Forensic Psychiatry Fellowship
Forensic Psychiatry Residency Program
Consultation and Correctional Service
Goals of the Forensic Psychiatry Residency Program
The primary goal of Forensic Psychiatry Residency Program is to provide systematic training in the area of forensic psychiatry, the psychiatric subspecialty that focuses on interrelationships between psychiatry and the law. The residency provides exposure to clinical cases, guided readings, interdisciplinary seminars, and research for all three major areas in which the law interfaces with psychiatry: civil, criminal, and administrative. At the conclusion of this fellowship, the resident is expected to have received training in the following four areas:
1) Psychiatric forensic assessment of individuals involved with the legal system
The training program aims to provide exposure to a variety of evaluees of both genders, including adolescent, adult, and geriatric age groups, spanning a broad range of mental disorders and circumstances, in both the civil and criminal contexts. These evaluations take place at the following training sites:
- The Institute of Law , Psychiatry and Public Policy Outpatient Forensic Clinic
- The Western State Hospital inpatient forensic unit
- The University of Virginia Forensic and Correctional Consultation Service
2) The provision of specialized psychiatric treatment to individuals incarcerated in jails, prisons, or special forensic psychiatric hospitals
This training takes place at the following training sites:
- Albemarle County Jail through the Forensic and Correctional Consultation Service
- The Western State Hospital inpatient forensic unit
3) Active involvement in the area of legal regulation of general psychiatric practice
Exposure to these areas takes place at the following site:
- The Institute of Law , Psychiatry and Public Policy, which provides specialized training programs and consultation to the state in the area of mental health law
4) Educational and research efforts
Residents will gain proficiency at critically reading the forensic psychiatric and legal literature and acquire the ability to effectively communicate such findings to others. This will be accomplished through a supervised, empirical research project in one of the above areas, through advanced forensic training programs that review the forensic research literature, through individually supervised readings of the research and legal literature, and through participation in the Institute of Law , Psychiatry and Public Policy’s research colloquium.
Overview of the Site
The Institute of Law, Psychiatry and Public Policy at the University of Virginia is an interdisciplinary program in mental health law, forensic psychiatry, and forensic psychology. Institute activities include academic programs, forensic clinical evaluations, professional training, empirical and theoretical research, and public policy consultation and review. The faculty includes attorneys, psychiatrists, psychologists, and social workers, and offers a variety of training programs pertinent to mental health practice, social policy, and the law. The local residency program directors for this site are William Stejskal, Ph.D. and Bruce Cohen, M.D.
The educational and training activities of the Institute include courses, seminars, workshops, symposia, and fellowships. These include a week-long course on how to perform basic criminal forensic assessments and more advanced one to three day training programs on risk assessment for violence, capital sentencing evaluations, sexual offender evaluations, and forensic assessment of juveniles. All ongoing cases also are discussed at a weekly multidisciplinary teaching conference, attended by core clinic evaluators as well as by many of the Institute’s affiliate faculty.
Other courses and seminars constitute part of the curriculum of the School of Law and are taught each year by interdisciplinary teams. These include two required courses in the residency, Criminal Law and Psychiatry and Mental Health Law. In addition, the resident will audit at least one introductory law school course, such as Criminal Law or Torts. In the civil realm, training includes training programs on assessing decision-making capacity, confidentiality, and civil commitment issues. The Institute is affiliated with the School of Law , the School of Medicine , the Curry School of Education Programs in Clinical and School Psychology, the Health Sciences Center at the University, and is supported in part by the Virginia Department of Mental Health, Mental Retardation and Substance Abuse Services (DMHMRSAS) and the Office of the Virginia Attorney General.
The Institute's research activities include multidisciplinary studies in clinical criminology, empirical studies of psychiatric and legal decision-making, and the analysis of mental health law and policy. Institute research projects have been sponsored by the National Institute of Mental Health, the National Institute of Justice, the MacArthur Foundation Research Network on Mental Health and the Law, the National Science Foundation, and private foundations. The most recent projects have involved empirical study of how best to approach the assessment of competence to consent to clinical treatment, competence to stand trial, risk assessment for violence, the use of coercion in the inpatient psychiatric admissions process. Other research has involved the forensic and ethical implications of the Human Genome Project, the epidemiology of campus and workplace violence, and the characteristics of sexually sadistic criminals.
