University of Michigan/Center for Forensic Psychiatry Fellowship
The University of Michigan/Center for Forensic Psychiatry fellowship in forensic psychiatry is one of the oldest most established fellowships of its kind in the country. Over the years its faculty have included national leaders in forensic psychiatry, forensic psychology, public psychiatry and the interface between mental health and the law. Located in the Ann Arbor area of Michigan, the fellowship offers linkages and opportunities unique in the country and all within an easy drive (and even a bike ride on warm days).
Serving as the fellowship’s main rotation site, in 1974 Michigan established the Center for Forensic Psychiatry (CFP) to provide diagnostic outpatient and inpatient evaluation and inpatient treatment of individuals committed to the Michigan Department of Health and Human Services by the criminal courts. Since its inception CFP has been one of the nation’s premier training sites for professionals in psychiatry, psychology and social work specializing in the interface between mental health and the law. CFP is currently operated out of the Michigan Department of Health and Human Services, Behavioral Health and Developmental Disabilities Administration’s Bureau of State Hospitals. The fellowship operates through a collaborative and contractual partnership within the academic graduate medical education framework of the University of Michigan Department of Psychiatry.
The fellowship program in forensic psychiatry is a one-year, post-residency training program for psychiatrists planning careers in forensic or correctional psychiatry. It is accredited by the American Board of Psychiatry and Neurology. Board certified general psychiatrists in good standing who complete this program are qualified to sit for the subspecialty examination in forensic psychiatry.
The fellowship program consists of rotations and experiences involving criminal evaluations, civil evaluations, risk assessments pertaining to release decisions for insanity acquitees, violence risk assessments, restoration of competency to stand trial, courtroom testimony and forensic consultation to general psychiatrists. Fellows work with the State Medical Director for Behavioral Health and Forensic Programs to learn about psychiatric administration, public policy and statutory development. Exposure to correctional psychiatry, police training, specialty courts and other alternatives to incarceration programs are among the opportunities available. Fellows interested in the intersection of child psychiatry and the law may be involved with case consultations related to juvenile justice programs and child welfare.
A key aspect of the program is its comprehensive didactic instruction including clinical and legal aspects of forensic psychiatry offered at CFP and taught by a rich faculty of board-certified forensic psychiatrists, forensic psychologists, program-affiliated attorneys and guest lecturers. CFP frequently hosts larger conferences on topics of forensic relevance. The mock trial series offers fellows the opportunity to participate in a mock trial as an expert to assist them in their actual testimony and observe others in mock trials conducted throughout the year. Tours of state hospitals, community mental health programs, correctional and court-related sites are available during the year. Classes at Michigan Law-University of Michigan and completion of a scholarly project are part of the program. Fellows can study in the CFP library and have access to the librarian who will assist in finding resources to help in any scholarly activities.
Key faculty involved in the program include;
Debra A. Pinals, M.D., Michigan Medicine, Department of Psychiatry
Margo Schlanger, J.D., Michigan Law, University of Michigan
Elissa Benedek, M.D., Michigan Medicine, Department of Psychiatry
Diane Heisel, M.D., Center for Forensic Psychiatry
Candyce Shields, Ph.D., Center for Forensic Psychiatry
Martha Smith, Ph.D., Center for Forensic Psychiatry
Fellows receive clinical training at three major sites in three major settings: inpatient treatment units at CFP; the outpatient Evaluation Unit at CFP; Michigan Medicine, Department of Psychiatry outpatient and inpatient sites. Additional time is spent in Lansing and at regional hospitals participating in work in administrative and consultative forensic psychiatry. Rotations at correctional facilities, including local jails and state prisons are also available. Correctional experiences are available within 20 minutes of the medical center. Center for Forensic Psychiatry-- Outpatient Evaluation Unit
In order to obtain certification as Consulting Forensic Examiners under Michigan law, fellows observe competency to stand trial and criminal responsibility evaluations in the outpatient unit. They then conduct at least ten supervised competency evaluations and ten criminal responsibility evaluations. These evaluations are supervised by both psychiatrists and psychologists who are Consulting Forensic Examiners, with 3 staff participating at the beginning and then again at the end of the process to evaluate the fellows progress. Fellows observe court testimony, participate in a mock trial, and provide testimony when required in cases they have examined. Other forensic issues arising in the evaluation unit include Miranda rights and competency to be sentenced.
Center for Forensic Psychiatry - Inpatient
Most inpatients at CFP have been found not guilty by reason of insanity or incompetent to stand trial. Fellows function both as treating psychiatrists for their own patients, and as forensic examiners for the patients of other clinicians. They receive ongoing supervision in the management of forensic patients with emphasis on clinical problems such as suicide, malingering, amnesia, self-injurious behavior, violence, psychosis, substance abuse, and antisocial behavior. Fellows prepare psychiatric reports and provide testimony for the courts, particularly competency to-stand-trial evaluations and clinical certificates for continued, involuntary hospitalization. Other important forensic issues encountered on inpatient units include the right to treatment, the right to refuse treatment, informed consent, and confidentiality/privilege. Typical case loads of 4-6 patients are carefully monitored to provide exposure to a variety of diagnostic groups, legal issues, and offenses.
