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Frequently Asked Questions About Forensic Psychiatry

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What is forensic psychiatry?

What is a forensic psychiatrist?

Is a forensic psychiatrist the same thing as a forensic psychologist?

How is forensic psychiatry useful to the legal process?

Are forensic psychiatrists "advocates" for one side or the other in legal matters?

Why does there always seem to be a psychiatrist (or other professional) willing to testify on either side of a trial?

Doesn’t the expert have an incentive to agree with the lawyer, so he or she can testify and make money?

Why can’t we just let the experts testify without being paid by one side or the other?

Doesn’t the lawyer always want to retain experts who agree with his or her side of the case?

How are forensic psychiatrists paid?

Are there professional ethics to which forensic psychiatrists are expected to adhere?

Forensic CAREER INFO and help for your class paper or report

What is forensic psychiatry? Forensic psychiatry is a branch of medicine which focuses on the interface of law and mental health. It may include psychiatric consultation in a wide variety of legal matters (sometimes with expert testimony), as well as clinical work with perpetrators and victims. This web page focuses on forensic work with attorneys, courts, or other parties involved in actual or potential litigation (going to court in a civil or criminal matter). Incidentally, a few readers may confuse forensic psychiatry with forensic pathology. Forensic pathologists (one kind at least) are the physicians who perform autopsies, a different medical specialty altogether. So don't ask me (as a few people actually have), "how do you do psychiatry on dead people." :-)

What is a forensic psychiatrist? A psychiatrist is a medical doctor (M.D. or D.O. in the U.S.) who has completed several years of additional training in the understanding, diagnosis, and treatment of mental disorders. A forensic psychiatrist is a psychiatrist who has additional training and/or experience related to the various interfaces of mental health (or mental illness) with the law.

Is a forensic psychiatrist the same thing as a forensic psychologist? No. Psychiatrists are physicians with specialty training in the understanding, diagnosis, and treatment of mental disorders. This includes biological evaluations and treatments (such as laboratory tests and medications), psychotherapy, and family & social issues. Doctoral-level (such as Ph.D., Psy.D., or Ed.D.) psychologists do not go to medical school, but are professionals in their own right, and may have special expertise in topics not usually studied in detail by psychiatrists (such as psychological testing).

How is forensic psychiatry useful to the legal process? When legal matters involve issues outside lay (general public) expertise, lawyers and judges regularly seek consultation from professionals in a wide variety of fields, including medical specialties. Such professionals are often called "experts" or "expert witnesses." Although forensic experts usually are truly knowledgeable, the criteria for "expert" designation in such cases are legal ones, and not necessarily scientific. Sometimes the expertise is sought in an effort to provide the best possible information to judges or juries, but there are many other situations in which a prudent attorney, judge, or other party may request consultation.

Are forensic psychiatrists "advocates" for one side or the other in legal matters? Usually not. Ethical forensic psychiatrists try to avoid bias. They focus on the data or evidence within their areas of expertise, and comment objectively on the information as they see it. Although we have some familiarity with the law, we are not attorneys or judges. We are often consultants to advocates (lawyers) or courts, and at other times we may participate in advocacy strategy, but we consider it unethical to combine our expert opinions (testimony, reports, or affidavits, for example) with advocacy per se. Ethical forensic psychiatrists do not accept contingency fees or otherwise conduct themselves in ways that may interfere with, or imply, a lack of professional objectivity.

Why does there always seem to be a forensic psychiatrist (or other forensic professional) willing to testify on either side of a trial? Such an impression of the expert's role is often misleading. When working in civil or criminal litigation, the forensic psychiatrist’s job is to assess the relevant facts thoroughly and, if asked, offer an opinion about them. If the expert’s opinion is helpful to the lawyer’s case, he or she may be asked to express that opinion via report or testimony. This is the attorney’s decision, not the expert’s (except when the expert is appointed specifically for the court’s own use). If the opinion does not support the lawyer’s case, the expert will not be asked to report or testify, and the opinion remains hidden from the court. Thus, the testimony one sees in court is very likely to be favorable for the lawyer who retained the expert, but not because the expert is biased or unethical. In some cases, a lawyer may consult with many experts before finding one whose opinion supports his or her side of the case; that's a lawyer's strategy, not the forensic expert's. Experts may disagree, of course, but each should arrive his or her view objectively; opinions must not be created just to please the attorney.

