Forensic psychiatry is a profession that stands at the intersection of psychiatry and law. While the field of psychiatry focuses on the mental health of the general population, forensic psychiatrists specifically work with clients who are currently involved in the legal system. A forensic psychiatrist is a medical doctor with training in mental health and the law.
The American Academy of Psychiatry and the Law (AAPL) defines forensic psychiatry as “a subspecialty of psychiatry in which scientific and clinical expertise is applied in legal contexts involving civil, criminal, correctional, regulatory, or legislative matters, and in specialized clinical consultations in areas such as risk assessment or employment”.
A primary skill forensic psychiatrists routinely use is evaluation and assessment. Examples of evaluations include mental competency evaluations, child custody evaluations, threat assessments, and the screening of law enforcement applicants. The assessment of the mental health of both adult and juvenile offenders who are currently interacting with the legal system is often a primary duty for a forensic psychiatrist.
Given this focus on assessment, forensic psychiatrists must have strong skills in interviewing as well as oral and written communications. Forensic psychiatrists may also serve as an expert witness in a courtroom. Serving as an expert witness ultimately helps parties within the legal system, such as juries, lawyers and judges, complete their respective duties. Though forensic psychiatrists can provide patient care, their services are typically sought to address a specific legal concern.
The potential applications of forensic psychiatry are numerous. The expertise of a forensic psychiatrist may be sought to address issues such as violence, criminal responsibility, competence to stand trial in both civil and criminal courts, child custody issues, psychic injury, mental disability, malpractice, involuntary treatment, ethics and human rights, and juvenile justice and rehabilitation. Given the wide variety of potential applications of forensic psychiatry, it is not unusual for a forensic psychiatrist to accrue additional training and experience, even after completing the specialization in forensic psychiatry, in order to work in a highly specialized niche field.
Due to the substantial amount of training necessary to become a practicing forensic psychiatrist, a number of accrediting agencies ultimately play some role in these practitioners’ professional development as well as their ongoing practice. Undergraduate academic degree and medical school programs have their own corresponding accrediting agencies. As these programs are just a part of a forensic psychiatrist’s formal training, details regarding these agencies can be found elsewhere. Accrediting agencies specifically relevant to the field of forensic psychiatry appear immediately below.
The American Academy of Psychiatry and Law (AAPL) is an organization of psychiatrists dedicated to a number of objectives including the promotion of excellence in forensic practice and the support of related educational and research activities. Through its activities, AAPL aims to develop and maintain a diverse and inclusive population of forensic psychiatrists.
Founded in 1934, the American Board of Psychiatry and Neurology (ABPN) is a nonprofit corporation whose mission is to promote and assess the competence of psychiatrists and neurologists to provide equitable and inclusive, high-quality patient care to diverse populations. ABPN is one of 24 American Board of Medical Specialties (ABMS) member boards. The ABPN serves the public interest through its certification programs and processes specifically focused on the fields of psychiatry and neurology. The field of forensic psychiatry is one of a number of specializations ABPN formally recognizes. As with most any specialization, a forensic psychiatrist must complete additional training to become certified in this specialty.
Finally, the Accreditation Council on Graduate Medical Education (ACGME) is responsible for the actual accreditation of forensic psychiatry fellowship programs. Details regarding the functional scope of this council can be found further down this page.
Forensic psychiatry is not identical to forensic psychology; one major distinction separates these fields. Psychiatrists are medical doctors while psychologists are not. This difference means that while both are trained to provide therapy, evaluation, and analysis, only forensic psychiatrists are permitted to prescribe medication. Forensic psychiatrists are thus potentially better equipped to assist clients in the midst of crisis.
Read on to discover the career outlook for forensic psychiatrists and learn about various specializations and related options.
Perceptions of the field of forensic psychiatry, and forensics in general, are influenced in part by sensationalized portrayals of these professions as seen in popular television shows and movies. In truth the field of forensics is a very important professional discipline.
According to the US Bureau of Labor Statistics (BLS 2023), psychiatrists are classified as “physicians and surgeons” when estimating career outlook projections. There were 816,900 professionals in this category as of May 2022, and it is expected to swell by 3 percent between 2023 and 2032.