Institute faculty members are involved in professional and public service activities on the international, national, state, and community levels. In addition to membership in major organizations in law, psychiatry, psychology, and social work, Institute personnel hold elected offices, serve on editorial advisory boards, chair and serve on commissions, committees, and task forces, at the state, national, and international level.
The Forensic Psychiatry Clinic is directed by Dan Murrie, Ph.D. Clinical supervision is provided by Dr. Murrie and by three board-certified forensic psychiatrists, Bruce Cohen, M.D., James Anderson Thomson, Jr., M.D., and Eileen Ryan, M.D. (Dr. Ryan also is board-certified in child and adolescent psychiatry and provides supervision in cases involving children and adolescent evaluees.)
The Clinic has provided evaluation services for over twenty years. Criminal defendants referred to the clinic typically have committed more serious offenses, e.g. homicide, arson, stalking and sexual assault. They typically are referred for assessment of competence to stand trial or related competence issues, criminal responsibility, or for assessment related to sentencing issues (including capital sentencing evaluations). About 20% of the clinics cases are adolescents referred by the child and family court.
The Clinic’s cases are often selected for their pedagogical value, and add a clinical dimension to the Institute’s educational endeavors. For example, an actual case might be observed via a closed-circuit monitor by psychology interns, general psychiatry residents, and law students, and might be discussed during a break in the evaluation. Questions raised by the class can then be integrated into the clinical evaluation when it resumes. Most cases are videotaped to help fellows develop better interview skills and to provide material for forensic teaching exercises. The Clinic performs between 40 and 50 evaluations per year, and the resident has the opportunity to participate in all of these, with the workload and case mix being adjusted over the year to allow for an optimal educational experience.
Forensic psychiatry residents rotate through the Institute Forensic Psychiatry Clinic for 50% of their time. The Institute also provides them with opportunities to learn research skills through seminars and through supervision in designing and conducting their own research project during the course of the fellowship.
Goals of this Site
- This rotation will provide opportunities for residents to acquire advanced clinical knowledge and skills in the field of forensic psychiatry, through a combination of supervised clinical experiences and formal didactic conferences. Residents will be given the opportunity to acquire not only knowledge and practical experience but also interpersonal skills and professional attitudes.
- Residents will be provided with opportunity to perform clinical assessments involving the most common types of forensic consultation questions, including mental status at the time of offense (insanity), competence to stand trial, sexual misconduct, risk assessment for violence, and forensic assessments of children and adolescents. Training will include education on preparation of reports and communication skills, (including testimony and/or mock testimony experience).
- Residents will receive supervised training in the relevance of legal documents, police reports, court testimony, polygraphs, hypnosis, narcoanalysis, psychological and neuropsychological testing, brain-imaging techniques, and other procedures relevant to assessments and treatment in forensic psychiatry.
- Residents will gain experience in review of clinical cases in the area of civil law, including domestic relations cases, personal injury cases, allegations of sexual abuse, and in review of cases involving ethical issues in psychiatric care and the legal regulation of psychiatric practice (e.g. involuntary hospitalization, confidentiality, right to treatment, right to refuse treatment, informed consent, and professional liability).
- Residents will gain proficiency at critically reading the forensic psychiatric and legal literature and acquire the ability to effectively communicate such findings to others. This will be accomplished both by engaging in a supervised, empirical research project in one of the above areas, through attendance at advanced forensic training programs that review the research literature, through individually supervised readings of the research and legal literature, and through participation in the Institute of Law, Psychiatry and Public Policy’s research colloquium.
- All forensic evaluations will be under the direct supervision of a faculty member, through direct observation of clinical interviews (most evaluations are conducted conjointly, with the attending clinician present in the room throughout the evaluation), through review and supervision of written reports, and through discussion and supervision of cases at the weekly multidisciplinary case conference.