Doesn’t the expert have an incentive to agree with the lawyer, so he or she can testify and make money? In most cases, no. Ethical experts are paid for their time, not their testimony. Since the time spent forming the opinion usually far exceeds time spent testifying, most payment is received regardless of whether or not the expert testifies. Forensic psychiatrists are similar to most other professionals in their respect for their work and their clients. The minority who "cheat" in some way risk severe censure and loss of credibility.

Why can’t we just let the experts testify without being paid by one side or the other? In some countries, that’s just the way it is done. In the U.S., however, we have (and greatly value) an adversarial system of justice. U.S. law believes that in most litigation the best way to reach the truth is to have the two sides (plaintiff and defendant in civil cases, prosecution and defendant in criminal ones) confront each other in front of a jury and/or judge, with clear rules and a powerful referee (the judge) to assure fairness to both sides. Within the rules (which include being sure the expert witnesses really are experts, and that the data on which they rely is scientifically sound), each side is free to present its case as it sees fit. The rules are different for different kinds of cases, but the idea is that in a fair contest, right will triumph. Is this system perfect? Of course not. Issues such as equal representation for indigent litigants are regularly confronted by courts and legislatures. Nevertheless, our system works well, both for finding the truth and for protecting the rights of all concerned.

Doesn’t the lawyer always want to retain experts who agree with his or her side of the case? In the long run, attorneys tend to want experts on whom they can rely for honest answers, not simply experts who will always agree with them. Lawyers know they fare better when they know both the strengths and the flaws in their cases as early as possible. A malpractice plaintiff’s attorney, for example, may retain a forensic psychiatrist to help assess the merits of a case before deciding whether or not to file suit. Many forensic professionals help prevent frivolous or meritless litigation.

How are forensic psychiatrists paid? In most cases, forensic psychiatrists charge an hourly fee for work with attorneys or courts. Occasionally, they work by contract to a court or other public agency. Flat fees or pre-set numbers of hours, while not unethical per se, are sometimes discouraged, since they may inappropriately limit the depth of one’s involvement in a case and lead to insufficient information for accurate opinions. Fees or reimbursement which are tied to the outcome of a case (e.g., contingency fees) are strictly unethical in our profession.

Are there professional ethics to which forensic psychiatrists are expected to adhere? Yes. Forensic psychiatrists are expected to adhere to the general ethics of the medical profession (e.g., the Oath of Hippocrates, the Oath of Geneva) and must meet many requirements of state licensing agencies. Most belong to one or more of the basic professional organizations of our profession (the American Academy of Psychiatry and the Law [AAPL], the American Psychiatric Association [APA], and/or the American Medical Association [AMA]), which have formal codes of ethics. Specific sections of the American Medical Association Principles of Medical Ethics and their APA annotations refer to doctors who work in legal settings. The AAPL Code of Ethics focuses exclusively on forensic practice. Psychiatrists who stray from the above requirements, for example by acting dishonestly, may face public expulsion from their organizations and, in some cases, lose their professional certifications and licenses.

It is important to note that organization codes of ethics (as contrasted with laws and rules that governing professional licensure) are binding only on members of those organizations. Thus attorneys, clients, and courts may wish to know whether or not the forensic consultants with whom they are working -- or whose testimony they are hearing -- belong to such groups as the American Psychiatric Association and AAPL.

Career Info and Special FAQs for Students and Class Projects

I get several e-mail requests per month for information on careers in forensic psychiatry and psychology, or for information to help with a school paper of some sort. I'm happy to answer the queries as time permits, but here are some frequently-asked questions and answers that may save you (and me) the trouble. My best advice? Start early and do your homework at the library instead of relying on someone else to give you the answers. Do not copy them directly into your term paper. That’s plagiarism, and if the teacher doesn’t know, you will.

What's the difference between a forensic psychiatrist and a forensic psychologist, and how do I get to be one?

