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Forensic Psychiatry

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Abstract

In this chapter, the literature on teaching, training, and research in forensic psychiatry in Europe and the United States will be reviewed. In general, there is a small body of literature available about this topic. Next, key themes in education and training in forensic psychiatry will be discussed, namely, the interface between forensic psychiatry and the law and mental health legislation; risk assessment and risk management, professional attitude, and ethics; and clinical expert/witness training. Due to the interface between teaching, training, and research, some issues about research will be mentioned. Consequently, the Ghent group will be discussed with special attention to topics that this group considers. Also the summer seminar in forensic psychiatry and psychology in Europe will be introduced. And finally, there will be special attention to future prospects and to the new special professional qualification in forensic psychiatry in Belgium.
Forensic Psychiatry
Kris Goethals
Contents
Introduction ....................................................................................... 2
Education and Training . .......................................................................... 2
Key Themes in Education and Training in Forensic Psychiatry . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
The Interface Between Forensic Psychiatry and the Law and Mental Health
Legislation ..................................................................................... 3
Risk Assessment and Risk Management .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . 4
Professional Attitude and Ethics .............................................................. 4
Clinical Expert/Witness training .. . . . . ........................................................ 5
Research ........................................................................................... 6
Future Prospects .. . . . . . .. . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . .. . . . . . . . . . 6
The Ghent Group Meetings .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
Summer Seminars in Forensic Psychiatry in Europe .. . . ........................................ 9
Special Professional Qualication in Forensic Psychiatry in Belgium .. . . . . . . . . . . . .. . . . . . . . . . . . 10
Conclusion .. . . . ................................................................................... 12
References .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . 12
Abstract
In this chapter, the literature on teaching, training, and research in forensic
psychiatry in Europe and the United States will be reviewed. In general, there is
a small body of literature available about this topic. Next, key themes in education
and training in forensic psychiatry will be discussed, namely, the interface between
forensic psychiatry and the law and mental health legislation; risk assessment and
risk management, professional attitude, and ethics; and clinical expert/witness
training. Due to the interface between teaching, training, and research, some issues
K. Goethals (*)
Collaborative Antwerp Psychiatric Research Institute (CAPRI), University of Antwerp, Antwerp,
Belgium
University Forensic Centre (UFC), Antwerp University Hospital, Edegem, Belgium
e-mail: kris.goethals@uantwerpen.be
#Springer Nature Singapore Pte Ltd. 2018
M. H. M. Hermans et al. (eds.), Education about Mental Health and Illness,
Mental Health and Illness Worldwide, https://doi.org/10.1007/978-981-10-0866-5_14-1
1
about research will be mentioned. Consequently, the Ghent group will be discussed
with special attention to topics that this group considers. Also the summer seminar
in forensic psychiatry and psychology in Europe will be introduced. And nally,
there will be special attention to future prospects and to the new special professional
qualication in forensic psychiatry in Belgium.
Keywords
Education · Training · Forensic psychiatry · Ghent group meeting · Summer
seminar · Belgian professional qualication
Introduction
In the Netherlands, the rst professor in forensic psychiatry had its chair in a medical
faculty since 2003. All other chairs are based in a faculty of laws. Above that forensic
psychiatry is not a subspecialty in many European countries, among the Netherlands,
nor is it a mandatory part of the curriculum of residents in psychiatry or medical
students. Residents in psychiatry can choose a course in forensic psychiatry, but only
three afternoons are dedicated to forensic psychiatry as an essential part of the training
in psychiatry. A psychiatrist trained in the Netherlands can work in forensic psychi-
atry without any apprenticeship in forensic psychiatry or experience in the eld. For
experts, there is a well-organized course in forensic psychiatric reporting organized
by the Dutch institute of forensic psychiatry and psychology (NIFP). The majority of
research in offenders with a psychiatric disorder is conducted by research psycholo-
gists. It can be emphasized that a lot of these offenders have a disorder with an
important biological etiology, e.g., schizophrenia spectrum disorders (Lanzenberg
and Kasper 2005), or a personality disorder (Popma and Raine 2006; Yang et al.
2008; Paris 2007; Van Haren et al. 2008). In several European countries, there is a
lack of education, training and research in forensic psychiatry.
