Serving Clients in Knox, Blount, Anderson, Loudon, Sevier & Roane Counties

What is an Independent Medical Evaluation (or Custody Evaluation?)

An independent medical (or mental health) evaluation is a report, prepared by a PhD Psychologist with special training in a field called “forensic psychology” that examines the relative psychological strengths and weaknesses of both parents, and compares it to the psychological needs and strengths of the parties’ child, to develop specific recommendations for co-parenting time. It also will likely identify any counseling needs for the family. A mental health evaluation is similar to a medical evaluation in a workers’ compensation case, except that it is common in child custody cases.

Independent medical evaluations are ordered pursuant to Tennessee Rule of Civil Procedure 35. To get one, a lawyer must show a court two things:

1. The mental health of one or both of the parents, and/or of the children, is an issue.

This is harder than it sounds. Your lawyer can’t get a custody evaluation simply by alleging your ex is crazy, no matter how much you believe this to be true. Instead, your lawyer will need to show an objective, relatively neutral basis for the claim that one of the parents has mental health issues. Your lawyer might need to show a history of documented mental health treatment, or perhaps produce testimony from people who have heard the parent recently threaten suicide, report having hallucinations, or produce some other concrete evidence of specific symptoms suggesting a diagnos-able mental health problem. Furthermore, that problem needs to have an identifiable impact on that parent’s ability to co-parent a child. Just because someone is bipolar, for example, doesn’t mean they can’t effectively parent – many sufferers of bipolar disorder effectively manage their illness with medication and treatment, and make great parents. Instead, your lawyer will need to show how that bipolar disorder limits their ability to parent safely and effectively.

2. Information related to the mental health of the parent is not available through any other means.

Most parents who suffer from a mental health disorder have obtained treatment at some point in their lives. However, records of mental health treatment, and in particular communications between the mental health service provider and the patient, are privileged. “Privileged” communication means that, absent any immediate threat of physical harm, no one other than the patient and her provider can know what was said in treatment.

That privilege can be waived by the patient, and if s/he does, then obtaining an independent custody evaluation is that much more difficult. You must show that there was something that the therapist did not consider – something that is incomplete and otherwise unobtainable in the therapist’s records.

This actually rarely comes up. Most patients are fiercely protective of their privacy in the therapeutic relationship. If the parent who has a mental health history refuses to disclose his/her records, then you likely have grounds to obtain an Independent Medical Evaluation.

Other things you should know if the subject of an Independent Medical Examination has come up in your case:

First, the law in this area is developing recently and rapidly, and different judges treat this matter differently. For instance, in some courts, even if both parents have no mental health symptoms, a court will order a mental health evaluation of the parents when a child is in treatment. It is extremely common for children of divorcing parents to be in therapy; thus, in these courts, it is relatively easy to obtain a mental health evaluation of either, or both parents.

Other courts point to how intrusive these evaluations often can be, and hold that only a parent who has a documented mental health history will be subject to an evaluation, even if the child is suffering due to his or her treatment by that parent.

Second, if both parents are accusing the other of having a mental health issue that interferes with their ability to parent (which happens all the time), then the court may well order a “custody evaluation.” A custody evaluation is simply an Independent Medical Evaluation that is performed on both parties, the children, and any other significant members of the household.

Third, the person who asks for the Independent Medical Evaluation gets to choose who performs it, and must pay for it. If a custody evaluation is performed instead, then the parents share the cost. These evaluations are expensive, running anywhere from $2,000-$12,000 for the first party, and more with each additional person who is evaluated, in the Knoxville market.

Fourth, you get what you pay for. Too often, in the name of saving expense, lawyers hire unqualified people who do a bad job, resulting in more of a mess being created than in psychological issues that affect parenting becoming identified and resolved. Mistakes made by evaluators often include:

  • Performing an evaluation when the evaluator has insufficient training or experience
  • Having a parent’s therapist perform an evaluation, instead of hiring a neutral
  • Offering opinions regarding the truth or falsity of an allegation, rather than simply offering an opinion regarding someone’s psychological health
  • Siding with one party or the other – often the party who paid.
  • Not sufficiently considering extrinsic evidence, like old medical records
  • Not performing the tests that are accepted within the profession accurately
  • Not providing the attorneys copies of the raw data used to construct the evaluation
  • Taking too long, so that the data relied upon is dated
  • Not getting all the data.
  • Relying on improper data

-“Cherry picking” the data to support an already-formed and often biased opinion, instead of allowing the evidence and test results to drive the conclusions.

Fifth, many courts make huge mistakes in dealing with psychological evaluations. Some courts mistakenly substitute the judgment of the evaluator for their own judgment. Your attorney should never allow this to happen. Evaluators should only evaluate the psychological profiles of the parents and children in a case. They should never give an opinion on any other of the fifteen statutory factors that a court is required to consider. (Katie, can you insert a link to our statutory factor blog there?) Second, some courts refuse to consider the opinions of evaluators at all. This is also poor practice, because the mental health of a parent is specifically listed as one of the considerations a court must assess in making a custody determination, and due to the patient-therapist privilege, an evaluation may be the only way for the court to complete that assessment.

Sixth, as of the day this blog was written, in the Knoxville area, there are almost no qualified psychologists performing quality Independent Medical Evaluations. Your attorney needs to know who the few that do good work are, and needs to ask them pointed questions along the way to make sure the evaluator does his or her job.

If mental health is an issue in your divorce or custody case, you must hire an attorney who is experienced in working with psychologists and forensic psychological evaluators. If your attorney does not understand how these reports are supposed to be prepared, s/he won’t understand how to defend a good one or attack a bad one. Your attorney needs to know enough about psychological evaluations to be able to assess the quality of the report, and review the raw data to determine whether there are any obvious mistakes, to review the testing process to determine whether there are any obvious procedural flaws, and to ask the right questions to connect the dots between the data and the procedure and the results of the evaluation. Your lawyer needs to have sufficient respect from psychologists to be able to ask pointed questions and get straight answers. S/he needs to know who the good evaluators are, and who to avoid, given the specific issues in your case. And s/he needs to be able to present the evaluator’s report and testimony effectively to the court.

At Held Law Firm, attorney Margaret Held typically reviews and prepares cases that involve custody and psychological evaluations, due to her experience and the specific, specialized knowledge and experience such preparation takes. Margaret Held has examined the work product of every qualified (and a few unqualified) custody and mental health evaluators in Knox and the surrounding counties. She has reviewed and analyzed numerous mental health evaluations and the raw data supporting those evaluations in the context of her child custody work, and knows what to look for, what to attack, who to hire, and who to avoid. She has assisted numerous evaluators in the preparation of their testimony, and cross-examined many more. If one of the parents in your custody case has a mental health issue, Held Law Firm may be the best firm for your family.