Forensic psychiatry is a specialised branch of psychiatry which deals with the assessment and treatment of mentally disordered offenders in prisons, secure hospitals and the community. It requires sophisticated understanding of the interface between mental health and the law.
This page provides useful information on the nature of the work, the common procedures/interventions, sub-specialties and other roles that may interest you.
Nature of the work
Forensic psychiatrists must balance the needs of the offender with the risk to society. They provide psychiatric treatment in a secure environment or where patients are subject to legal restrictions.
Assessment and treatment settings vary, from high security hospitals through to medium secure units, low secure units, prison settings and community based services. Forensic psychiatrists also evaluate the outcome of treatment programmes and provide expert advice to other health and social care professionals.
Knowledge of mental health legislation is central to the work and there is regular involvement with criminal justice agencies and the courts. Forensic psychiatrists need an in-depth understanding of criminal, civil and case law as it relates to patient care in forensic settings.
The majority of patients have had previous contact with the criminal justice system. A minority are referred from NHS facilities if their behaviour is challenging and they pose a risk which cannot be safely managed in less secure environments.
An important part of the work is risk assessment. Forensic psychiatrists assess and manage patients at risk in emergency and routine situations, in collaboration with colleagues and as part of a larger multidisciplinary team. They sometimes have to control patients with violent behaviour using medication, rapid tranquillisation, restraint or seclusion.
Referrals can range from those who have committed minor offences to serious and violent offenders. Forensic psychiatrists may also assess non-offenders displaying high-risk behaviour. They may also attend tribunals to review the detention of a compulsory patient.
Forensic psychiatrists also provide specialist advice to the courts, the probation service, the prison service and other psychiatric colleagues. They also prepare reports for mental health review tribunals, hospital managers’ hearings, other practitioners and criminal justice agencies.
Forensic psychiatry has expanded considerably in the last decade; with an increase in specialist medium secure services for women, for example those with learning disabilities and patients with personality disorders. Forensic psychiatry has also seen an expansion of forensic low secure beds, which provide a care pathway for patients as they rehabilitate and work towards discharge. It is likely that that there will be further expansion in low secure services and community forensic services. The last decade has also seen a reduction in the number of high secure beds in the UK.
Forensic psychiatrists regularly provide expert witness evidence to courts, for example to crown courts in criminal cases (including serious violent crimes) such as homicide or through court diversion schemes in a magistrate’s court. They provide expert opinions to the courts in various areas including:
- defendant’s fitness to plead and fitness to stand trial
- capacity to form an intent
- advice to the courts on the available psychiatric defences
- appropriateness of a mental health disposal at the time of sentencing
- nature of a particular mental disorder and link to future risks
- prognosis and availability of “appropriate treatment”
- level of security required to treat a patient and manage risk
When advising colleagues in the care of patients deemed to be a risk to others, forensic psychiatrists will need to be competent to provide a detailed forensic psychiatry assessment including advice on:
- risk assessment including use of structured risk assessments
- risk management
- expertise on pharmacological and psychological treatment approaches to violent behaviours associated with mental disorders
- psychodynamic formulation of the case
- therapeutic use of security
Community forensic work provides opportunities to assess and to work with mentally disordered offenders in residential facilities. In addition there are opportunities to provide consultation to probation staff regarding clients in bail hostels and probation accommodation.
Forensic psychiatrists participate in regular audit which helps to improve the quality of the service offered to patients. They attend clinical governance meetings and investigate complaints and serious incidents alongside colleagues in the multi-disciplinary team.
Teaching and training is also an important part of the work. This includes weekly supervision of trainee psychiatrists in forensic and general adult psychiatry. Forensic psychiatrists may lecture on the local MRCPsych training programmes and contribute to their local academic programmes.
Specialised services and teams in forensic psychiatry include:
- adolescent forensic psychiatry
- forensic learning disability
- forensic psychotherapy
Want to learn more?
Find out more about:
- the working life of a doctor in forensic psychiatry
- the entry requirements and training and development
- a first-hand account of life in forensic psychiatry
- Pay and conditions Expand / Collapse
This section provides useful information about the pay for junior doctors (doctors in training), specialty doctors, consultants and general practitioners.
Find out more about current pay scales for doctors, more information can be found on the BMA website.
NHS employers provides useful advice and guidance on all NHS pay, contracts terms and conditions.
Medical staff working in private sector hospitals, the armed services or abroad will be paid on different scales.
