Archives for posts with tag: forensic

I’m not saying goodbye to my blog. You might remember that I published a post about changes a few weeks ago. This is my last week at my job. I finish this Friday (28th of March), after nearly 8 years here (it would have been 8 years in May).

Caricature doctor dogImage courtesy of Grant Cochrane /

Caricature doctor dog Image courtesy of Grant Cochrane /

As some of you know, I work as a psychiatrist in a forensic unit. I work for the NHS (National Health System) in the UK. I came to this job after working for nearly two years in the private sector (also in forensic psychiatry, in a medium secure unit). I had no issues with the care offered there, and the pay was better than in the NHS (even after nearly 8 years here I only now I’m close to the same pay I had there). I left partly because I wanted to do further training (and it was difficult in a smaller organisation not set up to offer training opportunities) but also because the idea of medicine being run as a business didn’t quite fit in my head. The company could be bought and sold overnight to anybody (a petrol company, an investment firm, another health organisation) and you had no saying on the matter. It was difficult to know in which direction things were going when you didn’t know who was in charge from one day to the next.

MRI Scanner Image courtesy of cooldesign /

MRI Scanner Image courtesy of cooldesign /

I came back to the NHS, taking a pay cut (although my pay was quite reasonable for NHS standards in my particular role, as I was fairly experienced), because I felt at least I’d have some sense of where we were going. Years later I can honestly say I don’t like where things are going. I understand the NHS is a mammoth that swallows any money thrown at it. I also understand that things have changed dramatically from the time of its inception, when population was younger, smaller, and less demanding. Medicine has also changed, becoming much more reliant on technology and expensive procedures and medication (although some of the interventions that would increase massively the health of the population are not expensive, but convincing people to stop doing things that are harmful is very difficult). And yet, telling  people that you can do the same job for less money (or they’ll find others who will), cutting beds, getting rid of hospitals, and relying on systems of reporting and accounting that cannot reflect what is really important is not much of an answer. I’ve had enough and I’m off. I hope things get better, but I can’t see it. May I be wrong.

Thanks for reading and feel free to like, share and comment.

As a postscript, I intend to carry on blogging, if at all I can, although I might be itinerant for a while and doing some exploring. I will try and leave some posts prepared in advance and I hope my adventures will give me even more material for future posts. But if I’m missing or not replying to comments for a while, assume I’m somewhere having fun!

If you love your heart, don't smoke  Image courtesy of digitalart /

If you love your heart, don’t smoke Image courtesy of digitalart /

English: Image for mental health stubs, uses t...

English: Image for mental health stubs, uses two psych images – psychiatry (medicine) and psychology (Photo credit: Wikipedia)


After weeks of talking about my book (and yes, there will be links at the end of the post, of course) I decided to try something different. I’ve just noticed that when people read my profile, in Twitter or Facebook, they are always interested in the forensic psychiatrist thing. I must explain. Forensic in this context does not have much to do with crime labs, CSI and all those thing. It is a subspecialty of psychiatry that deals with people who in their majority have a forensic (criminal history) and are felt to be too dangerous or risky for standard psychiatric services. So forensic psychiatric hospitals normally have more security measures than a standard psychiatric hospital (alarms, fences, locks…), staff numbers tend to be higher, staff members are trained in how to deal with certain risky behaviours and there is an emphasis placed on producing good risk assessments and plans to manage difficult situations.


There appears to be some confusion between psychiatrists and psychologists. To become a psychiatrist you have to study Medicine first, so we are doctors who then train to become psychiatrists. All doctors will study Psychiatry as one of the subjects during their degree, but like with any other specialties you will need further training if  you want to work in psychiatry (in the same way that a surgeon or a cardiologist needs to train on their branch of Medicine). Psychology is a completely different career and although we work closely together with clinical psychologists (and sometimes Forensic psychologists in my line of work) our training is different. Psychologists can work in a variety of fields, not only related to clinical matters, and I’m sure that all of you who have children are aware of psychologists attached to schools, working to assess children’s needs and help with any difficulties. They also work in recruitment for big companies, in sports…They do assessments (like IQ assessments, assessments of risk of violence, assessment of cognitive difficulties with somebody who has suffered a stroke, for instance), and also therapy and treatment, depending on their specific training. They do not prescribe medication (unless they have had other training and qualifications) and deal with how the mind works, but not from an organic point of view.


I work in the UK, and here people suffering from a mental disorder who come in contact with criminal justice system are subject to a different subsection of the Mental Health Act (1983 but amended in 2007). I’m not familiar with the Mental Health Law in many other countries (not even in Spain, where I come from, as I haven’t worked there for years and have no contacts with psychiatrists in the country) and can’t comment on exact details but here somebody can be detained if they are deemed to be mentally unwell and be risky to themselves or others. They can be taken to hospital and treated against their will. Issues of Human Rights come into play, but such matters are accepted, not without debate.


How is the work? It is not really that different from standard psychiatry. I work in a public hospital, and don’t focus on talking therapies, so I’m nothing like the psychiatrist in the Sopranos or Robin Williams in Good Will Hunting (that I love). Luckily it isn’t like in Someone Flew over the Cuckoo’s Nest or Quills. Yes, ECT (what people used to call electroshock, now electroconvulsive therapy) is still in use, and works very well in extreme cases, with people very depressed and with risk to their lives due to not eating and drinking. Of course it is not like used to be now, and people are asleep. In summary we see people, listen to them, talk to them and prescribe them medication if they need it. We also have to prepare reports for the courts to give them our opinion about somebody’s mental health state and how their crimes might be related (or not) to their mental health. As I explained in forensic psychiatric hospitals the security measures are greater, and although sometimes we have to deal with people who are very unwell in general it does not result in the job being personally more risky than many others.


I work in a hospital and that means we work in a team with many other professionals who do a great job in trying to return people back to independent life in the community. We have nurses who are always by the side of the patients, occupational therapist who try to encourage them to engage in activities, look at college, work, practical skills for everyday life, psychologists who help assess specific problems and offer counselling and therapy for particular difficulties (anxiety, substance misuse, psychotic symptoms…). And housekeeping staff, administrative staff, and gardeners, maintenance…Patients have a lot of people around them, and sometimes that is a big part of the change and therapy, as unfortunately many have lived isolated lives in the community.


There are many sad stories, some entertaining ones, a few success stories, some less successful Who is to judge though? Now people are talking less about ‘cure’, quite difficult in some mental illnesses that are chronic and can be managed but not eradicated, and more about recovery. Recovery is about trying to bring people to their ideal level of functioning and well-being. And who could aspire to more than that?




And now, as promised, the links to my book. And TWO ANNOUNCEMENTS. This Friday, the 23rd of November, author Simon Jenner, will be talking to us about his writing and his new book, first on the series of Ethan Justice. I’ve read it and can truthfully say I can wholeheartedly recommend it!


Second announcement is that I’m going to feature in my friend and very successful author (The Undeparted Series) Deborah Palumbo’s blog on the 24th of November. I’ll remind  you, but I’m giving you the link now. She always has fantastic guests and her own posts are fascinating. Have a look:




The link to The Man Who Never Was is:


You can access the book trailer for The Man in my author’s page in Amazon, or directly in U-tube but if you wish to use links, please use the one above:


Thanks so much!





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