My first exposure to the world of
forensic psychiatry came when I was fortunate enough to spend a day
at Rampton Hospital, the high security hospital in Nottinghamshire.
I enjoyed my time there so much that I decided that I wanted to do
my elective in this field. The hospital I chose was in Vancouver,
British Colombia, in Canada.
Forensic psychiatry is a specialty that involves interaction
between psychiatry and the law. The forensic psychiatrist works
with the courts to hammer out medico-legal issues such as criminal
responsibility and fitness to plead.
In Canada, as in many countries, when an accused person is charged
in court, the question of ‘fitness’ is always asked. The court
wishes to know whether the accused is mentally fit to stand
trial.
Alternatively, during the trial the court may determine that the
person did commit the crime but, because of his or her mental
condition at the time it was committed, a verdict of “not
criminally responsible on account of mental disorder” could be
returned. If either of these issues arises, the accused is usually
sent to a forensic hospital (such as the one in which I was based)
under a 28-day assessment order. During my time at Vancouver
Forensic Psychiatric Hospital I had many opportunities to talk to
patients. Some of them had resided in the hospital for many years —
they had no other place to call home. I learnt a lot about their
past histories and misdemeanours.
Through sitting in on outpatient clinics I was able to appreciate
the degree of follow-up that is provided for patients who are
mentally stable enough to reside in the community. I was also
fortunate enough to have been able to accompany one of the other
forensic psychiatrists at her weekly clinic at the local prison,
where of course mental health problems are very
prevalent.
One thing I realised above all else was that these people who had
committed crimes had invariably led very tough and challenging
lives themselves, often being victims of sexual, physical, or
emotional abuse as a child.
I was given sole responsibility by my supervisor for producing a
court report for one of his patients who had been sent to the
forensic hospital under an assessment order. I realised quickly
that this task was not going to be easy, not least because I had a
mountain of paperwork from previous psychiatric admissions to read
through, as well as the entire police report of the crime in
question. I conducted several interviews with the accused to try to
establish whether he was fit to stand trial and whether he was
mentally ill at the time he committed the crime.
Trying to establish a rapport with forensic patients can be
extremely difficult. Often they will not speak to you very much
because they believe it may jeopardise their defence when they go
to court.
After spending several hours talking with this young man, my
conclusion was that he was fit to stand trial and had not been
experiencing any psychiatric symptoms at the time of the
offence.
I thoroughly enjoyed my
elective experience, and it certainly increased my interest in
forensic psychiatry as a subspecialty. My supervising consultant,
Dr Mark Riley, was very accommodating and keen for me to gain as
much as possible from the six weeks I was at the
hospital.
Over the course of my
elective, I also learnt a little about the First Nations people of
Vancouver. These are residents who trace their ancestry to the
aboriginal people that inhabited the land that is now British
Colombia prior to the arrival of Europeans and Americans in the
late 18th century. The First Nations people of
Vancouver tend to live in their own communities, and rates of
alcohol and illicit drug use are high in these people. I was
welcomed by their community within the hospital and fortunate
enough to experience their traditional food and attend an annual
festival held within the hospital grounds.
Vancouver as a city is a
fantastic place to do your elective. Being located on the west
coast of Canada it enjoys very warm summers, with little rain, and
mild winters. It boasts a massive public park called Stanley Park
and Grouse Mountain – a 2.9 kilometre hike that is not for the
faint-hearted, but provides an unrivalled panoramic view of
Vancouver.
I would thoroughly
recommend my medical elective experience to any medical
undergraduate who is interested in psychiatry, particularly
forensic psychiatry. These patients are a complex and
challenging group to diagnose and manage and that, for me, combined
with the emphasis of a multi-disciplinary approach to their care,
is what makes forensic psychiatry such an appealing career option,
and one that I wish to pursue.
Dr Declan Hyland, foundation year one doctor,
University Hospital Aintree, Liverpool
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Page last updated on 16 May 2010
by E Baker-Glenn