Consulting to Government Agencies—

Psychologists and psychiatrists in the United States are frequently called upon to provide consultation to federal agencies. Such consultation may involve providing expert advice relevant to criminal investigations, acts of terrorism, espionage, threat assessment, embezzlement, and disability fraud, and other cases involving the vital interests of an individual and/or the US.

When performing these types of consultations, practitioners are advised to remain acutely aware that in providing this professional service, their role will differ significantly from the traditional clinical role in a number of ways. First, the individual about whom the expert may be asked to provide advice is not the client; the client is the United States government—as represented by the federal organization requesting expert advice and consultation. The expert is being retained to assist or enhance the ability of the federal agency to do its legitimate job and in many cases preserve national safety and security.¹

Second, the majority of such consultations require the expert to provide expert advice and analysis without directly examining the individual(s) in question. The specific purpose of such indirect assessments will vary in direct relationship to the challenges faced by the government agency. For example, law enforcement and counter-terrorism personnel may seek advice about a person's potential for violence. Alternatively, they may ask for guidance in how best to gain information during an undercover interview with someone who is committing espionage or treason against the US.

Although the term might be new to some, an indirect assessment is not a new phenomenon. To the contrary, whether they realize it or not, many clinicians perform such assessments routinely in their clinical work. For example, when a psychiatrist or psychologist receives a phone call from a patient's family member about problematic behaviors on the part of the patient, the psychiatrist must often make a clinical assessment without having the opportunity to directly evaluate the patient. Whether there is a decision to alter the medication, to bring the patient to the hospital, or to do nothing at all, the psychiatrist has made an indirect assessment.

Indirect assessments are also common in the practice of forensic psychiatry and psychology. Forensic experts aid prosecutors and defense attorneys in interpreting medical records so that these professionals might better understand and make use of the documented behaviors of an individual for legal purposes. Forensic psychiatrists may also be asked to perform ‘psychological autopsies' or ‘retrospective psychological assessments' when retained in a case involving the contestation of a deceased individual's will or manner of death. These psychological autopsies are typically done by reviewing medical records and by interviewing people who knew the deceased at the time of the preparation of the will.

Thus, when consulting the federal government about matters involving national security and safety, the expert is primarily [but not exclusively] engaged in a routine and valid form of professional work in a novel context or setting.

As noted above, the reason a psychiatrist or psychologist is asked to consult to a federal agency is because there is a belief on the part of the agency personnel that the expert's experience will enhance the ability of the requesting federal agency to do its job.

In so doing, the work product will likely enhance the agency's ability to uphold the law and public safety in the traditional ‘balancing test' between the individual and society. At its core, this situation [of being on the side of the State] is no different from clinical situations that require a psychiatrist to involuntary commit a potentially homicidal person. Nor is it different from the situation wherein a prison psychologist or psychiatrist must inform the warden if an inmate is engaged in illegal activity while in prison. In certain situations, the rights of an individual to liberty or to doctor-patient confidentiality do not outweigh the need to protect the safety and welfare of the community.

The goal of the consultation is to give a useful description of the psychological makeup of an individual (or several individuals) who are of interest to the agency. Many decision makers feel that a better understanding about the type of person or persons with whom they may be dealing is extremely helpful in optimizing their ability to do their job. Thus, the challenge for the expert is to provide an indirect assessment, or a psychological profile, that is valid and of practical use to the client.

In order to provide some useful insight into the behavior, motivation, and personality of a person he or she has never met, the expert must make use of information provided by the client. The techniques used when performing indirect assessments have been adapted from clinical, forensic, organizational, and personnel psychology and include the use of instruments that may or may not be familiar to psychologists and psychiatrists (e.g., behavioral inventories that have been specifically designed and tailored to capture observable behavior in different operational settings.) For example, the Surveillance Behavioral Checklist is a comprehensive checklist of behaviors that are observable in a variety of settings. The inventory covers a wide array of possible behaviors ranging from the way a person drives a vehicle to the individual's sleep-wake cycles. Data for indirect assessments come from surveillance videos, wiretaps, reviews of electronic communications, or trash pulls, also known as “dumpster diving.”²

At times, experts may be given access to information located in a person's medical and mental health records in order to assist them in understanding the person's behavior, motivation, and mental status. However, in the majority of indirect assessments, medical/psychiatric records do not exist. This is largely due to the fact that the majority of people who are of concern to law enforcement and national security issues are not psychiatric patients. Even when such information is available, it is far less helpful than one might initially believe. This should not be surprising given the purpose and focus of most mental health records. Indeed, taken together, the findings from much research on zero acquaintance assessments of personality and behavior provide compelling evidence that compared to other sources of data, mental health information is of limited value. Put bluntly, if someone is suffering from major psychological distress (such as depression or psychosis), other sources of data will give evidence of this to a well-trained consultant.

The expert should partner with a multidisciplinary team made up of intelligence analysts, forensic scientists, lawyers, computer experts, and other technical experts whose members are versed in the various contexts in which sources of information are collected or derived. There are several reasons this recommendation. First, scientific research on the ability of individual experts to predict the occurrence of events (e.g., human behaviors, illness, or natural disasters) under conditions of uncertainty demonstrates that decisions based on multiple inputs from unrelated disciplines provides a more accurate prediction of outcome.³ Second, a partnership with a team of other professionals will give the expert greater insight into the nature and limitations of different sources of data that will be used in constructing a psychological profile. Third, a more comprehensive understanding of the context(s) in which specific behavioral data occurred will lead to more accurate formulations of the psychological profile created by the expert.

