For medical students and trainees
What is forensic psychiatry?
Forensic psychiatry is a speciality within psychiatry concerned with helping people who have mental disorder and who present a significant risk to the public.
It covers areas such as the assessment and treatment of mentally disordered offenders, investigation of the complex relationships between mental disorder and criminal behaviour and working with criminal justice agencies to support patients and protect the public.
Forensic psychiatrists work alongside many other services including the police, probation, courts, Crown Prosecution Service and prisons. See information below.
Psychiatry is a branch of medicine. Psychiatrists are doctors who have trained at medical school and then specialise in psychiatry (rather than, for example, general practice, surgery, general medicine, paediatrics etc).
After training for three to four years in psychiatry, it is possible to specialise; one of the specialities is forensic psychiatry (others include old age psychiatry, child and adolescent psychiatry, substance misuse, rehabilitation etc).
What do forensic psychiatrists do?
Forensic psychiatrists working in medium and high secure hospitals mostly manage inpatients, although some medium-secure forensic psychiatrist do also have a community case load.
Community forensic psychiatrists manage a mix of inpatients and outpatients. The work of forensic psychiatrists, as for all doctors, covers many areas including clinical and managerial roles as well as teaching. Forensic psychiatrists lead strong multidisciplinary teams. Some specific aspects of the work of forensic psychiatrists include:
- a strong focus on risk assessment.
- careful collection of in-depth information
- good documentation.
- helping patients to understand and reduce their risk.
- helping patients to understand their illness
- helping with anger control, stress management, assertiveness training, employability
- addressing problems of substance misuse
- helping patients to understand the impact of their action on victims
- good-quality relapse prevention plans
- careful rehabilitation back into society
- supporting carers, family and friends.
- Strong liaison with general psychiatry services and criminal justice agencies.
The Guardian: Where do forensic psychiatrists work?
Where do forensic psychiatrists work?
Most forensic psychiatrists work in:
- Local community forensic psychiatry services and low secure units
- Medium secure units (the majority probably work here)
- High secure hospitals
What is the difference between a forensic psychiatrist and a forensic psychologist?
Psychologists are different from psychiatrists. A psychologist has a degree is in psychology, whereas a psychiatrist, who is a medical doctor, has a degree in medicine.
Just as forensic psychiatry is a sub-speciality of psychiatry, forensic psychology is a sub-speciality of psychology. In brief, psychology involves scientific study of mental processes and behaviour (e.g. cognition, emotion, perception, personality, behaviour and interpersonal relationships). Psychologists apply this to various spheres of life (e.g. family, education, employment) and also to the treatment of mental health problems.
Psychologists working with patients usually have additional clinical training following which they are known as a 'clinical psychologist'. Some forensic psychologists working in prisons have not had clinical training (as they work with offenders on offender management programs rather than working with patients), but those working in low, medium and high secure psychiatric units have usually had clinical training and are therefore forensic clinical psychologists.
As a brief guide, there are some aspects of work that forensic psychiatrists are more likely to be involved in than forensic psychologists, these include:
- leading patient care teams
- prescribing medication
- representing patient care in mental health tribunals
- having a broad overview of patient's problems, needs, and treatment plan
- assessing patients for courts (fitness to plead, insanity, diminished responsibility etc)
- undertaking risk assessments on mentally disordered people in the community.
Forensic psychologists can more often be found in the administration of treatment programs and individual therapy under the leadership of a forensic psychiatrist.
How to become a forensic psychiatrist
After leaving medical school, all doctors spend two foundation years working in hospitals and general practice. You would then enter a speciality training scheme in psychiatry, and after three years choose to specialise in forensic psychiatry.
There would then be three years specialist training before being eligible to apply for a consultant post.
If you are reading this because you are interested in a career in forensic psychiatry, please contact your local postgraduate medical education deanery - you can arrange to meet your nearest training programme director in forensic psychiatry.