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The Royal College of Psychiatrists Improving the lives of people with mental illness

Forensic psychiatry

Background to forensic psychiatry

Forensic psychiatry involves the interface between the law and psychiatry. Forensic psychiatrists have particular expertise in the assessment and management of patients with mental disorders who have been, or have the potential to be, violent. They work in a range of settings including prisons, secure hospitals and the community. There are also specialised services and teams within forensic psychiatry including adolescent forensic psychiatry, forensic learning disability and forensic psychotherapy.

The primary role of a forensic psychiatrist is the treatment of mentally disordered offenders. These are patients who have committed crimes when mentally ill or who become unwell in prison. Such patients can receive a hospital order for treatment in hospital instead of a prison sentence or can be transferred from prison to hospital for treatment. Due to their offending behaviour, these patients need to be treated in a secure environment and low, medium and high secure psychiatric hospitals are available depending upon the nature and extent of the risks.

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Personal perspective

Clare OakleyMy fascination with forensic psychiatry began when I was a medical student and I chose to undertake a special study module to find out more about the specialty. I found the management of complex patients and the ethical and legal issues raised to be really interesting. It was stimulating to think that you may have to defend and explain your diagnostic skills and management decisions in a court of law. This need to be clear and precise about what you do was very appealing to me.

Once I was a core psychiatric trainee, I was able to pursue my interest further by completing two placements in forensic psychiatry, one in a medium secure unit treating men with severe and enduring mental illness and one in a medium secure unit treating adolescents. I am now a higher trainee in forensic psychiatry and I absolutely love my job! My work is varied and currently includes assessments in prison for admission to hospital, writing court reports, prison clinics, liaising with local community mental health teams to offer advice on risk assessment and management, and ongoing management of both inpatients and outpatients.

The common co-morbidities of serious mental illness, personality disorder and substance misuse, combined with complex social issues make forensic patients challenging to manage. I enjoy and value working in a multidisciplinary team and have found this to be the most effective and invigorating in the forensic setting. The nature of forensic psychiatry allows adequate time for rehabilitation and a broader consideration than the medical model, which I find very rewarding. Forensic psychiatry is a diverse and fascinating specialty.

Clare Oakley

ST4 in forensic psychiatry

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