What is forensic psychiatry?

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Forensic Mental Health: An Overview
What is Forensic Psychiatry? Forensic Psychiatry is a specialized branch of psychiatry where the medical and the legal worlds overlap. It is a fascinating sub-specialty that involves the application of medical psychiatric expertise in legal contexts.
The forensic psychiatrist practices in a broad multi-disciplinary environment, working with both health care professionals (nurses, social workers, psychologist, other medical specialties) and professionals from legal and/or non-medical arenas (lawyers, courts, correctional officers, parole officers). The work environment is similarly diverse: hospitals, general office practice, correctional facilities, courts. In most cases, traditional hospital practice forms only a small component of the forensic psychiatric practice.
What does Forensic Psychiatry deal with?
The field is comprised of three distinct but overlapping areas that deal with different issues:
§ Forensic Psychiatry:
Criminal Areas:
– Expert Witness/Testifying
– Dangerous or Long Term Offender Applications
– Fitness to Stand Trial
– Probation and Parole
– Review Boards
Civil Areas:
– Divorce & Custody Evaluations
– Negligence & Malpractice
– Personal Injury
– Workman’s Compensation Boards
– Workplace Violence
Clinical Criminology
– Developmental Delay Issues within the forensic mental health framework
– Impulse Control Disorders
– Interpersonal Violence
– Major mental illness within the forensic framework (psychosis, schizophrenia, mood disorders, etc)
– Paraphilias & Sex Offending
– Personality Disorders with the forensic mental health framework
– Psychopathy
– Substance Abuse within the forensic mental health framework
– Risk Assessment & Risk Management
– Treatment Programming within the forensic mental health framewor
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§ Psychiatry & Law
– Capacity: to consent to treatment, to manage property, to consent to emergency treatment, etc.
– Community Treatment Orders
– Consent
– informed, consent to treatment, etc.
– Consent & Capacity Board
– Confidentiality of Patient Records
– Duty of Care
– Duty To Warn
– Involuntary Hospitalization
– Mental Health Act, in general
– Patient Rights under the Mental Health Act
– Substitute Decision Making
Although the area is highly specialized and requires a specific knowledge that transcends the boundaries of general mental health, a solid grounding in general psychiatry and major mental illness is essential for those working in the field.
Who Works in Forensic Psychiatry? A number of other professionals work within the broader scope of Forensic Mental Health, each certified by their own professional governing bodies: forensic psychologists, social workers, nurses, psychometrists, occupational therapists, behavioral therapists, recreational therapists, and others.
Nurse Practitioners in Forensic Psychiatry? Forensic nursing may well be the fastest growing nursing specialty in the world, generating interest among both practicing and prospective nurses. A field with many subspecialties, forensic nursing has already spawned new roles and careers for many nursing professionals with an interest in the law. Educational opportunities in forensic nursing at many levels — certificate, Master’s degree, doctoral, or nurse practitioner — are also on the rise.
This good news for nurses is tempered by irony because the need for more forensic nurses stems from an epidemic of global poverty, violence, and crime. The zone where healthcare needs intersect with the law is expanding, and forensic nurses have stepped in to become leaders in the healthcare response to violence.
The Blending of Nursing, the Law, and Forensic Science: Long before holding the designation of forensic nurse, nurses provided care to the victims and perpetrators of violence. History reveals that in the 14th century, midwives performed gynecologic examinations for evidence of pregnancy or virtue, and then testified before the King’s court. Fast forward to 1984, when forensic nursing trailblazer Virginia Lynch conceived a discipline based on forensic nursing science, to formally educate nurses to provide the services they were already expected to provide. As the first nurse (and first woman) death scene investigator in a rural Texas jurisdiction, Lynch quickly realized that “every nurse I knew needed to be taught the things I was learning.” Like Lynch, most early forensic nurses had to forge their own roles and educational experiences. In 1992, the newly established International Association of Forensic Nurses brought forensic nurses together under the leadership of founding President Virginia Lynch.
An early emphasis on the care and assessment of sexual assault victims rapidly evolved to include almost every healthcare issue that had legal implications. Forensic nurses do not replace other forensic professionals, but instead bring a unique nursing perspective to the multidisciplinary forensic team. Forensic nurses blend biomedical knowledge and critical thinking skills with their understanding of the principles of law and human behavior. Forensic nurses recognize and meet physiological needs, while acknowledging and addressing psychological trauma and the priority of legal concerns.
Forensic nurses serve both the living and the dead — those who are victims, suspects, survivors, and those who are left behind. Their expertise combines nursing science, forensic science, and criminal justice. Found in both traditional and nontraditional roles and practice settings, forensic nurses work in various locales including emergency departments, mental health settings, correctional facilities, and coroners’ offices. Forensic nurses may collect evidence used by law enforcement or medical examiners, conduct death investigations, or provide crisis intervention for the victims and families of violence. Forensic nurses also know how to present themselves in court and provide expert testimony as a fact witnesses or expert witnesses.
The Challenge for Forensic Nurses:
Paul Clements, PhD, APRN, BC, interacts with children who have experienced emotional trauma of the most unimaginable kind: witnessing the murder of a parent or other family member. In the aftermath of homicide, children are at significant risk to develop posttraumatic stress disorder. Developmentally appropriate drawing tools and a simple, open-ended request to draw what they know about the death of their family member is a nonthreatening way to begin interactions with bereaved children. This activity enhances the child’s sensory memory (what the child saw, heard, and felt) and establishes a helping relationship with reluctant or nonverbal children. The child’s drawing and the accompanying narrative storytelling provide a platform for deeper exploration of events, insight into the child’s experience of trauma and bereavement, and guidance for assessment and intervention.
“When one parent murders the other, the child suffers a double loss,” explains Dr. Clements, an Assistant Professor at Old Dominion University School of Nursing in Norfolk, Virginia. “Children are the invisible victims.” Because these children may also be important witnesses, Dr. Clements helps police officers learn how to talk to and question children who have experienced a family homicide. Questions must be worded carefully to avoid frightening the already traumatized child into thinking he or she is guilty or responsible for the death. Dr. Clements also counsels the other family members, who often do not appreciate the degree of trauma suffered by the child, about their interactions with the bereaved child.