CFP oversees the community access points for individuals found Not Guilty by Reason of Insanity throughout Michigan. Many of the individuals are hospitalized at CFP, others are at one of three regional hospitals for adults (Caro Center, Kalamazoo Psychiatric Hospital, and Walter Reuther Psychiatric Hospital) or in the community. Interviews of these individuals are at times required, including assessments for readiness for step-down to regional hospitals or direct community placement. Fellows routinely participate in these interviews with senior forensic psychiatrists, including the Departmental Designee who is assigned to review specific release decisions for individuals whose NGRI was related to these more serious offenses.
Michigan Medicine Department of Psychiatry -- Legal Regulation and Civil Forensic Psychiatry
Michigan Medicine and the practices of forensic faculty psychiatrists serve as the venues for this rotation. Fellows consult to other psychiatrists on issues related to the legal regulation of psychiatric practice, such as civil commitment, confidentiality, refusal of treatment, emergency treatment, decision-making competence, guardianship and conservatorship, etc. Cases have also included federal criminal cases, asylum and immigration cases, as well as evaluation of high-risk professionals such as pilots. They gain experience in psychiatric aspects of civil litigation such as malpractice, disability, sexual harassment, psychic injury related to trauma, child custody, and in administrative and public policy aspects of forensic psychiatry.
The rotation includes several major components. First, fellows attend a monthly conference including psychiatry residents and faculty from the forensic psychiatry program of the University of Michigan Department of Psychiatry. At the conference, cases and questions pertaining to the law/psychiatry interface are presented for consultation and educational purposes. Fellows and psychiatry residents also participate in the presentations. Second, fellows meet regularly with University of Michigan Law School faculty to discuss matters relating to the legal regulation of psychiatry, with particular reference to active issues such as litigation, prison reform and policy issues across systems of care. Third, fellows observe and assist experienced forensic psychiatrists, in private practice and in settings related to civil controversies. Fourth, fellows can work with senior faculty who participate in high level behavioral threat assessments when consultation is requested from a variety of systems.
Mastery of forensic psychiatry requires immersion in a knowledge base and a style of thinking that are foreign to most clinicians. Didactics are therefore given a high priority, and protected time is offered for fellows to attend these trainings.
Landmark Cases and Legal Aspects of Forensic Psychiatry (Core Curriculum I)
Debra A. Pinals, M.D., reviews major legal systems and principles of law critical for the practice of forensic psychiatry through the primary fellowship Landmark Case Seminar. The Landmark Cases of forensic psychiatry provide source material for the study of the underpinnings of criminal and civil law, including criminal responsibility, pre-and post-adjudication disposition of defendants, criminal procedure, evidence, personal injury/malpractice, patient and prisoner rights, family law, disability law, and expert testimony as practiced in federal and state courts. The cases presented also provide a thorough introduction to legal principles that enable the forensic resident to understand the legal literature and appreciate the significance of developing case law. Dr. Pinals also emphasizes how these legal cases inform medical knowledge, practice-based learning and contribute to public policy and the legal regulation of psychiatric practice and systems of care.
To buttress this training core curriculum, faculty from the University of Michigan Law School serve as invited participants in select landmark case lectures pertaining to areas of expertise. Fellows also meet regularly with key law school faculty to assist in their understanding of law and its interface with psychiatry.
Clinical Aspects of Forensic Psychiatry (Core Curriculum II)
The program is fortunate to have a robust faculty group with training and experience in the practice of forensic psychiatry. These faculty participate in much of the teaching. Faculty lead discussions on all aspects of forensic psychiatry, emphasizing a practitioner’s perspective. The traditional subject matter of law and psychiatry is covered, including many of the topics addressed in Dr. Pinals’ course, but here the emphasis is less on the underlying principles and material facts related to the landmark cases and more on their practical application. Clinical topics in forensic psychiatry include seminars on conducting forensic assessments and writing forensic reports; serving as an expert witness; rendering forensic consultation to mental health practitioners; risk assessment in forensic and civil populations; malingering; assessment techniques (e.g., testing, structured instruments, etc.); special populations and behavior (antisocial personality, psychopathy, sexual offenders); and treatment approaches employed in forensic settings.
Michigan Law-University of Michigan
During the year trainees attend the “Law and Psychiatry at Criminal, Civil and Public Policy Crossroads” Course taught by Dr. Pinals at the University of Michigan Law School in the Winter semester. Trainees may elect to take additional courses in criminal law, mental health law, child mental health law or other subjects at Michigan Law- University of Michigan.
In addition, trainees meet regularly with select faculty of the law school during the year for individual instruction in an open forum type discussion.
Continuing Medical Education Psychiatry Seminar (Friday Conference)
Visiting speakers, Center Staff, and University of Michigan faculty present selected topics in general and forensic psychiatry, varying from year to year, but emphasizing newly developing knowledge and treatments.
How to Apply
Interested persons should submit a curriculum vitae and universal application (download) to the attention of:
Diane Heisel, M.D.
Center for Forensic Psychiatry
P.O. Box 2060
Ann Arbor, MI 48106