Forensic psychiatry

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.

Common procedures/interventions

Court work

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:

Consultation work

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:

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.

Sub-specialties

Specialised services and teams in forensic psychiatry include:

Want to learn more?

Find out more about:

Other roles that may interest you

Is there anything wrong with this page?

Help us improve Health Careers

If you would like us to recontact you about the issue, make sure you are logged in before submitting.