Contrasting Forensic and Acute-Care Psychiatric Environments

In countless forensic environments, individuals educated in non-forensic streamed clinical psychology programs are the most common forensic practitioner. The differences between clinical psychology work in a hospital type environment and a prison or forensics type unit environment can be quite large. Some large psychiatric facilities have their own forensic units. Work on such a unique ward offers unique challenges and perspectives compared to the remainder of the facility.

One of the most obvious differences between the two environments is the type of clientele. On a typical psychiatric unit you will have a number of individuals with a bevy of acute psychiatric disorders. The majority of these individuals will be voluntary clients. In other words, they can leave the facility at any time they so desire. Others may be on a "form." In Canada there is a number of forms (1,2,3) that are essentially a doctors order requiring and individual to stay at the facility for a certain period of time because they are a danger to themselves or others. While these individuals are 'officially' being held. For the most part it is just a piece of paper and often they can leave AMA (against medical advice).

On a forensic unit an individuals is very rarely allowed to leave the facility. While some regular psychiatric units are unlocked and clients can essentially come and go as they wish, all forensic units are locked. These individuals are required by law to stay at the facility as a result of their prior criminal acts. Where psychiatrists are constantly required to provide justification to place a new 'form' on a voluntary clients, a forensic client is required to remain on the floor until justification for his/her release is provided. In other words. The legal requirements to hold a person on the units is the exact opposite.

The second difference between typical psychiatric and forensic populations is the importance of standardized testing. While one could argue against the appropriateness of such practices, for the most part the complex psychometric assessment of normal psychiatric populations is not very common. In such environments the typical psychiatric clinical interviews is considered adequate for diagnostic and treatment considerations. However, when the legal system is involved and one must justify quantitatively their opinions by previously validated means, the psychometric evaluations becomes essential. Such is the case in forensic populations. When a psychiatrist or psychologist is to be bound legally to their opinions it is certainly a benefit to have some quantitative evidence to stand behind your claims. However, once a normal psychiatric client becomes a 'forensic case' I guarantee you that practitioner will be protecting them self with some good valid psychometric data for the next such instance.

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