Forensic Psychiatry: Fundamentals and Clinical Practice simultaneously provides a comprehensive and up-to-date review of key concepts in the specialty while emphasizing commonly overlooked topics in forensic psychiatry, such as foundational neuroscience and neuroimaging. Editors Basant Puri and Ian H. Treasaden (both faculty of Imperial College London School of Medicine, United Kingdom) have brought together an impressive set of expert contributors, drawing primarily from fellow U.K.-based forensic practitioners. This text serves as a reference and refresher for seasoned forensic practitioners and a welcoming introduction to the field for trainees. The text is written within the context of the British legal system but is largely applicable to the general field of forensic psychiatry, including its practice in the United States.
The text is divided into 11 parts that each cover important topics and concepts in the field. Part 1 provides an overview of the basic sciences. It emphasizes important advancements and developments in fields of neurobiology, neuroimaging, and genetics in the context of forensic psychiatry. This section is instrumental in establishing the foundations for understanding common clinical presentations in forensic psychiatry. The section begins with clearly labeled figures to help guide the discussion on neuroanatomy. This leads to a brief review of neurochemistry with an emphasis on serotonin metabolization and thyroid function and their significance in psychopathy and aggression. Chapters 3 and 4 are especially pertinent to understanding psychopathy and aggression with examples of changes in structure and neural activation found in the brains of those with violent tendencies.
The chapters in Part 1 addressing the psychology of memory, development, aggression, and violence provide a foundation to better appreciate later discussions in the book on clinical forensic psychiatry and assessments. Chapter 10 on the psychology of aggression and violence is particularly helpful as it describes various models and perspectives to better understand how violence manifests. Part 1 also includes a chapter supporting the need for cultural formulations, especially when working with marginalized groups.
Part 2 details clinical forensic psychiatry and comprises the bulk of the text. This section begins with an introduction of the interplay of psychiatry and law in the United Kingdom and then discusses specific areas of interest in forensic psychiatry. This part is helpful in emphasizing common presentations or concepts that can be applied to other psychiatric subspecialties, such as consult liaison, emergency, addiction, and correctional psychiatry. These topics include assessing, managing, and treating aggression/violence, malingering, PTSD, and substance use. This part is successful in covering well-documented and researched topics in forensic psychiatry, such as psychosis and law, while also highlighting less discussed topics like deaf offenders with psychiatric needs.
Part 3 examines the specific interactions of the legal system with mental health. It begins with a description of the criminal justice system found in England and Wales. Chapter 65 is especially informative as it discusses specific sentencing for mentally ill offenders with easy-to-follow tables. There is a later discussion on specific defenses applicable for mentally ill offenders, with Chapter 70 describing the history and implementation of the “not guilty by insanity” plea.
Part 4 details the clinical assessment process in forensics, with Chapters 89 and 90 covering risk and violence assessments. These assessments are applicable to other fields in psychiatry by providing objective tools to help create risk management plans. Parts 4 and 5 discuss the clinical responsibilities of forensic psychiatrists. These responsibilities include writing a medicolegal report, being an expert witness, and presenting formally in court. Each step is carefully discussed in layman's terms, which provides insight into the process for those unfamiliar. For example, Chapter 93 provides guidelines and considerations for report writing as well as examples that help reinforce the language and content expected in medicolegal documents.
Part 6 reviews treatment modalities within a level of care discussion. This part again discusses risk assessments while highlighting the U.K. level of care model for forensic populations. This part also includes discussions on managing severe personality disorders in a hospital and community setting. The discussions of specific therapy modalities (e.g., cognitive behavioral therapy, dialectical behavior therapy, psychodynamic psychotherapy, family therapy, etc.) provide a unique perspective on how these therapies are used within the forensic population. Part 7 continues the discussion of levels of care by addressing the U.K. prison system and the prevalence of mental illness within it. This part highlights unique aspects of correctional psychiatry, such as the treatment of women and those less abled in the prison setting. This part's most captivating chapter is a case example of HMP Grendon, an English prison that has become a novel personality disorder treatment center.
Part 8 covers the victims of violence, including torture, with a chapter dedicated to PTSD that encompasses prior discussions on the topic. Part 9 dives into the interplay of civil law and forensic psychiatry with thought provoking discussions on abortion and euthanasia. These topics are highly relevant in our current sociopolitical landscape. The discussion on abortion is particularly informative and encourages a conversation regarding the mental health impacts related to abortion.
Part 10 provides an overview of general ethics considerations, such as consent, confidentiality, and duty to warn. The duty to warn chapter is enlightening as it details the unique and contrasting legal obligations psychiatrists in the United States and United Kingdom face when deciding to report potential threats from patients. Finally, Part 11 concludes the text with a brief comparison of mental health laws found in other English-speaking countries.
Forensic Psychiatry captures the essence of the field and its practice in one accessible text. One possible drawback of providing such sheer depth of information is that chapters may become disjointed at times with few clear transitions between chapters within each part. The text partially mitigates this concern with repeatedly presenting key topics throughout the text to provide a sense of cohesion through building on prior discussions. Ultimately, this text is a reliable reference and guide to exploring the world of forensic psychiatry for all levels of training and expertise.
Footnotes
Disclosures of financial or other potential conflicts of interest: None.
- © 2021 American Academy of Psychiatry and the Law