A psychiatrist is a medical doctor who, after receiving his or her M.D., has completed three to five years of additional specialty training in psychiatry. The first steps after high school are to go to a good college, then take the required pre-med courses, and make really good grades. You don't have to major in a science or in psychology, but you will have to take lots of science courses. In your junior or senior year, you apply for admission to a medical school. If you are accepted, you spend four years there learning to be a physician. During the last couple of years of medical school, you decide on a specialty (in this case, psychiatry) and apply to "residency programs" for the specialty training. During the last year or so of the psychiatry residency, you will get some forensic experience (that is, experience at the interface of mental health and the law). If you want to truly specialize in forensic work, you will probably want to take a forensic psychiatry fellowship (usually one year) after you complete psychiatry residency.

Sounds like a lot, I know. You get a small salary to support you during the residency and fellowship.

A psychologist is someone who majors in psychology in college, and usually gets graduate training in psychology. Clinical psychologists usually get a Ph.D., Psy.D., or Ed.D., which takes 3-4 years of graduate school after they get their bachelor's degree. Forensic psychologists may get their training during the Ph.D. program or during a fellowship after their Ph.D.

It is important to note that even if you want to be a "forensic" psychiatrist or psychologist, you need to be interested in medicine and psychiatry in the first place (for psychiatry) or in mental health generally (for psychology). being a good clinician is the foundation for the forensic training and work.

Finally, those of you who erroneously thought that forensic psychiatry was mostly the study of crime and criminals might be interested in a career in criminology or law enforcement, which doesn't take quite so long. An undergraduate degree (BA, BS) in a criminology field prepares one to do a lot of things in law enforcement systems; a graduate degree (M.A., M.S., Ph.D.) is better. To go into law enforcement itself (as a policeman/woman or other form of officer), you may not need a college degree; however, most large law enforcement organizations prefer a college degree. The FBI and other federal agencies pretty much require a college education, often a graduate degree (which may be in lots of different things, including accounting, criminology, or computer programming).

What Does a Forensic Psychiatrist Do? Do You Work With Lots of Criminals and Gory Crimes?

Most forensic psychiatrists don't specialize in criminal matters, and those that do spend a lot of their time in work that isn't very sensational (but occasionally it is sort of gory). The word "forensic" refers to anything that has to do with the law (or it can refer to debating, as some of you smarter readers know from speech class). Forensic psychiatrists thus may be involved with criminal matters, civil litigation (such as malpractice lawsuits), competence to do things (like make a will, consent to medical care, or take care of children), child custody, treating and working with mentally ill people who get in trouble with the law, helping victims of crimes, helping lawyers and judges understand the psychological aspects of their cases, and many other things.

Here are three things we're not: (1) We're not lawyers. We may work with lawyers, or try to understand the legal aspects of the matter we're working on, but our job is to be good doctors who can translate what we know into something useful for the legal system, not to be lawyers ourselves. (A few forensic psychiatrists and psychologists have law degrees as well as medical ones. In my view, those folks usually do best when they pick one role or the other.) (2) We're not judges. We don't interpret the law or tell judges or juries how they should rule. Most of the time, psychiatric issues are only a small part of the entire legal matter being considered. Sometimes we're asked to give an opinion about those psychiatric issues, but that's to help the judge or jury decide, not to tell them what to do. (3) We're not cops. We aren't the folks who protect the community, deal with dangerous or criminal situations, or contain the bad guys. That's not our area of expertise, and nobody gives us permission to do it anyway. So the next time you hear about a hostage crisis on T.V., be glad they call the police negotiators instead of the shrinks. And if they call a shrink to negotiate with the perpetrator, you'll know it's fake.

Could you briefly describe a typical working day?

Every forensic practice is different, and some are very different from others. In my case, I see patients, review medical records and other information, examine patients for attorneys or courts, read and keep up my clinical education, write reports or clinical papers, teach clinical and forensic topics in medical schools and training programs, and talk with clinical and forensic colleagues. I also testify in court or in other judicial proceedings such as "depositions" but, as for most forensic psychiatrists, that only occupies a small portion of my professional time.

What methods do you use in your practice?

That's a complicated question. I review lots and lots of records of various kinds, interview lots of people in different kinds of cases, talk to lawyers and other legal or law enforcement professionals, stay aware of how I can use the expertise of other professionals (such as forensic psychologists) in some cases, and try to understand clinical and forensic information in such a way that I can help the lawyer or court see what I think is important (e.g., in conferences, reports, or testimony).

