Forensic psychiatry has developed into a formal subspecialty in recent years. However, as in any other subspecialty of psychiatry, general practitioners are encouraged to have some training in and knowledge of forensic psychiatry. Despite its new subspecialty status, general clinicians still perform the bulk of forensic assessment. Clinicians aware of their lack of training often fear becoming involved in forensic cases, avoid forensic practice entirely, and suffer undue anxiety when their participation becomes unavoidable.
Clinical psychiatrists can and should familiarize themselves with some of the principles and practice of this fascinating and challenging subspecialty. General clinicians receive training in a variety of subspecialties of psychiatry, such as child and adolescent psychiatry, geriatric psychiatry, or substance abuse. Although encouraged to recognize the limits of their expertise, and to refer complicated cases to specialists, general clinicians are able to evaluate, manage and treat patients in these categories based on their basic training if they so choose.
This Special Report has something to offer to both forensic specialists and general clinicians. Psychiatrists with forensic expertise will find these reviews useful synopses of common and relevant forensic issues. General clinical psychiatrists will find that these articles provide useful information should the issues discussed in these articles arise in their clinical practice. Perhaps more importantly, general psychiatrists may find that some of their anxieties regarding forensic involvement and their own professional liability exposure may be minimized by an understanding of forensic issues.
This Special Report reviews a number of areas of forensic practice. Philip J. Resnick, M.D., and Renee Sorrentino, M.D., have provided a thorough review of competency issues that commonly arise in consultation-liaison psychiatry and discuss the components of competency evaluations. Jacqueline M. Melonas, J.D., M.S., R.N., discusses an issue that has increasingly come to affect clinical practitioners: liability risk related to psychopharmacology. She provides suggestions to help practitioners reduce these risks by understanding where they lie and how good clinical practice can address them. I offer a review of the thorny issues that arise when the diagnosis of posttraumatic stress disorder, increasingly common in all types of litigation, becomes a legal point of contention. Richard A. Ratner, M.D., has reviewed the complex ethical issues surrounding evaluations of children and adolescents.
Psychiatrists are discovering that both the forensic and clinical practice of psychiatry can be professionally rewarding. Robert P. Granacher Jr., M.D., M.B.A., offers suggestions to those interested in expanding their practices to include forensic psychiatry. The business elements of forensic practices differ in some ways from those of clinical practice. However, general clinicians and forensic specialists alike will benefit from a review of these sound business principles.
Forensic psychiatrists can benefit from reviewing the expertise of their colleagues. General clinicians will find that the more familiar they are with this exciting subspecialty, the more confident they will become in the clinical practice of psychiatry.
Dr. Gold is a clinical and forensic psychiatrist and is clinical associate professor of psychiatry at the Georgetown University School of Medicine. She is also associate director of the Georgetown Psychiatry Residency Program in Psychiatry and Law. She is co-editor of The American Psychiatric Publishing Textbook of Forensic Psychiatry with Robert I. Simon, M.D.