted with diminished responsibility, they usually stay in the hospital until they are well enough to return to the prison for continuing their sentencing. With an approval of the court, a few offenders of NGRI are also transferred to the low security mental health centres after a long-term hospitalization, or to stay in their home under the strict supervision of their family for rehabilitation or prevention of offending or harm to others. The Prison Law had been performed since 1994 in China. About 1,500,000 prisoners are in the prisons so far, and male: female ratio is 25:1.  The accused persons, once found guilty, could experience a mental breakdown leading to unusual behaviours and thought, such as suicide, aggression and prison psychosis in the beginning of their sentencing. In such situations, sentencing would need to be postponed. A much more frequent scenario is deterioration in mental condition while the prisoner is in prison. These prisoners suffering from seriously mentally ill may be bailed to the prison psychiatric hospital for medication treatment or terminable custodial treatment. Once competency to be sentenced recovering from mental disorder, the prisoner must continue to serve the rest of prison sentence.
So far, there are not any precise nationwide statistics about the mental health of prisoners. According to Jiangsu provincial data, the prevalence of mental disorder is 10.9% in the prisoners, which is significantly higher than that (7‰) of general population.  In another epidemiological study of mental disorder in 3040 male prisoners, Zhao (1999) found that the total prevalence of mental disorder is 7.47%, and 4.24% for personality disorder, 0.89% for neurosis, 0.66% for affective disorder, 0.56% for sexual psychopath, 0.46% for schizophrenia, 0.20% for impulse control disorder and 0.16% for mental retardation respectively. Also, the prisoners with different prison term have different prevalence of mental disorder: 5.31% for 5-year, 8.20% for 10-year, 6.24% for 15-year, 12.15% for 20-year and 8.37% for more than 20-year.  In addition, a series of researches about the personality characteristics, CSS and correctional psychological treatment of the convicted, have been done as well. ,,
| Civil Forensic Psychiatry and Other Issues|| |
Apart from criminal forensic psychiatry, the experts are also asked to make civil assessments for the clients involved in civil litigation. The civil competency, in China, is divided as full civil competency, limited civil competency and no civil competency by General Principles of the Civil Law, the article 13 of which stipulates that a mentally ill person who is unable to account for his or her own conduct shall be a person having no civil competency and shall be represented in civil activities by his or her agent ad litem, and a mentally ill person who is unable to account fully for his or her own conduct shall be a person with limited civil competency and may engage in civil activities appropriate to his or her mental health. In the practice, the competency to contract and the competency to make a will are most common legal capacities need to be addressed by the experts.
According to the Criminal Law, the punishment of an offender is closely related to the severity of the injury he or she has inflicted. Regulations set standards for the injuries, which are classified into three degrees: Severe, light, and minor. The Evaluating Standard of Degree of Human Injury (2004) is released by the Ministry of Justice, which defines that human injury covers both physical injury and mental injury. Zhao (2004) thought that physical injury and mental injury have different feature of medicine and legal, as well as mutual dependence and conversion. 
There is an increasing number of personal injury litigation and disability cases in recent years. Disability Evaluation of Victims of Road Traffic Accident (GB18667-2002) and Standard for Identify Work ability-Gradation of Disability Caused by Work-related Injuries and Occupational Diseases (GB/T16180-2006) are the legal basis and basic standards of evaluation. The evaluation involves not only an assessment of the claimant's current clinical and functional condition but also retrospective and prospective assessment of claimant's condition. Opinions about the cause of the claimant's symptoms and the extent of impairment relative to the claimant's functioning before the trauma or event at issue are wanted. Moreover, these litigations are often involved in malingering or exaggeration, especially in mental injury caused by both physical and psychological trauma.
To improve the reliability of evaluation, many researches have been done. Gao (2000) considered that premorbid IQ can improve the determination of intellectual impairment from head injury.  Wu and Zhao (2004) tried to explore the relation of psychological trauma and hippocampal volume and metabolite level by functional MRI to screen some more sensitive and objective neurobiological variables for the evaluating post-traumatic stress disorder (PTSD).  In a cat-exposure to rats experiment, Zhao (2007) also found that apoptosis may be one of the most important neuropathological mechanisms for cell loss or hippocampal atrophy induced by predatory stress. Meanwhile, there exist the association of predatory stress responses and the number of apoptotic cells in CA3.  These results provide further evidence of the above theory. In addition, the techniques of detecting deception and psychometrics, such as Psychological Trauma Impact Questionnaire (PTIQ), have been applied greatly in civil forensic psychiatry. ,
| Challenges in the Future|| |
Chinese forensic psychiatry has formed the characteristics of its own under the certain legal system in the past years. Many challenges and chances are also faced by the experts in forensic psychiatry on the way. Firstly, they are often strapped in their work because of a paucity of strong scientific research and a lack of adequate resources and national support. It is very clear that change and advancements, both systemic and scientific, are needed in forensic psychiatry disciplines in order to ensure the credibility and reliability of the discipline, establish enforceable standards, promote best practices and their consistent application, and minimize the risk of results being dependent on subjective judgments or tainted by error or the threat of bias. Secondly, currently the expert's quality in forensic psychiatry varies with different province or area because of uneven regional development. In the most of western countries, to be a forensic psychiatrist, medical students must through 4 years psychiatric residency training and pass the national psychiatrist unified examination after they got the medcine degree, and finally received another 1-2 years professional training in forensic psychiatry fellowship program. In this respect, our policy of education and accreditation is much looser. In forensic psychiatry practice, because a substantial number of forensic psychiatrists are transformed from clinical, doctors tend to attach more importance to clinical diagnosis than mind state during crime as the judgement of criminal responsibility evaluation, but ignoring the judgement of identity and control ability. Therefore, in the future, under the support of the Ministry of Education, CAFP and FMAC should establish, enforce, and oversee education standards and the accreditation of forensic psychiatry programs in higher education, to improve the whole quality of experts and students. Furthermore, a standard assessment system, for example, the proficiency and management capacity tests are needed to improve in future, including standard case acceptance, case discussion, document examination and release procedures. Lastly, since the new criminal law pointed that the forensic experts have the duty of testify, thus, except professional training, relevant legal educations for forensic psychiatrists are indispensable, to adapt their roles of "expert witness" in court. After all, we believe that with better educational programs, constant supervision, compulsory accreditation and certification, qualified experts, sound operational principles and procedures, and serious research to establish the limits and measures of performance in forensic psychiatry, the Chinese forensic psychiatry will be better able to provide forensic services in the justice systems.
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