European training in forensic psychiatry

Forensic psychiatry in Europe

The European Union now includes 27 member states. The Council of Europe stretches even further with 45 member states. A comprehensive definition of Europe geographically embraces all of Eastern Europe, including the western part of Russia and the western part of Turkey. Increasing mobility and national cooperation within Europe requires enhancing mutual knowledge and understanding of the context of evaluation and treatment of mentally disordered offenders and similar individuals who manifest antisocial behaviour and violence. A recent study confined to the previous 15 member states of the European Union provides a useful baseline for subsequent European comparisons (Salize & Dressing, 2005).

Forensic psychiatry in Europe: The perspective of the Ghent Group

OBJECTIVE

The Ghent Group was established in 2004 as a forum for forensic psychiatrists from different countries in Europe in order to bridge the gaps in knowledge, experience, practice and care which exist between them due to their different legal traditions and constitutions in dealing with people having mental disorders who come into conflict with the law.

METHODS

The Ghent Group considers itself as a loosely organised think tank to which all interested and invited professionals can contribute without statutory restraints. Its aim is to facilitate communication with mentally disordered offenders appearing in court, to understand the procedures of our neighbouring countries and to find common ground between clinicians.

RESULTS

The major focus of the Ghent Group is on teaching and training both at a national level, where one can learn about the methods of training from each other, and at a European level. The group of trainees from different countries experiment in seminars in solving medico-legal cases considering European Human Rights issues and their respective national procedures and institutions.

CONCLUSIONS

This helps not only to understand the differences between the national medico-legal procedures but also to deepen the understanding of the principles and practice in one's own country.

What about forensic psychiatry as a career? Undergraduate and early post-graduate medical perspectives

BACKGROUND

Medical students in the UK are encouraged to plan their career earlier than ever before. What do they need to do that?

AIM

To explore the roles of the undergraduate curriculum and the foundation programme from the perspective of a foundation trainee looking towards a career in forensic psychiatry, and to conduct a pilot survey of undergraduates and early trainees about their knowledge and wishes with respect to forensic psychiatry.

FINDINGS

A fifth of those given a questionnaire responded. Among 36 responders, 14 were considering a career in forensic psychiatry. Some of the remainder did not know about the option at all; no one felt that they had sufficient information about this career option.

CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

This was a pilot study with a low response rate, and confined to Wales, so the findings must be regarded with caution. Nevertheless, it does appear that a concerted effort by medical schools and relevant professional bodies to provide more information and encouragement to trainees at an early stage would be likely to support recruitment to the specialty of forensic psychiatry.

Teaching forensic psychiatry in Europe

BACKGROUND

Forensic psychiatry was long regarded as sufficiently defined by the laws of a country to be restricted by national boundaries in all but a few areas. European Union (EU) employment rights and travel facilities have changed that within the EU.

AIMS

The goal of this research is to explore the role and development of a network of teachers and trainees in forensic psychiatry.

INFORMATION AND DISCUSSION

European Union countries differ widely in the extent to which they recognise forensic psychiatry as a specialty and thus also in the amount of training clinicians receive before they present themselves as expert witnesses in court, or develop or run services, or manage and treat individual offender patients. Nevertheless, a summer seminar for practicing clinicians, who also present evidence to court and for bodies considering discharge of potentially dangerous patients, has proved a useful forum for joint 'European learning'. Participants have left with a sense of improved understanding of their own law and practices as well as new perspectives on what works for offenders with mental disorder.

The role of forensic psychiatry in mental health systems in Europe

BACKGROUND

Forensic psychiatry at first glance seems to differ from one country to another due to different historical developments, different legal systems and different mental health systems. In spite of that, forensic psychiatry has several goals shared across countries, principally: assurance of treatment for severely mentally ill people who become delinquent; giving evidence to courts in cases when the offender's mental responsibility is in question; working effectively at the interface of the law and psychiatry, and, in so doing, working well with other clinical and non-clinical professionals in the field; preventing relapse of offenders with mental disorder. In order to achieve these goals, special knowledge and skills must be developed, especially in assessment and management of violence and sexual deviance and of the risk of these behaviours, incorporating techniques developed in neighbouring disciplines. One of the greatest challenges in the development of forensic psychiatry lies in its relationship with general psychiatry. It is arguable that the specialization of psychiatry into sub-specialties has lead to loss of some skills in general psychiatry and to a 'forensification' of people who would previously have been treated as general psychiatry patients.

AIMS

In partnership, however, general and forensic psychiatrists could potentially achieve more than either group on its own: they could better prevent people with mental illness from becoming offenders; prevent people with mental illness from becoming victims of crime; intervene in the vicious circle from victim to perpetrator; assess young people at risk for antisocial behaviour and protect them from becoming criminals. Clinical research on these topics is just beginning and this article argues for a close integration of forensic psychiatry into the wider mental health system and for a more intensive exchange of knowledge and skills from forensic psychiatry to general psychiatry and vice versa.