Conclusion: How to Learn More About Forensic Psychiatry

Abstract

After reading this text, readers’ increased understanding of the law will improve their capacity to discern which legal or forensic issues are within the scope of general psychiatry practice and which are beyond it. For those issues that are beyond the reader’s level of comfort or knowledge, it may be beneficial to consult with or refer to a forensic psychiatrist with more specialized expertise and training in these areas. Forensic psychiatrists have specialized knowledge and skill regarding forensic issues and are able to use their training to help clinicians understand and apply the law to their clinical work and to work with policy makers to help inform policies and statutes for legally regulated aspects of psychiatric practice (e.g., civil commitment and involuntary medication). For those readers who have an interest in gaining a greater level of expertise in forensic psychiatry, it may be worthwhile to pursue additional training through a forensic psychiatry fellowship. Additional opportunities to learn about forensic psychiatry are available via engagement with forensic psychiatry professional organizations and scholarly journals.

The authors hope that this text has been a helpful introduction to the intersection of psychiatry and the law across a number of domains and subspecialty areas. Chapter authors have highlighted important core concepts related to the particular focus of their chapter to introduce readers to these topics. However, it would be unrealistic to expect readers to feel completely comfortable with all of these areas simply as a result of reading this text, and thus knowing how and when to refer to an appropriate colleague and how to explore additional educational opportunities in forensic psychiatry may be of interest to readers.

After reading this text, readers’ increased understanding of the law will improve their capacity to discern which legal or forensic issues are within the scope of their general psychiatry practice and which are beyond it. For those issues that are beyond the reader’s level of comfort or knowledge, it may be beneficial to consult with or refer to a forensic psychiatrist with more specialized expertise and training in these areas. Forensic psychiatrists have specialized knowledge and skill regarding forensic issues and are able to use their training to help clinicians understand and apply the law to their clinical work and to work with policy makers to help inform policies and statutes for legally regulated aspects of psychiatric practice (e.g., civil commitment and involuntary medication). Examples of areas that might benefit from referral to a forensic psychiatrist include requests from attorneys or clinical teams for complex violence or suicide risk assessments or specific types of forensic evaluations (e.g., to answer questions regarding competence to stand trial or criminal responsibility).

For those readers who have an interest in gaining a greater level of expertise in forensic psychiatry, it may be worthwhile to pursue additional training through a forensic psychiatry fellowship. As of 2017, there are 46 Accreditation Council for Graduate Medical Education (ACGME)- accredited forensic psychiatry fellowship programs in the USA and eight programs in Canada (see Table 16.1) [1]. Given the large number of fellowship programs, with significant variability in the didactic curricula and hands-on experiences of each program, it is not possible to provide a comprehensive overview of the specific learning opportunities that fellows are exposed to at all programs. However, in 2015 the ACGME developed forensic psychiatry milestones, which were designed to provide forensic fellowship programs a framework for the assessment of the forensic psychiatry fellow’s development (see Table 16.2 for a summary of these milestones) [2]. For those readers considering forensic fellowship, these milestones also serve as a broad overview of the key elements taught in most forensic fellowships to develop competency in the subspecialty field of forensic psychiatry.

Table 16.1 List of forensic psychiatry fellowships in the USA and Canada

Table 16.2 ACGME forensic psychiatry milestones

In 2015, in an effort to assist applicants to forensic psychiatry fellowships, the Association of Directors of Forensic Psychiatry Fellowships , a council of the American Academy of Psychiatry and the Law (AAPL) , developed a set of guidelines regarding application, interview, and acceptance procedures for fellowship positions [1]. These guidelines recommend that any psychiatry residents interested in pursuing forensic psychiatry specialty training should begin to explore fellowships around the middle of their third postgraduate year (PGY-3). For nonresident applicants , this would mean researching fellowships beginning sometime around January to February of the year prior to the anticipated July 1 start date. Applications typically are screened by programs from the late spring to early fall, and interviews are generally scheduled between the summer and fall of the year prior to the fellowship start date. Programs that still have openings will consider later applications, although some programs fill their positions before the October AAPL annual meeting.

Additional opportunities to learn about forensic psychiatry are available via engagement with professional organizations and scholarly journals. AAPL, the largest American professional organization for forensic psychiatry, hosts a 4-day annual meeting at various sites throughout the country every October [1]. The annual meeting consists of dozens of presentations by the nation’s leading experts in the field and provides opportunities for those interested in forensic psychiatry to learn about current major issues, update their existing knowledge base, and engage in discussion with peers on the standards governing the profession. Each year, prior to the start of the annual meeting, there is also an intensive 3-day forensic psychiatry review course , which provides an in-depth review of selected topics in forensic psychiatry and relevant landmark cases covering basic concepts as well as recent updates in case law [1]. AAPL also has its own professional journal, entitled the Journal of the American Academy of Psychiatry and the Law , which is published quarterly [3].

The International Academy of Law and Mental Health (IALMH) is an international professional society focusing on the interaction of law and mental health through multidisciplinary and cross-national approaches while drawing on law, the health professions , the social sciences, and the humanities [4]. Every 2 years IALMH holds an International Congress on Law and Mental Health , bringing together the international community of researchers, academics, practitioners, and professionals in the field. IALMH also has its own official publication, the International Journal of Law and Psychiatry , which is intended to provide a multidisciplinary forum for the exchange of ideas and information among professionals concerned with the interface of law and psychiatry [5]. There are also a number of other scholarly journals related to forensic psychiatry published by other organizations, including the Journal of Forensic Psychiatry & Psychology [6], Law and Human Behavior [7], and Behavioral Sciences & the Law [8], among others.

The authors hope that this text has contributed to readers’ interest in the field of forensic psychiatry and will stimulate their enthusiasm for acquiring further knowledge and expertise in this rewarding and exciting field.