Searching for the Whole Truth: Considering Culture and Gender in Forensic Psychiatric Practice

Contemporary forensic psychiatrists practice in a system that has gender and cultural biases. Though we are only one small piece of the criminal justice system, learning about cultural and gender concerns is critical so that we properly engage and fulfill our mission of striving toward objectivity. Paternalism or chivalry are not the answer when faced with gender questions, as presuming color-blindness is not the answer when faced with cultural questions. Rather, we need to examine our own biases and educate ourselves. Many opportunities for teaching and public health exist in our field, each of which can help address these challenges on a larger scale as well.

A Multi-Site Survey of General Psychiatry Residents' Forensic Training

The authors surveyed general psychiatry residents across the United States to better understand residents' experiences with forensic training and to identify variables with the greatest impact on residents' exposure to, comfort with, and desire to learn more about forensic populations and settings. The survey inquired about these topics and the forensic psychiatry resources available at residents' training institutions. Respondents (n = 129) spanned eight of ten U.S. census regions. Residents' comfort with forensic psychiatry was low, whereas desire to learn was high. Residents' number of exposures and comfort increased with greater forensic experience in residency. Fewer than half of residents had completed a forensic rotation, were required to complete a forensic rotation, or had robust forensic resources available to them. Residents who had completed a dedicated forensic rotation had significantly greater forensic exposures and comfort; a finding that remained significant even after controlling for participants' PGY status. Among residents pursuing fellowship training, residents interested in forensic fellowship had more exposures during residency. This study represents the first published effort to survey general psychiatry residents from multiple residency programs regarding their forensic experiences in training. These results have implications for educators interested in developing broader exposure to and comfort with forensic psychiatry.

Toward a New Model of Training in Canadian Forensic Psychiatry

The Royal College of Physicians and Surgeons of Canada has recently introduced a new model of training for residents and fellows in all specialties and subspecialties, including forensic psychiatry. This model, Competence by Design, is intended to improve the training of residents with the goal of increasing the competence of practicing specialists. In the Competence by Design model, training is broken down into four distinct phases. Residents prompt their supervisor proactively when they are ready to be assessed on a specific task, and the feedback is specific and corrective. A resident's performance of each designated task is reviewed by a competency committee, which decides when the trainee is ready to move on to the next phase. In this article, we review some of the problems with the current model of training and explore how this new model will improve upon this training. We anticipate that this model will prove effective at improving training in forensic psychiatry.

Variations in Application Instructions for Forensic Psychiatry Fellowships

OBJECTIVE

In this study, the authors examined the consistency and the transparency of application instructions for forensic psychiatry fellowships in the USA.

METHODS

The authors collected the names of US forensic psychiatry fellowships listed in the Directory of Forensic Psychiatry Fellowships maintained by the American Academy of Psychiatry and the Law. Using data from active fellowship websites, the authors extracted for each program: (1) timelines for applications and interviews, (2) whether an application form was supplied, and (3) the presence of specific application requirements (e.g., curriculum vitae, personal statement, letters of recommendation, residency training director evaluations, writing samples).

RESULTS

Among 45 fellowship websites, 31 (68.9%) did not provide specific dates or months when their application cycle opened, nor did they indicate whether they accepted applications on a rolling basis. Fourteen (31.1%) did not have an application form, and 8 (17.8%) did not list application requirements. Among 37 programs that listed specific requirements on their websites, 36 (97.3%) required a curriculum vitae or letters of recommendation, 35 (94.6%) required a personal statement and/or letter of interest, and 27 (73.0%) required writing samples and/or evaluation materials from residency program directors.

CONCLUSIONS

This study found considerable variations among online application instructions for US forensic psychiatry fellowships. Although many factors shape recruitment into forensic psychiatry fellowships, improving the consistency and the transparency of application instructions might decrease stress related to the application cycle and streamline recruitment into the field.

