What is forensic psychiatry? “
Forensics” means refers to the application of science for the purposes of the law.  Many people think of forensic pathologists and presume that forensics implies “dead.”  There actually are forensic braches of all of the sciences.  Forensic pathologists are often medical examiners and deal with pathology and the law.  Forensic engineers deal with legal issues in the field of engineering (e.g.: bridges falling down or accident reconstruction.)  Forensic psychiatry deals with application and interpretation of psychiatric knowledge, principles and science to the law for the purposes of the law. 

Forensic psychiatry embraces four major branches of law: 

1) Civil law, including torts, malpractice, psychic stress litigation, Post Traumatic Stress Disorder (PTSD), traumatic brain injury (TBI), suicide, testamentary capacity, effects and side effects of medications, Tardive Dyskinesia (TD) product liability, right to treatment and right to refuse treatment;

2) Criminal law, including competency to stand trial (CST), criminal defense issues including the insanity defense (CR/NGRI), Guilty but Mentally Ill (GBMI), competency to be sentenced, competency to be executed as well as treatment of people awaiting trial, awaiting restoration of competency and those found not guilty by reason of insanity (NGRI);

3) Family/Domestic law, including children in need of supervision (CHINS), persons in need of supervision (PINS), divorce, custody, and any other matter in front of Family Court, and;

4) Regulatory law, including standards of care and treatment, Constitutional Rights of hospitalized or imprisoned people, oversight of hospitals, extended care facilities, nursing homes, prisons and correctional institutions, Medicare, HCFA, OBRA regulations and others. 

The forensic psychiatrist may work for either side (plaintiff/defense, prosecutor/defense, either side in family court, a governmental regulatory body, attorney, agency) in any legal matter and most forensic psychiatrists try to work for both sides to avoid being labeled as biased. This is consistent with the ethical principles articulated by the American Academy of Psychiatry and the Law www.AAPL.org. 

How do you become a forensic psychiatrist? 
Thanks to TV shows such as CSI and Law & Order, everyone wants to work in forensics.  TV has made our field seem glamorous and exciting.  Becoming a forensic psychiatrist takes a lot of work and time.  First you attend four years of college, usually with a pre-med/science curriculum/major, although that is not specifically necessary for entrance into medical school.  Medical school is four years long.  At the end of medical school, a person is a “doctor.”  However, you need to complete at least an additional year (often referred to as an internship) in order to practice medicine.  You also must pass the State licensing examination and the three parts of the National Medical Board Examinations. 

Most medical students decide to specialize.  That means an additional 2-7 years of residency training.  It is during this time, that the young doctor focuses solely on his/her area of interest.   In psychiatry, the internship and residency are usually combined into a four-year program.  At the end of residency, a doctor is now a psychiatrist. 

Psychiatrists are medical doctors who diagnose and treat people with mental disorders.  Psychiatrists specialize in the brain and the mind with an emphasis on emotions, thinking, cognition, behavior and the physical/somatic manifestations of psychiatric, emotional and stress based illnesses.  There is increasing research and interest in the biological basis for behavior and thinking as well as in the development and use of medications to help people with psychiatric problems.

After residency, comes super-specialty training, also known as fellowship training.  Each branch of medicine has fellowship areas.  In psychiatry there is: forensics, consultation-liaison, neuropsychiatry, geriatric psychiatry, neurophysiology, child and adolescent psychiatry.  Psychiatric fellowship training adds an additional 1-2 years of education.  After fellowship, a doctor may apply for and be granted permission top sit for specialty Board Certification in a specific area.  Passing the Boards is important in the credentialing process for a forensic psychiatrist and assures a minimum level of knowledge of the material.  In psychiatry, doctors must take their board exams every 10 years, to show that they have maintained a knowledge base.

In order to be a good forensic expert, you must first be a good clinician.  Clinical work is the backbone of what a psychiatrist does, and it is hard to imagine being an expert in something in which you are not regularly engaged.  Also, all branches of medicine require ongoing continual medical education (CME) training on a yearly basis.  This is necessary in order to stay current in the field and in order to maintain a State’s license to practice medicine.  In other words, the commitment to learning and education, including testing is life-long, as the Board exams must be re-taken every 10 years.  . 

What’s the difference between a psychiatrist and a psychologist?
Psychiatrists are medical doctors and have had the same basic training as all other physicians.  Psychiatrists  diagnose and treat people with illnesses such as depression link 2 and  anxiety, bipolar disorder, ADD/ADHD, schizophrenia link 2, obsessive-compulsive disorder (OCD) , post traumatic stress disorder (PTSD) , personality disorders, dementia, Alzheimer’s,  traumatic brain injury (TBI).  Psychiatrists may prescribe medication, monitor lab results, order and interpret brain scans and imaging studies and perform medical procedures.  Psychiatrists rely on their education and experience as well as evidence based medicine when approaching a problem.

