Should I go into clinical or criminal psychiatry?

Dear Belal,

I think Daniela has provided very detailed and accurate information and I only want to add a few comments.

It appears that Daniela lives in Brazil and the situation in the U.S. is somewhat different. In this country most forensic evaluations and treatments are provided by psychologists, who earn a Ph.D. degree and specialize in diagnosing and treating mental health problems by behavioral methods such as "talk therapy." Psychiatrists are medical doctors who also diagnose and treat mental health problems, but with medication. Almost no psychiatrists in the U.S. perform talk therapy. Additionally, since psychologists perform psychological testing they are able to assess clients' intellectual functioning, reality testing and other issues of interest to courts through methods besides interviews, which often makes them more in demand as expert witnesses. As a psychologist I have performed numerous evaluations for criminal and civil courts and testified numerous times as an expert witness. During that time I have seen very few psychiatrists testify as experts, although there have been some. If you substitute the term "psychologist" for "psychiatrist in Daniela's answer I think you will have a better understanding of the professional situation in this country. My comments are not intended as criticisms of psychiatrists but their field has gone in a different direction in the past 25 years as it has become "medicalized." I suggest that you investigate graduate programs in both medicine and psychology before making a decision.

I also want to note that forensic psychologists and psychiatrists must possess a thorough knowledge of psychological diagnosis and treatment, so a clinical background is essential. I see forensic psychology as an extension of traditional clinical knowledge and skills to the special world of the courts. For example forensic mental health experts are often asked to help determine a criminal defendant's competence to stand trial. In the American legal system a person cannot be tried for a crime if he does not understand the court process and cannot assist in his own defense by reason of mental disease or defect. The expert must be able to assess the defendant's mental capabilities and bring that knowledge to bear on the specific questions asked by the court.

I hope these comments have been helpful and not confusing. I wish you the best in your career pursuits.

Ray Finn, Ph.D.

Hi,

Forensic psychiatry is a specialised branch of psychiatry which deals with the assessment and treatment of mentally disordered offenders in prisons, secure hospitals and the community. It requires sophisticated understanding of the interface between mental health and the law.

Forensic psychiatrists must balance the needs of the offender with the risk to society. They provide psychiatric treatment in a secure environment or where patients are subject to legal restrictions.

Assessment and treatment settings vary, from high security hospitals through to medium secure units, low secure units, prison settings and community based services. Forensic psychiatrists also evaluate the outcome of treatment programmes and provide expert advice to other health and social care professionals.

Knowledge of mental health legislation is central to the work and there is regular involvement with criminal justice agencies and the courts. Forensic psychiatrists need an in-depth understanding of criminal, civil and case law as it relates to patient care in forensic settings.

An important part of the work is risk assessment. Forensic psychiatrists assess and manage patients at risk in emergency and routine situations, in collaboration with colleagues and as part of a larger multidisciplinary team. They sometimes have to control patients with violent behaviour using medication, rapid tranquillisation, restraint or seclusion.

Referrals can range from those who have committed minor offences to serious and violent offenders. Forensic psychiatrists may also assess non-offenders displaying high-risk behaviour. They may also attend tribunals to review the detention of a compulsory patient.

Forensic psychiatrists also provide specialist advice to the courts, the probation service, the prison service and other psychiatric colleagues. They also prepare reports for mental health review tribunals, hospital managers’ hearings, other practitioners and criminal justice agencies.

A clinical psychiatrist works with patients in the analysis and diagnosis of their mental state. They recommend treatment plans, medication and/or therapy. They are medical doctors that can provide counseling and therapy, and work with other healthcare professionals in finding solutions to mental health conditions. This position is concerned with balancing the demands of the patient’s life circumstances with lessons from empirical science and clinical experience. They help to put interventions together into effective treatment plans, and develop strategies that facilitate recovery from mental illness. This is a position that is also qualified to work in groups or family therapy. You can find clinical psychiatrists working in private practices, offices, hospitals or mental health clinics.

What skills are needed to become a clinical psychiatrist?

This is a highly specialized position that works with a variety of patients. Individuals in this field must have the following:

Listening: A clinical psychiatrist must be able to listen to the symptoms of their patient, as well as the observations from other mental health professionals to diagnose, recommend and implement an effective plan of treatment.

Writing: A clinical psychiatrist must be able to communicate effectively through writing to record notes, treatments and disseminate information to the right parties. A clinical psychiatrist may work with others or have their work published. Being able to write their research and information in a clear and concise manner is key.

Research: This is a clinical and research position. A clinical psychiatrist must be able to do a large amount of research to keep up with the trends and new breakthrough of treatment.

Speaking: A clinical psychiatrist must be able to speak well, as they speak at conferences, with patients, other healthcare professionals, in groups or family therapy. They must be able to communicate clearly and distinctly so that everyone will understand what they have to say.

Analysis: Being able to fully assess and analyze the symptoms of the patient is key in performing the duties of a clinical psychiatrist. It is important to be able to understand the symptoms to correctly administer treatment plans or medication.

Compassion: Mental health conditions are not to be taken lightly. They range from depression to schizophrenia and other illnesses. A high level of compassion is required to deal with patients and their families.

Decision-making: Being able to make sound decisions is one of the most integral parts of this position. Making the wrong decisions could be detrimental to the patient. It is important that all critical thinking skills are a major part of the entire process for the greatest results.

Observation: Before, during and after the recommendation of a treatment plan or medication, observation plays a key role. A clinical psychiatrist must be able to observe any behaviors or side effects that may occur as a result of treatment to make the necessary adjustments needed for the patient.

Critical thinking: Critical thinking skills must be sharp and involved in every aspect of a clinical psychiatrist’s practice. They must be able to think quickly and critically in determining the causes of the mental illness and in recommending the right medication or treatment plans. They must be able to take into account all factors, including societal, familial, emotional and socio-economic things that could be impacting the patient and their mental stability.

Coordination: A clinical psychiatrist must be able to coordinate a number of things at one time. This could mean treatment plans, records, counseling sessions, meetings with other healthcare professionals and more. Good coordination skills are essential.

Administrative: Most medical professionals utilize computers and software. A clinical psychiatrist must be able to use the latest technology and have some administrative skills in place to do their job effectively.

Sources:

https://www.healthcareers.nhs.uk/explore-roles/psychiatry/forensic-psychiatry%20
http://medicalandhealthcare.com/professions/psychiatry/clinical-psychiatrist-education-and-career-information.html

Good luck in your decision!