If by "methods" you're really asking about polygraphs, truth serum, and hypnosis, you need to know that those are either mythical (the truth serum) or highly overblown by old movies and the tabloids (especially the forensic uses of hypnosis). I use a few special tests, and often work with other professionals who use certain psychological or neurological tests and methods, but they're not magic.

By the way, do you like English? Grammar? Composition? Communication in speech and writing? Forensic psychiatry uses those skills a lot.

Do you still do medical things?

Yes. I see patients, teach in clinical settings, and write on clinical topics. I recommend that forensic psychiatrists, psychologists, etc., not lose touch with the clinical field, since that's what the law often relies on for their expertise. (Most forensic psychiatrists and psychologists do a lot of patient care.)

How much do forensic professionals make?

Private fees in my psychiatric subspecialty range from about $250/hour to about $800/hour. The latter is for one or two people who are internationally known for extremely specialized stuff. Most well trained and experienced forensic psychiatrists charge between $300 and $500/hour (as of May, 2012). Sometimes we discount our fees.

Forensic psychologists usually charge a bit less. The most expensive I know charge around $350-450/hour (May, 2012). The least expensive (but qualified) ones that I know charge about $200/hour.

Note that private fees are virtually always by the hour. It is unethical to charge a "contingency fee" (like some lawyers), in which the pay depends on the outcome of the case. Ethical experts never charge a big flat rate just for their "testimony" itself (that's just on TV, or maybe experts whom I might well consider unethical).

Professionals who are employees of someone else, such as a government agency, often get a salary, so the hourly fee concept may not be relevant . Most such people do "in-house" forensic work (such as being employed by a jail or prison to do inmate treatment, by a state mental health system to evaluate or treat patients referred by the judicial system, or by a medical school). Salaried positions vary from about $35-40,000/year for some entry-level masters-degree professionals to $150-250,000/year for senior forensic psychiatrists (May, 2012). Senior forensic psychologists (Ph.D.) may make over $100,000/year in a some salaried positions. And don't forget that salaried positions usually include health and retirement benefits, sick-leave, and paid vacations; involve less hassle than private practice; may be more stable than private practice, and have no office "overhead" expenses (such as rent, secretarial salaries, billing costs, or losses from unpaid fees).

Does gender make a significant difference for success in this field, either positive or negative?

No.

What about race per se?

No.

What about cultural things and personal preferences, like accents or the way someone dresses?

Like much of psychiatry and the mental health professions, familiarity with U.S. culture and society is important. Being well educated and experienced may not be enough. Forensic professionals also need to be able to communicate clearly with the people they evaluate or interview, lawyers and judges, other professionals, and sometimes juries. While some forensic fields depend a bit less than others on that familiarity and interpersonal communication, a lawyer who retains a forensic clinician will expect him or her to be articulate, to present himself or herself appropriately and credibly, and to be able to convey his or her findings in a clear and articulate manner. If the lawyer believes that a heavy accent or some aspect of one's physical appearance (such as long hair or visible tattoos) or presentation (such as unusual dress or a pronounced accent) would not convey the findings very well to a judge or jury, then the attorney will probably choose someone else. (See the articles and vignettes on "international medical graduates" elsewhere on this website.)

I always wanted to wear a gentlemanly pony tail, but that will have to wait until I retire. Hope I still have enough hair. :-)

Do you recommend your field for a career over the next 30 years?

Yes, but I also recommend that you be very good at it. Many clinicians are trying out forensic work as their clinical practices become smaller or more of an administrative hassle. Some do a good job and some don't. As in any field, those who do a good job are likely to have much more rewarding careers than those who don't.

Do you have any advice for a high school student or college undergraduate interested in becoming a forensic psychiatrist or psychologist?

Don't commit yourself to a forensic career before becoming competent in your clinical field, at the MD (or PhD, MSW, MSN, or other "terminal degree") level, unless you just want to work for someone else. If you want to be a forensic psychiatrist, be a physician first, then a psychiatrist, and only then a forensic psychiatrist. Also, try to talk with a psychiatrist or clinical psychologist in your community. Most of us are happy to talk with students about what we do, and a short visit will clear up a lot of questions. (Please note that I am not in a position to respond in detail to the many emails I get from students. Talk with some near you.)

