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Friday March 24, 2017

Medicine Meets Law: Forensic Psychiatrists Evaluate the Disturbed and Dangerous

Medicine Meets Law: Forensic Psychiatrists Evaluate the Disturbed and Dangerous

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Rutgers provides mental health services to thousands of prisoners throughout New Jersey

Jail Cell
More than half of male prisoners and three-quarters of female inmates in the United States have mental health problems.

'Being a forensic psychiatrist is like working on a good detective story ... the fellow has to learn how to put together an intricate puzzle by being persistent and gathering data bit by bit until it all fits together and gives a clear picture.'
 
– Donald "Rusty" Reeves

Eleanor Vo always thought she would become a surgeon. But after sitting in an elective course in forensic psychiatry during medical school, she knew that the courtroom, not the operating room, was where she wanted to practice medicine.

“I remember watching a case that was going to trial the same week I started my medical school course and was enthralled with the videos surrounding the confession,” says Vo, who grew up surrounded by a family of cops.  “I knew I didn’t want to do anything else.”

Vo – who works as a clinical psychiatrist in a busy New Jersey hospital emergency department – was one of the first doctors to go through a yearlong forensic psychiatry fellowship program at Rutgers Robert Wood Johnson Medical School.

She is also among a growing number of doctors entering the field of forensic psychiatry, a discipline which straddles the legal and medical arenas and has rapidly expanded over the past two decades to include almost 2,000 members.

Although psychiatrists can practice without forensic certification, the courts and legal system in New Jersey and throughout the country more often than not look to those who have received intensive forensic training to evaluate matters ranging from insanity and dangerousness to emotional injury and competence to stand trial.

“Many of these forensic psychiatrists will work in the public sector with our most disturbed, dangerous and complex patients,” says Donald ''Rusty'' Reeves, director of the Robert Wood Johnson Medical School’s forensic psychiatry program.

The medical school offers one of the 43 forensic fellowship programs in the United States. Since more than half of male prisoners and three-quarters of female inmates in this country have mental health problems, there has been an increase in the number of court-ordered psychiatric evaluations over the past decade as well as a need for more correctional psychiatrists.

Rusty Reeves
Photo: Kathryn Huang
Donald "Rusty" Reeves
Reeves says the state funding that Robert Wood Johnson received for the fellowship in 2009 enhanced psychiatric services already being offered to inmates in New Jersey’s 13 prisons by Rutgers University Correctional HealthCare (UCHC) – a branch of University Behavioral HealthCare – one of the largest providers of mental health services in the country.

The forensic fellows rotate through New Jersey’s correctional facilities, state psychiatric hospitals and private forensic practices. They perform psychiatric evaluations on adult and juvenile prisoners – assessing sex offenders, providing opinions to the court on patients’ competence to stand trial and conducting psychiatric evaluations for civil cases involving malpractice and child custody.

The goal: to hone the skills needed to become an expert in assessing those involved in legal matters.  The outcome could mean the difference between prison and a psychiatric hospital in a criminal case or being denied custody in a civil divorce case.

 “Being a forensic psychiatrist is like working on a good detective story,” says Reeves, who is also director of psychiatry at UCHC. “The forensic psychiatrist is being asked to provide an expert opinion about an individual’s behavior, so the fellow has to learn how to put together an intricate puzzle by being persistent and gathering the data bit by bit until it all fits together and gives a clear picture.”

For doctors like Tarita Collins, a graduate of the Robert Wood Johnson forensic program and now a correctional psychiatrist at Southwoods State Prison in Bridgeton, the question that comes up often is whether someone being released from prison is likely to commit another offense.

“We are asked if sex offenders and the mentally ill meet the criteria for civil commitment when they are released and what risk factors they have for continued violence,” Collins says.

Reeves, who graduated from a forensic psychiatry fellowship program at St. Vincent's Hospital in New York City in 1998, says the forensic psychiatrist must be able to make an accurate diagnosis and communicate it clearly to those outside the field of psychiatry.  Like journalists, they are somewhat skeptical, very persistent in tracking down information and have a love for writing.

“In forensic psychiatry you can’t take people at their word,” says Reeves. “You listen and never believe what they are saying until you have the information confirmed. Then you write it down and edit it until you get it right.”


For more information, contact Robin Lally of Rutgers Media Relations at 848-932-0557 or rlally@@ucm.rutgers.edu.

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