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Military Forensic Mental Health

Chapter 43

MILITARY FORENSIC Mental health

ELSPETH CAMERON RITCHIE, MD, MPH*

INTRODUCTION

THE PSYCHIATRIST AND THE CRIMINAL JUSTICE SYSTEM

Military Law 

Forensic Evaluations or “Sanity Boards”

Sanity Boards on Detainees

Courts-Martial Expert Consultants and Expert Witnesses

MALINGERING

PSYCHOLOGICAL AUTOPSIES

behavioral science consultation teams

SUMMARY

*Colonel, US Army (Retired); formerly, Psychiatry Consultant to The Surgeon General, US Army, and Director, Behavioral Health Proponency, Office 

of The Surgeon General, Falls Church, Virginia; currently, Chief Clinical Officer, District of Columbia Department of Mental Health, 64 New York 

Avenue NE, 4th Floor, Washington, DC 20002

A portion of this chapter appeared as: Ritchie EC, Benedek D, Malone R, Carr-Malone R. Psychiatry and the military: an update. Psychiatr 

Clin North Am. 2006;29(3):695–707.
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Combat and Operational Behavioral Health

INTRODUCTION

As the wars in Iraq and Afghanistan continue, the 

US military medical system is required to address 

many issues at the interface of psychiatry and the law. 

Service members with mental health consequences 

from war impact not just the healthcare system, but 

also the military justice and disability systems. This 

chapter highlights some of the most topical forensic 

issues facing military providers, attorneys, and the 

courts. 

The extent to which violent and aggressive behavior in the aftermath of deployment can be attributed 

to combat experience remains an area of debate and 

ongoing investigation.1–3 However, of the hundreds of 

thousands of veterans deployed in these wars, only a 

small subgroup has been involved in violent crimes. 

For this group, military forensic psychiatrists will be 

called upon to make determinations of competency 

and criminal responsibility and to inform the courts 

about the potential contributions of war-related distress or disorder to criminal behavior. 

Complicating the widespread occurrence of warrelated psychological disorders is the “signature 

wound” of these wars: traumatic brain injury (TBI). 

The numerous causes of head trauma include blast 

exposure, gunshot wounds, motor vehicle injuries, 

and other accidents. The severely wounded are 

routinely screened for head trauma; however, some 

soldiers who experience periods of unconsciousness may not present for treatment. They may later 

develop difficulty concentrating or irritability but 

be misdiagnosed or receive no medical treatment. 

More recently, updates in screening for TBI have been 

widely implemented. Now all deployed soldiers receive screening for TBI, as well as posttraumatic stress 

disorder (PTSD), upon their return from an overseas 

deployment. PTSD, although a well-recognized and 

validated psychiatric disorder, has also long been associated with malingering, allegedly for the purposes 

of both avoiding prosecution or punishment, and/or 

obtaining disability compensation.

Forensic psychiatry, psychology, and social work 

focus on the intersection of mental health issues and 

the law. Core topics include competency, criminal responsibility, sexual trauma, and disability. This chapter 

focuses on forensic psychiatry, rather than the other 

disciplines, as that is the best-developed discipline in 

the military; however, the concepts will apply across 

the disciplines. 

Military forensic psychiatrists currently serve in the 

US Army, Navy, and Air Force. Forensic psychiatry 

in the military has many similarities to forensic psychiatry as practiced in the civilian world, but some 

key differences exist. This chapter will accentuate 

some of the differences. It opens with a description of 

military law, determination of competency and criminal responsibility, and the role of expert witnesses in 

the courts-martial system. The next sections discuss 

malingering and psychological autopsies. Numerous forensic issues also relate to detainees. Although 

the care of detainees is presented in another chapter 

in this volume, this chapter will briefly discuss sanity boards on detainees and the behavioral science 

consultation team policies. A full discussion of the 

military forensic psychiatry issues and the military 

legal system is beyond the chapter’s scope but may 

be found in other sources.4–8 Several case examples, 

which are composites, are presented and are meant 

to illustrate principles.

Case Study 43-1: A soldier was returned from Afghanistan in the early years of the global war on terror (GWOT). 

