What is forensic psychiatry

Forensic psychiatry is a complex subspecialty that addresses psychiatric issues in legal contexts. While forensic psychiatry has become mainstream in the last few years as podcasts and documentaries explore the psychiatry of true crime, the specialty extends far beyond entertainment.

Forensic psychiatrists are medical doctors specializing in psychiatry have undergone additional training focusing on the interface of psychiatry and the law. This training is most commonly an additional one-year ACGME recognized fellowship after completion of general psychiatry residency.

Their training and strong ethics help them ensure justice is served and people's fundamental rights are protected. At the same time, they must be prepared, educated and equipped to understand and treat the complexities of mental health.

"We use our knowledge of psychiatry to help educate or provide some context around legal issues," said Dr. Jeffrey Khan, medical director and assistant professor in the Menninger Department of Psychiatry and Behavioral Sciences at Baylor and General Psychiatry Residency assistant director.

What do forensic psychiatrists do?

A forensic psychiatrist is a third party often hired by the courts or attorneys to perform objective psychiatric assessments. From these assessments, forensic psychiatrists may opine on how these findings impact the legal issue at hand. Examples of this are evaluating and testifying about a person's capacity to stand trial, symptoms affecting not guilty by reason of insanity, or civil issues such as fitness for duty, testamentary capacity or malpractice.

"In the evaluator role, we have to be very objective, not biased toward one side or the other, but this is often a population that is often at risk and is often taken advantage of and harmed," Khan stated. Forensic psychiatrists often work with those incarcerated or undergoing criminal proceedings on cases that face public scrutiny.

Abiding by a strict code of ethics, they use their knowledge of psychiatry and mental health to clinically treat those who are incarcerated or in treatment facilities. Treatment might range from therapy services to medication management. However, the role of a forensic psychiatrist may also include:

• Gauging testamentary capacity, which is someone's mental ability to create their own will.
• Providing expert witness testimony during court proceedings.
• Determining mental capacity to stand trial.
• Screening for threat assessments, child custody disputes and fitness-for-duty.
• Evaluating asylum seekers and refugees fleeing persecution.

The role of a forensic psychiatrist may involve working in prisons, jails, mental health facilities, legal offices and courtrooms.

How do you become a forensic psychiatrist?

The first step to becoming a forensic psychiatrist is to complete medical school and a residency in psychiatry. After completing residency, those interested in forensic psychiatry should complete a fellowship in forensic psychiatry.

A fellowship in forensic psychiatry includes training in:

• Criminal and civil law
• Theory and background of forensic psychiatry
• Practical clinical and consultative skills
• Skills related to advocacy and public policy
• Mock trials and learning about landmark cases

Following completion of a forensic psychiatry fellowship, fellows will take the American Board of Psychiatry and Neurology's Forensic Psychiatry certification exam.

In previous years, the state of Texas has been extremely limited in available forensic psychiatry fellowship training programs, which has caused a backlog in courts throughout the state. While training opportunities are still limited, new opportunities for forensic psychiatry fellowships in Texas are opening, including a forensic psychiatry fellowship program at Baylor College of Medicine's Menninger Department of Psychiatry and Behavioral Sciences.

Contributed by the Menninger Department of Psychiatry and Behavioral Sciences

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