In this chapter, the literature on training and research in forensic psychiatry in
Europe and in the United States will be reviewed. Next the Ghent group will be
discussed with special attention to the topics that this group considers. Also the
summer seminar in forensic psychiatry in Europe will be introduced. And nally,
there will be special attention to the new special professional qualication in forensic
psychiatry in Belgium.
Education and Training
In their review paper, Folino and Pezzotti (2008) reported that there are only a few
publications with regard to training in forensic psychiatry. According to them, formal
training and research experience are the best manner to develop expertise in the eld of
forensic psychiatry. They stated a plea for an academic support of forensic psychiatry
2 K. Goethals
and for practical guidelines for experts who have to witness in court. Several authors
concluded that there are some European countries with a well-organized curriculum
(e.g., Germany) or with a subspecialty in forensic psychiatry (e.g., United Kingdom,
Ireland, and Sweden). However training requirements and training standards varied
among countries (Layde 2004a; Gunn and Nedopil 2005; Scott 2005). Taylor and
colleagues (2009) highlighted the difculties and some solutions with regard to
learning research skills in forensic psychiatry. Above that some authors agree that a
basic training in forensic psychiatryshould be mandatory for all residents in psychiatry
but also for medical students (Lewis 2004; Pinals 2005; Rotter and Preven 2005;Reiss
and Chamberlain 2001). British research showed that residents in psychiatry were not
introduced in penitentiary psychiatry in an early state of their apprenticeship (Reiss
and Famoroti 2004). Since that time there is little change in this situation, although it is
vital to attract future psychiatrists in the eld of forensic psychiatry.
Cultural aspects such as sensitivity for the mothers tongue of the patient,
religion, and country of origin are important in the broad eld of psychiatry and
especially in forensic psychiatry. This cultural sensitivity is extremely important in
expert reporting. Knowledge of culturally different expressions of some perceptual
disorders in particular and of psychiatric disorders in general are essential in order to
give evidence to the accountability of a suspect (Layde 2004b). In some European
countries, psychiatrists are asked to answer this question in court. For example, in
the Netherlands, the expert psychiatrist has to advice the judge about the degree of
accountability of the suspect. There is a gradual scale of accountability, namely, ve
degree, so there is more room for gradations of diminished responsibility. Therefore
it is necessary that they know transcultural aspects in suspects with a psychiatric
disorder.
Wettstein (2005) stressed the importance of accreditation for experts with a
mandatory training, tests, and preferably recertication. In general, we can say that
there is a lack of literature in the eld of training in forensic psychiatry in several
European countries. For the Belgian and the Dutch situation, we could not nd any
paper about this topic.
Key Themes in Education and Training in Forensic Psychiatry
The following key themes will be considered here: the interface between forensic
psychiatry and the law and mental health legislation; risk assessment and risk
management, professional attitude, and ethics; and clinical expert/witness training
(Howitt and Thomson 2015).
The Interface Between Forensic Psychiatry and the Law and Mental
Health Legislation
Mental health legislation, which includes a wide variety of legal topics and pertain to
people with a diagnosis or possible diagnosis of a mental health condition and to
Forensic Psychiatry 3
those involved in managing or treating such people, varies across Europe. A well-
trained forensic psychiatrist must have a good understanding relevant to their role of
the laws in their jurisdiction. This is important both for daily forensic psychiatric
practice and for undertaking medicolegal work. In order to gain the required
knowledge and experience in this area, trainees need specialist teaching and super-
vision. Firstly they must develop an awareness of the relevant legislation. Once a
theoretical knowledge of relevant legislation has been acquired, the trainee must
undertake medicolegal work under supervision. Ideally this should involve consul-
tation prior to the patient being assessed, supervision of assessment and review, and
discussion of draft report. Only by undertaking such work the trainee will develop an
understanding of the legal tests and become familiar with the correct terminology.
The supervision of such work also provides the trainer with an opportunity to assess
progress and provide feedback.