A Review of Forensic Fellowship Training: Similar Challenges, Diverse Approaches

OBJECTIVE

As the specialty of forensic psychiatry and the numbers of justice involved individuals with mental illness continue to grow, forensic education is receiving more attention. To add to this discussion, the authors reviewed current training practices in forensic psychiatry fellowship programs.

METHODS

As part of a project funded by the state legislature looking at psychiatry and psychology training, with special focus on state hospital partnerships, the authors interviewed and surveyed forensic psychiatry fellowship program directors and conducted site visits to select programs. Given the mandate, special attention was given to programs with state hospital and psychology training affiliations.

RESULTS

The literature and fellowship directors identified several key features and challenges for forensic training programs. Forensic fellowships focused primarily on evaluations and consultations but differed in their offerings related to training in treatment, scholarship, and particular types of evaluations. Common concerns included maintaining adequate funding, variety of training experiences, adequate faculty time, and adequate institutional support. Directors described cultivating institutional support by demonstrating mutual benefit as particularly important for securing resources.

CONCLUSION

Forensic fellowships operational during the 2016-2017 academic year offered a range of forensic training activities, but experienced common challenges such as inadequate funding and faculty supervision. Empirical studies are needed to evaluate the relationship between programmatic offerings, the noted challenges, and acquired competencies.

Examining the Past and Advocating for the Future of Forensic Psychiatry Training

The American Academy of Psychiatry and the Law (AAPL) has been devoted to the teaching of forensic psychiatry, and as AAPL celebrates its 50th Anniversary, it seems fitting to examine the history and the current status of forensic psychiatry teaching in general psychiatry residencies and forensic psychiatry fellowships. After a brief review of the history of AAPL and forensic psychiatry training, this article explores the current state of graduate medical education (GME) in the United States, the growing popularity of psychiatry as a specialty and forensic psychiatry as a subspecialty, the Accreditation Council for Graduate Medical Education's requirements for forensic training, and the methods currently used to teach forensic psychiatry to general psychiatry residents. This article also examines the current status of forensic psychiatry fellowship training in the United States. Finally, future challenges to forensic training in both residencies and fellowships will be discussed, as well as the need for AAPL and others in the profession to advocate for increased forensic teaching in a manner that leads to the production of both general and forensic psychiatrists who are competent to practice independently and who are sufficient in number to meet the growing demands for forensic expertise.

Teaching Forensic Concepts to Residents Using Interactive Online Modules

Psychiatrists without specialty forensic training routinely encounter forensic questions and treat justice-involved patients, which underscores the importance of adequate forensic training in general psychiatry residency. Some programs may face challenges providing adequate forensic instruction due to a lack of local forensic psychiatrists or other forensic resources. Novel training approaches are needed to fill this gap. This article describes the development, dissemination, and preliminary impact of two online learning modules designed to teach general psychiatry residents about basic forensic psychiatry principles: confidentiality and the duty to third parties. The modules are based on adult learning theory and synthesize clinically relevant vignettes from historically significant legal cases. We disseminated the modules nationally with built-in pre-tests and post-tests. The module responses demonstrate three significant themes: the modules reached learners across the United States; even advanced residents had relatively low subject matter knowledge prior to module completion; and module completion was associated with a significant improvement in resident learners' knowledge of these two topics. This work shows one potential avenue for filling gaps in forensic education within general psychiatry training, although further studies are needed to appreciate the impact of such educational interventions on clinical practice.

Practice Resource for Forensic Training in General Psychiatry Residency Programs

Full Document: Alonso-Katzowitz JS, Cardasis W, Cerny-Suelzer CA, et al: Practice Resource for Forensic Training in General Psychiatry Residency Programs. Journal of the American Academy of Psychiatry and the Law Online Supplement 2019, 47 (1). Available at: http://www.jaapl.org/content/47/1_Supplement.

