The clinical experience in the Advanced Training Programme in Forensic Psychiatry will consist of the equivalent of three years full time experience all of which must be spent in designated forensic psychiatry. As a trainee in forensic psychiatry you cannot obtain endorsements in other clinical subspecialties, because you are required to spend all 3 years working in substantive forensic placements.
During their higher training, trainees will work across two Trusts, Birmingham and Solihull NHS Foundation Trust (BSMHFT) based in Birmingham and Midlands Partnership NHS Foundation Trust (MPFT) with sites in Stafford and Shrewsbury. Through a provider collaborative, the two NHS Trusts work closely with colleagues from secure service at St Andrew’s healthcare in Birmingham.
The main training placements will usually be in medium secure settings, with experience of community management of forensic patients, prisons as well as high and low secure placements. Most placements are 12 months long. Posts in specialised areas, such as PICU, outpatient, personality disorder and women’s services may be for 6 months, although this is flexible and is tailored to meet the individual development needs of trainees.
Your first placement will be determined by vacancies and will be decided by the Training Programme Director. Thereafter, you will be expected to discuss your training needs with the TPD and give preferences for future placements. The size and flexibility of the training scheme means that it is usually possible to accommodate requests to gain experience in specialist services over the course of higher training.
At the end of 3 years, if you have made satisfactory progress and have achieved the required competencies, you will receive a Certificate of Completion of Training (CCT) in forensic psychiatry. Thereafter you will be eligible for up to 6 months further employment within the clinical placements of the scheme – the so-called “period of grace”, prior to taking up a consultant post.
Aims & Objectives of Higher Training in Forensic Psychiatry
- To gain an understanding of the organisation of local and national forensic psychiatric services
- To gain expertise in the social, psychological and physical assessment and management of complex patients, as part of a large multidisciplinary team
- To develop a fuller understanding of the Mental Health Act including the role of the Ministry of Justice in dealing with restricted patients
- To gain expertise of inter-agency working with probation, the courts and prisons.
- To become competent at preparing psychiatric reports for Magistrates or Crown courts.
- To conduct forensic assessments of patients in hospitals, prisons and other settings including custody suites
- To participate in prison clinics and the bail hostel in-reach service
Opportunities that you should consider as a forensic psychiatry SpR may include:
- Presenting evidence at tribunals
- Assessing patients in other hospitals, including high and low secure facilities
- Visiting Approved Premises
- Observing court proceedings
- Being involved in psychological interventions and group work
- Visiting court diversion schemes
- Preparing formal risk assessments
- Going on visits with the forensic community teams
- Arrange a specialist interest session and participate in research
The Role of the Higher Trainee
As a higher trainee, your primary role varies depending on the expectations of your psychiatric supervisor and the number of doctors/allied mental health professionals within teams. You will be involved in the assessment and management of patients under the care of your team. You will have opportunities to assess patients referred by other secure units, prisons and police stations. You will be involved in mentoring and supporting junior colleagues.
Clinical Supervision
Clinical supervision is delivered by your trainer, who will be a substantive consultant forensic psychiatrist. The designated trainer will provide a fixed one-hour per week meeting, focussed on your personal learning and development needs. You should keep a record of supervision sessions and the issues discussed. Additional ad-hoc clinical supervision will be provided as required.
On Call
All higher trainees in Forensic Psychiatry are expected to take part in an on call rota, providing telephone advice to colleagues and participating in joint assessments where necessary, often in custody suites across the West Midlands. The rota is non-resident, and you are not expected to stay in the hospital. However, you are expected to be able to attend promptly and on-call rooms are available on most sites.
In Birmingham and Solihull Mental Health Foundation Trust (BSMHFT), the registrar provides 2nd tier cover to Reaside Clinic, Tamarind Centre, Hillis Lodge and Ardenleigh in Birmingham. In Midlands Partnership NHS Foundation Trust (MPFT), the registrar provides 2nd tier cover to the Hatherton Centre and Ellesmere House in Stafford and Clee in Shrewsbury.
The registrar may be contacted for advice by the 1st tier duty doctor. Higher trainees are also expected to participate in seclusion reviews. There are currently two seclusion suites at Reaside Clinic, three at the Tamarind Centre, two at Ardenleigh, one at the Hatherton Centre and one at Clee.
Prisons
Prison psychiatric work is an important part of higher specialist training in forensic psychiatry.
Trainees generally spend half a day a week attending a particular prison during their training, in addition to conducting assessments of prisoners that are referred to their clinical service. Ttrainees are encouraged to spend a year attending a local remand prison in addition to providing clinics in other prisons according to their training needs.
In the West Midlands, BSMHFT and MPFT provide prison mental health services to the following prisons:
Local male remand prisons: HMP Birmingham, HMP Dovegate and HMP Hewell
Dispersal prison for category A prisoners: HMP Long Lartin
Young Offenders Institutions and prisons for young adults: HMYOI Brinsford, HMP/YOI Swinfen Hall and HMP Werrington (juveniles)
Prisons for female offenders: HMP Drake Hall; HMP Foston Hall
Training prisons: HMP Featherstone; HMP Oakwood; HMP Stafford (a prison for sex offenders)
Open prison: HMP Sudbury
BSMHFT provides the input to HMP Birmingham.
Dr Matt Tovey (mtovey@nhs.net) is the medical lead for the remaining prisons whose mental health teams are provided by MPFT.
