One realm of forensics has nothing to do with crime scene evidence like blood, bones, or ballistics, but its intangible contributions are no less important to the flow of criminal and civil justice.

Forensic psychiatry deals with matters of mental health. Its own health is robust.

“Forensic psychiatry is booming,” said Timothy Allen, MD, director, Forensic Services, Department of Psychiatry, University of Kentucky.

Over 40 forensic psychiatry training programs currently exist at U.S. universities. The work of forensic psychiatrists ranges from evaluating competency to stand trial, sentencing recommendations, and providing expert opinions on mental health questions via written report, deposition, or courtroom testimony.

Of all the activities conducted by forensic psychiatrists, the most frequent pertain to a person’s mental competency. Court ordered competency evaluations in some areas have doubled in the past five years.

In criminal cases, forensic psychiatrists evaluate a defendant’s competency to waive Miranda rights, competency to stand trial, and competency to waive legal representation. They also contribute to the jury’s decision as to whether the defendant is sent to prison or to a mental hospital. Once convicted, the forensic psychiatrist might assess the defendant’s competency to waive appeal or be executed.

“Forensic psychiatrists play an important role because neither interrogations, nor trials, nor executions can proceed if the person is not mentally competent,” said William Bernet, MD, director of Forensic Services in the Vanderbilt University School of Medicine.

One of the biggest challenges in the field of forensic psychiatry is what to do with mentally ill individuals who are repeatedly found incompetent to stand trial and are released, but continue to reoffend.“

Often, these individuals do not meet commitment criteria of being a danger to themselves or others,” Allen said.