A Seat at the Table

Organized medicine and psychiatry have a long tradition of governmental advocacy and public engagement. The American Academy of Psychiatry and the Law (AAPL), since its founding 50 years ago, has made some forays into these fields. However, its involvement has been less substantial than other similarly situated professional organizations. With its increasing membership and expertise, AAPL now possesses the capacity to dedicate some of its organizational attention, energy, and resources to educating policymakers and the public on current and future topics related to forensic mental health. In addition, an increasing number and type of professional activities related to this discipline are affected by governmental regulation and public opinion. Therefore, the need to become involved in shaping policy is more urgent, particularly in light of the fact that other forensic mental health organizations have been actively involved in governmental advocacy for decades. Finally, as a field and in the near future, we likely will deal with life-changing technological innovations related to the practice of forensic psychiatry. AAPL and its members are perhaps uniquely qualified and have a responsibility to help ensure that these innovations are developed, implemented, and utilized appropriately. This can only be accomplished by having a proverbial seat at the table in the process.

The Benefits of Required Forensic Clinical Experiences in Residency

OBJECTIVE

The growth of forensic psychiatry has spurred efforts to improve forensic psychiatry training in general psychiatry residency. The Accreditation Council for Graduate Medical Education requires that residencies provide an experience that "exposes" residents to forensic issues, but leaves the specifics to individual programs. However, there is growing need for psychiatrists to understand the unique circumstances of individuals with mental illness involved in the criminal justice system.

METHODS

The authors developed a new mandatory forensic rotation for general psychiatry residents and conducted a pilot study to assess its impact on residents' interest and comfort working with criminal justice-involved patients, interest in forensic fellowship, and knowledge of available resources for consultation and supervision.

RESULTS

Rotation completion was associated with a significantly increased interest in working with forensic populations and pursuing forensic fellowship, but no changes in residents' level of comfort or knowledge of supervisory and consultative resources.

CONCLUSIONS

This study adds to the growing body of literature describing the benefits of expanding forensic education for residents.

[Development of a forensic psychiatric curriculum in Belgium and the Netherlands]

Forensic psychiatry attracts considerable attention from media and politicians. All psychiatrists, not only those working in the forensic field, should be able to evaluate safety for society on the one hand and qualitative health care for psychiatric patients on the other. However, little attention is paid to specific forensic issues, in both psychiatric training and in medical school.<br/> AIM: To map relevant topics for a forensic psychiatric curriculum in medical schools and psychiatric residency training.<br/> METHOD: The main findings regarding educational topics in forensic psychiatry are discussed based on policy papers and scientific articles.<br/> RESULTS: Four important topics should be covered in general psychiatric training, i.e. mental health legislation, risk assessment and management, professionalism and ethics, and expert witness training. The Netherlands has a specific training programme for psychiatrists interested in expert report writing and testimony for criminal courts. In Belgium, psychiatrists can acquire specific professional competence in forensic psychiatry.<br/> CONCLUSION: Acknowledgement of the above-mentioned topics in the general medical and psychiatric curriculum will lead to better knowledge and competencies for all psychiatrists, both in Belgium and the Netherlands. Continuing attention and evaluation will be necessary given the high societal relevance.

The Barriers and Benefits to Developing Forensic Rotations for Psychiatry Residents

Psychiatry residents' experiences in forensic psychiatry vary greatly across the country, and many psychiatry programs meet the Accreditation Council for Graduate Medical Education requirements for a forensic experience through general psychiatry rotations (e.g., on a consult-liaison service) or classroom-based activities. Forensic clinical experiences during psychiatry residency are important for preparing future general psychiatrists for practice with justice-involved patients, generating interest in forensic psychiatry, and easing the transition from "healer to evaluator" for future fellows. Unfortunately, residency programs interested in expanding their forensic training may face many challenges because of current regulatory frameworks, the nature of forensic practice, and competing demands within residency training programs. This article describes these challenges, and the experience of the authors at one institution with developing a novel forensic experience in a criminal justice diversion setting. The authors conclude with some practical considerations for educators interested in developing forensic experiences at their institutions.

Role of Forensic Psychiatry in Legislative Advocacy

Dr. Piel presents a model curriculum for elective legislative advocacy training of general psychiatry residents at the University of Washington. In this commentary, we discuss the role of the physician as a leader in legislative advocacy and emphasize the need for training in this neglected arena. We highlight the common ground between legislative advocacy and forensic psychiatry and make a case for increased involvement of forensic psychiatrists.

