What a psychiatric expert report should contain — and the five omissions criticised at proof

A psychiatric report is read by three different audiences: the instructing agent deciding whether to found on it, the opposing agent looking for a basis to challenge it, and, if the case reaches proof, a sheriff or judge who has no clinical training and must decide how much weight the opinion deserves. A report that is clinically sound but poorly organised does its author's opinion a disservice, because the reasoning that supports the conclusion is hard to find and therefore hard to test in evidence-in-chief and difficult to defend in cross-examination.

The structure that Scottish courts expect of expert evidence is not exotic. It follows the logic of a competent clinical assessment: what was I asked, what did I read, what did the examinee tell me, what did I find on examination, and how do I get from those findings to my opinion on each question asked. Reports that depart from this order — burying the opinion in narrative, or reciting history without linking it to the questions in the letter of instruction — are the reports most often picked apart in cross-examination, not because the underlying clinical judgment is wrong, but because the judgment cannot be followed.

The report should open by identifying who instructed it, on whose behalf, and the questions asked, quoting the letter of instruction rather than paraphrasing it. This matters because an opinion answering questions no one asked, or failing to answer questions that were asked, is of limited use to the instructing agent and an easy target for the other side.

A list of documents considered follows, dated and identified with enough particularity that another reader could establish exactly what was and was not available — GP records to what date, hospital records from which board, occupational health file, pleadings, earlier expert reports. Where records are known to exist but were not provided, that should be stated, because a report prepared on an incomplete evidential base is not thereby worthless, but its limitations must be visible on the face of the document.

The clinical history follows: personal and developmental history, past psychiatric and medical history, family history where relevant, and the examinee's own account of the index event and its sequelae. This should be recorded as the examinee's account, distinguished from matters independently corroborated by the records, because the two carry different evidential weight.

Mental state examination findings are recorded as observations at the time of assessment, not conflated with the history. The report then sets out a reasoned opinion, addressing each question in the letter of instruction in turn, in language that shows the inferential steps from findings to conclusion rather than asserting the conclusion.

Where the clinical picture genuinely admits of more than one reasonable diagnostic formulation, a report that states only the preferred formulation without acknowledging the alternative, and without explaining why the alternative is rejected, invites the criticism that the opinion was not independently arrived at. An expert's duty is to the court, not to the instructing party, and a report seen to omit an obvious alternative view will be treated as advocacy rather than opinion.

A report that recites the examinee's account of causation and then proceeds as though the account were proved is vulnerable whenever the account is disputed on the pleadings. The clinical opinion on diagnosis and prognosis can properly be founded on the account given at interview, but the report should make clear that questions of fact for the court — whether an event happened as described — are not for the psychiatric witness to resolve, and should where appropriate offer a conditional opinion: if the account is accepted, this follows; if it is not, the opinion may differ.

It is not enough to state that an event caused a disorder. Where there is a pre-existing history, a competing stressor, or a period between the index event and onset of symptoms that requires explanation, the report should show the reasoning: why this event, rather than something else, is taken to have caused or materially contributed to the presentation, and what, if anything, should be apportioned to constitutional or pre-existing factors. Causation and apportionment in Scottish psychiatric injury claims are addressed further in a companion article on this site.

Where GP or hospital records are inconsistent with what the examinee reports at interview — an earlier attendance for symptoms said to be new, or a gap in treatment inconsistent with the account of continuous disability — a report that does not mention the discrepancy will be assumed, fairly or not, to have missed it or to have chosen not to engage with it. Either inference damages the report's credibility. The discrepancy should be identified, and the opinion should state how it has been resolved and why.

Scottish expert evidence requires a statement that the expert understands the duty owed is to the court and not to the instructing party, and that the opinion given is the expert's own and independent one. Beyond the formal declaration, a report should be candid about the limits of psychiatric opinion: where the evidence permits more than one conclusion, where a matter falls to a different discipline, or where further information would change the opinion, that should be said. A report that reads as unqualified certainty on matters that are genuinely uncertain is the report most easily unpicked in cross-examination, and the one that does the instructing agent the least service when the case is tested at proof.