December 4, 1998

Beginning forensic psychiatrists learned about opportunities to train in Australia or work with the FBI at the annual conference of the American Academy of Psychiatry and the Law last month in New Orleans. Their peers also provided information on doing research, obtaining grants, and writing about the field.

Dawn Dawson, M.D., a senior instructor in the University of Colorado Health Sciences Center and a child and adolescent psychiatrist, provided tips and recommendations for securing grant monies. She also recommended that early career psychiatrists formulate a long-range career plan.

Those who wish to do research, she said, should identify an idea that reflects a national and a professional need as well as the need of a funding agency. Ideas can come from work with patients, professional literature, conversations with people at conventions, societal trends, legislative initiatives, public documents, and agency goals. In addition, she said, Internet sites for some government agencies such as the Department of Health and Human Services and the Centers for Disease Control and Prevention provide ideas for projects that are likely to get funded.

"The importance of mentors cannot be overestimated," said Dawson. They have experience in applying for grants and forging relationships with donors. They also can spot mistakes in proposals and help increase the chances of getting funding, she said.

Dawson spoke about the importance of having a larger plan beyond obtaining a particular grant, such as ways to use information gained from a study in work with patients or for further inquiry. She recommended building credentials and presenting papers at meetings. She also suggested working on teams with more experienced researchers as well as serving as a book reviewer and later as a reviewer of abstracts for grant competition.

Andrew Schultz-Ross, M.D., spoke about fictional and nonfictional writing on topics related to forensic psychiatry. He noted that there are large gaps in the academic literature and that portrayals of criminals are often inaccurate in media and fictional accounts.

Psychiatrists might want to write to share knowledge and expertise, express concerns and elucidate issues, shape policy and opinion about topics of concern, become better known as an expert, and exercise their creativity. He encouraged prospective writers to let their writings "have a life of their own" and not judge their work too critically.

David Alcorn, M.D., a forensic psychiatrist from Brisbane, Australia, discussed forensic psychiatry opportunities in his country. He said forensic psychiatry trainees from the U.S. can work for six to 12 months in state hospitals in Australia. Those who want to practice longer, he said, need to acquire permanent residency.

Like the U.S., Australia has federal and state governments. Each of its six states has a supreme court, and the highest federal court is the High Court of Australia. A right of appeal exits from each Supreme Court to the High Court. There is no death penalty in Australia.

In the 1970s it became apparent that mental health issues were not being dealt with as efficiently as possible in the Queensland state legislature, said Alcorn. Thus, in the mid-1980s a mental health tribunal was introduced. The tribunal, which is inquisitorial, consists of a judge assisted by two psychiatrists, and it deals only with mental health issues. Sessions are convened in public court, but the media cannot report on proceedings for 28 days.

The tribunal makes decisions on such questions as soundness of mind, fitness for trial, and fitness to endure trial without serious consequences to the accused person's health. It has powers to compel the accused person to undergo an examination that may include blood and urine tests and neuro-psychiatric testing. The rules of evidence do not apply. Lawyers, judges, and psychiatrists can all cross-examine witnesses.

Referrals are made by the local director of mental health for the state, the director of public prosecution, or by the defense council. Once a referral is made, a hearing must be held. Experts can be asked their opinions about future management and disposition of the accused, and they can be retained by the accused person, defense council, prosecutor's department, or the tribunal.

Emily Keram, M.D., the panel moderator, spoke for Dickson Diamond, M.D., a psychiatrist with the FBI, who was not able to attend. She presented information on consultation to law enforcement agencies, focusing on the FBI's Employee Assistance Program (EAP). This program is developing a national consultation team for agents and other FBI employees. It is active in every aspect of the organization, is office based and on site, and offers assessment, treatment, and consultation to management and specialty services.

Members of the consultation team assess fitness to carry firearms and to receive and maintain security clearances. They will also make diagnoses and prescribe medications. Work on the program can include providing psychological support to agents on site-bombing sites, SWAT team deployment, and hostage negotiations.