Risk Assessment and Risk Management
For those working within forensic psychiatry, risk assessment is paramount to
identify and manage risk of harm both to patients and to others. But risk management
should always be the second step. There are a variety of tools in which clinicians can
undertake training and can utilize to recognize and classify risk including actuarial
tools like the STATIC-99/STATIC-2002 (Hanson and Thornton 1999,2002) for sex
offenders and Structured Professional Judgment (SPJ) tools like the HCR-20-V3
(Douglas et al. 2013) for general violent offending. The 2007 Brieng Document
Giving up the Culture of Blame. Risk Assessment and risk management in psychi-
atric practice(Morgan 2007) concluded that interventions may decrease risk in one
area only to increase in another and that risk cannot be eliminated. For example, an
offender with a schizophrenic disorder and a comorbid personality disorder can
become less psychotic by taking antipsychotics but can then get more pronounced
personality traits, such as hostility or callousness. They also concluded that a perfect
risk management system would have only a modest impact on rates of homicide by
mentally disordered offenders and may inuence debate from a position where the
greatest good may be done to the greatest number of people. For this reason,
residents in forensic psychiatry (and preferably also residents in general psychiatry)
must have guidance and teaching not only in identifying risk but in conceptualizing
it and being able to manage personal and professional anxiety associated with
informed risk management. Therefore supervision is mandatory for residents and
young psychiatrists in order to cope with feelings of anxiety.
Professional Attitude and Ethics
For psychiatrists working within the eld of forensic psychiatry, the four principles
of biomedical ethics must be considered (Beachamp and Childress 2001). These
principles are:
4 K. Goethals
Respect for autonomy respecting the patients right to make decisions around
their own health care
Benecence acting in the patients best interest
Non-malecence doing no harm
Justice fairness concerning the distribution of resources and who gets what
treatment
For trainees in forensic psychiatry and forensic psychiatrists, the pursuit of these
ethical standards is complicated by not only having to consider both the general
public and the individual but also in some countries by the dual roles of providing
care and treatment while providing expert opinion and evaluation to the court, often
via third parties (e.g., probation ofcers). While most experience in this eld will be
acquired through practice under supervision during training, formal teaching may be
of benet. The Madrid Declaration on Ethical Standards for Psychiatric Practice,
most recently updated in 2011, sets out an internationally applicable ethical code on
which to base practice and teaching. This declaration devised by the World Psychi-
atric Association (WPA) also provides guidance concerning 16 specic situations.
Three of them are of relevance for trainees in forensic psychiatry and forensic
psychiatrists: torture, death penalty, and dual responsibilities of psychiatrists.
Working with mentally disordered offenders can evoke strong feelings within the
professional team providing their care. This is something for which general training
can leave trainees poorly prepared to manage their own feelings and complex team
dynamics, especially when an offender had a serious and terrible index offense, such
as murder of a child or sexual abuse of a child. Attending a case-based Balint style
discussion group may be helpful in understanding and managing some of the
complex emotions generated as may considering the countertransference evoked
(Riordan 2008; Reeder and Schatte 2011). In a Balint group, participants meet
regularly with a leader and discuss a clinical case brought by one of the participants.
Discussion focuses on the patient-doctor relationship and is useful for discussing
cases when strong feelings have been evoked in the trainee or psychiatrist. For cases
in which sexual boundaries are exceeded, the work of Tschan (2014) is a useful tool.
Clinical Expert/Witness training
In most European countries, one role of forensic psychiatrists is to provide an expert
opinion on a patients mental health to courts or other legal bodies. This evidence can
be written or verbal. Giving verbal evidence in court can be an anxiety provoking
experience for which trainees should receive guidance, training, and support. This
will reduce anxiety and improve the impact of evidence delivered. Key components
are training on the content of the written report which forms the basis for any
examination, knowledge of court proceedings and etiquette, advice regarding deliv-
ery of evidence, and practice in undergoing cross examination. Such teaching can be
delivered on an informal basis, such as during a supervision session, or in a more
formal environment. Some bodies and agencies provide specialist training in this
Forensic Psychiatry 5
eld, such as the Dutch Ministry of Justice or the Swiss Society of Forensic
Psychiatry. These trainings involve role-playing techniques, video recordings, and
watching experienced colleagues in practice, among others.
Research
Due to the fact that research is intertwined with training, we have to consider some
research issues in this chapter. In the United Kingdom, Taylor and colleagues (2009)
have expressed their concerns about the lack of resources for academic forensic
psychiatry and about the decline of the number of trainees in forensic psychiatry
between 2001 and 2004. Academic forensic psychiatrists have to divide their time
between clinical practice, policy duties, giving lectures, and research. In Germany,
there are full-time chairs in forensic psychiatry at ten universities, but nding
resources for research is also a problem.
