Forensic Nurses' Views Regarding: Medications for Inmates

1. High arrest rates among people with mental illnesses may suggest that the illness is a factor in their arrests. 2. The increased number of individuals with severe and persistent mental illnesses in the criminal justice system reflects deficient community-based mental health services. 3. Jails and prisons act as revolving-door treatment facilities and are a poor substitute for proper community-based mental health care. 4. Mandatory discharge medication and follow-up treatment for ex-inmates with mental illnesses may lower the rate of recidivism.

Commentary: developmental stages of forensic psychiatry fellowship training--from theoretical underpinnings to assessment outcomes

Dr. Pinals' paper provides an excellent foundation for studying the developmental process of forensic psychiatry fellows during their training year. She proposes three stages: (1) transformation, (2) growth of confidence and adaptation, and (3) identification and realization. This commentary compares Dr. Pinals' proposed developmental stages to Margaret Mahler's theory of infant development and to Dr. Lev Vygotsky's social learning theory. Assessment methods to evaluate core competencies suggested by the American Council on Graduate Medical Education (ACGME) and American Board of Medical Specialties (ABMS) are reviewed. A potential survey of forensic psychiatry fellowship program directors to validate Dr. Pinals' proposed developmental model is described.

Commentary: general residency training--the first forensic stage

Training in Forensic Psychiatry, as described by Dr. Pinals, requires the gaining of knowledge, expertise, and confidence as part of a process of professional transformation and identification with a new psychiatric role. Training in General Psychiatry does, however, include placing the resident in situations and roles that are either formally forensic in nature, or at least, forensic-like. We will argue that these experiences from general training can be used by forensic supervisors to help ease the resident into the forensic role by building on the resident's existing expertise and making the forensic environment less foreign.

The manualization of a treatment programme for personality disorder

BACKGROUND

The advantages of manualized psychological treatments include: the promotion of evidence-based practice, the enhancement of treatment integrity, the facilitation of staff training, and the potential replicability of treatment.

ARGUMENT

The manualization of a multi-component, multidisciplinary treatment programme for male personality-disordered offenders is described. The background to this development is explained and the treatment setting is described briefly, followed by a description of the eight treatment manuals: (1) the treatment overview, (2) Psychoeducation focusing on personality disorder diagnosis and core beliefs, (3) Trust and Self-awareness group exercises, (4) Stop and Think! -- a social problem-solving intervention, (5) Controlling Angry Aggression, (6) Controlling Substance Use, (7) Criminal Thinking/Belief Therapy, and (8) Skills for Living -- a social skills manual.

CONCLUSIONS

In addition to the original aims of manualization, this exercise has clarified the treatment programme, included less highly trained staff in the delivery of therapy and permitted the evaluation of treatment modules, thus contributing to the incremental evaluation of the overall programme. These manuals may usefully be shared with other practitioners in the field.

Subspecialization in psychiatry: third-generation programs

Psychiatry, unlike internal medicine, was slow to develop subspecialty certification. For many years, child and adolescent psychiatry was the only major subspecialty recognized by the American Board of Psychiatry and Neurology (ABPN). The situation changed in the early 1990s with the recognition by the ABPN of additional subspecialties of psychiatry including forensic psychiatry. Using the experience of the American Board of Internal Medicine as a guide, this commentary asks what comes next? What are our options as it becomes clear that there is a deepening of knowledge in the field of forensic psychiatry? Are we ready for, or interested in, the development of so-called third-generation certification programs?

Forensic psychiatry fellowship training: developmental stages as an educational framework

As an official subspecialty of psychiatry, forensic psychiatry residency training must meet the requirements established by the Accreditation Council of Graduate Medical Education. Attendant to these requirements is the expectation that graduates demonstrate core competencies in general areas common to all medical training programs but delineated for each specialty. In forensic psychiatry, trainees must learn to move from the role of healer to objective evaluator on behalf of third parties, a task that differs from general medical care and treatment. Thus, it is important for educators to maintain awareness of the experience of trainees as they adapt to forensic psychiatry, while understanding core competency requirements. This article outlines stages of development of forensic psychiatry fellows as a model for characterizing learning objectives and for supervising trainees in forensic psychiatry fellowship programs. These stages of development include (1) transformation, (2) growth of confidence and adaptation, and (3) identification and realization. Training directors and trainees can utilize this theoretical framework as a basis on which to establish parameters for core competency attainment and supervisory and assessment methods for forensic psychiatry training.

