Professor Keith Rix
- Qualified in medicine in 1975
-
“A most experienced and distinguished psychiatrist, well known to this court”
(Henriques J in R v Colin Howard Parker [2005] EWCA Crim 1916) -
“An acknowledged expert in his field”
(Burnett LCJ in (United States of America v Assange [2021] EWHC 3313 (Admin))
Career
As a teenager, Keith’s ambition was to become a forensic pathologist but as a result of school and vacation work at East London’s Bow Methodist Mission, the influence of its minister, the Revd. James Martin, MBE, and living and working with mentally disordered and substance using offenders in the Mission’s hostels, it was inevitable that his career would be in forensic psychiatry. One of his first publications, while still a medical student, was a study of men and women charged with drunkenness offences appearing before the Aberdeen Burgh Police Court.
At medical school he completed an intercalated Bachelor of Medical Biology in neurophysiology, studying the effects of alcohol on neural transmission, and spent a summer continuing this research as the First Visiting Research Scientist at the New York State Research Institute on Alcoholism and the Department of Pharmacology, State University of New York at Buffalo. This led to Keith becoming a Chartered Biologist and Member of the Royal Society of Biology. He founded, and was first secretary and then chairman of, the Aberdeen Council on Alcoholism and helped establish what became the Scottish Council on Alcohol.
He qualified in medicine at Aberdeen University in 1975 and then began his psychiatric training in Edinburgh where he achieved Membership of the Royal College of Psychiatrists and obtained his Master of Philosophy in psychiatry. He completed his psychiatric training in Manchester where his doctoral research was supervised by Professor Sir David Goldberg.
Between 1983 and 2000, Keith held consultant appointments in Leeds, including as a visiting consultant psychiatrist at HMP Leeds, which post he did not relinquish until 2014. He founded the Leeds Magistrates’ Court Mental Health Liaison and Diversion Scheme and established the city’s forensic psychiatry service. With Dr Clare Chambers he was funded by the Mental Health Foundation to evaluate the liaison and diversion scheme. In a detailed account of the project in Care or Custody? Mentally Disordered Offenders in the Criminal Justice System by Judith M. Laing (Oxford University Press, 1999) the author commented: “Much of this has been due to the efforts of committed individuals, such as Dr. Keith Rix and his colleagues, who have clearly demonstrated the benefits which can be gained”.
Between 2000 and 2005 he undertook locum appointments in a range of psychiatric specialties and increasingly applied his wide experience of psychiatry as an expert witness in criminal, personal injury, family, Chancery and professional regulatory cases – and also at an agricultural land tribunal.
Between 2006 and 2014 he was a psychiatric intensive care unit consultant in the independent sector but at a hospital that was entirely contracted to take NHS (‘overspill’) patients so he often found himself providing continuity of care to patients who had been under his care many years previously in the NHS. At the same time, he was a member and then chair of the Fitness to Practise Panel of the General Medical Council and subsequently the Medical Practitioners Tribunal. As a result, he made the subject of his research, for the De Monfort University Master of Laws in Medical Law and Ethics, the fitness to practise procedures of the GMC.
Anticipating semi-retirement, in 2014 Keith became an Honorary Consultant Forensic Psychiatrist in the Norfolk and Suffolk NHS Mental Health Trust and in 2024, as a result of ill-health, he gave up clinical and expert witness practice. However, he continues in academic work, publishing editing, writing and increasingly in training with 2DRJ.
At present he is working on the creation of a microsite of resources for all healthcare expert witnesses which is being housed by the Royal College of Psychiatrists in its website’s MAEP pages. This is linked to his monthly newsletter Expert Healthcare Witness Matters (https://www.rcpsych.ac.uk/improving-care/ccqi/multi-source-feedback/maep/maep-newsletter-resources). He is also working on a training programme for expert psychiatric witnesses with 2DRJ and, for Cambridge University Press, with Dr Michael Powers KC, a series of expert healthcare evidence textbooks modelled on his own Expert Psychiatric Evidence.