According to data from Salary.com from 2023, a forensic psychiatrist earns an average salary of $216,794. Additional salary data by percentile appears below:
The BLS (May 2022) also details the salary percentiles of the 26,500 psychiatrists in the United States. They made an average annual salary of $247,350 with the following percentiles:
As noted above, the location where a forensic psychiatrist works can substantially impact one’s salary. Here are the top-paying states for psychiatrists listed with their corresponding mean salaries (BLS May 2022):
North Dakota stands out as a strong outlier in US BLS data. At first, it may seem counterintuitive that North Dakota would offer such a high salary for a psychiatrist. A closer examination of BLS data strongly suggests why this would be so. States like North Dakota, Wyoming, and New Mexico are highly rural states with both low total populations and population densities. Offering a high salary is one of the best ways for a state facing low interest from qualified candidates to increase that interest. Because rural states often attract comparatively little interest from highly skilled professionals who seek or even need a high salary, psychiatrists seeking a high salary may seek opportunities in these states if these states make appealing offers such as high salaries.
Of the five aforementioned states, one of them, California, has a high cost of living. Individuals seeking to enter a new profession may find the Missouri Economic Research and Information Center (MERIC 2023) website to be valuable in making career planning decisions. MERIC provides analysis and assistance to both policymakers and the general public through the study of state economic trends, targeted industries, and related labor markets. Among its analyses is a cost of living data series. In 2023, MERIC noted California to be in the top five most expensive states. Though Illinois is considered a low-cost state overall, the city of Chicago is not an inexpensive place to live and work.
The BLS (2022) also reports the top-employing states for psychiatrists as follows:
The top five most lucrative employers for this profession (BLS May 2022):
Top employers of psychiatrists nationwide are as follows (BLS May 2022):
Forensic psychiatrists may work in several environments due to the necessity of collaborating and consulting with a variety of people and institutions. Though forensic psychiatrists frequently work in some form of incarceration facility, it would be an exaggeration to state this is their standard or only work environment. Forensic psychiatrists may complete their assessments and other tasks and share their findings in various settings, including correctional facilities, court facilities, hospitals, and the offices of other practicing physicians. To share their findings they may also travel to other venues, including police stations, research laboratories, and the offices of various professionals.
While the industry in which psychiatrists hold the largest share (by percentage) of industry employment is psychiatric and substance abuse hospitals, US BLS data notes that the industry with the largest sheer number of psychiatrists is the offices of physicians category. Given the numerous potential contact points in which medicine and the legal system may interface with one another, it makes sense that physician offices would be one of those major points of contact for psychiatrists. Other industries in which psychiatrists feature prominently include medical and surgical hospitals, outpatient care centers, and state government. Forensic psychiatrists who develop further specialized knowledge may be called upon to provide consultation or conduct research in other settings such as schools and private sector research organizations.
A forensic psychiatrist ultimately completes an intensive training process to become a licensed, practicing professional. The total time commitment to become a forensic psychiatrist between entry into undergraduate studies and completing a fellowship is often something like twelve years. Once trained in forensic psychiatry, such professionals may pursue more education to specialize their skills further to work in niche areas.
Step 1: High school (four years)
Those aspiring to become forensic psychiatrists will do well to show skill in physical sciences, mathematics, and psychology as early as their high school education. Early experience with the legal system, as evidenced by volunteer work in settings such as a local police department or legal services provider, may put a person on a promising path toward becoming a forensic psychiatrist.
Step 2: Undergraduate degree (four years)
Upon graduating from high school, a person seeking to become a forensic psychiatrist must complete both a formal undergraduate academic degree and medical school. Highly skilled individuals may ultimately complete their undergraduate degree in less than four years, thereby shortening the total time commitment. Those interested in forensics but as yet uncommitted to forensic psychiatry may elect to complete an undergraduate degree in forensic science. Popular bachelor’s degrees for forensics professionals include degrees in chemistry, biology and other natural sciences.
Admissions requirements for many undergraduate programs include official high school transcripts, a satisfactory test score (SAT or ACT, in addition to the TOEFL test for non-native speakers of English), a personal or motivational statement, and an application fee. Students already sure of their interest in forensics should seek out programs accredited by the Forensic Science Education Programs Accreditation Commission (FEPAC), the country’s predominant program approval body for forensics programs.
