FORENSIC PSYCHIATRY SUBINTERNSHIP

DESCRIPTION

This elective provides a focused clinical experience in Psychiatry that builds upon and enhances the basic clinical experience provided in the Psychiatry clerkship. Emphasis is placed on clinical interaction with forensic patients as well as inpatients who have been involuntarily hospitalized under the provisions of the Illinois Mental Health and Developmental Disabilities Code. Students will act as subinterns at the Chester Mental Health Center (Chester). Lodging must be arranged in advance. Faculty, particularly Ms. Karen Lee, will assist students in their efforts to locate and arrange housing.

Supervision will be provided by designated attending psychiatrist(s) at Chester and will consist of daily oral review of diagnosis, treatment and management plans, as well as individual supervisory sessions reviewing all aspects of patient care, with emphasis on forensic considerations and medical-legal interventions.

Activities and experiences will include daily rounds, psychiatric evaluation and management of assigned patients, daily written progress notes and orders, and preparation of forensic reports based on psychiatry assessment of patients involved in criminal proceedings regarding their sanity and fitness to stand trial. Students also will participate in treatment interventions with medical-legal ramifications, such as involuntary treatment, restraint, and seclusion.

OBJECTIVES

1. As a result of participation in this elective, students will develop skills in the following: Examination and evaluation of patients who have been referred for psychiatric assessment because they have relied upon the defense of "insanity" in a criminal proceeding.
2. Assessment of the mental fitness of hospitalized patients to stand trial under applicable Illinois law
   a) When patients have been found unfit to stand trial, students will develop treatment plans intended to restore patient fitness.
   b) When fitness cannot be restored, students will develop appropriate extended inpatient treatment and management plans, with ongoing assessment of potential for patient discharge.
   c) Students will prepare forensic reports regarding patient fitness and treatment progress as required by the courts.
   
3. Evaluation of whether patients acquitted of criminal wrongdoing on the basis of NGRI (not guilty by reason of insanity) are subject to involuntary admission or in need of mental health services following acquittal. Such evaluation will include
   assessment regarding placement in a moderate or maximum security setting.
   
4. Development of appropriate treatment plans, and review of existing treatment plans, for patients acquitted as NGRI but subsequently hospitalized as being in need of mental health services or subject to involuntary admission.
   
5. Examination and evaluation of patients hospitalized following NGRI acquittal to determine need for continued hospitalization, or the propriety of conditional release or discharge.
   
6. Preparation of expert psychiatric testimony in connection with forensic evaluations and assessments.
   
7. Making inpatient treatment decisions relative to such medical-legal interventions as involuntary (forced) administration of psychotropic medication, restraint, and seclusion.
   
8. Participating in treatment team meetings, staff conferences, and milieu activities involving forensic patients.

EVALUATION

Evaluation will consist of daily review of clinical activities, periodic student-faculty evaluation conferences, case presentations to faculty, review of quality of patient write-ups and forensic reports, and oral assessment of assigned reading in forensic psychiatry. The student shall also maintain and submit a comprehensive forensic psychiatry log book detailing the highlights of daily activities during the elective.

PREREQUISITES

• Students must contact Karen Lee at least FOUR WEEKS prior to the start of this elective at 545-7658.
• Successful completion of all third-year clerkships
• Enrollment in MD/JD Dual Degree Program