Forensic Psychiatry Fellowship

In 1974 Michigan established the Center for Forensic Psychiatry to provide diagnostic evaluation and treatment of patients committed to the Department of Mental Health by the criminal courts. Since its inception the Center has been one of the nation’s premier training sites for professionals in psychiatry, psychology and other disciplines specializing in the interface between mental health and the law.

The fellowship (residency) program in forensic psychiatry is a one-year, post-residency training program for psychiatrists planning careers in forensic or correctional psychiatry. The program is accredited by the Accreditation Council for Graduate Medical Education. Board certified (American Board of Psychiatry and Neurology) general psychiatrists in good standing who complete this program are qualified to sit for the subspecialty examination in forensic psychiatry.

Program Description

The fellowship program consists of rotations on forensic, correctional, and general hospital psychiatry services; a comprehensive program of didactic instruction including clinical and legal aspects of forensic psychiatry; classes at the University of Michigan School of Law; and completion of a scholarly project.

Clinical Rotations

Residents receive clinical training at three major sites in four major settings: inpatient treatment units at the Center for Forensic Psychiatry; the Outpatient Evaluation Unit of the Center for Forensic Psychiatry; the University of Michigan Medical Center; and the Scott Correctional Facility, a state prison for women located about 20 minutes from the medical center.

Center for Forensic Psychiatry - Inpatient

Most inpatients at the Center have been found not guilty by reason of insanity or incompetent to stand trial. Residents 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 particular emphasis on clinical problems such as suicide, malingering, amnesia, self-injurious behavior, violence, psychosis, substance abuse, and antisocial behavior. Residents 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 2-3 patients are carefully monitored to provide exposure to a variety of diagnostic groups, legal issues, and offenses.

Center for Forensic Psychiatry-- Outpatient Evaluation Unit

In order to obtain certification as Consulting Forensic Examiners under Michigan law, residents observe at least five competency to stand trial evaluations and five criminal responsibility evaluations in the outpatient unit. They then conduct five supervised competency evaluations and five criminal responsibility evaluations; the final evaluation regarding each issue is supervised by the Director of Training and Research. Residents 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, competency to be sentenced, juvenile waiver, and pre-sentencing recommendations.

University of Michigan Health System-- Legal Regulation and Civil Forensic Psychiatry

The University of Michigan Health System and the practices of faculty forensic psychiatrists on serve as the venues for this rotation. Residents consult to a general psychiatric service on issues related to the legal regulation of psychiatric practice, such as civil commitment, confidentiality, refusal of treatment and the "right to die," emergency treatment, decision-making competence, guardianship and conservatorship, etc. They gain experience in psychiatric aspects of civil litigation such as malpractice, disability, sexual harassment, psychic injury related to trauma, and child custody, and in administrative aspects of forensic psychiatry. The rotation includes three major components. First, residents attend a monthly conference including faculty from the forensic psychiatry program and from the consultation-liaison service of the University of Michigan Department of Psychiatry, where cases and questions pertaining to the law/psychiatry interface are presented for consultation and educational purposes. Second, residents meet regularly with the hospital attorney for the University of Michigan Health System to discuss matters relating to the legal regulation of psychiatry, with particular reference to active problems, law suits, and policy issues at the hospital. Third, residents observe and assist experienced forensic psychiatrists, both in private practice and at the Child and Adolescent Psychiatric Hospital, engaged in the full range of civil controversies.

Didactic Program

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 assigned a full day each week at the Center, along with sequences at the Scott Correctional Facility and at the University of Michigan Law School.

Legal Aspects of Forensic Psychiatry (Core Curriculum I)

Professor Guyer reviews major legal systems and principles of law critical for the practice of forensic psychiatry. 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.

Clinical Aspects of Forensic Psychiatry (Core Curriculum II)

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 Professor Guyer’s course, but here the emphasis is less on the underlying principles 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., hypnosis, polygraphy, amobarbital interview, plethysmography); special populations and behavior (antisocial personality, psychopathy, sexual offenders); and treatment approaches employed in forensic settings.

University of Michigan Law School

Trainees may elect to take courses in criminal law, mental health law, child mental health or other subjects at the University of Michigan Law School.

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.

Correctional Psychiatry Seminar

This course is held at the Scott Prison as an integral part of the clinical rotation in correctional psychiatry. Topics include the following: roles and ethical problems in correctional mental health; legal regulation of psychiatric care in prisons; landmark cases in correctional psychiatry; prisons; epidemiology and causes of crime and criminality; classification/nosology of crime; sex offenders; sexual homicide, serial killers; and mass murderers; mental illness and criminality/violence; mentally ill prisoners; common syndromes in prison populations (psychopathy and antisocial personality disorder; malingering; somatization; self-injury and suicide; substance abuse in prisons; attention deficit hyperactivity disorder; post-traumatic stress and acute stress disorders; psychoses associated with isolation/segregation); risk appraisal and dangerousness; death row and executions; juvenile delinquency and young offenders; use of testing and formal quantitative instruments in assessment of psychopathology and risk (PCL-R; HCR-20; VRAG; ASSESS-LIST; MMPI-II, etc.)

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 assigned a full day each week at the Center, along with sequences at the Scott Correctional Facility and at the University of Michigan Law School.

How to Apply

Interested persons should submit a curriculum vitae and universal application (download) to the attention of:

Craig Lemmen, M.D.
Center for Forensic Psychiatry 
P.O. Box 2060
Ann Arbor, MI 48106
734-295-4301
E-mail: lemmenc@michigan.gov

 

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