After serving a hard 6 months there, he received an e-mail 

from a neighbor, saying: “I have seen a red pick-up truck in 

your driveway overnight the last few nights. What’s up?” The 

soldier applied for emergency leave, saying his mother was 

dying. The day after he returned home, he and his wife had 

a fight over his perceptions that she had a lover. He pulled 

his personal gun out of the nightstand and shot and killed 

her. He then turned the gun on himself. 

The Psychiatrist and the Criminal Justice system

Military Law 

The birth of American military law can be traced 

to the first American Articles of War, which consisted 

of 69 separate articles enacted by the Continental 

Congress on June 30, 1775, governing the conduct of 

the Continental Army.5,6 Congress enacted today’s 

Uniform Code of Military Justice (UCMJ) in 1950.8–10

The UCMJ combined the laws formerly governing 

the US Army, Navy, and Air Force into one uniform 

code. As a result, the US military has its own system of 

criminal justice with hierarchical sources of rights. In 

addition to the UCMJ, military law is based on the US 

Constitution, federal statutes, executive orders containing the Military Rules of Evidence (MRE), Department 

of Defense (DoD) directives, service directives, and 

federal common law. The US Constitution applies to 

service members unless superseded by military or 

operational necessity.9,10

The UCMJ established several levels of courtsmartial. General courts-martial are analogous to felony 

trials, and special courts-martial are analogous to mis-
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demeanor trials. The summary courts-martial, comparable to a justice-of-the-peace court, is a single-officer 

court with significantly limited authority.9 The Fifth 

Amendment of the Constitution specifically denies the 

right to grand jury indictment to service members.9 In 

place of the grand jury, the military states that no case 

may be referred to a general court-martial unless there 

has been a UCMJ Article 32 investigation.9

An Article 32 investigation is an open hearing designed to inquire into the facts of the case surrounding 

the charges. Although similar to both civilian preliminary and grand jury hearings, an Article 32 investigation is a more protective procedure because it affords 

the opportunity for discovery, to confront adverse 

witnesses, and to present evidence. Additionally, the 

recommendation of the Article 32 investigating officer 

is advisory only and not a final decision.9

Forensic Evaluations or “Sanity Boards”

The issue of criminal responsibility is addressed 

in many military settings, typically during Article 32 

hearings and special and general courts-martial. In accordance with Rule for Courts-Martial 706, if it appears 

to any commander who considers the disposition of 

charges, or to any investigating officer, trial or defense 

counsel, military judge, or court member, that there 

is reason to believe that the accused (or defendant in 

civilian legal proceedings) lacked mental responsibility for any offense, the fact and basis of the belief is 

transmitted ultimately to the officer authorized to 

order such an inquiry.10

Determinations of mental or criminal responsibility 

are referred to a board, commonly referred to as a “706 

board” or “sanity board.” Sanity boards determine 

the capacity of the accused to stand trial and address 

any other questions requested by the convening authorities, usually related to the clinical diagnosis and 

criminal responsibility. The board officially consists 

of one or more persons who must be either a physician or a clinical psychologist. Normally, at least one 

board member is either a psychiatrist or a clinical 

psychologist.10

Although not specifically required by the rule, a 

military forensic psychiatrist or psychologist is in 

many cases best qualified to serve as a member of 

the board.7,10 This is especially true for cases with 

complicated mental health issues or those involving 

very serious crimes, when the potential for appellate 

scrutiny of the sanity board findings is high. Military 

lawyers usually acknowledge the specialized training 

and experience that a military forensic psychiatrist or 

psychologist brings to sanity boards, frequently asking 

convening authorities and military judges to request 

such specialists to participate during assessments of 

criminal responsibility.7

According to Article 50a of the UCMJ, 

[i]t is an affirmative defense in a trial by court-martial 

that, at the time of the commission of the acts constituting the offense, the accused, as a result of a severe 

mental disease or defect, was unable to appreciate the 

nature and quality or wrongfulness of the acts.11

The above is often called the cognitive prong of the 

insanity defense (ie, that the accused knows the difference between right and wrong). This military standard, 

