The proposition that forensic psychiatry has become more a legal than a medical discipline is intentionally provocative, designed to stimulate discussion about the nature and direction of the specialty.
The evidence suggests that contemporary forensic psychiatric practice is dominated by legal-administrative tasks, that expertise is primarily valued for its legal rather than medical applications, and that the discipline’s conceptual framework is increasingly shaped by statutory and case law rather than medical science.
This is neither inherently positive nor negative but rather reflects the complex reality of managing mental disorder within a rights-based legal framework, enmeshed in a body of national guidance e.g. NICE, MHRA, CQC, RCPsych etc.
What I deal with daily - minute by minute - hour by hour - is a wrestling match with MHA 1983, MCA 2005, their respective codes of practice, and the practical realities of insufficient resources. I have medical duties of care arising from the Medical Act 1983 pushing down via quasi-legislation into clinical care. I have to consider a range of other duties arising from needs to respect Human Rights. My role in ‘public protection’ is a serious one that interfaces with criminal justice systems. I am constantly vigilant to protect life and rights and I have to obey national guidance whilst avoiding the jaws of the GMC. In amongst all that, I am required to demonstrate compassion and holistic medical care.
I think that recognising contemporary forensic psychiatry as primarily a legal-administrative discipline with medical foundations might be a first step toward a more coherent understanding of its role and potential.
Perhaps it is an accurate characterisation that forensic psychiatry has evolved into something sui generis; partly medical but not fully legal. It exists in the interstices between medicine and law, drawing authority from medicine while forced to operate according to legal logic.
If this post is allowed, I welcome perspectives.