Remote psychiatric assessments: when they are appropriate, and when they are not

Secure video assessment is now well established in psychiatric practice generally, and it has a legitimate place in medico-legal work. It reduces the burden of travel on examinees who may be anxious, in pain, or living at a distance from Glasgow, and it allows instructions to be progressed without the delay of arranging a venue. It is not, however, appropriate for every instruction, and an expert who agrees to a remote assessment without considering whether the particular case calls for direct examination is not serving the court or the instructing agent well.

The question is not whether video assessment is convenient — it usually is — but whether the clinical questions posed by the instruction can be reliably answered without the additional information that direct, in-person examination provides. That depends on the nature of the presentation and the questions asked, not on a fixed rule applied to whole categories of case.

Remote assessment is usually adequate where the clinical question is principally about mood, anxiety or post-traumatic symptoms in an examinee without a complex or contested presentation; where a detailed documentary record already exists and the assessment is largely confirmatory of a clear clinical picture; where the examinee has practical difficulty attending in person — significant travel distance, physical disability, or caring responsibilities — and there is no specific indication that direct observation is required; and where the instruction is for a supplementary or follow-up opinion rather than an initial full assessment, and no material change in presentation is in issue.

Personal injury instructions involving straightforward anxiety, depressive or post-traumatic presentations are frequently well suited to remote assessment on this basis, and it is addressed as a routine option in personal injury and PTSD instructions.

Several categories of instruction call for direct examination as a matter of course, because the information that would otherwise be lost is central to the opinion.

Where remote assessment is used, it should be conducted on a secure, encrypted platform appropriate for clinical use, with the examinee's identity verified at the outset, and with the same duration and structure as an in-person assessment rather than a curtailed version of it. The report should record that the assessment was conducted remotely, the platform used, and confirmation that the examinee was alone and unprompted during the interview, so that the mode of assessment is transparent to the court and can be tested if the opposing agent wishes to raise it.

The decision to proceed remotely, and the reasons for it, should also be recorded, particularly where the instructing agent has expressed a preference either way. This protects both the reliability of the opinion and the expert's position if the choice of format is challenged.

Agents should raise the question of format at the point of instruction rather than leaving it to be resolved administratively. Where there is any doubt about whether remote assessment will be adequate for the questions asked, that doubt should be put to the expert directly, so that a considered clinical view can be given before the appointment is arranged, rather than after an assessment has been conducted in a format that later proves inadequate to the questions the report must answer.