Interaction of Forensic Medicine Experts and Psychiatrists

An Interdisciplinary Interaction between Forensic Medicine Experts and Psychiatrists

Event Overview

  • Date & Time: Baisakh 3, 2082 B.S. (April 16, 2025), from 6:30 PM to 8:30 PM.
  • Venue: Dhangadhi, Kailali District, Sudurpashchim Province.
  • Organizers:
    • MeLeSoN, the MedicoLegal Society of Nepal.
    • PAN, the Psychiatrists’ Association of Nepal.

Executive Summary

This report details the highlights and outcomes of the interaction program held on Baisakh 3 (April 16, 2025) in Dhangadhi, bringing together forensic medicine experts and psychiatrists under the joint auspices of the MedicoLegal Society of Nepal (MeLeSoN) and the Psychiatric Association of Nepal (PAN), FarWest Province. Six core themes were discussed: (1) the urgent establishment of forensic psychiatry as a formal subspecialty in Nepal; (2) advocacy for the decriminalization of substance use disorders in favor of a healthbased model; (3) strengthening rehabilitation centres with mandatory psychiatric oversight; (4) ensuring psychiatric referral for all sexual assault survivors postforensic examination to mitigate PTSD; (5) enhancing suicide prevention through detailed family interviews and collaborative research; and (6) promoting ethical medical practice with robust referral guidelines. For each theme, the working group identified current gaps, shared international and local insights, and proposed actionable next steps geared toward policy reform, capacity building, and intersectoral collaboration.

Key Discussion Points

1. Development of Forensic Psychiatry as a Specialty in Nepal

Forensic psychiatry remains an underdeveloped subspecialty despite the evolution of both forensic medicine and psychiatry in Nepal. Whereas forensic medical experts receive training in pathology, anthropology, and clinical forensic examination and they generally lack structured component of psychiatry, psychiatrists generally lack structured exposure to legal aspects of mental health evaluations. Formal fellowship programs and Continuing Professional Development (CPD) modules in forensic psychiatry are absent nationwide.

Further points:

  • Collaborate with the Ministry of Health and Population to design a 12month forensic psychiatry fellowship covering criminal responsibility, capacity assessments, and violence risk evaluation. In the absence of such courses in Nepal, advocate the stakeholders to make provisions of such fellowship in foreign countries till capacity developments in Nepal.

2. Advocacy for Decriminalization of Substance Use Disorders

Nepal’s punitive approach to substance use has been shown to exacerbate stigma and limit treatment access. International evidence suggests that decriminalizing possession and shifting individuals toward treatment models reduces overdose deaths and HIV transmission.

Further points:

  • Pilot Diversion Schemes: Work with the National Drug Abuse Control Centre to introduce drug courts that divert minor possession cases to licensed treatment providers rather than incarceration.
  • CommunityBased Services: Scale up harmreduction programs (e.g., needle exchange, opioid substitution therapy) in urban and rural settings.
  • Policy Dialogues: Organize stakeholder workshops with law enforcement, policymakers, and civil society to draft amendments to the Narcotic Drugs Control Act.

3. Improvement of Rehabilitation Centers

Rehabilitation facilities in Nepal are unevenly regulated, and many lack onsite psychiatric services, undermining care quality. No national accreditation requires a psychiatrist’s certification for admission or ongoing treatment.

Further points:

  • Standardized Accreditation: Develop criteria mandating at least one fulltime psychiatrist and clinical psychologist per 20 beds in rehab centers, overseen by the Department of Drug Control and Psychotropic Substances.
  • Multidisciplinary Teams: Integrate social workers, occupational therapists, and peer support specialists to deliver holistic biopsychosocial care.
  • Telepsychiatry Linkages: Use telemedicine platforms to extend psychiatric supervision to remote centers lacking inperson specialists.

4. Referral of Sexual Assault Victims to Psychiatry

Survivors of sexual violence face up to a 30 percent risk of developing PTSD, depression, or anxiety disorders. While forensic medical examination is standard, routine psychiatric referral is often overlooked.

Further points:

  • Consider immediate referral to psychiatric services postexamination, with clear pathways for outpatient followup.

5. Suicide Prevention Strategies

Nepal’s suicide rate remains among the highest in South Asia, driven in part by pesticide selfpoisoning and limited mental health infrastructure. Detailed interviews with bereaved families can uncover genetic or psychosocial vulnerabilities in surviving members, guiding targeted interventions.

Further points:

  • Postvention Services: Implement structured bereavement counseling for families after a suicide to reduce contagion risk.

6. Ethical Practice of Medicine

Ethical lapses, especially around dual roles and conflicts of interest, can undermine patient trust and judicial processes. The Nepal Medical Council’s Code of Ethics mandates physicians to “dedicate life to the service of humanity” and uphold confidentiality.

Further points:

  • Referral Ethics Guidelines: Advocate to develop detailed guidelines clarifying circumstances for voluntary vs. compulsory referrals, capacity assessments, and consent documentation.

Recommendations

  • Policy Advocacy: Engage the Ministry of Health, Nepal Medical Council, and Ministry of Home Affairs to institutionalize forensic psychiatry fellowships and substance use decriminalization measures.
  • Capacity Building: Conduct training programs, telepsychiatry infrastructure, and accreditation systems for rehabilitation and medicolegal services.
  • Interdisciplinary Collaboration: Form a standing committee of MeLeSoN and PAN to oversee implementation of SOPs, research initiatives, and ethics audits.
  • Community Engagement: Leverage civil society and survivor networks to cocreate culturally sensitive mental health and legal support pathways.

Conclusion

The Dhangadhi interaction program successfully galvanized forensic medicine experts and psychiatrists around shared priorities for advancing justice and mental health care in Nepal. By translating these discussion points into concrete policies, training programs, and collaborative frameworks, stakeholders can significantly improve forensic psychiatric services, patient outcomes, and ethical standards across the country.