state can also be raised by the crown or by the court itself, rather than solely by the defence counsel, differentiating it from many other legal defences. treatment/assessment conflict in ontario, a court-ordered inpatient forensic assessment for criminal responsibility typically involves both treatment and assessment being performed with the accused in the custody of a single multidisciplinary team over a 30- or 60-day period. concerns have been expressed that an accused may feel compelled on ethical, medical, or legal grounds to divulge information, medical, or otherwise, to assessors in an attempt to allow for and ensure safe and appropriate treatment during that period of custody. some internet references address treatment/assessment conflict as it relates to various justice systems, particularly civil litigation in other jurisdictions. the american academy of psychiatry and the law states in its ethics guidelines, "when a treatment relationship exists, such as in correctional settings, the usual physician-patient duties apply", which may be seen as contradiction. south africa in south africa, patients are referred for observation for a period of 30 days by the courts if questions exist as to cst and mso. serious crimes require a panel, which may include two or more psychiatrists. should the courts find the defendant not criminally responsible, the defendant may become a state patient and be admitted in a forensic psychiatric hospital. they are referred to receive treatment for an indefinite period, but most were back in the community after three years. training standards some practitioners of forensic psychiatry have taken extra training in that specific area. in the united states, one-year fellowships are offered in this field to psychiatrists who have completed their general psychiatry training. such psychiatrists may then be eligible to sit for a board certification examination in forensic psychiatry. in britain, one is required to complete a three-year subspeciality training in forensic psychiatry, after completing one's general psychiatry training, before receiving a certificate of completion of training as a forensic psychiatrist. in some countries, general psychiatrists can practice forensic psychiatry, as well. however, other countries, such as japan, require a specific certification from the government to do this type of work.