Forensic Psychiatry
Nature of the work
Forensic psychiatry is a unique field of
psychiatry which deals with the assessment and treatment of
mentally disordered offenders. It requires sophisticated
understanding of the interface between mental health and the
law. The work of forensic patients is stimulating as patients
present with diverse psychopathologies and complex psycho-social
difficulties.
Forensic psychiatrists have to balance the needs
of the individual and the risk to society. They provide
medical treatment in a secure environment or where patients are
subject to legal restrictions.
Working in forensic psychiatry
Assessment and treatment settings vary, from
high security hospitals through to medium secure units, low secure
units, prison settings and community based services.
Knowledge of the law in relation to clinical
practice is central to the work and there is regular involvement
with criminal justice agencies and the courts.
The majority of patients have had contact with
the criminal justice system, although a minority are referred from
NHS facilities (if their behaviour is challenging and they pose a
risk which cannot be safely managed in less restrictive
environments). The range of referrals is immense, from minor
to very serious offenders, as well as non-offenders with high risk
behaviours. The reasons for referral include advice on risk
management and consideration for admission to a forensic
service.
Forensic Psychiatrists also provide specialist
advice to the courts, the probation service, the prison service and
psychiatric colleagues.
The specialty has expanded considerably in the
last ten years; with an expansion of specialist medium secure
services for women, for example, for patients with learning
disability and patients with personality disorders. Forensic
psychiatry has also seen an expansion of forensic low secure beds,
which provide a care pathway for patients as they rehabilitate and
work towards discharge. It is likely that that there will be
further expansion in low secure services and community forensic
services. The last 10 years has seen a concomitant reduction
in the number of high secure beds in the country.
Common procedures / interventions
Court Work
Forensic psychiatrists regularly provide expert
witness evidence to courts, for example to Crown Courts in criminal
cases (including serious violent crimes) such as homicide or
through court diversion schemes in a Magistrates Courts.
Forensic psychiatrists regularly give opinions to the courts in
respect of:
-
Defendant’s
fitness to plead and fitness to stand trial
-
Capacity to form
an intent
-
Advice to the
courts on the available psychiatric defences
-
Appropriateness of
a mental health disposal at the time of sentencing
-
Nature of a
particular mental disorder and link to future risks
-
Prognosis and
availability of “appropriate treatment”
-
Level of security
required to treat a patient and manage risk
Consultation Work
In advising colleagues in the care of patients
deemed to be a risk to others, forensic psychiatrists will need to
be competent to provide a detailed forensic psychiatry assessment
including advice on:
- Risk assessment including use of structured
risk assessments
- Risk management
- Expertise on pharmacological and psychological
treatment approaches to violent behaviours
associated with mental disorders
- Psychodynamic formulation of the case
- Therapeutic use of security
Community forensic work provides opportunities
to assess and to work with mentally disordered offenders in
residential facilities. In addition there are opportunities
to provide consultation to probation staff in respect of clients in
bail hostels and probation accommodation. Forensic psychiatry
may also include inter agency working.
Further information
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