Step 3: Medical school (four years)
Forensic psychiatry candidates next complete medical school. Medical school takes four years to complete, with the first two years consisting of academic instruction in classroom and lab settings. In the final two years of medical school, students complete rotations in a number of specializations. These rotations allow them to practice what they’ve learned in clinical settings. They take part in clerkships in many practice areas, including psychiatry.
Step 4: Residency (two years)
After completing medical school, graduates begin a residency program. Residents choose an area of specialization for their residence. In their residencies new doctors practice under the supervision of experienced doctors in their field. Those pursuing a career as a forensic psychiatrist will generally complete a two-year residency program in general psychiatry. During their residency, psychiatrists take exams to become medically licensed doctors in their states.
Step 5: Fellowship (two years)
Having completed their residency training, psychiatrists finally reach the step of further specialization in which they train to become forensic psychiatrists. Development of specialized expertise is accomplished via a fellowship. While a residency in general psychiatry gives new doctors the experience they need to practice as physicians, it is the fellowship stage that ultimately prepares psychiatrists to practice in their specialty. A forensic psychiatry fellowship is typically a two-year program in which a licensed psychiatrist gains specific experience in forensics. Fellowship programs usually feature training requirements in research, practical experience and academic coursework.
Step 6: Board certification (timeline varies)
Having completed their lengthy formal training process, forensic psychiatrists can finally pursue board certification. The particular certification a forensic psychiatrist seeks is called an Initial Certification in Forensic Psychiatry. This certification is provided by the American Board of Psychiatry and Neurology (ABPN). The ABPN board certification process involves passing an examination on the forensic psychiatry principles doctors learn during their fellowship. Although such certification is optional, successful completion of this step may help candidates improve their chances of getting a job in the field and more easily pursue additional training later in their careers.
Step 7: Secure employment
After meeting educational and licensure requirements and obtaining board certification, forensic psychiatrists are finally prepared to pursue a job. Forensic psychiatry professionals work in settings including correctional facilities, hospitals, private practices, government, private sector organizations, and research institutes.
Given the variety of career trajectories, there is not necessarily a typical work week for forensic psychiatrists. Such psychiatrists may work evenings, weekdays and holidays. Those doing specialized research or working closely with law enforcement may work irregular work hours, including on-call. Forensic psychiatrists practicing in high-demand job markets may easily exceed traditional full-time (40 hours) employment.
A number of universities offer forensic psychiatry fellowship programs. A sample of available programs appears below. All these programs are accredited by the Accreditation Council for Graduate Medical Education (ACGME). A more thorough directory of current forensic psychiatry fellowship programs can be found on the AAPL website.
Emory University offers a forensic psychiatry fellowship program featuring an education formulated to serve both state government as well as the academic orientation typical of a private university. This program emphasizes forensic teaching, public policy development, and research. It also emphasizes the particular specialty of child forensic psychiatry. Various child forensic experiences are open to those who have previously completed a fellowship in child and adolescent psychiatry.
Primary elements of the program include Program Director guided weekly seminars, substantial individual supervision of fellows, participation in existing or self-directed research projects and the training of psychiatry and child psychiatry residents who rotate through this program. Successful fellows must also present a seminar on a forensic psychiatry topic to general psychiatry residents.
University of South Florida (USF) offers a program designed to teach fellows excellence in multiple elements of forensic psychiatry, such as both civil and criminal realms. Fellows develop skills in expert witness testimony, evaluation, consultation, and report preparation. Program sites through which fellows rotate include a veterans hospital, a competency restoration unit, and a public defender’s office.
Fellows must also independently complete criminal evaluations and prepare parallel cases for civil evaluation with the help of the program director. The program faculty includes multiple board-certified forensic psychiatrists, psychologists, and attorneys. Many faculty have national reputations in numerous topics such as competency evaluations, addiction, and child forensic psychiatry. The USF program is also noteworthy for training fellows in the use of standardized instruments in evaluations.
New York University (NYU) Grossman School of Medicine offers a full-time one-year fellowship designed to train fellows in all fundamental elements of forensic psychiatry such as evaluation, report writing, courtroom testimony and treatment in correctional facilities. The program features a didactic curriculum and a significant roster of required rotations designed to provide the hands-on training needed to effectively apply their skills on behalf of a variety of client populations. Students from underrepresented backgrounds are encouraged to apply.