like the federal standard since the Insanity Defense 

Reform Act of 1984, does not include a volitional prong 

(eg, the capacity of the accused to conform his conduct 

to the requirements of the law). The burden of proving lack of mental responsibility falls on the accused, 

who must prove the defense by clear and convincing 

evidence. The court can then find the accused guilty, 

not guilty, or not guilty by reason of lack of mental 

responsibility.11

Because the accused is obligated to participate in 

the sanity board process, protections afforded to the 

defense limit discovery of the findings. Two reports 

are prepared: (1) a full report that includes all of the 

board’s findings and the basis for its opinions, and 

(2) an abbreviated report containing only the board’s 

ultimate conclusions on all questions specified in the 

order. The full report is furnished only to the defense 

counsel and, upon request, to the commanding officer of the accused. The full report may be released by 

the board (or other medical personnel) only to other 

medical personnel for medical purposes. Release of 

the full report to any person not authorized to receive 

it is allowed only pursuant to an order by the military 

judge. The abbreviated report is provided to the officer 

ordering the examination, the commanding officer of 

the accused, the investigating officer (if any) appointed 

pursuant to Article 32, and to all counsel in the case.8

 If 

the accused chooses to raise a mental health defense, 

the full report (redacted to exclude direct statements 

made by the accused) may become discoverable.

Case Study 43-1 (continued): The gunshots were 

heard by the neighbor who had previously sent the soldier 

the e-mail about his wife. The soldier survived, although 

with severe brain damage and hearing loss. The defense 

requested a sanity board, on the basis that the soldier had 

PTSD and traumatic brain injury, and therefore was neither 

competent to stand trial nor criminally responsible because 

of his PTSD.

Sanity Boards on Detainees

In July 2008, requests for “706 Boards” or sanity 

boards began to be made for the detainees at Guan-
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tanamo Bay. This author did four sanity boards that 

fall, until the trials ceased. While no individual issues 

are discussed here, a few thorny questions will be reviewed. Issues of culture and coercion are central. If a 

detainee discusses “djin” or spirits, is that psychosis 

or cultural belief? If he says that Allah made him do it, 

is that religiosity or terrorism? If he goes on a hunger 

strike, is that depression or coercion from other detainees? If it seems he cannot understand the questions, is 

that poor education, language difficulties, or deliberate 

refusal to cooperate with the examiners?

Courts-Martial Expert Consultants and Expert 

Witnesses

In accordance with MRE 706, “[t]he trial counsel, 

the defense counsel, and the court-martial have equal 

opportunity to obtain expert witnesses under Article 

46 [of the UCMJ].”10(p275) MRE 706 also allows for accused individuals to select expert witnesses at their 

own expense. MRE 702 states that 

[i]f scientific, technical, or other specialized knowledge 

will assist the trier of fact to understand the evidence 

or to determine a fact in issue, a witness qualified as 

an expert by knowledge, skill, experience, training, or 

education, may testify thereto in the form of an opinion 

or otherwise . . .10(p275)

MRE 703 addresses the bases of opinion testimony 

by experts. It states that 

[t]he facts or data in the particular case upon which 

an expert bases an opinion or inference may be those 

perceived by or made known to the expert, at or before 

the hearing. If of a type reasonably relied upon by 

experts in the particular field in forming opinions or 

inferences upon the subject, the facts or data need not 

be admissible in evidence in order for the opinion or 

inference to be admitted.10(p275)

Sources for these facts and data include stipulations of fact, investigative and police reports, medical 

and service records, testimony heard during a courtmartial, and personal and professional knowledge.10

However, MRE 403 states that an expert’s reliable and 

relevant testimony 

may be excluded if its probative value is substantially 

outweighed by the danger of unfair prejudice, confusion of the issues, or misleading the members, or by 

considerations of undue delay, waste of time, or needless presentation of cumulative evidence.10(p255)

MRE 704 allows experts to testify on the ultimate 

issue, stating that the expert’s “opinion or inference 

otherwise admissible is not objectionable because it 

embraces an ultimate issue to be decided by the trier 

of fact.”10(p275) MRE 705 allows the expert to testify 

in terms of opinion or inference and give the expert’s 

reasons therefore without prior disclosure of the 

underlying facts or data, unless the military judge 

requires otherwise. The expert may in any event be 

required to disclose the underlying facts or data on 

cross-examination.10(p275)

