Forensic psychiatry

Career prospects are strong in the specialty whose job it is to assess and treat mentally abnormal offenders. John Sandford reports

Criminally insane people have long been a source of fear and fascination for public and doctors alike. Tell people at a dinner party that you are a forensic psychiatrist, and they will either bombard you with questions about infamous criminals or shy away, fearful that doctors become like their patients. Contrary to the popular Hollywood stereotype, little time is spent analysing the internal mental processes of serial killers. In reality, the working day is spent travelling between prison, hospital, and community to provide assessments, opinions, and treatment for a variety of mentally disordered people who exhibit antisocial behaviour.

The first special hospital was established in 1863, but it was not until the 1970s that forensic psychiatry developed as a distinct specialty. Concern over the limited psychiatric input into prisons and problems with discharging patients from special hospitals led to the establishment of regional forensic psychiatrists and secure psychiatric units. The numbers of consultants and beds have slowly expanded since.Forensic psychiatry is an applied rather than theoretical specialty. It is the application of a part of medical knowledge to legal and custodial settings. As psychiatry is a diverse branch of medicine, so this diversity is reflected in its forensic aspect (box B1). The core skill is the treatment of mentally abnormal offenders, be this in secure hospital, prison or under supervision in the community.

What do forensic psychiatrists do?

Most forensic psychiatrists are based in medium secure units located near major towns or cities. These provide a highly staffed environment where potentially dangerous patients can be assessed and treated. Patients generally come from prison, high secure hospitals, or general psychiatric wards. The inpatient work of consultant forensic psychiatrists involves planning and overseeing patient care, an important emphasis being the balance between treatment and security needs. Outpatient work, in prisons and the community, centres on assessing offenders for …