Overview of the Site
Western State Hospital is a 330-bed state psychiatric hospital located in Staunton , Virginia , 35 miles west of Charlottesville . It serves a catchment area of more than two million people in Northern and Western Virginia . The hospital includes 14 wards. In addition to the forensic ward where forensic residents will primarily be located, there are two 26-bed admission wards, a forensic ward, a geriatric ward, a deaf unit, a substance abuse unit, a clinical studies unit, and several more extended rehabilitation services.
The collaboration between the hospital and the University of Virginia was given the American Psychiatric Association State/University Collaboration Project 1990 Award for Exemplary Performance. The Medical Director is a board-certified psychiatrist, and the facility director is also a board certified psychiatrist who also serves as Associate Chair, Western State Hospital Division of the Department of Psychiatric Medicine. Almost all psychiatrists on staff are board certified and have faculty appointments at the University of Virginia . Psychologists and social workers work with the residents on multidisciplinary teams. Treatment approaches include psychopharmacology, milieu therapy, individual psychotherapy, group psychotherapy, behavioral approaches, and family and patient education. Residents are active members of an interdisciplinary team.
The forensic ward is a locked unit that consists of 24 inpatient male beds, with all patients being over the age of 18. Its patient population is drawn from throughout the state of Virginia . The primary supervisor in the forensic residency program at this site is Robert Gardella, M.D., who is board certified in psychiatry with added qualifications in forensic psychiatry. Residents are required to work on the inpatient forensic service throughout the year, spending 20% of their time there. There is an opportunity for consultation on other wards where female forensic and male insanity acquittees are treated. The forensic unit is a minimum security unit, drawing its patients from throughout the state. In addition to treating incarcerated individuals in need of acute psychiatric inpatient care, the unit provides pretrial evaluations, including evaluation of competence to stand trial and evaluations of mental state at the time of offense (insanity). If treatment is required as part of the evaluation, this is done with a multi-disciplinary team. The resident is typically involved with 1-2 cases at any given time. The resident is responsible (with appropriate supervision) for primary and collateral interviews, record review, opinion formulation, report preparation, and trial testimony. Residents have one hour of individual supervision twice weekly. Additional supervision may be provided on an individual basis.
Goals of this Site
- The Western State Hospital rotation will provide opportunities for residents to acquire advanced clinical knowledge and skills in the field of psychiatry and criminal law, particularly as it is practiced in the inpatient setting. Residents will be given the opportunity to acquire knowledge, practical experience, and also interpersonal skills, professional attitudes, and supervision in report preparation.
- Residents will be provided with the opportunity to perform the most common type of forensic assessments as applied to criminal law, including mental status at the time of offense (insanity), competence to stand trial, sexual misconduct, and risk assessment for violence.
- All forensic evaluations will be under the direct supervision of a faculty member, via direct observation of clinical interviews (with most evaluations being conducted conjointly, with the attending clinician present throughout the evaluation) as well as through review and supervision of the resident’s written reports.
Overview of the Site
The University Virginia Health Sciences Center is a university-based general hospital program, with almost 600 inpatient beds and 28,000 admissions per year. The Psychiatric Consultation-Liaison Service provides approximately 1,000 consultations per year on the general medical, surgical and pediatrics units, while the Department of Psychiatric Medicine also staffs two 20-bed acute inpatient psychiatric units. In both settings, the need for forensic psychiatric consultation frequently arises, with requests for advice about issues such as a patient’s competence to manage his or her personal affairs or to make medical decisions, whether a substitute decision-maker should be appointed, whether the patient poses a significant potential for violence toward himself or others (and how best to manage such situations), how best to balance patients’ rights in the civil commitment process, the limitations of confidentiality in cases where this ethical principle comes into conflict with other concerns, and treatment of psychiatric patients over their objections.
In the medical/surgical setting, the Forensic Psychiatry Consultation Service provides a higher-level consultation to both the psychiatric consultation service and to the original requesting medical service. In the inpatient psychiatric setting, the Service consults directly to the inpatient treatment team.
