Forensic psychiatry

Forensic psychiatry is a sub speciality of psychiatry. It involves the legal aspects of psychiatry. Some practitioners of forensic psychiatry have taken extra training in that specific area. In the United States one year fellowships are offered in this field to psychiatrist who have completed their general psychiatry training. A general psychiatrist can practice forensic psychiatry as well. However, some countries require a specific certification from the government to do this type of work (e.g. Japan)

Court work
Forensic psychiatrists work with courts in evaluating an individual's competency to stand trial, defences based on mental diseases or defects (e.g., the "insanity" defence), and sentencing recommendations. There are two major areas of criminal evaluations in forensic psychiatry. These are Competency to Stand trial (CST) and Mental State at the Time of the Offence (MSO).

Competency to stand trial (CST)
This is the determination that a defendant has the mental capacity to understand the charges and assist his attorney. This is seated in the Sixth Amendment to the US Constitution, which ensures the right to be present at your trial, to face your accusers, and to have help from an attorney.

As an expert witness
Forensic psychiatrists are often called to be expert witnesses in both criminal and civil proceedings. Expert witnesses give their opinion about a specific issue. Often the psychiatrist will have prepared a detailed report before testifying.

Mental state opinion
This gives the Court an opinion, and only an opinion, as to whether a defendant was able at the time of the crime, to understand what he was doing. This is worded differently in many states, and has been rejected altogether in some, but in every setting, the intent to do a criminal act and the understanding that it was a criminal act bear on the final disposition of the case. Much of forensic psychiatry is guided by significant Court ruling or laws that bear on this area. "Not guilty by reason of insanity" is one potential outcome in this type of trial. Insanity is this case is a legal not a medical term. Often there will be a psychiatrist(s) for the defence as well as the prosecution.

They are also involved in the care of prisoners, both those in jails and those in prisons, and in the care of the mentally ill and dangerous (such as those who have been found not guilty by reason of insanity).

Britain
In Britain most forensic psychiatrists work for the National Health Service, in specialist secure units caring for mentally ill offenders (as well as people whose behaviour has made them impossible to manage in other hospitals). These can be either medium secure units (of which there are many throughout the country) or maximum security hospitals (also known as Special Hospitals), of which there are three in England and one in Scotland.

The psychiatrists often also do prison inreach work, in which they go into prisons and assess and treat people suspected of having mental disorders; much of the day to day work of these psychiatrists comprises care of very seriously mentally ill patients, especially those suffering from schizophrenia. Some units also treat people with severe personality disorder, learning disabilities, developmental disorders or other illnesses.

The areas of assessment for courts are also somewhat different in Britain, because of differing mental health law. Fitness to plead, and mental state at the time of the offence are indeed issues given consideration, but the mental state at the time of the trial is also a major issue, and it is this assessment which most commonly leads to the use of mental health legislation to detain people in hospital, as opposed to their getting a prison sentence.

Fictional depictions
A fictional television show, Wonderland, briefly aired in the United States. It was based on the daily work lives of forensic psychiatrists at Bellevue Hospital in New York City. Only 2 episodes aired of the 6 filmed, possibly because of the controversial nature of the show.