Doctoral-level (PHD/PSYD) psychologists are professionals in their own right, and may have special expertise in topics not usually studied in detail by psychiatrists (such as psychological testing).  Doctoral level psychologists generally have 4 years of training after obtaining a bachelors degree.  Psychologists are trained to understand illness but their education may emphasize an approach more rooted in statistics and theory.  Psychologists frequently have additional training in specific non-medication approaches for treatment (e.g.: cognitive behavioral therapy (CBT), stress inoculation therapy (SIT), Dialectical Behavioral Treatment (DBT))

Why and when are psychiatrists invited into the legal arena?
As noted above, there are many times and ways that allow a psychiatrist entry into the legal arena.  In the law, experts are brought in when the material requires special knowledge and/or experience to aid in its understanding.  Good forensic psychiatrists are teachers, and are there to teach the “trier of fact” (e.g.: judge, jury, hearing board, magistrate) the medical science.  This allows that person(s) to apply the facts of the case to the science and thus reach a conclusion or legal opinion, decision or verdict. 

It is especially common to bring in a psychiatrist when a person’s behavior is in question.  Psychiatrists can often help to explain why someone has acted in a certain way. They may also help to explain issues such as psychic or stress damages, future risk and treatment needs.  

Are there rules for forensic psychiatrists? 
Yes.  Like all professionals, forensic psychiatrists must do their work to the “standard of care” in the field.  It is important to remember that forensic psychiatrists are invited into the legal arena, and that the rules are set by the law, and not by the medical profession.  The American Academy of Psychiatry and the Law is the pre-eminent professional organization for forensic psychiatrists and promulgates a Code of Ethics for its members.  It is important for forensic psychiatrists to strive for objectivity and impartiality when approaching a case, however, advocacy for an opinion, once formed is appropriate.  Forensic psychiatrists should testify within their knowledge/experience and recuse themselves when personal bias may cloud judgment.  Forensic psychiatrists are paid for their time and never work on a contingency basis, as payment that is dependent on the outcome suggests a lack of objectivity. 

Forensic psychiatrists need to be honest and may not always reach an opinion that is helpful to the side/person who has hired them.  However, it is possible that honest, well-trained professionals may review the same materials and have a legitimate disagreement on their interpretation.  While this is sometimes seen as a “battle-of-experts”, the reality is that if there were no disagreement in interpreting the “facts”, there would be no legal case.

The courtroom and legal process are adversarial by their design/nature.  Expert forensic psychiatrists should conduct themselves in a professional manner and avoid unnecessary personal attacks of the other expert.   On rare occasions, the court/judge will employ a forensic psychiatrist directly, or both sides may agree to use a single expert, who is then subjected to two cross-examinations. 

Why is honesty important-isn’t law about winning for your client? 
“Whores, hired guns, plaintiff experts, defense experts” are just some of the terms used to describe unethical experts.  At the end of the case, honesty will win, and experts who provide honest answers, even when it might not be what the lawyer wants to hear, will be valued.  Honest experts help lawyers see both side of their case and may save lawyers money by helping them to drop weak cases before investing significant resources.  Good experts help root out frivolous lawsuits and thus save everyone time and money and thus preserve respect for the American judicial system.

How much do forensic psychiatrists earn? 
There is no simple answer to this question.  Psychiatrists and forensic psychiatrists generally bill for time at an hourly rate.  Rates vary based on experience, region, reputation and other factors, but 250.00/hour-500.00 hour is common, with some experts charging higher or lower fees.  Occasionally an expert will work for a flat fee or is on a contract or salary with an agency.  Board Certified psychiatrists earn $140,000-180,00 in many salaried positions.  It is not permissible to work on a contingency basis, where fees or payment are dependent on the outcome of the case.  Generally, the expert’s bill will be paid in full prior to any testimony, so that it can be assured the testimony is not prejudiced by fear of non-payment.  It takes many years of schooling to get to be a forensic psychiatrist, and the work is demanding and challenging.  It also takes many years to build up a practice. 

What is a typical day like for a forensic psychiatrist? 
For most forensic psychiatrists, the typical day is mostly spent doing clinical work-evaluating and treating people with the usual psychiatric disorders, especially anxiety and depression.  Forensics may make up only a small portion of a forensic psychiatrists practice, unless the person is doing forensic treatment in a jail or hospital type of setting. 

While TV makes forensics look sexy, the bulk of the work is actually reading through medical records, legal documents, charts and other materials related to a case.  It can be tedious and boring a lot of the time, and struggling to read bad handwriting in the records can be especially frustrating.  Interviewing a person is usually done as part of an examination/evaluation and usually takes 1-3 hours, depending on the complexity of the case, the question being addressed and the cooperation and ability of the person being interviewed.  Writing reports is a big part of the job and you have to like to write reports if you want to be a good forensic psychiatrists.  Many cases are disposed of (settled, plea-bargained, mediated or negotiated) based on the written reports.  Only a small percentage of cases ever make it into the courtroom.

Credentials   Articles   News   Rates   Radio Archives   Contact