The forensic resident also has the unique opportunity to use their forensic skills in the University’s honor system process. Students in any school within the University who have been accused of honor’s offenses who believe that they might have been experiencing a contributory mental disorder during the time of the offense may need to have their cases reviewed by a psychological panel. Members of this panel, which typically includes a psychiatrist, a psychologist, and an attorney, review academic and clinical records and conduct hearings.
The forensic psychiatry resident also gives lectures to the psychiatric residents and medical students on the consultation and inpatient services related to such forensic issues. Forensic residents perform on average of 1 general hospital consultation per month. The forensic resident also engages in additional readings, including landmark legal cases, through this rotation.
The service also provides consultation services to the Albemarle County Jail, a 400-bed correctional facility located about 5 miles from University of Virginia Health Sciences Center. Residents spend a required half-day per week providing psychiatric care under the supervision of Dr. Cohen. The psychiatric consultation service provides care to about 10% of the Jail’s inmates. Dr. Cohen follows half of these, while the resident follows the other half. Dr. Cohen supervises the resident’s cases using a combination of direct, participatory, and indirect supervision. During a typical week, the fellow would perform one to two new patient evaluations along with three to four followup visits.
A wide range of Axis I and Axis II psychopathology is encountered among this correctional population, including Mood Disorders, Psychotic Disorders, Alcohol and Substance Abuse, Sexual Disorders, and severe Personality Disorders. Treatment modalities include medication management and brief individual supportive and educational psychotherapy. In addition to Dr. Cohen and the forensic psychiatry resident, evaluation and treatment services are offered by a licensed clinical nurse specialist who has worked at the jail for 20 years, Lillian Juanita Morris, Ph.D. Residents are provided with professional liability coverage through the University of Virginia , which covers all of their clinical activities at the jail.
Goals of this Site
- The Forensic and Correctional Psychiatry Consultation Service will provide forensic psychiatry residents with a greater understanding of the ethical and legal issues that arise in the course of care for psychiatric patients in general hospital, psychiatric inpatient, and correctional settings.
- Through clinical and didactic experience, residents will learn how to provide comprehensive forensic assessments in the general medical and inpatient psychiatric setting and how to communicate findings and offer education about forensic psychiatric issues to both to their psychiatric peers and to other parties who may become involved in such cases (medical staff, family members, attorneys, etc.).
- At the Albemarle County Jail, residents will gain an understanding of how psychiatric illness presents in the correctional setting and will have the opportunity to provide direct treatment in this setting. Through clinical and didactic experience, residents also will gain an appreciation of the difficulties that arise in providing psychiatric care in this setting, including limitations on confidentiality, the need to educate correctional staff about psychiatric illness, comorbid Antisocial Personality Disorders and/or malingering, and how the goals of the correctional and mental health professions can come into conflict (e.g. punishment vs. attempting to relieve suffering, respectively).
- At each site, residents are expected to obtain and record detailed histories, perform mental status examinations, formulate differential diagnoses and treatment recommendations, order appropriate diagnostic studies, and appropriately document their assessment in the medical record. They also are expected to provide education about psychiatric and forensic psychiatric issues to other physicians, nurses, and medical student, both through their consultations and through more formal lectures or discussions about psychiatric issues.
- All forensic evaluations will be under the supervision of a faculty member. The faculty member directly supervises allhospital-based consultations within 24 hours. The faculty member also accompanies the resident to the jail psychiatric clinic and provides direct, participatory,or indirect supervision of the resident’s cases.
To apply for the Forensic Psychiatry Residency Program send us:
- The universal application form: (get it here NRMP Universal Application )
- Three letters of reference, one from your training director
- Copies of your medical school transcripts and Dean's letter
- Copies of your USMLE or COMLEX steps 1-3.
- A personal statement
Bruce J. Cohen, M.D.
Program Director Forensic Psychiatry Training Program
Department of Psychiatriy and Neurobehavioral Sciences
UVa Health System, Box 800623
Charlottesville, Virginia 22908
phone: (434) 924-5408
fax: (434) 924-5149