Several authors have highlighted the problem of tremendous savings and as a
result a lack of well-trained professionals. In this situation, professionals from other
countries with a poor developed training and education ll this gap. Other authors
emphasized the importance of the participation in research and in writing papers for
trainees in psychiatry (Bloom 2007; Simon 2007). The development of research
skills and writing scientic papers can avoid stereotypes about forensic psychiatry,
for example, the myth of untreatable patients or the myth of being an unscientic
discipline. And by doing these tasks, younger forensic psychiatrists can be assisted
by experienced colleagues and academic forensic psychiatrists in developing new
treatment models (Goethals and Van Lier 2009).
Future Prospects
First of all, a well-dened educational program in forensic psychiatry should be
developed for residents in psychiatry. We can refer here to the WPA Section of
Forensic Psychiatry that has its documents available online. Recently, the EPA
Section of Forensic Psychiatry completed a guidance paper on forensic psychiatry
in order to support evidence-based assessment and treatment of mentally disordered
offenders. These young doctors can learn to cope with judicial measures and to get
skills in order to switch between several roles they have to take in the interface with
criminal law. More education can also result in a better understanding of and more
enthusiasm for the eld of forensic psychiatry. More (future) psychiatrists can
hereby be attracted to take a position in forensic psychiatry. The earlier mentioned
mandatory module about expert reporting could be an excellent starting point.
What can be said about the lack of training for forensicpsychiatrists in several
European countries? Let us consider the Belgian or the Dutch situation. The fact that
there is only one professor in adult forensic psychiatry at a medical faculty is just a
symptom of a larger problem. In some countries around Europe, there exists an
excellent training in forensic psychiatry (Gunn and Nedopil 2005). Countries with a
6 K. Goethals
poor or nonexisting curriculum could prot of this knowledge and experience.
Preferably there should be a special professional qualication or a subspecialty in
forensic psychiatry. In the next heading, we will elaborate the special professional
qualication in Belgium.
A recognition of forensic psychiatry as a special professional qualication or a
subspecialty can promote research in this eld by forensic psychiatrists. This latter is
an important pain point. Most research in forensic mental health is done by psy-
chologists. In many European countries, there is a lack of forensic psychiatrists, so
their core business is taking care of patients, and not doing research. If research skills
should be learned and if trainees and forensic psychiatrist should have co-authorship
of at least one paper, then the downward spiral of recruiting good doctors could be
stopped. All clinicians and not only those with academic qualications could
then become better teachers, trainers, and supervisors. This goal is crucial since there
is more and more emphasis on evidence-based practice in every eld of medicine
(Khan and Coomarasamy 2006; Van Tilburg 2008). Present forensic psychiatry leans
too much to general evidenced-based psychiatry. We should all be aware of the fact
that our forensic psychiatric patients differ from general psychiatric patients with
regard to the complexity and comorbidity of their psychiatric disorders but also due
to their problematic history and several circumstantial conditions that are often risk
factors (Goethals 2008; Van Marle 2000).
In many countries, funding is the largest obstacle for other tasks of psychiatrists,
such as education, training, and research. Due to nancial motives, psychiatrists with
less clinical tasks are less attractive to hospitals, health insurances, and even phar-
maceutical rms. More training and more research incentives could result into better
trained psychiatrists and more evidence-based clinical practice. A serious decrease in
costs in forensic psychiatric care could also be an outcome. Besides these advan-
tages, psychiatrists should also take a more proactive attitude in the eld of forensic
psychiatry, have more attention to the medical roots of their discipline, and take a
stand in order to improve forensic psychiatric services (Goethals and Van Lier 2009).
Service development is the laboratory of forensic psychiatry. We ought to improve
treatment conditions and in- and outpatient facilities for forensic psychiatric patients.
And we ought to communicate this mission to our colleagues and to the broader
world.
In the following headings, we will outline two important initiatives of European
collaboration with regard to training and teaching in forensic psychiatry, next to
ofcial bodies such as the Forensic Psychiatry Section of the European Psychiatric
Association (EPA) (website: http://www.europsy.net/sections/?id=7).
