What is forensic psychiatry?
Forensic psychiatry is the assessment and management of people with actual or suspected mental disorder who pose a risk to others, and often to themselves. Many patients receive treatment in secure mental health units of low, medium or high security. Others are treated as out-patients in the community and others in settings such as prisons, probation and other hostels and rehabilitation units. Forensic psychiatry is a fascinating area, involving work at the interface of medicine and the criminal justice system. Patients often present with a complex mixture of mental illness, personality style, social context, criminal justice involvement, physical healthcare needs and risk issues, which have to be taken into account in assessment and management. A multidisciplinary approach is vital and forensic psychiatry at its best represents a very comprehensive, holistic approach to patients.
What we do
Forensic psychiatrists assess and treat (when appropriate) people with actual or suspected mental disorder who are involved with the criminal justice system. Most patients are closely involved with the criminal justice system. Forensic psychiatry often involves careful assessment of individuals charged with the most serious criminal offences. The forensic psychiatrist is often asked to provide expert opinion to the Court, often at the instruction of defence solicitors or the Crown Prosecution Service. Assessments can be relatively brief, as little as a couple of hours, or can involve admission to a secure hospital for very detailed assessment lasting some months. Patients are often seen in prison and many forensic psychiatrists spend some time visiting a prison on a regular basis to provide a specialist service within the prison.Common misconceptions
There are a number of common misconceptions about forensic psychiatry:
Mental illness is not amenable to treatment. Patients never get better.
This is nonsense. Patients are often severely ill when admitted to hospital, with florid hallucinations and delusions, together with behavioural changes associated with these. Effective treatment with appropriate medication almost invariably leads to a rapid and marked improvement in patients’ conditions within days. The biggest problem we have with regards to teaching students and trainees is in finding patients who still have ongoing symptoms to observe and learn from.
Psychiatrists aren’t proper doctors.
Really?
All psychiatrists are registered with the General Medical Council and undertake the same undergraduate training and early postgraduate training (in the Foundation Years) as all other doctors. Doctors start to specialise at what used to be called the Senior House Officer level. This is now the CT 1-3 or ST 1-3 level – for psychiatry as it is for every other area of medicine.Many psychiatrists take the opportunity to work in a range of clinical and geographical areas before specialising. Other medical specialties might see this “lack of focus” as a problem. Psychiatrists often see this evidence of “wider life experience” as an advantage, as it often brings a degree of maturity and more highly developed interpersonal skills which are essential in psychiatry. Many psychiatrists are less familiar with some aspects of medicine and surgery than they were on leaving medical school. The same is true for all specialists, whether they are surgeons, physicians, virologists, public health doctors, and so on.
Psychiatry isn’t scientific.
Some of the first randomised controlled trials ever conducted were carried out within the field of psychiatry. Read this paper and then claim that psychiatry isn’t scientific! In common with many very specialised areas of medicine, forensic psychiatry would benefit from more research findings and stronger evidence to support various treatments, particularly for patients with highly treatment-resistant illnesses. Medical students and trainee doctors are often surprised when they come to understand that some specialties, such as oncology, diabetes care and many others, are so driven by evidence and the search for more evidence that clinical protocols and care pathways drive patient care, leaving relatively little scope for individual clinicians or patients to deliver more individual care. Although it has a solid scientific base, psychiatry is not primarily a technological discipline. We don’t have the machines, robots, scanners and other fancy bits of kit that are coming to characterise radiology, surgery, cardiology and other disciplines. We are human-based, and all the better for it. Psychiatry, and particularly forensic psychiatry, allow for individualised, holistic care, delivered with the benefit of a robust scientific foundation.
Forensic Psychiatry is a branch of medicine and a sub-specialty of psychiatry.
Forensic psychiatrists are experts in the care of people with mental health problems who are involved with the criminal justice system. This is often because they are believed to pose a risk to others.
Useful personal qualities include:
- Good clinical skills with sound experience in general psychiatry
- Natural curiosity about unusual behaviour and willingness to examine it in a multi-dimensional manner
- Tolerance for challenging patients – capacity to accept – without condoning – anti-social behaviour
- Clarity of thought and of expression, both written and oral
- Thoroughness and attention to detail
- Capacity to lead a clinical team
- Willingness to respond to emergencies and see patients at short notice
- A commitment to working with and advocating for the rights of people marginalised and rejected by society