Legislative Advocacy and Forensic Psychiatry Training

Very few residency and fellowship programs offer mandatory or elective rotations in health advocacy. Where there are formal training opportunities, they are commonly didactic or clinical community rotations, where trainees participate in a clinically oriented project with a local community organization. Fewer programs offer specific training opportunities in legislative advocacy and the legislative process. The University of Washington assembled two task forces to advise the general psychiatry residency program on training needs in the areas of (1) Forensic Psychiatry and (2) Advocacy and Public Policy. Both task forces identified, as an aspirational goal, resident involvement in legislative and regulatory processes as means of advocacy. This article describes a model curriculum in legislation developed at the University of Washington that is suitable for trainees at different stages in their professional development (including residents and fellows), and an explanation of how the curriculum supports training in forensic psychiatry. Challenges in creating the elective training opportunity are also discussed.

Forensic Psychiatry Milestones: Experience After 1 Year

OBJECTIVE

In 1999, the Accreditation Council for Graduate Medical Education (ACGME) and the American Board of Medical Specialties identified six core competencies for medical practice. In 2013, the milestones were introduced to demonstrate these educational outcomes across each specialty. This study represents the first examination of the sub-specialty Forensic Psychiatry Milestones.

METHODS

Members of the Association of Directors of Forensic Psychiatry Fellowships were surveyed. Areas of inquiry included whether milestones assisted in identifying areas of deficiency in fellows or programs, whether the graduation milestones matched the goals of training, and what changes were planned, or had been made, based on their implementation.

RESULTS

Twenty-six of 35 programs responded, for a response rate of 74%. The majority found the milestones somewhat or very useful, half found the graduation-level milestones matched the program's graduation goals, and a significant majority reported that the milestones assisted in identifying improvements, change, or intended change. In choosing terms to describe the milestones, however respondents chose a variety of negative or neutral terms, rather than positive ones.

CONCLUSIONS

The milestones provided a standard mechanism for identifying areas for improvement and a common language to standardize practice. However, due to the variability across fellowship programs and the limitations of educational resources and time, implementation of the new ACGME requirement was characterized in largely negative terms. Recommendations for improvement included modification of the milestones themselves, flexibility in their implementation, and evidentiary support for their use.

Evidence for Greater Forensic Education of all Psychiatry Residents

Booth and his colleagues have made an important contribution to the emerging evidence base that shows education in forensic psychiatry topics can improve attitudes toward the field. Given the desinstitutionalization of those with severe mental illness from state psychiatric facilities and the incarceration of many individuals with severe mental illness in correctional facilities, the need to train many more psychiatrists with competence in correctional settings is clear. Simply training more forensic psychiatrists will not both meet the psychiatric needs of incarcerated patients and fulfill the essential roles forensic psychiatrists play in the justice system. Therefore, it is essential that all psychiatry residency programs include time allotted to forensic psychiatry just as time is allotted to the other major subspecialties, including child and adolescent psychiatry, addiction psychiatry, geriatric psychiatry, and psychosomatic medicine. It is likely that the only way to achieve this necessary outcome is through advocacy for the Accreditation Council for Graduate Medical Education (ACGME) to mandate a rotation in forensic psychiatry, for psychiatry residency programs to be accredited.

Implications of the Group Model of Supervision and Consultation in Forensic Training

The clinical case conference has been a hallmark of undergraduate and graduate medical education for decades and affords attendees the opportunity to hear about interesting and difficult cases and to learn from a discussion of the complexities of diagnosis and treatment. In forensic psychiatry, the complexities in a case conference also extend to the formation of a forensic opinion. The application of the clinical case conference to forensic psychiatry has not been described in the literature, although many fellowship programs engage in this activity. In the forensic arena, special ethics concerns may arise regarding confidentiality, dual agency, and conflicts of interest. In this commentary, we discuss the implications of using the group approach to supervision and consultation outlined by Buchanan et al., as it relates to professional development and understanding of ethics among forensic psychiatry trainees. We also discuss the usefulness of this type of group consultation in faculty development, including the satisfaction of the Accreditation Council of Graduate Medical Education's (ACGME) Common Program Requirements and, potentially, one part of the Maintenance of Certification requirements of the American Board of Psychiatry and Neurology, Inc.

