Department of Psychiatry

Forensic Psychiatry Fellowship

Rotation/Clinical Service Information

CORRECTIONAL SETTINGS

Fellows provide psychiatric services at various correctional settings throughout their Fellowship year. The institutions vary from year to year, but include facilities in the Colorado Dept. of Corrections and the Denver County Jail system.

In the CO Dept of Corrections (CDOC), Fellows rotate one day each week at the nearby Denver Regional Diagnostic Center or Denver Women’s Correctional Faciltiy. These rotations involve intake and diagnostic assessment, ongoing treatment, and experience in management of a distant clinic through telepsychiatry. Department of Corrections.

• Each facility is staffed with a full-time internist, a full-time PhD psychologist, and several mental health workers (exact number and type varies from facility to facility).
• Daily case loads average 15-20 inmates each day.
• Supervision is provided by the Facility Mental Health Coordinator and the Chief of Forensic Psychiatry for the CDOC. Case loads are carefully monitored to prevent overload.
• Fellows share responsibility with contract psychiatrists for the evaluation and treatment of all seriously mentally ill inmates in the facilities to which they are assigned. Inmates are representative of correctional populations, with males and females, and Caucasian, Hispanic, African-American, and Native American inmates. Inmates referred suffer chiefly from Axis I disorders with associated Axis II disorders. Forensic issues include right to treatment, right to refuse treatment, segregation, transfer to mental health facilities, and evaluation for parole.
• Fellows work within an interdisciplinary team.
• Each Fellow participates for an additional full day every other week with the Chief of Psychiatry within the DOC on a research project.

Fellows also have clinical responsibilities within the Denver County Jail system. This includes one morning a week of rounding with the mental health nurse at the Denver County intake jail. This involves mostly risk assessment of individuals placed in observation for various reasons. For six months, Fellows also participate with the Director of Denver County Jail mental health programs in various clinical and administrative settings.

Lastly, each Fellow has a six month rotation for 3 hours each week in a Community Corrections Residential facility in Denver.

Overall, the Fellowship program is designed so that each Fellow has experience with the mentally ill within the correctional setting at various stages of intake, treatment, stabilization and discharge.

EVALUATION OF PRISON SYSTEMS IN LITIGATION

Each Fellow joins the Associate Director of the Fellowship Program, Dr. Jeffrey Metzner, on a 2-3 day out of state site visit to a jail or prison involved in class action litigation. Dr. Jeffrey Metzner is a nationally-known expert in this field and former president of AAPL.

Fellows learn how to approach evaluation of systems in litigation, including interview of prison staff, review of institutional policies and records and interviews of inmates; and how to evaluate these facilities under existing case law.

DENVER HEALTH MEDICAL CENTER FORENSIC PROGRAMS

The Forensic Fellowship program is now located at Denver Health Medical Center, located in downtown Denver, several blocks from a new Justice Center and Jail to be completed in 2010. DHMC is a large “safety-net hospital” that provides care to the uninsured and poor, and is responsible for the health and mental health needs of 2400 inmates incarcerated within the Denver County Jail system. In addition to rotations at the Denver jails as described above, the forensic program provides consultation to the City and County Denver Courts including mental health assessments of pre-adjudicated defendants. In addition, Fellows are expert consultants to the medical, surgical, and psychiatric services of the Denver Health Medical Center.

COLORADO MENTAL HEALTH INSTITUTE AT PUEBLO (CMHIP)

Fellows perform 35 evaluations of criminal defendants under contract to the Colorado Mental Health Institute at Pueblo during their Fellowship year. The majority of these evaluations are for competency to proceed and insanity; but there are also sentencing evaluations and evaluations under the state's Sex Crimes Law. The great majority of the evaluations are performed in the greater Denver area, either in local jails or in the Fellows' offices at Denver Health Medical Center. More complicated evaluations involve travel to CMHI-P with the Director of the program. CMHIP is located 100 miles south of DHMC and UCD. Since more complicated cases are at CMHI-P on inpatient status, Fellows make approximately 4-6 trips each year. Fellows write reports that are submitted to courts under the supervision of the Forensic Program Director and Chief of Forensic Psychiatry CMHIP, and provide testimony to the courts when required.

ROCKY MOUNTAIN SURVIVORS' CENTER

This center is under the umbrella of the UCD with grant funding obtained by Dr. Daniel Savin. The Center is staffed with a variety of clinicians who specialize in evaluating and treating foreign survivors of torture. Fellows will learn about the unique characteristics of survivors of torture, and how to provide evaluations for asylum seekers. The population consists of immigrants who have been tortured in their native lands. Fellows complete 2 evaluations under the supervision of Dr. Dan Savin and Dr. Martinez each year. Rocky Mountain Survivors' Center

FAMILY LAW EVALUATIONS (DHMC)

Fellows provide evaluations for termination of parental rights through the Denver Health Medical Center (DHMC), which has a contract to provide these evaluations for the Denver juvenile courts. Each Fellow performs 1-2 evaluations over the year. The evaluations are performed in the context of a team evaluation process. Direct supervision is provided by a forensic psychologist, James Bartsch, Ph.D. Fellows write reports to the courts, and provide testimony where required.

LEGAL AND MISCELLANEOUS ROTATIONS

The Forensic Training Program works closely with the National Institute of Trial Lawyers and the Denver University Law School in including Fellows in Mock Trial Experiences each year. Dr. Richard Martinez, Director of the program, is on the faculty of the DU Law School and teaches a course, “Psychiatry and the Law” each spring. Residents in the general psychiatry residency are required to take an 8-week course on forensic psychiatry, and many residents take additional electives with the Forensic program. Fellows are expected to participate in these additional didactic and teaching opportunities. The Fellowship program provides Fellows experience as future educators and teacher, while developing their clinical skills as forensic psychiatrists.