The request for mental health professional certificate has been growing each year, including the fit-to-work or Fitness-For Duty (FFD) evaluation. This trend has also been seen in both Soerojo Hospital, as a referral centre in Central Java province, and Cipto Mangunkusumo Hospital, as a national referral centre. This study aimed to systematically review the evidence of standardised FFD evaluation, particularly to provide an objective forensic psychiatry report and minimise the risk of legal disputes.

A qualitative systematic review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology. The clinical question was formulated based on Patient, Intervention, Comparator, Outcome (PICO) model, with (P): mental health problem or mental health disorder or psychiatric problem or psychiatric disorder or work disability, (I): fit-to-work examination or fit-to-work evaluation or fit-to-work assessment or fitness-for-duty examination or fitness for-duty evaluation or fitness-for-duty assessment, (C): Comparative intervention: -, (O): psychiatric report or forensic psychiatry report. The Pubmed, Scopus, ProQuest, PsycInfo, and Cochrane databases were searched. The eligible studies were then critically appraised using the Authority, Accuracy, Coverage, Coverage, Objectivity, Date, Significance (AACODS) checklist for grey literature. The findings were synthesised and presented as FFD examination procedure and the subsequent opinion formulation.

Five US-based studies met the eligibility criteria, potentially limiting their applicability outside US contexts. The FFD evaluation procedure includes formulating aims and questions of the evaluation, ensuring complete supporting data and collateral information, and conducting standard psychiatric examination, including other investigations if necessary. The opinion formulation process includes analysing the association between mental disorder and work disability, formulating alternative explanations of disability, and providing recommendations.

Understanding the FFD evaluation procedure and opinion formulation processes is essential to enable objective and logical reporting, thus preventing unnecessary legal dispute.

Ni Kadek Duti Ardi Suarjani Putri Lestari is a forensic psychiatrist based in Magelang, Indonesia. She completed her specialist training in psychiatry at Diponegoro University in 2015 and her subspecialty training in forensic psychiatry at University of Indonesia in 2022. She currently serves as the Chief of the Medical Committee at Soerojo Hospital and, since 2023, has also been the Chief of the Collaboration Committee of the Forensic Psychiatry Section of the Indonesian Psychiatrist Association.