Educating jurors about eyewitness testimony in criminal cases with circumstantial and forensic evidence

We investigated whether the Interview-Identification-Eyewitness factors (I-I-Eye) educational aid could sensitize mock jurors to the quality of eyewitness evidence in criminal cases which also contained circumstantial and forensic evidence. After participants were randomly assigned to read either the I-I-Eye or a control aid, they read a trial transcript containing either strong or weak eyewitness evidence. The police consistently followed scientific interviewing and identification procedures in the strong case, but not in the weak case. In two experiments, the I-I-Eye participants were approximately three times more likely than the control participants to enter guilty verdicts in the strong case than in the weak case. Thus the I-I-Eye educational aid increased participants' sensitivity to the eyewitness evidence. The I-I-Eye method provides a valuable analytical framework for evaluating eyewitness evidence in criminal cases. It may be capable of becoming "a standard feature for criminal cases" with eyewitness evidence.

Impact of Repeated Questioning on Interviewers: Learning From a Forensic Interview Training Project

Forensic interviewers have a difficult job with high risk for career burnout and secondary trauma. Few studies have addressed how new forensic interviewers or trainees experience repeated questioning and multiple interviews. This study simulated the process of training new forensic interviewers through the creation of two interview videos in which social work graduate students participated as actors portraying the roles of interviewer and child. These films served as instructional aids preparing graduate social work students for professional child welfare roles while promoting research-based approaches to interviewing children about sexual abuse allegations. Qualitative data from two cohorts of student actors were collected to analyze interviewers' perspectives on repeated questioning and interviews in child sexual abuse cases. Two themes were extracted from the subjects' experiences: "It is emotionally taxing" and "Navigating the interviewer role is unexpectedly complex." Exposure to repeated questions and multiple interviews affected the performance and confidence of the interviewers.

The Mock Trial: Revisiting a Valuable Training Strategy

The number of forensic psychiatrists has increased dramatically over the past 40 years. With this welcome development has also come some challenges for educating future generations of practitioners, specifically the greater demands on training programs and the need to divide practice hours among a larger pool of individuals. Junior trainees and experienced practitioners alike can benefit by supplementing work experience with well-designed, theoretically informed simulations. In this article, the theoretical perspectives of simulation, deliberate practice, and experiential education are discussed and linked to the design of mock trials, a form of simulation used to teach the essential skill of expert testimony. My argument is that, by explicitly linking the mock trial to learning theory, its efficacy and range of application can be increased. I provide recommendations for effective design and application.

Child sexual abuse research knowledge among child abuse professionals and laypersons

The purposes of this study were to: (1) Assess child abuse professionals' and nonprofessionals' knowledge of scientific research findings that are relevant to forensic child sexual abuse (CSA) evaluations and (2) describe associations between child abuse professionals' levels of research knowledge and their education and experience. An 18-item multiple-choice test was administered to 188 child abuse professionals and 457 nonprofessionals (undergraduate college students) in Brazil and the United States. The nonprofessionals' average percent correct, M=44%, was not significantly different than what would be expected for random guessing (45%). The professionals' average percent correct, M=55%, was higher than that of nonprofessionals and random guessing (both ps<.001). The average percent correct score for the US-sample psychologists, M=76%, was higher than the average score of the other professionals, M=51%, p<.001. Professionals' educational level, as measured by the highest academic degree obtained, was positively associated with percent correct scores, Spearman's ρ=.46, p<.001. Controlling for educational attainment, professional experience, as measured by the total number of CSA evaluations performed, was weakly associated with percent correct scores, partial r=.15, p=.04. Percent correct scores were low for both nonprofessionals and professionals. Most of the participants in this study were uninformed or misinformed about scientific research findings that are important for conducting optimal forensic CSA evaluations and for making accurate judgments about the validity of sexual abuse allegations.