Training within High Secure Hospitals
The forensic curriculum requires trainees to develop competencies in relation to the full range of secure levels, including high security. There are 3 high secure hospitals in England – Ashworth, Broadmoor and Rampton Hospitals. While working within the medium secure and low secure services in the West Midlands, trainees will be exposed to high secure conditions periodically. Additionally, trainees are encouraged to undertake a placement in a high secure setting. Taking into account personal circumstances and individual training needs, this may be achieved as a block placement or by attending one or two days a week over a longer period of time
High secure placements need to be planned well in advance. Early discussions with your psychiatric supervisor will help to ensure that arrangements for covering your clinical work can be put in place. Trainees usually complete their high Secure training as an ST5 or ST6.
Special Interest in Forensic Psychiatry
As an advanced trainee in forensic psychiatry, you have 1 day a week personal development time, which you can use flexibly to gain experience and develop competencies away from your substantive clinical placement. You will split this, during the course of your training, between clinical special interest sessions and non-clinical activities such as research, teaching and management experience. There is great flexibility in how you use this time and you should think and plan creatively and carefully; you will need to discuss with and gain the approval of your trainer and the TPD. Special interest sessions undertaken in facilities outwith the employing Trust require trainees to obtain an honorary contract.
Clinical Special Interest Sessions
Clinical special interest sessions are defined as "a clinical or clinically related area of service which cannot be provided within the core training post, but which is of direct relevance to the prospective career pathway of the trainee" (RCPsych, 2009). Common areas for forensic trainees include specialised secure or forensic services, such as those for children and adolescents, patients with intellectual disability, autism spectrum disorders, or brain injury; and areas of general psychiatry such as addictions, or neuropsychiatry. But the range of possibilities within the West Midlands, in NHS services but also sometimes with other providers, is very wide.
Examples within the West Midlands may include;
- Elliott House, approved premises (bail & probation hostel) for mentally disordered offenders in Edgbaston, Birmingham. Set up as a joint venture between West Midlands Probation Service (as it then was) and Reaside Clinic in the 1980s, it was the only such specialised probation hostel in the country for a long time; there are still very few similar facilities. This is an excellent opportunity to understand probation and community management of offenders.
- Forensic Psychiatry and Intellectual Disability: Janet Shaw Clinic, Brooklands Hospital
- Ellesmere House low secure forensic ID and ASD service
- FCAMHS at Ardenleigh Hospital (low secure, medium secure and community)
- Womens’ Secure Services at Ardenleigh Hospital
- Forensic Personality Disorder Service at the Tamarind Centre
- HMP Stafford, a sex offender-only Cat C prison
- Forensic liaison schemes in Wolverhampton and Shropshire
- MAPPP panel attendance in areas of your choosing
- Forensic Intensive Recovery and Support Teams in BSMHFT and MPFT
Higher Degrees
Some trainees use a proportion of their personal development time to study for a higher degree, usually a taught Masters in a subject related to forensic psychiatry, often mental health law or medical law, criminology, or medical education.
Such courses of study can be a very valuable learning experience, increasing your knowledge of a particular subject area and giving you a broader understanding of the approach taken by another discipline or profession.
It is possible to use your study leave allowance to contribute towards the cost of such courses, although you will need to balance this with other demands on your study budget during your training.
Academic Programme
The academic programme, held every Wednesday in term time between 2pm-4pm, is a training requirement for medical trainees in forensic psychiatry and is open to all those who work in forensic services. Topics presented are wide ranging and include clinical case presentations, ‘learning lessons’ sessions, focusing on feedback from recent serious clinical incidents, research presentations, journal presentations and service user presentations. The teaching programme provides an opportunity for teams to present and discuss challenging cases and clinical cases of interest.
Trainees are encouraged to attend the meeting, where they (with prior notice) are given the opportunity to present a case presentation, journal article or research project to a varied audience. Specific trainee learning objectives from the programme include achievement of annual training requirements, assessment of teaching, and improving their skills in the presentation of interesting and challenging cases, and critical appraisal of research and literature.
The West Midlands Forensic Psychiatry Academic Programme has established an innovative video-conferencing network to deliver the forensic mental health academic programme and the development of a Community of Practice across forensic services in Birmingham and Staffordshire/Shropshire. To ensure a skilled workforce across the different forensic services in the region, the academic programme has been delivered via video–conference for several years, thereby uniting services across a range of specialist areas including gender specific services and forensic Child and Adolescent Mental Health Services (CAMHS), and cutting down on clinician travelling times and costs. We have also been able to welcome eminent speakers, both nationally and internationally, including Dr Mark Komrad, psychiatrist and medical ethicist at Johns Hopkins University, Prof Carmine Pariante, professor of biological psychiatry at the Institute of Psychiatry, Kings College London and Dr Frank Farnham, Consultant Forensic Psychiatrist and Clinical Lead for the National Stalking Clinic. Our innovative programme and use of technology was presented at the RCPsych Annual Medical Education Conference in 2019.
The Academic Programme is followed by either a Balint Group or a peer group for SpR colleagues, which is held between 4pm-5pm.
Instruction regarding the timetable and location for attendance are provided by the academic programme organisers. The current SpR lead for the Forensic Academic Programme is Dr Aqib Hussain, supported by Dr Anis Ahmed, Consultant Forensic Psychiatrist at the Tamarind Centre.
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