Forensic psychiatry
Forensic psychiatry is the legal application of psychiatry.
Forensic psychiatrists work with courts in evaluating an individual's competency to stand trial, defenses based on mental diseases or defects (e.g., the "insanity" defense), and sentencing recommendations. They are also involved in the care of prisoners, both those in jails and those in prisons, and in the care of the mentally ill and dangerous (such as those who have been found not guilty by reason of insanity). Forensic psychiatrists are often called to be expert witnesses in both criminal and civil proceedings.
There are two major areas of criminal evaluations in forensic psychiatry. These are Competency to Stand trial (CST) and Mental State at the Time of the Offense (MSO).
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Competency to Stand trial (CST)
This is the determination that a defendant has the mental capacity to understand the charges and assist his attorney. This is seated in the Sixth Amendment to the US Constitution, which ensures the right to be present at your trial, to face your accusers, and to have help from an attorney.
Mental State Opinion
This gives the Court an opinion, and only an opinion, as to whether a defendant was able at the time of the index crime, to understand what he was doing. This is worded differently in many states, and has been rejected altogether in some, but in every setting, the intent to do a criminal act and the understanding that it was a criminal act bear on the final disposition of the case.
Much of forensic psychiatry is guided by significant Court ruling or laws that bear on this area.
In Britain
In Britain most forensic psychiatrists work for the National Health Service, in specialist secure units caring for mentally ill offenders (as well as people whose behaviour has made them impossible to manage in other hospitals). These can be either medium secure units (of which there are many throughout the country) or maximum security hospitals (also known as Special Hospitals), of which there are three in England and one in Scotland.
The psychiatrists often also do prison inreach work, in which they go into prisons and assess and treat people suspected of having mental disorders; much of the day to day work of these psychiatists comprises care of very seriously mentally ill patients, especially those suffering from schizophrenia. Some units also treat people with severe personality disorder, learning disabilities, developmental disorders or other illnesses.
The areas of assessment for courts are also somewhat different in Britain, because of differing mental health law. Fitness to plead, and mental state at the time of the offence are indeed issues we consider, but the mental state at the time of the trial is also a major issue, and it is this assessment which most commonly leads to the use of mental health legislation to detain people in hospital, as opposed to their getting a prison sentence.