[The Institute Philippe-Pinel and the department of Psychiatry of the University of Montreal: intricate paths]

The Institute Philippe-Pinel (IPPM) and the Département de psychiatrie de l'Université de Montréal, who are both celebrating their 50 years, have intricated paths and a long history of collaboration. Since its conception (1964), the Institute Philippe-Pinel was planned to become a site for training and teaching in the bosom of the Université de Montréal.Unique in its mission to offer state of the art psychiatric care and forensic assessments to patients presenting a high risk of violence, the Institute Philippe-Pinel, throughout the years, was also able to leave its mark by the way of academic teaching to psychiatric residents and trainees of all disciplines, of organizing national and international conferences, of research and by the publication of numerous articles and books in the field of forensic psychiatry.With, from its beginning, psychiatrists at its helm, the Institute Philippe-Pinel has at all times greatly contributed to the academic activity of the department. Highly committed psychiatric clinicians and professors were always involved at all levels of the psychiatric department. With the coming of the forensic subspecialty, the commitment and influence can only continue.

Training directors' self-assessment of forensic education within residency training

OBJECTIVE

The authors provide information pertaining to forensic education within psychiatry residency based upon training directors' self-assessment of their programs, utilizing the 2007 ACGME program requirements for forensic psychiatry as an assessment guideline.

METHODS

A sample of 100 general psychiatry residency training directors from 182 training programs in the USA were selected by a random number generator to complete a survey to evaluate forensic training provided within their residency programs.

RESULTS

Seventy-one percent of the 100 surveyed training directors completed and returned the questionnaire. Ninety-three percent of training director respondents reported their program meets the ACGME program requirements for graduate medical education in forensic psychiatry. The forensic topics covered most thoroughly in general psychiatry training are involuntary civil commitment and violence risk assessment. The topics covered least thoroughly include exposure to courtroom testimony, writing a forensic report, and evaluating a defendant's criminal responsibility. The respondents further indicated most forensic psychiatry topics are covered more extensively through educational exposure than through clinical exposure.

CONCLUSIONS

Greater effort may be required to emphasize clinical and educational exposure to certain forensic psychiatry topics during the course of general psychiatry residency training, to ensure that the forensic topics of greatest importance are appropriately addressed.

General psychiatric residents and corrections: moving forensic education beyond the classroom

Mental illness in the criminal justice system is one of the most important and underserved public health challenges in psychiatry today, but few general psychiatry residency programs offer clinical education in correctional psychiatry. Developing such rotations might seem intimidating to educational leaders unfamiliar with the criminal justice system, but a variety of potential solutions exist for residency programs to offer this increasingly important clinical training.

Forensic mental health assessment in France: recommendations for quality improvement

The quality of forensic mental health assessment has been a growing concern in various countries on both sides of the Atlantic, but the legal systems are not always comparable and some aspects of forensic assessment are specific to a given country. This paper describes the legal context of forensic psychological assessment in France (i.e. pre-trial investigation phase entrusted to a judge, with mental health assessment performed by preselected professionals called "experts" in French), its advantages and its pitfalls. Forensic psychiatric or psychological assessment is often an essential and decisive element in criminal cases, but since a judiciary scandal which was made public in 2005 (the Outreau case) there has been increasing criticism from the public and the legal profession regarding the reliability of clinical conclusions. Several academic studies and a parliamentary report have highlighted various faulty aspects in both the judiciary process and the mental health assessments. The heterogeneity of expert practices in France appears to be mainly related to a lack of consensus on several core notions such as mental health diagnosis or assessment methods, poor working conditions, lack of specialized training, and insufficient familiarity with the Code of Ethics. In this article we describe and analyze the French practice of forensic psychologists and psychiatrists in criminal cases and propose steps that could be taken to improve its quality, such as setting up specialized training courses, enforcing the Code of Ethics for psychologists, and calling for consensus on diagnostic and assessment methods.

