Forensic psychiatry is a psychiatric sub-speciality based on detailed knowledge of relevant law, criminal and civil justice systems, mental health systems and the relationship between mental disorder, antisocial behaviour and offending. Psychiatrists in this speciality deal with some of the most complex and challenging patients in psychiatric practice. Forensic psychiatrists provide leadership in the care and treatment of mentally disordered offenders and others needing similar services, including risk assessment and management and the prevention of further harm. Achievement of this requires a consistently high standard of both multidisciplinary and inter-agency working.
Forensic psychiatrists work in a variety of settings including high, medium or low secure services, in prisons and in the community. The majority of forensic psychiatrists will have an inpatient caseload, but may also have a number of outpatients for whom they retain responsibility. Many forensic services host liaison schemes, providing advice and support to colleagues from general mental health services and criminal justice agencies managing high risk patients/individuals.
Patients of forensic services tend to suffer from severe mental illnesses, but they often have co-morbid personality pathology, addiction problems and other criminogenic needs. Inpatients can come from a variety of settings; most notably prisons, but also from general psychiatric hospitals, psychiatric intensive care units, independent sector hospitals, and directly from the community. Most of the patients have committed offences of some kind (some very serious, including homicide and rape), all suffer from mental disorder and the majority are detained under the Mental Health Act.
The clinical teams working with patients may be larger than you may have encountered elsewhere – every team (should) have a secretary, consultant, junior doctor, social worker, psychologist, occupational therapist, pharmacist, senior nurse and CPN.
A truly holistic and multidisciplinary approach is essential; trainees often cite this as what attracts them to the specialty:
“When working in forensic psychiatry as a core trainee, I found that the patients we admitted were at the lowest point they could possibly be. Not only had they developed a serious mental illness but they had committed an act of violence, often against a loved one. Seeing them recover from such depths was incredibly rewarding and managing the complexity of that recovery process such an invigorating therapeutic challenge. That’s why I chose to pursue forensic psychiatry as a career.”
Forensic psychiatry has diversified greatly over the years. While it is always concerned with the criminal law and patients who are involved with the criminal justice system, there are distinct services for women, adolescents and older adults; for patients with personality disorder (sometimes led by forensic medical psychotherapists), intellectual disabilities, autism spectrum disorders, head injuries and other brain disorders. Some services have a short term focus, aiming for quick recovery from acute illnesses; some provide acute treatment followed by forensic rehabilitation; and others provide longer term care. There are an increasing number of specialist forensic outpatient teams.
A Certificate of Completion of Training in forensic psychiatry is a gateway to a very broad specialty.
A forensic psychiatrist needs to have an excellent knowledge of mental health law and related legislation. Many forensic psychiatrists undertake expert witness work, providing advice to the courts as to the management of mentally disordered offenders. This aspect of practice is an essential part of training.
Forensic psychiatry is an intellectually stimulating specialty in which ethical dilemmas are common. Practitioners need to maintain a high level of self-awareness. Reflection and clinical supervision are essential to ensure safe and effective practice.
If you want to be a forensic psychiatrist, you will need:
- Excellent 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 and a capacity to accept - without condoning - anti-social behaviour.
- Clarity of thought and of expression, both written and oral
- Thoroughness and attention to detail
- To understand and value the importance of the multidisciplinary team and the capacity to provide leadership to it
Forensic Psychiatry in the West Midlands
Our training scheme provides a wide range of clinical experience in forensic psychiatry, including:
- an incredibly diverse geographical area and population, including both deprived inner city areas and rural counties
- inpatient care in conditions of medium and low security,
- varying models of forensic community care,
- opportunities to undertake medico-legal work,
- prison psychiatry (with services providing input into 13 local prisons, including the high secure estate, local remand prisons, Category C prisons, young offender and juvenile establishments, female prisons and an open prison)
- forensic liaison schemes,
- medium secure and outpatient services for females
- an inpatient personality disorder service
- an inpatient intellectual disability and ASD service.
Close links with three University medical schools, Birmingham, Keele and Warwick, provide a wealth of opportunities for teaching and research.