Since 2001 he has been involved in the planning of the Grange Annual Conference for psychiatrists who provide expert evidence to courts and tribunals. Over the years there have been presentations by lawyers, including two Irish Supreme Court judges, four United Kingdom Supreme Court Judges, circuit and High Court judges, solicitors, barristers and coroners. The Conference pioneered medicolegal case-based discussions, which are now more generally established in medicolegal peer groups. Next year’s 25th anniversary conference will be a milestone.
Academic Appointments
- Research Fellow, Department of Physiology, University of Aberdeen, 1975 - 1976
- Lecturer in Psychiatry, University of Manchester, 1979 – 1983
- Visiting Lecturer, Alcohol Studies Centre, University of Paisley, 1979 - 2002
- Senior Lecturer in Psychiatry, University of Leeds, 1983 – 1990
- Senior Clinical Lecturer in Psychiatry, University of Leeds, 1990 - 2000
- Part-time Lecturer, Department of Law, De Montfort University, 2010 – 2014
- Visiting Professor of Medical Jurisprudence, University of Chester, 2014 - present
- Honorary Associate Professor, Norwich Medical School, University of East Anglia, 2024 - present
Expert Witness Practice
Beginning with a family case in 1983, Keith spent over forty years combining clinical practice with expert witness practice. He has prepared expert reports for the Department of Health, the General Medical Council, the General Dental Council, what were the Legal Departments of the Yorkshire Regional Health Authority and the North Western Regional Health Authority, the NHS Litigation Authority, all three medical defence organisations, mental health review tribunals, solicitors in various cases where medicolegal issues arise, courts martial and The Prisoner Ombudsman for Northern Ireland. He prepared reports for Crown Prosecution Service branches from Exeter to Carlisle and also for the General Casework Division of the CPS which deals with sensitive and potentially high profile ‘public interest’ cases.
He reported pro bono in Caribbean death penalty cases and on the same basis examined and reported on Mariette Bosch, the first white woman to be sentenced to death and executed in post-colonial Botswana. His other notable cases have included the force feeding of the so-called ‘Moors murderer’ Ian Brady (R v Collins and Ashworth Hospital Authority, ex parte Brady [2000] Lloyd’s Rep Med 355), Harold Shipman, Ian Huntley and Julian Assange (United States of America v Assange [2021] EWHC 3313 (Admin), albeit that in this case the Court of Appeal ruled his evidence inadmissible.
Keith is the lead author of the Royal College of Psychiatrists report CR193 on Responsibilities of psychiatrists providing expert evidence to courts and tribunals and he has developed a system for case-based discussion (CBD) of expert reports and ‘Multisource Assessment for Expert Practice’ (MAEP) (https://www.rcpsych.ac.uk/improving-care/ccqi/multi-source-feedback/maep) which is an online feedback system for experts. Both the CBD peer review process and MAEP can be used by any expert witness and MAEP is identified by the GMC as a resource for medical experts in its guidance Providing witness statements or expert evidence as part of legal proceedings.
Law Reform
Keith was a supporter of the Criminal Procedure (Insanity and Unfitness to Plead) Bill which was passed in 1991. The briefing on this Private Member’s Bill by the Law Society’s Mental Health Sub-Committee included a case history which he supplied of someone detained in hospital ‘unfit to plead’ for 14 years after allegedly stealing a bottle of milk from a doorstep.
His observations on the Law Commission’s Consultation Paper ‘Intoxication and Criminal Liability’ are acknowledged in the Commission’s report ‘Legislating the Criminal Code: Intoxication and Criminal Liability’. He has since contributed to Law Commission consultations including ‘Partial Defences to Murder’ (2004), ‘Expert Evidence in Criminal Proceedings in England and Wales’ (2011), ‘Unfitness to Plead’ (2013) and ‘Criminal Liability: Insanity and Automatism’ (2013).
With Sir Paul Beresford MP he was involved in a move to amend the Mental Health Act 1983 s 136. Sir Paul referred to Keith’s research and one of his coronial cases in two debates on this issue in the House of Commons in September 2016 and July 2017.
