Forensic Psychiatry

Law enforcement, lawmakers, and the public are increasingly concerned about how people with mental illness are treated within the criminal justice system. This chapter focuses on the role of public psychiatrists in the provision of timely evaluation, expertise, and care for individuals in custody—particularly for individuals with serious mental illnesses. A case-based discussion illuminates important aspects of the legal and health care challenges facing individuals at the time of arrest, arraignment, incarceration, trial, and community re-entry. The chapter discusses mental hygiene law, criminal procedure law, advocacy, and the formation of policy with an emphasis on fitness to stand trial. Appropriate diversion of individuals with mental illness from incarceration, and its role in helping these individuals to achieve recovery, is explored in detail.

Families

Mental illness can deeply impact a family’s dynamic, sometimes leading to its breakdown. At the same time, family support can make or break the recovery trajectory of a person with mental illness. When traditional individual treatments are not effective, it is often an indicator that the family should be included. Observing family interactions can help determine a family’s and individual’s needs. In this chapter, a family’s story is used to illustrate how public psychiatrists can work with families to preserve attachments, develop understanding and support for the affected individual, and prevent caregiver burnout. The case illustrates how a genogram, family inclusion, and family psychoeducation can be used create a broader narrative and build empathy for the family system.

Correctional Settings

Correctional settings could represent an opportunity to provide treatment and rehabilitation for the disproportionately large numbers of people with mental illness who are incarcerated. Public psychiatrists have developed compassionate models of care for these individuals in prisons throughout North America, and they have worked to prevent victimization of individuals in these contexts. Risks including substance use, violence, and suicide are among the challenges that psychiatrists manage in these settings, and continuity of care following release into the community presents broad systemic challenges as well. The forensic psychiatry chapter’s discussion of diversion and fitness restoration dovetails with the focus on care provision within correctional settings explored in this chapter.