Forensic psychiatry

Life as a forensic psychiatrist 

You’ll assess the risk of harm to others and the patient themselves. This is a huge responsibility and will require you to contribute to a treatment plan for the management of each patient. You’ll be part of a forensic mental health team and your job will be to ensure the appropriate and regular review of a patient’s assessment and strategy. 

In this demanding and diverse role, you’ll provide specialist advice to the courts, the probation service, the prison service and other psychiatric colleagues. You’ll need to prepare reports for mental health review tribunals, hospital managers’ hearings, other practitioners and criminal justice agencies. 

You’ll need a highly developed understanding of multidisciplinary clinical and inter-agency skills. Liaising and listening to other psychiatric experts will be a daily part of your job.  

When guiding colleagues in the care of patients deemed to be a risk to others, you’ll be expected to provide advice on: 

• risk of harm to others, including use of structured risk assessment/professional judgement tools 
• risk management 
• pharmacological and psychological treatment approaches to violent behaviours associated with mental disorders 
• psychodynamic formulation of the case, including psychotherapeutic strategy 
• therapeutic use of security 

You’ll need a comprehensive knowledge of the relevant legislation and criminal, civil and case law as you’ll work closely with the criminal justice agencies and the courts. Your patients will usually be referred from the criminal justice system or occasionally from other health services if a patient is a perceived risk. 

The majority of your patients will be subject to legal restrictions, so most of your time will be spent working in a secure hospital, prison or in the community delivering specialist services. 

You’ll be required to appear in courts as an expert witness in cases that can involve homicide, serious violence and sexual offences. Your expertise will need to include:  

• defendant’s fitness to plead and fitness to stand trial 
• capacity to form intent 
• advice to the courts on the available psychiatric defences 
• appropriateness and circumstances required for an individual’s admission to hospital for assessment 
• 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 

How much can I earn? 

You’ll first earn a salary when you start your foundation training [1] after medical school. The basic salary ranges from £29,384 to £34,012. Once you start your specialty training as a forensic psychiatrist employed by the NHS, you can expect to earn a salary of at least £40,257, which can increase to between £84,559 and £114,003 as a consultant. 

How about the benefits? 

• make a difference 
• flexible and part-time working 
• high income early in your career 
• work anywhere in the world 
• excellent pension scheme 
• good holiday entitlement 
• NHS discounts in shops and restaurants 

Must-have skills 

• excellent communication skills to manage a wide range of relationships with colleagues, and patients and their families  
• emotional resilience, a calm temperament and the ability to work well under pressure  
• teamwork and the capacity to lead multidisciplinary teams  
• problem-solving and diagnostic skills  
• outstanding organisational ability and effective decision-making skills  
• first-class time and resource management for the benefit of patients  

Entry requirements 

Your first step is medical school. Typically, you’ll need excellent GCSEs and three A or A* passes at A level including chemistry for a five-year undergraduate degree in medicine. Many medical schools also ask for biology and others may require maths or physics.   

If you already have a degree, you could study for a four-year postgraduate degree in medicine.  

You’ll need to pass an interview and admissions test. You’ll be asked to show how you demonstrate the NHS values such as compassion and respect.  

Some medical schools look to recruit a mix of students from different backgrounds and geographical areas, so your educational and economic background and family circumstances could be considered as part of your application. 

"It’s so rewarding to see people recover from the most fractured state of mental health. Changes can be subtle and take time, but they do happen. We don’t focus solely on disease – psychiatry is a holistic [2] specialty."

Read Brad's story [3]. 

What are my chances of starting a career as a forensic psychiatrist? 

There are currently 333 consultant forensic psychiatrists working in the NHS in England. In 2020, there were 55 applications for 34 specialty training places. 

How to become a forensic psychiatrist 

After medical school, you’ll join the paid two-year foundation programme [4] where you’ll work in six placements in different settings.  

After your foundation programme, you can apply for paid specialty training [5] to become a forensic psychiatrist, which will take a minimum of six years.  

You may be able to train part time, for example for health reasons or if you have family or caring responsibilities. 

Where a career as a forensic psychiatrist can take you 

You’ll have the opportunity to specialise in:  

• adolescent forensic psychiatry 
• forensic learning disability psychiatry  
• forensic psychotherapy 

There’s also a growing need for specialists in old-age forensic psychiatry and substance misuse. 

You’ll also teach medical students or postgraduate students in training and get involved in research at universities, the NHS or private sector.