Past Issues

The Needs for Developing Forensic Child and Adolescent Psychiatry in Taiwan

Yen-Nan Chiu

Pioneered by professor H Rin and SN Lin,
forensic psychiatric assessment for adolescents in
Taiwan started in 1950s. [1] Among the fi rst fi fty
offenders who received forensic psychiatric assessment,
there were fi ve cases less than twenty
years old; and four of them were mentally retarded.
[2] They also had conducted a survey on juvenile
offenders and delinquents from 1976 to 1978.
One hundred fi fty-three cases were referred from
Taipei Juvenile Court and Taipei Juvenile Institute.
Among them, there were 142 boys and 11 girls of
8 to 19 years old, while only 32 were under thirteen.
Among the diagnoses coded after assessment,
mental retardation still was the most (48%),
conduct disorder being the second (21%) frequently
diegnosed, while psychotic disorders were
presented only as a minority group (6%). [3]
Before early 1990s, the forensic assessment
for children and adolescents was implemented
mainly for those who were suspected or taken as
offenders in Taiwan. Such a need has never declined,
probably goes higher in the changing society
of Taiwan. However, after the amendment of
Child Welfare Act in 1992 and the merging with
Youth Welfare Act in 2003, child protection has
been increasingly enforced. The annual rate of
substantiated cases of child abuse has increased in
Taiwan since 1993. [4] More legal actions have to
be taken for those abused youth (or suspected
ones) for child protection. As the needs for testifying
the cases by the youth themselves have been
acknowledged more and more gradually. The
child cases requesting for forensic psychiatric
evaluation on child abuse and custodianship have
been increasing in the past one decade in Taiwan.
In the beginning, some experts believed that
children less than seven were not suitable for psychiatric
assessment because they were not competent
under The Civil Code of the Republic of
China in 1990s. But following the infl uence from
the development of child psychology and forensic
child and adolescent psychiatry in developed
countries, [5,6] and the establishment of special
program for abused children in child psychiatric
services in Taiwan, [7,8] the judicial system gradually
accepted the role of forensic psychiatric assessment
for children under seven years of age to
assist the processing of the judicial procedures;
not only for the children’s mental status, but also
for the competence and/or reliability of their testimonies,
assignment of custodianship and access,
and the needs for psychological interventions,
From 2001 to October 2008, there were 30
cases received forensic assessment by the child
and adolescent psychiatric team (CAFPT) of
Department of Psychiatry of National Taiwan
University Hospital. Among them, 26 cases were
related to child sexual abuse (CSA), i.e. 22 suspected victims and 4 suspected perpetrators. About
half of the suspected victims were under seven
years old. The testimonies of the suspected CSA
victims were taken as highly reliable in about twothirds
of the cases after comprehensive assessment
by the CAFPT. However, the reliability was much
lower among those alleged cases under seven
years old. Posttraumatic stress disorder and attention
defi cit / hyperactivity disorder were highly
presented among these 30 cases. The standard
procedure for assessing CSA cases were established
by taking references from which in the U.
S.A.[10,11] For CSA victim cases, the CAFPT
often spent a lot of working hours in reviewing the
tape/video records and fi les, doing the transcripts,
interviewing different parties, and writing the reports.[
12] The time needed to complete a case was
often much more than that of the adult cases.
Therefore, the fee for the child and adolescent forensic
assessment is relatively low in Taiwan. The
author also have found that there is a great need
for improvement in the investigating system for
CSA cases among social services, police and judicial
system, just as which among psychiatric and
psychological professionals. The collaborative
works among the above systems could not be emphasized
much more.
After the reform of The Code of Criminal
Procedure of the Republic of China, cross examination
system at court has been implemented in
Taiwan since September 1 2003. The Taiwanese
Society of Child and Adolescent Psychiatry
(TSCAP) held workshops on child forensic psychiatry
in 2004, and set up a working group for the
improvement of the assessment for the handicapped
and on forensic area in 2007. The experiences
in cross examination as the expert witness
and the forensic psychiatric assessor were shared
in Psychiatry Newsletter of the Taiwanese society
of Psychiatry.[13] However, the amount of qualifi
ed professionals working in forensic child psychiatry
are still limited in Taiwan. Probably, it is
related to the complexity of the problem, the training,
time-consuming laborious work, low payment,
and the different role from being a therapist,
There is much progress of child psychiatry in
Taiwan after Soong’s advocation. [14] The TSCAP
was established in 1998. The certifi cation and
training system for the subspecialty of child and
adolescent psychiatry in Taiwan was started in
2002. By now, 143 members of TSCAP have got
the certifi cate of the subspecialty. At the fi rst
glance, current amount of professionals in lower
case letter this subspecialty have already met as
proposed by Soong in 1993. But it appears being
far from the needs of the youth in Taiwan nowadays
[15], because that many of these sub-specialists
serve the youth only on part time basis and
that the standard proposed for the manpower of
this subspecialty in Taiwan was one-forth of which
of the developed countries at that time. The author
estimates that these sub-specialists only provide
one-tenth of the psychiatric needs of the youth in
Taiwan currently.
The needs for forensic child and adolescent
psychiatry was not specifi cally mentioned in
Soong’s article.[14] The author would like to take
this opportunity to advocate that the subspecialty
of forensic child and adolescent psychiatry need
to be established in Taiwan. The authorities in
public sectors need to put more budgets on training
professionals in this fi eld and more effort to
improve the system of investigating victimized
minority youth. Such investments are timely needed.
They will not only bring a better tomorrow for
the youth and their families involved and reduce
the impact of false allegations, but also help the
establishment of the justice of our society, which
in turn will save much more consumptions from prolonged legal process and reduce the burden of
related professionals. The author sincerely expect
the guidance and support from senior professional
colleagues in our society and allied fi elds for the
above advocates, and also, more promising junior
colleagues to devote themselves to this fi eld in the
near future.
Key Word
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