What has become evident during interviews with these children is that the things adults think are helpful and important are usually not what the children think are important. Children often believe that they are the equivalent of ‘damaged goods,’ that they are no longer normal like other kids. Adults keeping silent or whispering about the murder to protect the child only reinforces the stigma of guilt.” Dr. Clements helps these children not to forget the loved one or what happened, but to remember the deceased and put what has happened into an adaptive perspective. He helps the child find an anchor for safety to get through the acute phase of trauma, and helps surviving adults in the child’s life understand puzzling delayed responses, such as regressive behavior.
As a forensic psychiatric nurse, Dr. Clements works with both the offenders and survivors of a wide array of violent offenses, including interpersonal violence, sexual assault, child molestation, elder abuse, stalking, suicide, homicide, arson, motor vehicle accidents, industrial and occupational deaths, sudden infant death syndrome, and gang violence. Believing that forensic nurses must also work to prevent violence, Dr. Clements has recently become a certified gang specialist.
Gaps remain, however, in the continuity of care across different forensic specialties. “Ideally, forensic nurses will refer patients to other forensic nurses for continuing care,” suggests forensic nurse Paul Clements. For example, when a SANE nurse makes a referral for ongoing psychiatric care for a victim of rape, the ideal professional to provide this care is a forensic psychiatric nurse.
Although there are many more forensic nurses than there were 10 or 20 years ago, forensic nursing is still addressing the challenges of a growing specialty. One of these is recognition of forensic nursing practice not only by the public, but by the nursing profession itself. Although forensic nursing achieved official recognition by the American Nurses Association in 1995, widespread understanding of the role of the forensic nurse has not yet been realized. Image building is all the more difficult because of the diversity of roles and patients found under the umbrella of forensic nursing.
Forensic nursing practice is not new, but its science is at an early stage. Forensic nursing is rooted in clinical care and, like other nursing disciplines, must conduct the necessary research to support evidence-based practice. Research into the primary prevention of violence, the effects of violence, and the outcomes of forensic nursing practice is also needed, both in the United States and on a global scale.
References:
Hucker, S. (2012). Forensic Mental Health: An Overview. http://www.forensicpsychiatry.ca/intro.htm
Stokowski, L. (2008). Forensic Nursing: Part 2. Inside Forensic Nursing. http://www.medscape.com/viewarticle/571555_7
Bobby James Moore vs Texas. Volume 18, U.S. page 443. U.S. Supreme Court. February 19, 2019. https://supreme.justia.com/cases/federal/us/586/18-443/case.pdf
Moore vs Texas. Volume 15, U.S. page 797. U.S. Supreme Court. March 28, 2017. https://www.supremecourt.gov/opinions/16pdf/15-797_n7io.pdf
U.S. Department of Education. (2022, March 18). A history of the individuals with disabilities education act. https://sites.ed.gov/idea/IDEA-History

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