The Ghent Group Meetings
The Ghent group is an important European network for forensic psychiatrists
(Nedopil et al. 2012). The group focuses on training but also delivers specialized
education in forensic psychiatry in several European countries, mostly in the
European Union, but also in countries such as Norway and Switzerland. Its name
Forensic Psychiatry 7
derives from the rst meeting in Ghent, Belgium, in 2004 (Gunn and Nedopil 2005).
The aim of this group is not to harmonize justice or clinical practice in various
countries around Europe but rather to learn from European colleagues how to deal
with medical and judicial questions and how to communicate differences in clinical
practice to a learning audience.
Soon it became obvious that the vision on and the used methods in forensic
psychiatry are strongly inuenced by the historical background of judicial systems in
different countries but also by the way whether or not criminal law wants the
involvement of the psychiatric discipline. A black page in history is the role of
(forensic) psychiatry in Germany during the Second World War. Psychiatrists were
abused by the political regime and the economic situation, whereby they contributed
actively to eugenics and euthanasia of vulnerable people. But also in other countries
outside Germany, psychiatry and forensic psychiatry were abuse for political rea-
sons. This led to the fact that the reputation of the medical discipline was severely
hurt. By studying historical backgrounds in other countries, we can prevent making
the same mistakes of their past by taking the wrong decisions in our own country
(Strous 2007).
The members of the Ghent group agreed very quickly about a common denition
of forensic psychiatry, namely, a medical specialty based on detailed knowledge of
relevant judicial determinants, civil law and criminal law systems, mental health and
the association between psychiatric disorders, antisocial behaviour and delinquency.
Her aim is the evaluation, the care and the treatment of psychiatric disordered
offenders and of others who need equivalent care. Risk assessment, risk management
and the prevention of further victimization are key concepts.As a group, we are
also convinced that ethical guidelines of general psychiatry are applicable to forensic
psychiatry.
One of the recurrent themes is the practice of teaching and training in forensic
psychiatry. From the knowledge that the evaluation and treatment of psychiatrically
disordered offenders are multidisciplinary tasks, the group could explore the possi-
bilities for multidisciplinary and interdisciplinary teaching and training. In several
countries, there is a multidisciplinary training staff (psychiatrists, psychologists, and
lawyers, among others) to teach and train forensic psychiatrists.
Finally it is important for the Ghent group that residents in forensic psychiatry
and young forensic psychiatrists can participate and be involved in the organization
of these meetings. It is the mix of experienced psychiatrists and newcomers in the
eld that makes these meeting very fruitful. But nancial limitations can prevent
residents in forensic psychiatry to participate. By a continuous lack of support from
European training organizations, the initiative from forensic psychiatrists of the
Ghent group grew to develop a summer seminar.
An extraordinary example of multidisciplinary teaching and training is The
School of Forensic Mental Healthin Scotland that was founded in 2007 (website:
http://www.forensicnetwork.scot.nhs.uk/school-of-forensic-mental-health/).
In that time, there were important changes in laws, new services, and new
initiatives in Scotland. The School of Forensic Mental Health was developed to
meet these needs and is a virtual school with an administrative center but delivering
8 K. Goethals
training usually on a multidisciplinary basis across Scotland using a variety of
teaching methods. The school organizes a range of training events, clinical forums,
and special interest groups, coordinating research and teaching across the country.
There is a short program course, postgraduate qualications such as a Master of
Science degree in Forensic Mental Health delivered electronically which has four
online modules:
Mental disorders and the law; treatment and interventions for mentally disordered
offenders
Problem behaviors
Risk assessment and risk management
Evaluating evidence to develop research and inform practice.
One teaching resource developed by the School of Forensic Mental Health is the
New to Forensicsteaching program (see website: http://www.forensicnetwork.scot.
nhs.uk/school-of-forensic-mental-health/new-to-forensic-suite-of-programmes/).
New to Forensicsis a learning tool developed between National Education for
Scotland and the Forensic Network. It is applicable for clinical and nonclinical staff
and is multidisciplinary in approach. A mentor, who is an experienced forensic
mental health worker, supports a student. It includes patient case scenarios from high
secure psychiatric care to community care. This Scottish school is a model to which
other countries can mirror.
Summer Seminars in Forensic Psychiatry in Europe
In 2010, the rst seminar was held in the monastery of Irsee (Bavaria, Germany).
