A Journey Through Saint Elizabeth An Insightful Clerkship in Forensic Psychiatry

Working in forensic psychiatry offers a unique window into the intersection of mental health and the legal system. My six-week clerkship at Saint Elizabeth was an eye-opening experience that deepened my understanding of psychiatric disorders and patient care in a challenging environment. This post shares my journey, the types of patients I encountered, the skills I developed, and the knowledge I gained during this intense but rewarding period.

The History and Role of Saint Elizabeth

Saint Elizabeth is a well-established psychiatric facility known for its forensic psychiatry services. It primarily serves patients who come from the criminal justice system, requiring careful psychiatric assessment and treatment. The hospital’s mission focuses on providing compassionate care while ensuring public safety. This balance makes Saint Elizabeth a critical institution for patients who need both mental health support and legal evaluation.

My Six Weeks at Saint Elizabeth

During my clerkship, I was assigned to the 1E unit, a team that welcomed me warmly and supported my learning. The hours were manageable, allowing me to balance study and clinical work effectively. The team’s positive feedback was encouraging—they noted how patients responded well to me, often opening up and even seeking my advice. This connection was one of the most rewarding parts of my experience.

At times, working in male-dominant units required extra caution. Despite having security guards, I had to stay alert and aware of my surroundings. This reality underscored the importance of safety in forensic psychiatry settings.

Types of Patients and Competency Evaluations

One of the core responsibilities I observed was assessing patients referred from jail for competency evaluations. These patients often faced complex legal and psychiatric challenges. The evaluations determined whether they understood court proceedings and could participate in their defense.

Patients varied widely, including those with:

• Schizophrenia: Many showed symptoms like hallucinations, delusions, and disorganized thinking.

• Bipolar Disorder: Some experienced mood swings from manic episodes to deep depression.

• Postpartum Depression: A few female patients struggled with mood disturbances after childbirth, complicating their legal cases.

  
  

Each patient required a tailored approach. I learned to ask focused questions that targeted psychiatric symptoms clearly and respectfully. This skill helped me gather accurate histories and build trust.

Learning Through Didactics and Study

Every Tuesday, the team held didactic sessions where we explored different psychiatric disorders and their treatments. These sessions covered:

• Diagnostic criteria for disorders like schizophrenia and bipolar disorder

• Medication options and their side effects

• Strategies for managing acute psychiatric symptoms

  
  

Alongside clinical work, I committed to studying extensively. I completed 240 UWorld questions related to psychiatry, which reinforced my understanding of symptoms, diagnoses, and treatments. I also reviewed six key textbooks to deepen my knowledge.

Taking a Psychiatric History

One of the most valuable skills I developed was taking a thorough psychiatric history. This process involves:

• Asking about current symptoms and their impact on daily life

• Exploring past psychiatric episodes and treatments

• Understanding social and family history, including substance use

• Assessing risk factors like suicidal thoughts or aggression

  
  

A clear, focused history is essential for accurate diagnosis and treatment planning. It also plays a vital role in competency evaluations, where understanding the patient’s mental state is crucial.

Reflections on the Experience

The six weeks at Saint Elizabeth flew by but left a lasting impression. I gained practical skills, clinical knowledge, and a deeper appreciation for the challenges faced by forensic psychiatric patients. The experience taught me the importance of patience, empathy, and clear communication.

While I am grateful to have completed this clerkship, I look back on it with pride. The patients’ willingness to open up and the team’s support made it a meaningful chapter in my medical education.