Which do you think is the better field to go into, psychiatry or psychology?

It depends on what one wants to study and how one wants to spend the rest of his or her life. Psychiatry involves becoming a medical doctor first -- a special kind of lifelong commitment -- then several years of training in diagnosing and treating mental illness. Psychology is a fine profession as well, with education and commitment requirements of its own, but different from medicine.

Would you consider forensic psychiatry to be a very high, normal, or low stress job?

It varies with the case or situation. In private practice, I have a bit of control over my time, which is a plus, but I get involved in some tragic situations, which is very stressful. In addition, forensic matters often have deadlines which must be met. Finally, forensic work involves a lot of writing (reports and the like, which are a little like doing term papers for which you have to get an "A" every time), and occasional testimony (a little like oral exams). When I was in school, I never thought I would be writing term papers and taking oral exams for a living. :-)

How much time do you spend testifying in court?

Like most forensic psychiatrists and psychologists, I don't spend much time in court. Four or five times a year is about average for me, although some experts testify more often.

What is it like to work with . . . (law enforcement, SWAT teams, hostage negotiations, serial killers, CSI labs)?

Such work is rare in more forensic practices. Like most forensic psychiatrists and psychologists, I spend little time in those situations. After all, I'm a doctor, not a law enforcement officer or investigator. A tiny number of psychiatric or psychological experts do work often in such settings, but what most of us really do from day to day is quite different, and usually far less exciting, than the things one sees in movies and television shows. Don't base your career choice on what you see on TV or in the movies!

What is the most interesting case you have ever worked on?

There are many. Some have involved rare mental disorders or very unusual situations. Many have involved some level of tragedy for sometimes for lots of people. I'm particularly interested in improving mental health conditions, treatment, and fairness, especially in the public sector (state hospitals, community mental health centers, prisons, etc.).

Are the courses needed to become a forensic psychiatrist very difficult?

The "courses" include pre-med college courses, medical school, clinical psychiatry training, etc. Yes, they are often hard, and one has to make very good grades. Your undergraduate college education should be at a good college or university, to prepare you to get into, and complete, medical school or graduate school.

Do you work closely with other fields of forensic science?

Not many, in my case. I often work with psychologists, and sometimes with other kinds of medical specialists, but forensic psychiatry rarely involves fields such as fingerprinting, ballistics, chemistry, or pathology. I am a member of the American Academy of Forensic Sciences, however, and enjoy learning about other fields.

How much of your practice is devoted to evaluating people accused of crimes?

Maybe 10% of my forensic practice, and less than 5% of my professional time.

Do you still have time to treat and see patients unrelated to the legal system?

Of course. Staying in touch with clinical topics and patients is very important to forensic expertise and credibility.

If so, is this typical of most forensic psychiatrists?

Almost all forensic psychiatrists, and most forensic psychologists, have a significant clinical practice or other cliinical connection. In addition, it is important to note that "clinical" is not the opposite of "forensic." Many forensic endeavors include clinical activity, and vice versa.

How much of your practice is devoted to family court evaluations (such as for child custody)?

None. Family court, child custody, and child evaluations require very special training in child psychiatry or psychology. Although courts sometimes allow general psychiatrists, psychologists, or counselors to do such evaluations, most good psychiatrists agree that such work is so specialized, and so important to the children, that a child specialist is required.  Incidentally, that requires another year or two of residency or graduate school.

How much money do you make? What do you charge for your work?

Now that’s a bit personal. See above for some typical hourly rates for different kinds of forensic professionals.

Do you find your career choice rewarding and satisfying?

Yes. When you choose a career, be sure you’re going to like it for a long, long time.

Do you have any regrets about becoming a psychiatrist?

No, except maybe that I never pursued my dream to become a famous folksinger. :-)

Thank you for visiting this website. I hope this information has been helpful.

If you are a clinician or a legal or judicial professional and wish to discuss a forensic matter,
please contact Dr. Reid at

P.O. Box 4015, Horseshoe Bay, TX 78657
(830) 596-0062 (voice)
(830) 596-9047 (fax)
e-mail: reidw@reidpsychiatry.com

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