Academic journal article Hong Kong Journal of Psychiatry

Training in Forensic Psychiatry-An English Perspective

Academic journal article Hong Kong Journal of Psychiatry

Training in Forensic Psychiatry-An English Perspective

Article excerpt

Summary

Forensic psychiatry is an important and expanding sub-specialty. This paper describes the experience required for adequate training in forensic psychiatry from an English perspective. The relevant clinical, theoretical and research issues in forensic psychiatry are described within the broader framework of medical and psychiatric training and the facilities required. International issues and higher qualifications in forensic psychiatry are discussed.

Keywords: forensic psychiatry, training, education, qualifications

INTRODUCTION

Forensic psychiatry, is an expanding branch of psychiatry whose emphasis is primarily towards the prevention of victimisation caused by mental disorder, through appropriate assessment and treatment. It examines the causes and treatment of aggressive behavior, offensive sexual behaviour and other destructive behaviours in mentally disordered people. It is also concerned with the psychological damage caused to victims of severe psychological stress and the relationships between being a victim and victimising others. The term "forensic" is defined as "pertaining to the courts of law" (Oxford English Dictionary, 1989). By its nature, it is intimately involved with mental health legislation, compulsory treatment and associated ethical issues. Society is often judged by the manner in which it treats its most deprived members. Mentally disturbed offenders are doubly stigmatised and the problems they raise can force a critical evaluation of the development of that society.

There has been a protracted debate as to whether forensic psychiatry should be a sub-specialty. Part of the argument is that if it is, general psychiatrists mid their clinical colleagues will become progressively deskilled in the assessment and management of psychiatric patients presenting with significant behavioural disturbance or requiring compulsory treatment and supervision. How-ever, such a process probably predates the advent of the formal sub-specialty of forensic psychiatry and has its roots in the pharmacological., legislative and social revolutions of the 1950s. The counter argument is that there is a recognised need to provide expertise for this most severely affected group of patients and ignoring its sub-specialty status does not remove that need. We would contend that specialists can develop centres of excellence in their field and the research and developments so produced can help to alter practice and raise standards in the surrounding area. The Royal College of Psychiatrists (in the United Kingdom) formally recognises forensic psychiatry as a sub-specialty of psychiatry. Moreover, there is a continuing need for special circumscribed training and expertise in forensic psychiatry, not least because of public and governmental pressures following inevitable tragedies involving mentally disordered people. (Ritche et al, 1994; BIOM-COOPOT et al, 1995)

Medical training is an area of immense importance. The training and education of staff is one of the principal ways of ensuring continuing high standards of treatment for the whole of the population, be it through hospital or community care or indeed through psychiatry. Medical education begins in medical school. All medical students in England have to complete a module in psychiatry and a number of these modules include some brief experience and education in forensic psychiatry. Although forensic psychiatry is only a small area of the knowledge medical students are expected to learn, we know of such exposure inspiring students to enter forensic psychiatry and going on to be consultants.

Training in forensic psychiatry can only he built on the solid foundations of a broad basic knowledge of the rest of medicine and psychiatry. With regard to psychiatry this would include a knowledge of adult psychiatry, child and adolescent psychiatry, drugs & alcohol misuse, learning disabilities and the psychiatry of old age. …

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