In 2024, as a result of his submission to the Criminal Procedure Rule Committee, the Lady Chief Justice amended Criminal Practice Direction Chapter 7.3.2 and 7.3.5 concerning the ‘Pre-hearing discussion of expert evidence’ to remove inconsistency between the Rules and the Practice Direction and to describe in more detail the required content of the ‘Experts’ statement’.
Forensic Medicine
As Mental Health and Intellectual Disability Lead of the Faculty of Forensic and Legal Medicine of the Royal College of Physicians, he has been involved in the training of forensic physicians and custody nurses. He organised the Faculty’s study days on mental health. He is co-author of the Faculty’s guidelines ‘Acute behavioural disturbance: guidelines on management in police custody’. He is author of its ‘Code of Practice on Expert Evidence’, he has updated its guidance ‘Forensic clinicians (physicians, nurses and paramedics) as witnesses in criminal proceedings’ and he has written for the FFLM ‘Expert Evidence: Frequently asked questions’ which has been published in the Journal of Legal and Forensic Medicine.
Honours
In February 2015 Keith was elected an Honorary Fellow of the Faculty of Forensic and Legal Medicine of the Royal College of Physicians being ‘a person of eminence who has rendered exceptional services to the science and practice of forensic and legal medicine’. In 2024, with a similar citation, he was presented with Honorary Fellowship of the Expert Witness Institute by its President, Lord Hodge, Vice President of the Supreme Court.
Publications
Keith is the author or editor of a number of books and of more than a hundred papers and book chapters.
The books are
- Alcohol and Alcoholism. Annual Research Review (Churchill Livingstone, 1977)
- with his wife, Elizabeth, Alcohol Problems – A Guide for Nurses and other Health Professionals (John Wright and Sons, 1983),
- as editor, A Handbook for Trainee Psychiatrists (Baillière Tindall, 1987),
- Expert Psychiatric Evidence (RCPsych Publications, 2011) which was highly commended in the BMA Medical Book Awards 2012, and,
- edited with Laurence Mynors-Wallis and Ciarán Craven SC, Rix’s Expert Psychiatric Evidence, 2nd ed (Cambridge University Press, 2021).
- The third edition, being edited with Professor Rajan Nathan and Dr Samrat Sengupta of 2DRJ, is in preparation.
- About to go to press is Expert Musculoskeletal and Orthopaedic Evidence which he is editing with Dr Anthony Howard, an Academic Clinical Lecturer in Trauma & Orthopaedic Surgery and Barrister-at-Law in the Chambers of Mr Charles Kennedy KC, 9 St John Street, Manchester.
His book chapters concern: alcohol problems and the fishing industry in North East Scotland; fitness to be interviewed by the police; parasuicide; personality disorder: reform of the wrongfulness limb of the M’Naghten Rules; mental capacity; treatment without consent; automatism; adjustment disorders; neuropsychiatry and the law; fitness to plead and stand trial; expert reports for coronial proceedings; and the duties of the expert witness and the medical expert reporting process (in M. Powers and A. Barton (eds) Clinical Negligence (6th edn), Bloomsbury).
His published papers concern: sexual jealousy in alcoholics; arsonists; psychiatric morbidity in prisoners; depersonalisation and intent; blood or needle phobia as a defence under the Road Traffic Act; myxoedematous madness and grievous bodily harm; privilege and the prison inmate medical record; provocation and the ‘battered woman syndrome’; long-term psychiatric morbidity in the aftermath of police CS spray exposure; decision-making in minimally-aware patients; psychiatric aspects of fraud offending; health professionals and capital punishment; informed consent in English and Scottish law; malingering mental disorders; compensating secondary victims for psychiatric injury; sexual rights; mental disorder and intellectual disability, miscarriages of justice and expert psychiatric evidence; and bias in expert witness practice.
In his spare time ….
Keith is also using his semi-retirement to write a biography for the Wisbech Society of the enigmatic and eccentric Wilfred Lewis Hanchant, a pink-bearded, bohemian night-clubber, friend of D.H. Lawrence, E.M. Forster, Aleister Crowley, Dylan Thomas and Ronald Searle, who became the curator of the Wisbech and Fenland Museum.
