European Meeting of Teachers of Forensic Psychiatry
Ghent 2004

Forensic Psychiatrists with responsibilities for teaching in a number of European countries held an inaugural meeting in Ghent, Belgium in late March 2004.  The following countries were represented: Holland, Germany, UK, France, Sweden, Denmark, Belgium and Ireland.

A series of discussions and meetings took place to identify ways in which education and in Forensic Psychiatry can be approved across the Union.

Discussion took place with special reference to possible changes in CCST arrangements.  It became clear that due to working across different legal jurisdictions links were not very strong either in Europe and many countries were working in isolation.  The objective of the conference was to learn about training in other systems.

European Forensic Psychiatry

In Flanders trainees undertake General Adult Psychiatry training for 5 years and can then sub specialise.  There is a Diploma course in Forensic Psychiatry and Psychology which is organised in conjunction with the 4 Flemish Universities.  This is a 2-year part time course.  Assessment is based on attendance there is no course work or exams.

The German medical association has agreed to recognise Forensic Psychiatry as subspecialty.  This came about following public demand for only those with a special expertise to give expert evidence in Court.  This was controversial as general psychiatrists were concerned that they would lose out financially, if not permitted to give evidence in Court.  It is now a requirement for trainees to spend 36 months in an accredited training scheme following their general training in order to be accredited.  As part of the course all trainees are required to provide 70 written opinions under supervision.  Thirty of these must be criminal cases including 5-risk assessment before certification can be granted.

Core competencies that are necessary before accreditation can be granted in the UK were presented by Dr Janet Parrott.  In the UK there are 160 forensic psychiatric psychiatrists serving a population of 60 million. 

Specialisation in Forensic Psychiatry in Sweden is combined with General Psychiatry.  The training is task orientated rather than time orientated.  Approximately 70 full-time forensic psychiatrists serve a population of nine million in Sweden.

In Holland there is a population of 16 million.  75% of the patients in the forensic units have been diagnosed as personality disorder and 75% of these are drug dependent.  In prison 10% of the prisoners suffer from mental illness.  In Holland the position of forensic psychiatry is legally rather than medically based.  Hence, a lot of medical developments in forensic psychiatry have been missed as a result of this association.  The Dutch system developed after World War II when there was much optimism about the treatment of personality disorder.  There is now much debate about how the Dutch are focusing their treatment efforts on personality disorder patients while patients who suffer from severe psychotic illness are ending up in prisons.  In Holland there are no training programmes in place.

Forensic Psychiatry in Denmark has increased in importance in recent years.  It has now been accepted that forensic psychiatry has developed as a sub-speciality.  However, as yet, there is no specialist-training programme.  There is a process whereby general psychiatric beds are being converted into forensic beds.  There are 50 Forensic Psychiatrists serving a population of 5 million.  There are recruitment problems in general psychiatry but not in forensic psychiatry.  There is a large interest in forensic psychiatry and there is a forensic psychiatry section for which holds a large conference jointly with Judges and lawyers.  In Denmark, forensic patients are 80% psychotic and severe personality disorders are looked on ‘as ordinary criminals who are best placed in prison’.  The prisons are well staffed with many psychologists and psychiatrists.

There is a formal training programme in forensic psychiatry in France with a Diploma in Forensic Psychiatry available.

Future Pan European Collaboration

There is a general difficulty in funding research in comparative law.  Notwithstanding this, there was a consensus that there is a role for a European network with courses in training.  Such a network would help to establish harmonisation of guidelines in the practice of forensic psychiatry across Europe.  It is also hoped that the network would facilitate training in different countries also serving as a platform to train the trainers and arrange for exchange programmes and workshops.  The network will also provide an opportunity for distance learning.

 

Dr Damian Mohan
Chairman – Faculty of Forensic Psychiatry