The didactic core curriculum comprises modules on forensic assessment, criminal law, civil law, mental health law, correctional psychiatry, the legal system, child and adolescent forensic psychiatry, neuroscience, and the principles of forensic research. Fellows also attend seminars featuring topics such as ethics and addiction medicine. Fellows must also attend a mental health disability law course offered by the NYU School of Law.
The NYU fellowship program also offers a robust number of clinical rotations. A non-exhaustive list of these rotation sites includes the Bellevue Jail Forensic Psychiatry Inpatient Service, Rikers Island Correctional Center and the Manhattan Assisted Outpatient Treatment Program. Through this collection of rotations fellows develop the skills necessary to effectively work with the variety of populations often found in correctional facility settings.
University of Southern California (USC) Keck School of Medicine offers a fellowship program designed for individuals who have completed an accredited residency training program in general or child/adolescent psychiatry. The didactic portion of the program features coursework in topics including, but not limited to, civil law, criminal law, family law, federal criminal law, juvenile and dependency law, mental health law, landmark mental health case law, the biological, psychological and sociological determinants of crime and delinquency, and correctional psychiatry.
Hands-on learning consists of assignments to real forensic court cases and rotations through local sites. Fellows are generally assigned several forensic court cases each week and will have a minimum of six supervisors at any time. Court cases feature a range of topics relevant to the operations of criminal, dependency, juvenile and mental health courts. All assigned supervisors are Keck School faculty. The large, diverse population of the Los Angeles metro area affords fellows diverse clinical rotation options. Major rotation partners include the Los Angeles General Medical Center, the LA County Department of Human Services, the LA County Mental Health Court, and the LA County Office of the Medical Examiner-Coroner.
Northwestern University offers a one-year, full-time program designed to develop proficiency in forensic psychiatric practice. Proficiency is cultivated through a didactic curriculum and supervised clinical experiences. Fellows develop a comprehensive knowledge of principles of psychiatric treatment in justice-involved settings, learn how to conduct forensic evaluations, and effectively interact with various parties customarily found within the legal system.
The program emphasizes the development of leadership, scholarly, and clinical skills. Qualified applicants must have completed an ACGME-accredited general psychiatry residency program in the United States. If coming from Canada, applicants must have completed an RCPSC accredited general psychiatry program.
As previously mentioned, a medical doctor must first complete residency training in psychiatry before pursuing a forensics specialization. Details about the accreditation process for general psychiatry training can be found elsewhere. The Accreditation Council for Graduate Medical Education (ACGME) is specifically responsible for the accreditation of forensic psychiatry training programs in the United States. ACGME has provided accreditation of such programs since 1997.
To receive ACGME accreditation a program must demonstrate it meets the standards for forensic psychiatry training established by ACGME. Persons who graduate from forensic psychiatry training programs certified by ACGME may apply for the Added Qualifications in Forensic Psychiatry examination of the American Board of Psychiatry and Neurology (ABPN) anytime.
As previously mentioned, forensic psychiatrists can go on to further specialize their skills and work in highly specialized subdisciplines in which they target a specific client population. Several professional organizations provide education, networking, and professional representation services for psychiatrists practicing in varied subspecialties. A summary of some positions and related professional organizations one may encounter within forensic psychiatry appears below.
This type of forensic psychiatrist works with individuals in the early stages of their life development. Such psychiatrists may play a critical role in deterring juvenile behavioral issues that could result in serious encounters with the legal system that may cause substantial harm to a person’s future personal and professional development. The American Academy of Child and Adolescent Psychiatry serves as a major professional development and networking organization for this psychiatry subdiscipline. It offers resources including career development guidance, leadership and advocacy skills information, and mentorship and peer support. Such resources can prove vital to newly graduated practitioners just starting out in their careers.
Correctional psychiatry focuses specifically on the practice of medicine for incarcerated patient populations. Until recently, this branch of forensic psychiatry was held in relatively low regard; it was previously often associated with low professional status and poor working conditions. More recent recognition of both the prevalence and severity of mental illness within populations involved in the criminal justice system and how it has often been an underacknowledged public health issue may be leading to a shift in prevailing perceptions. Two organizations play an important role in this psychiatry specialization. They are the National Commission on Correctional Healthcare (NCCHC) and the International Association for Correctional and Forensic Psychology. NCCHC acts as an accreditation organization.
