2022/Mar/18 Forensic Psychiatry in Indonesia, Reflections and Response to a BSNNP Presentation on Law, Brain, and Behavior

The BSNNP co-sponsored a presentation on neuroscience and the law in collaboration with the Massachusetts General Hospital Center for Law, Brain, and Behavior. One of the attendants on Zoom was from Indonesia and had asked about whether the presentation will be videotaped as it was 1AM there and he wanted to catch the rest of the program (it is taped, and we'll putting it up on the Youtube channel soon enough). I was so intrigued he heard of and joined our program all the way from Indonesia, and so, I invited him to write about his experience of forensic psychiatry in Indonesia and how the BSNNP programming might affect his practice. 

He writes the following reflection with the head of his division.

Adhitya - Natalia - FKUI-RSCM

Authors Left to Right: Dr. Adhitya S Ramadianto, SpKJ and Dr. Natalia Widiasih Raharjanti, SpKJ(K), MPdKed

The science and practice of forensic psychiatry can be challenging or even daunting for some, especially when the legal system has not kept up with advances in neuroscience and psychiatry or when the case at hand poses significant risk of legal complications for the assessing psychiatrist. This complicated situation also affects recruitment into the field. They are all major issues that we have to face every day as forensic psychiatrists in the Department of Psychiatry, Faculty of Medicine Universitas Indonesia – Cipto Mangunkusumo Hospital in Jakarta, Indonesia (FKUI-RSCM).

In an archipelago of more than 273 million people, there are less than 10 active forensic psychiatry consultants. Thus, the majority of forensic psychiatry services in the country, for both criminal and civil cases, falls on the shoulder of general psychiatrists. However, the teaching of forensic psychiatry in the nine psychiatric residencies in Indonesia varies widely in terms of case variations and required skills. Additionally, not all residency programs are staffed by board-certified forensic psychiatry consultants. A 2-year subspecialty training or fellowship program for forensic psychiatry was established in FKUI-RSCM in 2017, but its capacity cannot catch up with national demand.

The practice of forensic psychiatry in Indonesia is mostly focused on assessments for criminal and civil cases. Our previous research revealed that psychiatrists often experience negative emotions (fear, anxiety) when dealing with forensic cases. They attribute those emotions not only to inadequate training, but also to their perceived complexity and high-risk nature of forensic psychiatry, especially when testifying as an expert witness. We also found that legal practitioners (e.g. judges, lawyers, prosecutors) have very different, and sometimes inaccurate, views on mental health issues. All these shortcomings have led to inconsistent decisions that negatively affect the lives of legal-involved people.

As faculty members of Indonesia’s leading medical school and its national referral hospital, we are making efforts to improve the quality of forensic psychiatric education and services at all levels. The Neuroscience in the Service of Justice seminar by the BSNNP and MGH CLBB sparked so many ideas on how to improve and diversify those efforts.

We have established working relationships with the Faculty of Law at Universitas Indonesia, prosecutor offices, court judges, and lawyers associations. So far we have been sharing the basic principles of forensic psychiatry practice and how it relates to their respective lines of work. However, from the seminar, we see how we can also present neuroscientific advances to influence not only legal decisions at individual levels, but also at the policy level so that justice can be achieved more consistently. It will be very exciting to learn more about this form of advocacy, especially how we can translate neuroscience into practical information for legal practitioners. We are optimistic that our expertise would be welcomed by our partners in the legal profession, as our efforts have been received warmly and they are eager to learn more about our work.

We are also reminded that there are numerous avenues for research collaboration even within our department itself. In the seminar talk, we were given clear examples of how substance use and adolescent development impact the mental state that is central to forensic psychiatry practice, and how research on those areas can serve justice as well. Here in FKUI-RSCM, we also have experts in addiction psychiatry, child and adolescent psychiatry, geriatric psychiatry, community psychiatry, neuropsychiatry, psychotherapy, and consultation-liaison psychiatry. The seminar sparked interesting research ideas to collaborate on with our colleagues, and as the seminar has shown, such research can have meaningful impact for our practice.

Last, this seminar really gave a boost to our motivation and confidence in developing our field of forensic psychiatry in Indonesia through collaboration with partners from all parts of the world. Indonesian mental health and legal systems are still evolving to serve everyone better. We have learned a lot to adopt the advances and avoid the pitfalls that our colleagues have shared, and we will be continuing to do so. There is ample room for improvement in forensic psychiatry services, education, and research here - we would be glad to welcome potential collaborators.

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Dr. Adhitya S Ramadianto, SpKJ is a junior faculty member at the Forensic Psychiatry Division, Department of Psychiatry Faculty of Medicine Universitas Indonesia – Cipto Mangunkusumo Hospital. His interests include clinical reasoning in forensic psychiatry, social determinants of mental health, and psychiatric education. He can be reached at adhitsr@gmail.com or his Twitter @aditsr.

Dr. Natalia Widiasih Raharjanti, SpKJ(K), MPdKed is the head of Forensic Psychiatry Division, Department of Psychiatry Faculty of Medicine Universitas Indonesia – Cipto Mangunkusumo Hospital and is the Psychiatry Residency Program Director at the same university. Her current PhD research involves identifying core skills in forensic psychiatry practice and developing its training module. She can be reached at widiasih_1973@yahoo.com.