Since then, it is an annually recurring training. The trainers are based in several
European countries, and among them there is a professor of international criminal
law who is responsible for the theoretical underpinnings of the judicial lectures and
discussions.
The format of the seminar exists of a combination of lectures and group work
with case vignettes (Nedopil et al. 2015). The aim of the seminar is to make young
European forensic psychiatrists and psychologists aware of common aspects and
differences in forensic psychiatry in various European countries. Another aim is to
learn from each other and from renowned trainers how to improve their own skills
and at the same time improve forensic psychiatric services in their own country or
region. Participants follow the pathway of offenders through the system of different
European countries and thus learn about the principles that govern the methods and
the practice of their work and especially the treatment of mentally ill offenders at the
interface of law and psychiatry in different parts of Europe (Nedopil et al. 2012).
Some of these pathways are already published in a paper (Hillier et al. 2012).
By using this method, participants do not only learn about systems in other
countries, but they can also better understand their own judicial system. The task
is to explain these issues to colleagues without or only a little experience means that
Forensic Psychiatry 9
no one can hide behind some knowledge assumptions. By role-playing, participants
can take away certain prejudices and evoked emotions and disappointments with
stakeholders involved in criminal proceedings, such as the judiciary or the court. By
this intense training, participants can contribute to a better understanding of each
ones own systems. This summer seminar can be considered as an example of
multidisciplinary and contemporary way of teaching and training in forensic
psychiatry.
Special Professional Qualification in Forensic Psychiatry
in Belgium
Since 1998, Belgium has been repeatedly condemned by the European Court of
Human Rights for the detention of internees in inappropriate facilities. These
detentions needed structural solutions, especially with the building of two high-
security hospitals for internees in Ghent and Antwerp. In 2014, the Royal Academy
of Medicine of Belgium formulated an advice with the following statements:
1. There is a need for the recognition of a special professional qualication in
forensic psychiatry, for which a proper interuniversity training program should
be worked out.
2. In the context of the enhanced scientication of psychiatry in general, special
attention should be given to research in forensic psychiatry.
3. General health care and psychiatric care in prisons should no longer be a
responsibility of the Ministry of Justice but that of Public Health. In this respect,
important accompanying measures should be taken, such as funding through
social insurance. These measures are urgent in connection with the arrival of
the two high-security hospitals in Flanders.
The training requirements leading to the special qualication in forensic psychi-
atry consist of three parts:
A theoretical training (interuniversity organized seminars over a period of
2 years) with a nal exam. An accreditation committee decides which educations
are suitable for this.
A period of apprenticeship related to the primary working eld (treatment or
expert reporting). The candidate has to submit a training plan which the accred-
itation committee has to approve.
A continued theoretical training.
With regard to the theoretical training: at the start, a master degree is necessary,
allowing access to courses such as the interuniversity academic education Forensic
Psychiatry and Psychology,organized by four Flemish universities. During this
education, sufcient attention should be given to the development of multidisciplinary
10 K. Goethals
collaboration among psychiatrists, forensic psychologists, social workers, nurses,
criminologists, and other disciplines. Mandatory modules are introduction to
criminal and procedural law; introduction to youth and family law, including the
relinquishment; and an overview of forensic psychiatric services, multidisciplinary
work,
forensic psychopathology, risk assessment, treatment inside and outside prisons,
pharmacotherapy in a forensic psychiatric context, brain imaging, ethics and
deontology,
expert reporting on victims, and capita selecta.
Pending the organization of an appropriate accreditation system at a European
level, the Belgian accreditation committee should evaluate other trainings and
foreign trainings with regard to the content and the usability in a Belgian context.
With regard to the apprenticeship: depending on the primary work eld (treat-
ment or expert reporting), there are two orientations:
1. Treatment: an internship under the supervision of an approved training supervi-
sor, in an inpatient forensic psychiatric service, penitentiary or extra-penitentiary
(800 h in a period of maximum 3 years). A part of the internship can take place in
an outpatient forensic psychiatric service. This internship can start in the second
year of the theoretical training.
2. Expert reporting: an internship under the supervision of an approved training
supervisor (a forensic psychiatric expert) (also 800 h in a period of maximum
3 years). The expert reports have to be done on behalf of the judiciary. An average
of 40 expert reports should be completed during the internship. Here again, the
internship can start in the second year of the theoretical training. The fee of every
expert report is paid by the Ministry of Justice.