The defense may request an expert consultant if a 

sanity board’s opinions are deemed favorable to the 

prosecution, if mitigating factors might affect sentencing, or in both cases.6

 The expert may be either civilian 

or military. In accordance with a seminal military case, 

United States v Toledo, the defense must specifically request appointment of a confidential expert consultant 

for the consultant to be protected by the attorney–client 

privilege. Such requests are often subject to intense 

scrutiny during pretrial motions.7

 If the appointment 

is not granted, the military forensic psychiatrist may 

still function as an expert within the limitations of 

rules of discovery. 

The defense may request a military forensic psychiatrist or psychologist to testify during the merits 

phase (or “guilt phase”) or after conviction during 

the sentencing phase. For example, the expert witness 

may be asked to provide expert testimony during 

the merits or sentencing phases about the impact of 

combat-related PTSD, “Gulf War syndrome,” or the 

“Vietnam syndrome” on the mental state or behavior 

of the accused.12 In addition, the expert witness may 

be specifically asked to provide testimony on mitigating factors during the sentencing phase. For example, 

issues addressed by military forensic psychiatrists 

include the cumulative effects of sleep deprivation 

(secondary to combat stress or combat-related PTSD) 

and operational tempo on judgment and decisionmaking capacity. 

Either defense or trial counsel may request expert 

consultation if a sanity board reaches a conclusion that 

is not favorable to its side. In addition, sanity boards 

have been successfully challenged on the basis of thoroughness, accuracy, and misapplication of the proper 

military standard for criminal responsibility. 

 The military forensic psychiatrist may also be asked 

to provide expert testimony for the prosecution during 

the merits phase on counterintuitive behaviors of an 

alleged victim, such as “rape trauma syndrome” or 

“battered spouse syndrome.”13 Because the accused 

may not be compelled to submit to any psychiatric 

evaluation beyond that of a sanity board, any testimony on aggravating factors at sentencing is often 

limited to a review of collateral documents and obser-
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vation of the accused during the court-martial, which 

requires the military forensic psychiatrist to testify to 

this limitation.

Case Study 43-1 (continued): The sanity board did 

an extensive evaluation, including reviewing interviews of 

numerous witnesses, and a week-long assessment of the 

accused, including psychological testing. Although they 

agreed that he had PTSD, they did not think it rendered 

him not criminally responsible. The damage from the head 

wound did interfere with some of his activities of daily living. 

However, he knew the functions of the judge and jury and the 

basic elements of the case. He was able to cooperate with the 

defense attorney and to behave in the courtroom. Therefore 

he was found both competent and criminally responsible. 

Perhaps because of his diagnoses of PTSD and organic brain 

syndrome, he received a sentence of only 10 years. 

Board certification in the subspecialty of forensic psychiatry now requires completion of an accredited 1-year 

fellowship program, and then a board examination in 

forensic psychiatry. Currently only one forensic psychiatry program exists in the DoD—the National Capital 

Consortium’s Military Forensic Psychiatry Fellowship 

Program (in existence since 1992), located in Washington, DC. Recently a forensic psychology program 

was started there as well. In addition to the training 

requirements specified by the Accreditation Council for 

Graduate Medical Education, fellows receive training 

to serve as consultants and expert witnesses in courtsmartial involving military-specific offenses. 

Malingering

Case Study 43-2: A soldier presented to the combat 

stress control unit in Balad, Iraq. He had been in an improvised explosive device attack the day before. Two of his 

buddies had been severely wounded. He had hit his head 

against the hatch in the explosion, but was otherwise unhurt. 

His chief complaint was, “I just want to go home.” He said he 

might shoot himself if he could not. The brief screen for traumatic brain injury and for PTSD was negative. He also said 

he could not stop shaking. The junior psychologist thought 

he might have a factitious disorder (tremor).