The educational mission in forensic publishing

Organizing frameworks that affect medical education include requirements for residency education set out by the Accreditation Council for Graduate Medical Education (ACGME), board certification requirements of the American Board of Psychiatry and Neurology (ABPN), and requirements of the Accreditation Council for Continuing Medical Education (ACCME) for awarding continuing medical education (CME) credits. Physicians rely on a variety of sources to meet these requirements, including medical journals. It is unclear, however, whether journals actually assist physicians in meeting these educational requirements. In this review of articles, we make the first known attempt at a systematic comparison of an academic journal's content areas to national standardized educational indices for physicians. Findings from the 2008 to 2012 content of The Journal of the American Academy of Psychiatry and the Law demonstrated that The Journal's articles cover the gamut of board certification examination topics, although content areas are not weighted in parallel with the examination. Some overlap and differences were seen when comparing journal content with ACGME topic areas. The Journal appears to meet identified gaps in knowledge that CME can address. The importance of balancing readers' educational needs with the ability to provide a resource for unique topics is discussed, along with other implications of these findings.

Forensic child and adolescent psychiatry: from field experiences to education standards

OBJECTIVE

Forensic evaluation of children is one of the most problematic areas of child and adolescent psychiatry. In this study we aimed to examine Turkish Child and adolescent psychiatrists' attitudes and problems in forensic psychiatry.

METHOD

Thirty nine (80%) of all practitioners who are on their compulsory medical service programme countrywide were reached and requested to complete a questionnaire.

RESULTS

76.9% of the specialists found their education to be inadequate in dealing with practical issues. The most common reason of this inadequacy was endorsed as not receiving structured forensic evaluation training. The inadequate number or skills of health professionals from other disciplines and excessive workload were the leading factors mentioned as negatively affecting the quality of assessments. Most favoured solutions to solve current problems were reported as reorganising the residency training and curriculum of child and adolescent psychiatrists and establishing education programmes for other disciplines.

CONCLUSION

The standardisation of forensic psychiatry education in child and adolescent psychiatry training and the establishment of global standards for forensic evaluation teams and processes should be considered as the first steps in enhancing the global quality of child and adolescent forensic psychiatric evaluations.

[Development of forensic psychiatry in Serbia]

The development of legislation in the field of mental health in our region is linked with the emergence and development of the oldest psychiatric hospitals in Serbia.The principle that the mentally ill who committed a criminal offense need to be placed in a psychiatric hospital instead of a prison was introduced at the same time as in the most developed European countries. The founders of the Serbian forensic psychiatry, Dr. Jovan Danić, Dr.Vojislav Subotić Jr. and Dr. Dusan Subotić, were all trained at the first Serbian Psychiatric Hospital ("Home for the Unsound of Mind") that was founded in 1861 in the part of Belgrade called Guberevac. Their successors were psychiatric enthusiasts Prof. Dr.Vladimir F.Vujić and Prof. Dr. Laza Stanojević. A formal establishment of the School of Medicine of Belgrade, with acquirement of new experience and positive shifts within this field, based on the general act of the University in 1932, led to the formation of the Council of the School of Medicine, which, as a collective body passed expert opinions. Thus, the first Forensic Medicine Committee of the School of Medicine was formed and started its activities in 1931 when Forensic Medicine Committee Regulations were accepted. After the World War II prominent educators in the field of mental health, and who particularly contributed to further development of forensic psychiatry in Serbia were Prof. Dr. Uros Jekić, Prof Dr. Dusan Jevtić, Dr. Stevan Jovanović, Prof. Dr. Borislav Kapamadzija, Prof. Dr. Maksim Sternić, Prof. Dr. Josif Vesel and Prof. Dr. Dimitrije Milovanović.