The approved training supervisors are after a transition psychiatrists with this
special professional qualication with at least 8 years of experience.
With regard to the continued theoretical training: this training is mandatory for
maintaining the accreditation.
Next to these three training conditions, a minimum professional activity is
required:
1. Or at least an average of 10 h a week dedicated to forensic psychiatric treatment
activities, measured over a period of 5 years
2. Or at least an average of ten expert reports per year, measured over a period of
5 years.
Finally, it is recommended that the competent authority would establish a man-
datory format for reporting criminal expert reports. In designing this model, the
Section of Forensic Psychiatry of the Flemish Psychiatric Association and the
Flemish Ministry of Public Healths Accreditation Committee should be involved
in the developing of the model.
Forensic Psychiatry 11
Conclusion
In several European countries, there is insufcient attention to teaching, training, and
research in forensic psychiatry, especially from the medical-psychiatric discipline.
Notwithstanding this very difcult context, there are excellent examples of teaching
and training across Europe. Countries with a nonexisting or poorly developed
program could prot from these experiences. Also in the Netherlands, there is still
a long road ahead (Taylor et al. 2012).
In this chapter, we attempted to uncover some pain points but also to apply some
possible avenues of improvement. Initiatives such as the Ghent group meeting and
the summer seminars can contribute to a lively and dynamic teaching and training
environment in a European context but also to implement in their own country. The
new special professional qualication in forensic psychiatry is a promising milestone
for the Belgian situation. In particular we need young psychiatrists to continue
our job.
References
Beachamp T, Childress J (2001) Principles of biomedical ethics, 5th edn. Oxford University Press,
New York/Oxford
Bloom JD (2007) Commentary: authorship and training in forensic psychiatry. J Am Acad
Psychiatry Law 35:3233
Douglas KS, Hart SD, Webster CD, Belfrage H (2013) HCR-20-V3: assessing risk of violence
user guide. Mental health, law, and policy institute. Simon Fraser University, Burnaby
Folino JO, Pezzotti LC (2008) Education in forensic psychiatry. Curr Opin Psychiatry 21:514517
Goethals K (2008) Diagnostic comorbidity and circumstantial risks in psychotic offenders: an
exploratory study. Printpartners Ipskamp, Enschede
Goethals K, Van Lier E (2009) Editorial: Dutch training and research in forensic psychiatry in a
European perspective. Crim Behav Ment Health 19:286290
Gunn J, Nedopil N (2005) European training in forensic psychiatry. Crim Behav Ment Health
15:2072013
Hanson RK, Thornton D (1999) Static-99: improving actuarial risk assessments for sex offenders,
vol 2. Solicitor General Canada, Ottawa
Hanson RK, Thornton D (2002) Notes on the development of the Static-2002. Public Works and
Government Services Canada, Ottawa
Hillier B, Lambourne C, Larsen TG (2012) Mapping offender-patient pathways in the different
jurisdictions of the European Union. Crim Behav Ment Health 22:293293
Howitt S, Thomson L (2015) Mental health services in prison. In: Sheehan R, Ogloff J (eds)
Working within the forensic paradigm. Cross-discipline approaches for policy and practice.
Routledge, Oxon/New York
Khan KS, Coomarasamy A (2006) A hierarchy of effective teaching and learning to acquire
competence in evidence-based medicine. BMC Med Educ 6:59
Lanzenberg R, Kasper S (2005) Neuroimaging in schizophrenia. Fortschr Neurol Psychiatr
73:5153
Layde JB (2004a) Recent trends in forensic psychiatric training. Curr Opin Psychiatry 17:411415
Layde JB (2004b) Cross-cultural issues in forensic psychiatry training. Acad Psychiatry 28:3439
Lewis CF (2004) Teaching forensic psychiatry to general psychiatric residents. Acad Psychiatry
28:4046
12 K. Goethals
Morgan J (2007) Giving up the culture of blame: risk assessment and risk Management in
Psychiatric Practice’–brieng document to Royal College of psychiatrists. Royal College of
Psychiatrists, London http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.424.4677&
rep=rep1&type=pdf
Nedopil N, Gunn J, Thomson L (2012) Teaching forensic psychiatry in Europe. Crim Behav Ment
Health 22:238246
Nedopil N, Gunn J, Thomson L (2015) Teaching forensic psychiatry in Europe: the perspective of
the Ghent group. Int J Psychiatry Clin Pract 19:8083
Paris J (2007) The nature of borderline personality disorder: multiple dimensions, multiple symp-
toms, but one category. J Personal Disord 21:457473
Pinals DA (2005) Forensic psychiatry fellowship training: developmental stages as an educational
framework. J Am Acad Psychiatry Law 33:317323
Popma A, Raine A (2006) Will future forensic assessment be neurobiologic? Child Adolesc
Psychiatr Clin N Am 15:429444
Reeder D, Schatte D (2011) Managing negative reactions in forensic trainees. J Am Acad Psychi-
atry Law 39(2):217221
Reiss D, Chamberlain S (2001) A survey of forensic psychiatry teaching in UK medical schools.