Though previously not held in high esteem in psychiatry, correctional psychiatry is nonetheless a very important specialty. A substantial percentage of forensic psychiatric practice is done for prison populations. Given that the US has one of the highest rates of incarceration among Western societies, this particular specialty is likely to feature numerous job opportunities for the foreseeable future.
Geriatric psychiatrists focus on the prevention, evaluation, diagnosis and treatment of mental and emotional disorders in the elderly as well as the improvement of psychiatric care for both healthy and ill elderly patients. When elderly persons become involved in the criminal justice system, they do so more frequently as victims rather than as offenders. Geriatric forensic psychiatrists may be called upon to intervene for evaluation and care purposes when elderly individuals’ behavior becomes problematic to their families, caregivers or third parties. This forensics specialty will likely also have a heightened need for new practitioners in coming years due to the aging demographic of the American populace.
The American Association for Geriatric Psychiatry (AAGP) is a primary professional organization representing geriatric psychiatry practitioners’ interests and professional training needs. Since its founding in 1978, AAGP has worked to serve members’ patients and their own families, support the training of new professionals, and advocate for research to sustain and improve the mental health of the elderly.
In addition to patient care and advocacy on behalf of incarcerated populations, forensic psychiatrists may also elect to pursue careers focused primarily on research. Given the diversity of patient populations a forensic psychiatrist may treat naturally, there is also an abundance of research topics those devoted to research may pursue.
Forensic psychiatrists who pursue research careers may ultimately find significant professional support through the previously mentioned American Academy of Psychiatry and the Law (AAPL). Given its dedication to excellence not just in practice and teaching but also in research, AAPL can serve as an excellent resource for forensic psychiatrists who seek research-oriented careers.
Substance abuse and addiction issues are other problems that too often can easily lead to affected individuals becoming involved in the legal system. Given the risk to both individual and community health that addiction represents, the field of addiction psychiatry serves a vital function. High rates of substance abuse and addiction within the American populace suggest that this psychiatry specialization will also feature high demand for newly trained individuals in the coming years.
Addiction psychiatrists may have some duties, including counseling patients, partnering with other healthcare and human services professionals in the development and execution of recovery and care plans, performing diagnostic and other testing, conducting research, and facilitating group therapy offerings.
The American Academy of Addiction Psychiatry (AAAP) is the premier national professional society dedicated to serving the needs of addiction professionals as well as their patients in the United States. AAAP emphasizes evidence-based prevention, treatment and recovery strategies. The organization’s focus areas include promotion of quality prevention, treatment and recovery, support of addiction psychiatry training programs and related careers, and education of the populace about substance abuse issues and closely related policy problems.
In addition to the aforementioned specializations, forensic psychiatrists may also apply their skills by serving as an expert witness. An expert witness plays a valuable role by providing critical information in court proceedings that may ultimately prove decisive in the outcomes of such proceedings. Expert witnesses may provide information relevant to a large number of topics, including general psychiatry, psychopharmacology, mood disorders, psychotic disorders, mental illness, trauma, post-traumatic stress disorder (PTSD), anxiety disorders, sleep disorders, neuropsychiatry, neurology, and much more. Forensic psychiatrists who serve as expert witnesses may have a variety of specialized skills and lengthy experience in those skills. Some skills they may hold include psychiatric evaluation, independent medical examinations, and outpatient services.
There is an important distinction between forensic psychiatrists who serve as expert witnesses and similar practitioners. A treating psychiatrist is ethically required to serve a patient’s best interests. In serving a patient’s interests a treating psychiatrist customarily lacks the independence and objectivity expected of a forensic psychiatrist who serves as an expert witness. In addition, because of their medical school training, expertise, higher status, and capacity for objective analysis, a forensic psychiatrist expert witness is often considered a more credible witness than a forensic psychologist expert witness. Forensic psychiatrists with substantial experience in identifying and treating particular patient populations may be considered even more compelling expert witnesses. Examples of such populations include domestic violence victims, elderly victims of abuse and neglect, and child abuse victims.
Bernd Geels is a Berlin, Germany-based freelance writer and artist. He holds an undergraduate degree in atmospheric science and two graduate degrees. He completed his most recent graduate degree in international environmental studies at the Monterey Institute of International Studies in 2011. He is interested in healthcare, climate change, marine conservation, indigenous science, and refugee issues. You can reach him directly at [email protected].