The role of university-based forensic clinics

As forensic psychiatry and forensic psychology have grown and matured, the range of specialized services provided by each has expanded. In addition to traditional services such as forensic mental health assessments in criminal, family, and civil contexts, forensic specialists are now involved in delivering services in the community that include (in the criminal justice context) assessment for diversion into specialized probation or problem-solving courts, rehabilitation needs upon reentry (including specialized parole), and risk assessment for particular populations such as sexual offenders. Specialized forensic treatment services include those provided to clients under the jurisdiction of problem-solving courts or parole/probation. Similar specialized assessment and treatment services may be provided for juveniles. The nature of such service needs underscores the importance of the university-based forensic clinic as one source of specialized forensic services in the community. Such clinics are based in universities, directed by supervising faculty, and offer services provided in part by forensic trainees (psychiatric residents and forensic fellows; psychology doctoral students, interns, and post-doctoral fellows). The structure and operations of such clinics are described, with different models provided. Implications for specialized training, forensic practice, and research are discussed.

No worries, mate: a forensic psychiatry sabbatical in New Zealand

Sabbaticals were initially intended to take place one year of every seven and to provide an opportunity for study or travel. Psychiatrists rarely take sabbaticals, but they can be of tremendous value in widening professional and personal horizons. It is not merely the psychiatrist taking the sabbatical who reaps the benefits, but also the home institution and patients. Sabbatical-takers have an opportunity to learn across cultures, to experience a new system of medical care, and to develop a less provincial view of their work and indeed their place in the world. A sabbatical can be a time of substantial accomplishments, such as writing or reorganizing programs. In this article, the benefits of a forensic psychiatry sabbatical experience in New Zealand are described.

Selling forensic psychiatry: recruiting for the future, establishing services

BACKGROUND AND AIM

The Ghent Group - a group of European forensic psychiatrists - has discussed ways of informing fellow professionals and the wider public about their difficult and frequently misunderstood discipline, agreeing that the specialty may have to be 'sold' to those who pay for it and use it. Our aim was to consider the areas where this commonly occurs and the strengths and pitfalls of such promotion.

DISCUSSION

Forensic psychiatrists need to be effective, accurate communicators. For court work, they need special training. High standards of work are the best selling technique. Outside court, the greatest challenge for forensic psychiatry is to reduce its stigma - it can easily be construed, wrongly, as excusing serious anti-social behaviour. Special attention should be given to writing for a wider audience, not just the inner circle of practitioners. Electronic social media should also be deployed for this task. Those who provide funds for academic work should be specifically but differently targeted. They need to be persuaded of the scientific merit of the subject.

ETHICS

Temptation to claim more for the discipline than can be justified have to be resisted. An English case that led to a miscarriage of justice illustrates this. The limitations of science here have to be understood. Philosophical questions relating to responsibility and culpability cannot be resolved by physical science alone. Misuse neuroimaging in court, for example, can lead to miscarriages of justice.

CONCLUSION

Selling forensic psychiatry to public and professionals is difficult but essential to counter anti-forensic psychiatry movements that have emerged. The discipline needs to persuade others of its unique skills and embrace good science, compassion, public duty and ethical practice. It needs to treat with politicians and funders as well as the medical, psychological and legal professions.

Training in forensic psychiatry when no nationally recognised scheme exists

BACKGROUND

In some European countries, forensic psychiatric training is formalised within a psychiatric framework. In others, the approach is radically different, but the end result may be a practitioner who is qualified to practise forensic psychiatry in all European jusrisdictions.

AIM

The aim of this study is to describe the context of training to work with offender-patients in Spain.

INFORMATION AND DISCUSSION

There is no nationally recognised training scheme in forensic psychiatry in Spain but rather a dichotomy between legal doctors, trained to assess offenders and provide reports for the courts but not necessarily in psychiatry, and psychiatrists, trained in clinical management and treatment but not necessarily in relation to offender patients. This dichotomy arose as training pathways diverged historically, legal medicine being the older discipline. In this system, the courts are always assured of an independent medical opinion, although treating psychiatrists would generally advise on release decisions. Almost all offender-patient treatment is in prisons. The system is heavily dependent on the goodwill and drive of practitioners who seek to provide themselves with dual skills in the absence of national guidance and support for such training.

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.