Malingering has always presented a challenge for 

forensic psychiatrists, especially in the armed forces, 

where it can be a specific criminal offense under the 

UCMJ. Healthcare professionals are reluctant to label 

patients as malingerers for many reasons, including 

the perception that it is tantamount to accusing the 

individual of fraud and deceit. Clinicians, accustomed 

to using their skills to diagnose and treat those who 

seek help for problems, often feel uncomfortable when 

confronted with patients who seek not therapeutic 

assistance to improve their well-being, but rather 

“official” corroboration of an attempted deception. 

However, reluctance to diagnose an obvious case of 

malingering or, even worse, treating patients as if 

they had the feigned illness (perhaps seen as the path 

of least resistance), may actually violate the maxim of 

“primum non nocere” (first do no harm). Insulating the 

patient from the consequences of malingering might 

be tempting, with the shortsighted view that either the 

benefits accrued by a successful deception or avoiding 

the penalties associated with fraud would be in the 

patient’s best interest. This action may promote a dysfunctional psychosocial developmental process and 

foster longer-term negative effects. Military healthcare 

practitioners must find ways to make their ethical 

and fiduciary responsibility to act in the patient’s best 

interest coincide with the needs of the system. Such 

dual responsibilities, of course, are not limited to the 

military; therapeutic practice often requires balancing 

the individual needs of the patient with broader social 

obligations.

Malingering has a longstanding history of recognition in the military, as highlighted by “avoidance of 

military duty” topping the list of external incentives in 

its description in the Diagnostic and Statistical Manual of 

Mental Disorders.

14 This text describes malingering as 

the intentional production of false or grossly exaggerated physical or psychological problems, motivated 

by external incentives such as avoiding military duty, 

avoiding work, obtaining financial compensation, 

evading criminal prosecution, or obtaining drugs.14

Malingering may be viewed as adaptive behavior 

under extreme circumstances, for example, when a 

prisoner of war feigns illness to escape maltreatment. 

This issue has predictably come to the forefront of 

clinical practice during wartime. Malingering might 

increase in the attempt to avoid combat duty by 

service members who otherwise lack the antisocial 

tendencies usually associated with this behavior. In 

this context, malingering can also be seen as a maladaptive response in an extremely stressful situation.15,16

However, because military service in the United 

States is now voluntary, recruits know they are going 

to a theater of operations. In the author’s experience, 

soldiers are more likely to deny symptoms than to 

exaggerate them, a phenomenon known as “negative 

malingering.” 

The treatment of the malingering patient in combat 

is complicated by dual agency and ethical considerations. Although the motivation may appear as no 
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more than a superficial attempt to return home, it is 

often predicated by a primal fear for personal safety. 

In either sense, individual malingering creates a concern for an “epidemic” of malingering within the unit. 

Furthermore, malingerers’ actions create a danger to 

the lives of their fellow soldiers, which creates a need 

for discipline and a duty to third parties when such 

deception has been detected. Military psychiatrists 

are challenged with balancing these considerations 

and the employment of limited therapeutic resources, 

including their own time and energies. Often the adage of “greatest good for the greatest number” dictates 

the type of treatment that can be offered in the combat 

zone, with substantial pressures to treat “bona fide” 

combat stress reactions, rather than “misconduct stress 

behavior.”

A “diagnosis” of malingering does not necessarily 

equate to the crime of malingering. Article 115 of the 

UCMJ describes the criminal offense of malingering 

as follows: 

Any person subject to this chapter who for the purpose 

of avoiding work, duty, or service (1) feigns illness, 

physical disablement, mental lapse or derangement; or 

(2) intentionally inflicts self-injury; shall be punished 

as a court may direct.10(p344)

Military law recognizes the two distinct forms of 

malingering—feigning illness and intentional selfinjury—with different punishments for each (greater 

for self-injury than for feigning illness). If the offense 

was committed in time of war or in a hostile-fire pay 

zone, the more serious offense of malingering to avoid 

combat duty brings even stronger penalties. Maximum 

prison sentences may range from 1 year for feigning 

illness in a noncombat situation to a maximum of 10 

years for intentional infliction of self-injury to avoid 

combat duty.