Using psychosocial interventions within a high-security hospital

Psychosocial interventions have been used for many years in caring for people with mental health problems. The few interventions that have a recognised evidence base are cognitive behavioural therapy (CBT), family interventions, and education programmes for patients and carers. The process of implementing these interventions in a forensic setting will be described and recommendations will be made for future practice.

[False forensic expertise--analysis of occurrences]

Main problems that await the modern Polish forensic psychiatry are presented. The most common mistakes made in forensic expertise are discussed and their causes are shown. The need for a change in the manner of teaching forensic psychiatry at an academic, as well as post graduate level to medical students/doctors as well as law officials, has been stressed. The criteria for calling on experts, system of control and evaluation of the expertise formulated and rules of payment to the experts--all need changing. The altered criminal structure and possibilities of putting pressure on experts through corruption, threatening or blackmail were noted. The clearly defined status of the forensic psychiatric expert gives him a guarantee of legal defence and through this an unbiased position. Giving forensic expertise is not only part of the diagnostics in forensic psychiatry. An even layout of protection, treatment and rehabilitation of psychiatrically ill criminals has to be present in this system.

Teaching forensic psychiatry to general psychiatry residents

OBJECTIVE

The Accreditation Council on Graduate Medical Education (ACGME) requires that general psychiatry residency training programs provide trainees with exposure to forensic psychiatry. Limited information is available on how to develop a core curriculum in forensic psychiatry for general psychiatry residents and few articles have been published on the topic.

METHODS

The objective of this article is to provide an overview of forensic psychiatry topics likely to be of benefit to general psychiatry residents.

RESULTS

The article is intended to be a springboard for future development of forensic curricula suitable for residents rather than a blueprint for an educational program.

CONCLUSION

Although most general psychiatry residents will not specialize in forensic psychiatry, a working knowledge of basic concepts in forensic psychiatry should be considered an important component of general psychiatry education.

Gender differences in the practice patterns of forensic psychiatry experts

In the past 25 years, the number of female forensic psychiatrists has increased dramatically. To assess whether there are gender differences in the practice patterns of forensic psychiatry experts, members of the American Academy of Psychiatry and the Law were surveyed during an annual business meeting. Women in the sample were shown to perform fewer categories of evaluation than men. Women were less likely than men to do criminal work, civil commitment/involuntary medication evaluations, and testamentary capacity evaluations, but there was no significant difference in the percentage of those performing some personal injury/disability/fitness for duty, custody, sexual harassment, or malpractice evaluations. Gender was not a significant factor in determining hourly rate. When subjects were asked to comment on whether they thought that gender was a factor in the selection of a forensic expert, 80 percent of the women, but only 41 percent of the men, believed that gender was a consideration.

Cross-cultural issues in forensic psychiatry training

OBJECTIVE

Forensic psychiatry was officially recognized as a subspecialty by the American Board of Medical Specialties in the 1990's. In 1994, the American Board of Psychiatry and Neurology (ABPN) gave its first written examination to certify forensic psychiatrists. In 1996, the Accreditation Council for Graduate Medical Education (ACGME) began to officially accredit one-year residency experiences in forensic psychiatry, which follow a 4-year residency in general psychiatry. The extra year of training, colloquially known as a fellowship, is required for candidates who wish to receive certification in the subspecialty of forensic psychiatry; since 2001, completion of a year of training in a program accredited by ACGME has been required for candidates wishing to take the ABPN forensic psychiatry subspecialty examination. With the formal recognition of the subspecialty of forensic psychiatry comes the need to examine special issues of cultural importance which apply specifically to forensic psychiatry training.

METHODS

This paper examines the current literature on cross-cultural issues in forensic psychiatry, sets out several of the societal reasons for the importance of emphasizing those issues in forensic psychiatric training, and discusses how those issues are addressed in the curriculum of one forensic psychiatry fellowship at the Medical College of Wisconsin (MCW).

CONCLUSION

While much has been written about cross-cultural issues in general psychiatry, very little has appeared in the literature on the topic of cross-cultural issues in forensic psychiatry.