LETTERS TO THE EDITOR
Residency training in Fontcalent Prison Psychiatric Hospital
Currently, training in legal and forensic aspects for both psychiatrists and residents is not regulated and is significantly scarce. However, concern on these areas has increased throughout recent years, and hence there are increasingly more young professionals interested in Psychiatry’s legal and forensic issues. Nevertheless, during the specialized training of residents, Legal Psychiatry is poorly promoted and therefore, for many this remains a completely unknown field whose learning and insight is, frequently self-taught.
For me personally this was not a recent interest since I had worked for Prison Health before becoming a resident. Therefore, during my last year as a resident I applied for an internship at Fontcalent Prison Psychiatric Hospital, where I directly contacted experts in the field. During this training period, I had the opportunity to become familiar with the legal basis, medical-legal assessment criteria and experts’ opinion on patients hosted in this facility. Through specific cases, I studied in greater depth the legal concept of dangerousness, the rehabilitation of inmates, the psychogenesis of crime and the main criminogenic factors. Moreover, I learnt about legal criteria and medical-legal aspects of hospitalization, expertise proceedings and hospital care protocols. In any case, I learnt how to make an expert assessment of causality, an assessment of risk and to provide appropriate clinical care to these particular patients. My experience was significantly rewarding since it allowed me both to improve the approach to a very specific patient profile and it led me to reflect on the relevance of medical-legal aspects of everyday clinical practice.
I believe that interactions between Psychiatry and legal issues should raise further interest among professionals, as to provide an appropriate and quality response. Moreover, an improved training in this area could enhance the skills of psychiatrist as clinicians and entail the extension of their competences. For example, it could imply: psychiatrists going to court more often (both as witnesses and experts), further involvement in questions regarding the admission of patients to mental hospitals and their capacity and it could promote the participation of these professionals in professional responsibility issues (clinical records, professional secrecy, involuntary treatment, suicide, etc.).
Therefore I strongly believe that clinical psychiatrists should not avoid involving themselves with the legal system in view of the importance of ethical-legal implications of everyday medical practice. Therefore, and in view of the great interest and usefulness of being familiar with Legal and Forensic Psychiatry, and in the absence of any regulated training, I believe that applying for internships during your residency in hospitals like this is very interesting and appropriate: something which should be promoted by Teaching Commissions in hospitals responsible for the training of psychiatrists.
Ana Fructuoso Castellar
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