- Where the role can lead Expand / Collapse
Read about consultant and non-consultant roles in forensic psychiatry, flexible working and about wider opportunities.
Managerial opportunities for consultants include:
- clinical lead - lead NHS consultant for the team
- clinical director - lead NHS consultant for the department
- medical director - lead NHS consultant for the Trust
Most NHS consultants will be involved with clinical and educational supervision of junior doctors.
Here are some examples of education and training opportunities:
- director of medical education - the NHS consultant appointed to the hospital board who is responsible for the postgraduate medical training in a hospital. They work with the postgraduate dean to make sure training meets GMC standards.
- training programme director - the NHS consultant overseeing the education of the local cohort of trainee doctors eg foundation training programme director. This role will be working within the LETB/deanery
- associate dean - the NHS consultant responsible for management of the entirety of a training programme. This role will be also be working within the LETB/deanery
SAS doctor roles
SAS doctors (Staff, Associate Specialists and Specialty Doctors) work as career grade specialty doctors who are not in training or in consultant posts. You will need at least four postgraduate years training (two of those being in a relevant specialty) before you can apply for SAS roles.
Further information on the SAS doctor role is on this site.
Other non-training grade roles
These roles include:
- trust grade
- clinical fellows
If you have trained on an academic psychiatry pathway or are interested in research there are opportunities in academic medicine.
For those with a particular interest in research, you may wish to consider an academic career in psychiatry. Whilst not essential, some doctors start their career with an academic foundation post. Entry is highly competitive. This enables them to develop skills in research and teaching alongside the basic competences in the foundation curriculum.
Entry into an academic career would usually start with an Academic Clinical Fellowship (ACF) at ST1-2 and may progress to a Clinical Lectureship (CL) at ST3 and beyond. Alternatively some trainees that begin with an ACF post then continue as an ST trainee on the clinical programme post-ST4.
After completion of the academic foundation trainees can then apply for academic core training posts (instead of normal core training). A PhD is often taken, either during core or specialty training.
Applications for entry into Academic Clinical Fellow posts are coordinated by the National Institute for Health Research Trainees Coordinating Centre (NIHRTCC).
There are also numerous opportunities for trainees to undertake research outside of the ACF/CL route, as part of planned time out of their training programme. Find out more about academic medicine.
The Clinical Research Network (CRN) actively encourages all doctors to take part in clinical research.
Psychiatrists often undertake research, which includes collaborating with colleagues in the UK and overseas, writing papers and presenting work at conferences. Research within this specialty, as is often the case, is subject to financial constraints. There is not always sufficient money to carry out all the necessary work.
There may also be opportunities to work in the private sector and overseas.
- Job market and vacancies Expand / Collapse
This section provides useful information about the availability of jobs, how to find vacancies and sources of further information.
Job market information
Psychiatry is the fifth largest medical specialty in the UK. Consultant psychiatrists comprise 4.5% of the mental health workforce and 10.5% of the total NHS consultant workforce (Health and Social Care Information Centre, HSCIC 2014). Most areas of psychiatry have seen considerable growth in the consultant workforce in the last ten years, and forensic psychiatry is no exception. In 2003 there were 212 (full-time equivalent) forensic psychiatrists in post and by 2013 this had risen to 311, showing a 47% growth. (CfWI analysis based on HSCIC, 2014).
8% of consultant psychiatrists specialise in forensic psychiatry.
The competition ratio (CR) for core psychiatry training (CT1), the first stage in the training (post-foundation), in 2015 was 1.42 (NHS Specialty Training, 2015). The competition ratio (CR) to forensic psychiatry training in 2015 was 1.70 (NWPGMD).
In 2014 there was an in-depth review of the whole psychiatric workforce by the Centre for Workforce Intelligence (CFWI).
On this section we have information for England only. For information regarding Scotland, Wales and Northern Ireland please click on the links below.
Where to look for vacancies
Specialist forensic psychiatry training is open to those who may want to train flexibly on a less than full-time basis (LTFT). You can request and apply for this after you have been offered the job. Restrictions apply.
Recruitment into specialist psychiatry training (excluding Northern Ireland) is coordinated by the North Western Deanery, Health Education North West.
Registration and applications for psychiatry core and higher specialist training is online via Oriel.
Northern Ireland has its own recruitment process for psychiatry. For further details please visit the Northern Ireland Medical and Dental Training Agency website.
- Further information Expand / Collapse