Again, although there is a perception that malingering is common, in today’s all-volunteer military malingering is probably much less common than believed. 

In actuality, it is the author’s belief that soldiers are 

far more likely to conceal psychiatric symptoms than 

to embellish. 

Case Study 43-2 (continued): The combat stress team 

treating soldiers in Balad was presented with a common 

dilemma. Should the team send him home, and therefore 

potentially have an epidemic of soldiers who had the same 

complaint of “I just want to go home”? The team members 

consulted with the division psychiatrist, who diagnosed a 

conversion disorder, rather than a factitious disorder. They 

elected to try the classic principles of combat psychiatry 

(eg, immediate treatment with the expectation of recovery 

and return to his unit). Unfortunately, the soldier did not 

respond and eventually had to be evacuated to Landstuhl. 

He was then evacuated to Water Reed Army Medical 

Center in Washington, DC, where he received numerous 

diagnoses. When he learned that he was going to be discharged from the Army, he ended his life by jumping off a 

bridge in Washington, DC. 

Psychological Autopsies

Before 2001, a report known as a “psychological 

autopsy” was required on every suicide in the US 

Army. After completion, it was submitted to the Army 

Surgeon General and the Walter Reed Army Institute 

of Research. These retrospective suicide investigations were designed to gather information from the 

soldier’s unit and family to provide lessons learned 

that might prevent future suicides. However, many 

of these postmortem investigations were performed 

by mental health officers who may not have had any 

specific training in this particular task. Investigators 

generated long narrative reports that seldom produced 

any feedback or change to the system. Furthermore, 

the report format made data extraction and analysis 

difficult. Another major issue of the psychological autopsies was who had access to their information. Before 

2001, psychological autopsies were accessible under 

the Freedom of Information Act, which resulted in violation of patient privacy. For example, a reporter from 

the Raleigh News and Observer published salacious and 

intimate details obtained from over 50 psychological 

autopsies from Fort Bragg, North Carolina.17

DoD changed the requirements for psychological 

autopsies first in a Health Affairs policy letter in 2001 

and later in a DoD directive in 2003.1,18 The policy requires a formal psychological autopsy only if the death 

were equivocal, that is, it was not known whether the 

death was a suicide, homicide, or accident. All suicides 

still must be evaluated. A DoD suicide event report 

is now generated for both attempted and completed 

suicides. If mental health personnel had been following 

the soldier, a quality assurance review—known as a 

root cause analysis—should be conducted. As part of 

the new requirement, practitioners must receive additional training in conducting psychological autopsies. 

The additional training should cover basics of crime 

scene investigation, physical autopsy procedures, 

toxicology, and understanding of suicidal behavior 

and determinants. Forensically trained psychiatrists 

have usually already received this training.19

Cases that require psychological autopsies tend to 

cluster in the following categories:

	 •	 an accidental or deliberate drug overdose;
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	 •	 an accidental or deliberate motor vehicle

accident;

	 •	 a gunshot wound, which may have been selfinflicted, accidental, or a homicide; or

	 •	 a hanging, which may have resulted accidentally from autoerotic asphyxia or intentionally 

from suicide. 

Case Study 43-3: A soldier in the Warrior Transition 

Unit was found deceased. In his room were found numerous pill bottles and an empty bottle of whisky, but no 

suicide note. The investigation found that he had recently 

gotten a divorce, but had seemed upbeat in the past several days. He had told his therapist that he was glad the 

divorce was finalized and was excited about the future. 

His command did not think it was a suicide. His family 

thought it might be a homicide, with his ex-wife giving him 

the pills for an overdose. The medical examiner agreed 

to a psychological autopsy. The results eventually supported an accidental overdose, although suicidal intent 

was suspected. 

BEHAVIORAL SCIENCE CONSULTATION TEAMS

Although psychologists have supported detention operations and interrogations for many years, 

the events of September 11, 2001 and the ongoing 

GWOT have required the unprecedented and sustained involvement of behavioral science consultants 

(BSCs) in support of both detention operations and 

intelligence interrogations/detainee debriefing operations. Prior to GWOT, support for these missions 

was provided by personnel organic to the intelligence 

and special operations communities. However, the 

expanded demand for BSCs to support these missions has required assignment of psychologists and 

forensic psychiatrists from other mission areas within 

the DoD. 

