Working life (forensic psychiatry)
This page provides useful information about the roles and responsibilities of forensic psychiatrists, where they work, who they work with and what they feel about their role.
"It’s a great specialty if you want to be intellectually challenged and to work with complex patients with severe psychopathology who have committed serious crimes.”
“It’s an opportunity to work with a group of patients over a long period of time, with a team of expert mental health professionals.”
“It gives me the opportunity to develop skills over and above my medical skills such as evaluating complex information and writing reports. I find the interface with the law intellectually stimulating.”
“It’s rewarding to work with patients who are seen as having a poor prognosis and helping them.”
(Quotations from forensic psychiatrists)
The working week would usually involve a combination of clinical work, clinical governance, teaching and training.
Usual working hours are 9am to 5pm. Consultant forensic psychiatrists normally participate in an on call rota for the forensic service, and trainees may sometimes be part of an out-of-hours rota.
On average, a consultant forensic psychiatrist working in medium security will have clinical responsibility for up to 15 inpatients, but this figure will vary depending on other required commitments as well as the level of security and the demands of the case load. Other clinical commitments will involve assessments in police stations, prisons, courts and other hospitals. Many consultants have a specialist clinical commitment such as regular prison in-reach clinics or community forensic mental health services.
Patients include those with mental illness, personality disorders, intellectual disability, other developmental disorders such as autistic spectrum disorders or ADHD in adults as well as children or adolescents, organic brain damage and other co-morbid conditions such as substance misuse and histories of trauma and abuse.
Forensic psychiatric work is carried out in high, medium and low secure hospital services, in prisons and community settings. Most forensic mental health services operate from well-equipped, purpose-built modern facilities, but work often involves travelling considerable distances for prison assessments.
Forensic psychiatrists work as part of large multidisciplinary clinical teams within a secure unit, prison or hospital.
They work with:
- clinical and forensic psychologists
- mental health nurses
- occupational therapists
- arts therapists
- other mental health professionals
- medical secretaries and administrative staff
- lawyers and others attending for reviews including Mental Health Review Tribunals
They are also required to work with other agencies from time to time, including
- lawyers and court staff
- prison and probation service
- third sector organisations
- other lay personnel including civil servants, politicians and journalists.
Social workers are generally not employed by the health service, but also commonly act as full members of the clinical team.
Patients referred to forensic psychiatrists face many complex problems. Many have severe and enduring mental health problems and they may pose a risk to the public. Delivering security is similarly complex. It must be proportionate to the risk, and will need varying as the patient’s condition fluctuates. Even though the patient – and staff - may be required under legislation to accept secure hospitalisation, every effort must always be made to work collaboratively with the patient at all times.
Understanding the relationship between mental illness and crime and offering the appropriate care and treatment to enable patients to recover from trauma is very satisfying. The work of forensic patients is stimulating as patients present with diverse psychopathologies and complex psycho-social difficulties.
Helping distressed and ill patients divert from the criminal justice system in a timely fashion and contributing to their recovery using psychiatric skills is very rewarding.
Providing expertise to the courts to enable mentally disordered patients to receive the appropriate treatment and risk management is also a fulfilling part of the job.
Helping to influence service development and design new services is stimulating and fulfilling.