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
My 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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Page updated on 8
December 2010