The Army is the executive agent for the administration of DoD detainee policy. The GWOT has resulted 

in the detention of large numbers of detainees by US 

forces. The intelligence interrogation and debriefing of 

detainees is a vital and effective part of the GWOT. It 

is designed to obtain accurate and timely intelligence 

in a manner consistent with applicable US and international laws, regulations, and DoD policy. Behavioral 

science personnel provide expertise and consultation 

to commanders to directly support the detention and 

interrogation/debriefing operations. 

BSCs are psychologists and forensic psychiatrists, 

not assigned to clinical practice functions, but to 

provide consultative services to support authorized 

law enforcement or intelligence activities, including 

detention and related intelligence, interrogation, 

and detainee debriefing operations. Because BSCs 

are not engaged exclusively in the provision of 

medical care, they may not qualify for special status 

accorded retained medical personnel or carry DoDissued identification cards identifying themselves 

as engaged in the provision of healthcare services. 

Analogous to behavioral science unit personnel of a 

law enforcement organization or forensic psychiatry 

or psychology personnel supporting the criminal 

justice, parole, or corrections systems, BSCs employ 

their professional training not in a provider-patient 

relationship but in relation to a person who is the 

subject of a lawful governmental inquiry, assessment, investigation, adjudication, or other proper 

action. 

BSCs function as special staff to the commander 

in charge of both detention and interrogation operations (ie, the Commander, Detainee Operations). BSCs 

should be aligned to report directly to this commander, 

not to one charged solely with command of the detention facility or Joint Interrogation Debriefing Center. 

This arrangement enhances the BSC’s ability to provide 

comprehensive consultation regarding all subjects 

within the BSC’s area of expertise on combined aspects 

of detention operations, intelligence interrogations, 

and detainee debriefings. Often behavioral science 

consultation to detention operations, intelligence 

interrogations, and detainee debriefings is conducted 

by individual BSCs working alone. 

“Behavioral drift”—the continual reestablishment 

of new, often unstated, and unofficial standards in an 

unintended direction—is commonly observed in detention and other settings in which individuals have 

relative control or power over others’ activities of 

daily living or their general functioning. It often occurs 

when established official standards of behavior are 

not enforced. Ambiguous guidance, poor supervision, 

and lack of training and oversight contribute to this 

change in observed standards. Certain psychological 

and social pressures can greatly increase the likelihood 

of behavioral drift. Drift is detrimental to the mission 

and may occur very quickly without careful oversight 

mechanisms and training 

The mission of a BSC is to provide psychological 

expertise and consultation to assist the command in 

conducting safe, legal, ethical, and effective detention 

facility operations, intelligence interrogations, and detainee debriefing operations. This mission is composed 

of two complementary objectives:

1. To provide psychological expertise in monitoring, consultation, and feedback regarding 
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the whole of the detention environment to 

assist the command in ensuring the humane 

treatment of detainees, prevention of abuse, 

and safety of US personnel. 

2. To provide psychological expertise to assess 

individual detainees and their environment 

and provide recommendations to improve 

the effectiveness of intelligence interrogations, detainee debriefings, and detention 

facility operations.

SUMMARY

The United States has historically been concerned 

about the successful adjustment of its military members returning from war. Although the greater population of war veterans will not be involved in criminal 

proceedings, a substantial minority will develop 

career-ending disabilities as a result of mental illness. 

In rare instances, these will be life-ending events. For 

a very small yet highly visible minority of returning 

veterans, questions about the cause, precipitants, 

and manner of death will necessitate psychological 

autopsies. This chapter highlighted recent updates 

in military forensic psychiatry and the mechanisms 

through which answers to questions of competency, 

criminal culpability, and motivation underpinning 

self-injurious behavior are determined within the 

US military. As the GWOT progresses, so, too, will 

the experience and study of combat-related mental 

health. Military judicial processes and the policies and 

procedures governing psychological autopsies must 

continue to evolve to meet increasing demands.

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