There are a number of ethical challenges that will confront psychologists and psychiatrists who conduct consultations to government organizations. We suggest that individuals who perform indirect assessments keep the following ethical issues in mind:

1. The expert should adhere to sound professional judgment and not be unduly influenced by the organization or the emotionality of its leadership. In situations that are urgent, time sensitive, and in some cases dangerous and life threatening, the decision maker interacting with the psychological consultant can be under pressure from his or her senior leadership. His or her urgency can range from a political agenda, perceived liabilities, and naiveté, to being being uninformed of ground level operations. The expert must guard against over-identifying with the operational agenda, monitoring his or her own counter-transference per se when leadership wants his or her help and expects him or her to do magic.

The consulting psychiatrist or psychologist must not assume responsibilities or functions of the roles of others. The expert's purpose is to provide an operationally relevant assessment to the strategic decision maker; the expert is never the decision maker. For example, if asked to provide consultation to professions responsible for an interrogation, the expert should limit his or her analysis to a psychological profile. Although the professionals who conduct the interrogation may believe that a subject is guilty and want to obtain a confession from the subject, the expert does not, but is, instead, agnostic on the issue of guilt and on the need for a confession. In such circumstances, the expert's responsibility is to objectively assess whether or not factors known to promote or elicit false confessions are present, and if present, help interrogators to avoid exerting undue influence or coercion on the subject. The expert's advice is limited to what mental health experts know about human behavior under conditions of high stress and the factors that may lead to erroneous or false information. The expert is never a policeman or an interrogator.

2. The expert who performs indirect assessments should know his or her limits of expertise. We suggest that a sound understanding of the research on indirect assessments is critical. Psychiatrists wishing to engage in this type of work should seek out training and mentorship in order to develop the skills necessary to provide a valid opinion. In court, an expert witness is expected to provide an opinion that is “within a reasonable degree of medical certainty.” Given that recipients of our consultations may use them to take specific actions—actions directly related to the health and welfare of one or many individuals—we suggest that this standard is most appropriate when providing expert consultation to government agencies.

3. The expert must recognize who the client is (e.g., law enforcement organization, intelligence agency, etc.). The subject of the assessment may not be aware of the assessment process, and in most cases he or she is not aware that he or she is under investigation. There is no doctor-patient relationship and there is no informed consent. To the reader who may find this idea uncomfortable, we point out that this situation is very similar to the ones wherein mental health professionals participate in hostage negotiations. It would be inappropriate and dangerous for a mental health expert to divulge operations-related information (such as the presence and location of police snipers or the timing of rescue team's activities) so that the hostage had informed consent.

The expert providing indirect assessments is often not permitted to fully “inform” individuals that they are being evaluated or of the legal jeopardy in which they may be. For example, a person working in a nuclear facility may be suspected of espionage and under investigation. Such an individual may be asked to meet with a psychiatrist or psychologist for a psychological assessment that is part of the security clearance process. The expert conducting the direct assessment of the individual would not know the interviewee was under investigation. However, the expert performing the indirect assessment for the investigating agency would be aware of the investigation. But he or she would not be able to divulge this information to either the individual or the examiner.⁴

The ethical issue in such situations is related to the act of balancing risk of harm to the individual (if he or she does not realize the situation he or she is in) and the risk to the welfare or safety of others in society (if the person being evaluated should become aware that he or she is being assessed and, as a result, thwart the enforcement of law). Professionals who are uncomfortable with this dilemma should remember this historical fact: People have been killed because of information provided by American citizens committing espionage. Seen in this light, we believe that the act of choosing to not inform an espionage suspect is as valid as the choice to not inform the hostage taker that the sniper has the chance for a clean shot. In both situations, the expert is reducing the potential for loss of life. While the sense of immediacy is somewhat less in investigations of medical fraud or of embezzlement, the ethical issue is the same: By not disclosing full information to the suspect, the chances of improving the safety and welfare of others are improved. People who get away with medical fraud diminish the availability of services to those who truly need them. The cost to society is significant.

In both the American Psychological Association and the American Psychiatric Association, there is a consensus that we as professionals must always strive to “do no harm.” There are times that we may do harm by refusing to take action.^5,6 In our discipline, we have expertise and skills that can reduce risk harm and potentially prevent the loss of innocent lives. As in the arena of hostage negotiations, psychiatrists and psychologists have made and continue to make significant contributions to matters of national safety and security. We can assist other professionals in their efforts to reduce harm and save lives.

Over the past 60 years, a large number of psychiatrists and psychologists have consulted with government agencies. These professionals have enjoyed the satisfaction of providing a meaningful contribution to our nation's security. Efforts to prohibit these professionals from engaging in their work are more likely to alienate them from existing professional organizations rather than influence them to seek new professional roles. Because of the confidential nature of the work, individuals who engage in the work will cease to inform others of their legitimate activities. As a consequence, an ethical dialogue with the greater professional community will be lost and such government consultants [or employees] will become increasingly insular in their practice.

Membership in professional organizations provides a professional identity and a measure of accountability that keeps psychologists and psychiatrists from over-identifying with their operational leaders and motivates them to continually examine their professional behavior. With the myriad of government agencies recognizing the value of psychiatric and psychological consultation, now is the time to engage such consultants in the difficult process of establishing ethical guidance for this emerging area of practice. Disengagement deprives these professionals of an avenue of external feedback and places them at greater risk for unethical behavior.