Examining Contributors to Burnout and Well-Being in U.S. Forensic Psychiatrists

• wellness
• burnout
• mental health
• forensic psychiatry

Forensic psychiatrists navigate complex ethics and clinical challenges at the intersection of health care and the criminal justice system. In North America, forensic psychiatry is practiced by a relatively small number of highly trained mental health specialists who work across diverse geographic regions and organizational structures. Sustaining this critical workforce requires deliberate, strategic efforts focused on recruitment and retention, including identifying and addressing the factors contributing to burnout and bolstering professional fulfillment.

A range of factors influence individuals’ decisions to enter the health care workforce, remain in it, and find satisfaction within their professional roles. Workplaces fostering autonomy and providing support, feedback, and opportunities for professional development (especially when these outweigh job demands like workload or challenging environments) are more likely to cultivate motivation and job satisfaction.¹ This effect is particularly pronounced when the demands are high but intellectually stimulating.² Stress and dissatisfaction arise when the effort invested in work is not matched by adequate rewards, including compensation, recognition, status, or job security, especially for those who are highly committed to their profession.³

One of the most effective models used in health care organizations posits that job satisfaction and dissatisfaction stem from different sources.^4,5 Intrinsic motivators (such as achievement, recognition, responsibility, and the nature of the work itself) drive engagement, whereas extrinsic or hygiene factors (like salary, working conditions, and supervision) primarily prevent dissatisfaction.⁶ Simply addressing hygiene factors does not lead to satisfaction in the absence of intrinsic motivators. On the other hand, ensuring intrinsic motivators alone may be insufficient to prevent job dissatisfaction in jobs with poor extrinsic factors. Further, three fundamental workplace motivators have been posited: the need for achievement (through career advancement), affiliation (via collegial relationships and networks), and power (having influence over outcomes).⁷ Overall, career satisfaction arises from a dynamic interplay between internal and external influences.

Within the context of factors that contribute to professional fulfillment, various terms have been used to describe physicians’ experiences in the workplace. The term burnout has gained prominence over the past decades to signify poor well being among physicians.⁸ A systematic review of 182 studies found 142 different definitions of burnout, underscoring the conceptual variability of the term.⁹ The most common definition is that of a psychological syndrome resulting from prolonged exposure to job-related stress and is characterized by emotional exhaustion, depersonalization, and a reduced sense of personal accomplishment.¹⁰ Further, a review of physician well being literature found agreement on the importance of the concept of wellness but significant inconsistency in its definition, with 86 percent of reviewed articles failing to offer a clear or consensus definition.¹¹

Globally, across health care professions, occupational stress and job dissatisfaction, often manifesting as burnout, pose a threat to workforce well being and patient care. Its consequences are well documented, including diminished quality of care, reduced job satisfaction, increased staff turnover, and adverse outcomes at the individual level, such as fatigue, substance use, and depression.^12,–,16 Workload has emerged as the most consistent and significant predictor of burnout across health care settings, including the impact of cognitive load and complexity.^17,18

In forensic mental health settings, the workforce faces stressors contributing to burnout, such as exposure to trauma, conflict, legal and clinical complexity, and risk of violence;^19,20 most of this literature has been focused on the experience of forensic nurses. Some studies report moderate to high levels of emotional exhaustion, depersonalization, and diminished personal accomplishment among forensic staff, sometimes accompanied by physical symptoms and demoralization.^20,21 Forensic mental health staff can feel unsupported by organizational leadership and perceive their well being as undervalued in a setting where distress may be mistakenly viewed as normative. Some studies have found no significant differences in burnout rates of forensic nurses compared with nonforensic counterparts,^22,23 whereas others suggest that involvement in team decision-making and supportive work environments enhance job satisfaction.²⁴

Although the literature has focused on the impact of vicarious trauma and compassion fatigue among mental health professionals in forensic settings,^25,–,27 there has been limited focus specifically on burnout and well being in forensic psychiatrists. In 2002, Strasburger et al.²⁸ surveyed members of the American Academy of Psychiatry and the Law (AAPL) and found that nearly half of respondents reported little to no occupational stress and 78 percent reported enjoying the challenges of their work. Respondents identified testifying or concerns about legal proceedings to be the most commonly reported stressors.

In 2022, we conducted a survey (34% response rate) of Canadian forensic psychiatrists through the Canadian Academy of Psychiatry and the Law (CAPL).²⁹ Just over half of respondents reported experiencing burnout, aligning with other surveys done during the COVID-19 pandemic.^30,31 Higher burnout rates were reported among early-career psychiatrists, those who perceived misalignment between their values and that of their organization, and those with low perceived levels of control over their workload. Professional fulfillment was associated with intellectual stimulation, engagement with the legal system, and job flexibility. The findings underscored the need to shift attention from individual to systemic interventions. Recommendations included commitment from organizational leadership to address burnout, support for early-career psychiatrists through mentorship and peer networks, enhanced communication to foster value alignment, and greater autonomy to improve control over workload. These align with broader literature emphasizing the moderate to large effects of system-level interventions on reducing burnout among health care professionals.¹⁶

Building on insights from the Canadian context, the present study seeks to assess the prevalence of, and factors contributing to, burnout and professional fulfillment among forensic psychiatrists in the United States. Given the structural differences between the Canadian and U.S. health care and legal systems, a dedicated examination of the American context is essential to generate actionable findings. In the Canadian context, citizens have universal access to medically necessary health care services funded by taxation and administered by provincial governments under the Canada Health Act. In the U.S. context, services are funded by private insurance or public programs (e.g., Medicare), and access is dependent on insurance status. Regarding the legal system, Canada is generally based on British common law, with a national framework with provincial and territorial courts, having Crown counsel that represent the state. In the United States, there are separate federal and state court systems, prosecutors are often elected, and there is a stronger emphasis on constitutional and state-level variation of common law.^32,–,35 There are also national differences in the organization of services and practice locations. For example, in Canada, forensic mental health services are organized in a provincial and territorial model, with most services being available in forensic institutions or forensic divisions within psychiatric hospitals. In the United States, although the majority of states have specialized forensic departments, some states provide treatment within psychiatric wards or medical institutions. Although there are provincial and state differences in treatment models and access, there are many forensic mental health services in courts, correctional facilities, and the community in both countries.³⁶ By identifying targets for institutional and systemic intervention, this research aims to advance strategies that reduce burnout, promote well being, and support the long-term health, effectiveness, and retention of the forensic psychiatry workforce in the U.S. context.

• © 2026 American Academy of Psychiatry and the Law