Psychiatr Bull 25:301304
Reiss D, Famoroti OJ (2004) Experience of prison psychiatry: a gap in psychiatristsbasic
professional training. Psychiatr Bull 25:301304
Riordan D (2008) Being ordinary in extraordinary places: reective practice of the total situation in
a total institution. Psychoanal Psychother 22(3):196217
Rotter M, Preven D (2005) Commentary: general residency training the rst forensic stage. J Am
Acad Psychiatry Law 33:324327
Scott CL (2005) Commentary: developmental stages of forensic psychiatry fellowship training
from theoretical underpinnings to assessment outcomes. J Am Acad Psychiatry Law
33:328334
Simon RI (2007) Authorship in forensic psychiatry: a perspective. J Am Acad Psychiatry Law
35:1826
Strous RD (2007) Psychiatry during the Nazi era: ethical lessons for the modern professional. Ann
General Psychiatry 6:8
Taylor PJ, Chilvers C, Doyle M, Gumpert C, Harney K, Nedopil N (2009) Meeting the challenge of
research while treating the mentally disordered offenders: the future of the clinical researcher. Int
J Forensic Ment Health 8(1):28
Taylor PJ, Gunn J, Goethals K, Nedopil N (2012) Editorial: can training support free movement of
forensic psychiatrists between nations? Crim Behav Ment Health 22:233237
Tschan W (2014) Professional sexual misconduct in institutions. Causes and consequences, pre-
vention and intervention. Hogrefe Publishing, Abingdon
Van Haren NE, Bakker SC, Kahn RS (2008) Genes and structural brain imaging in schizophrenia.
Curr Opin Psychiatry 21:161167
Van Marle HJC (2000) Forensic psychiatric services in the Netherlands. Int J Law Psychiatry
23:515531
Van Tilburg W (2008) Een kwarteeuw opleiding tot psychiater in Nederland. Tijdschr Psychiatr
50:2327
Wettstein RM (2005) Quality an quality improvement in forensic mental health evaluations. J Am
Acad Psychiatry Law 33:158175
Yang Y, Glenn AL, Raine A (2008) Brain abnormalities in antisocial individuals: implications for
the law. Behav Sci Law 26:6583
Forensic Psychiatry 13
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Article
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Aims and Method To survey the forensic psychiatry training and experience received by a sample of successful MRCPsych candidates. A questionnaire was sent to all 208 candidates who passed the Spring 2001 MRCPsych Part II examination. Results A total of 99 candidates replied. Of the 42 who had not trained in forensic psychiatry posts, two-thirds had never visited a prison. Clinical Implications More supervised visits to prisons should be provided for basic specialist trainees.
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Forensic mental health services must be theoretically driven and subject to sound research evaluation if they are to be maximally effective. People who are trained in both clinical and research skills are ideally placed to ensure this, but now the clinician researcher is often under threat, regardless of clinical subject, professional discipline, or even country of residence. Although size is not the only factor, smaller fields, of which forensic mental health is one, tend to be particularly vulnerable. Funding appears to be disproportionately scarce for research into the difficulties and management of offenders who have a mental disorder, with some avenues, such as dedicated charitable funding, absent altogether. A range of the challenges and some possible solutions are considered with particular reference to Germany, Sweden, and the UK. It is as vital to good clinical practice as to the future of research to have the means to attract young scientists into the field.
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