Dr. Faulkner began his presidential address with a quote from Abraham Lincoln: "If we could first know where we are, and whither we are tending, we could then better judge what to do, and how to do it." This aptly set the tone for his talk, entitled "Ensuring the Survival of Forensic Psychiatry as a Medical Specialty in the 21st Century."
The underlying premise of his message was that forensic psychiatry must be useful to medical systems in order to survive and grow; otherwise it will be ignored or eliminated as unnecessary or unimportant in the new health care era. From his special vantage and experiences as a medical school dean, Dr. Faulkner constructed a set of requirements for all medical systems in this new era and then described the opportunities for forensic psychiatry to help meet each of those requirements. He emphasized that forensic psychiatrists are first physicians and psychiatrists, and have a natural role as medical specialists.
There are six requirements that Dr. Faulkner described as an essential part of the response to forces shaping medicine in the 21st century: 1) Organizations that are effective, efficient and responsible; 2) Quality educational programs of appropriate type and size; 3) Participation in health care networks; 4) Primary care capacity and services; 5) Restructured systems for research; 6) Effective leadership. For each of these requirements, Dr. Faulkner provided an explanation of the major forces shaping the requirement, followed by his suggestions for the strategic role that forensic psychiatry should adopt in helping medical systems to meet that requirement.
These proposals presented a serious, thoughtful and ambitious agenda for forensic psychiatry in an organized and detailed format. It is difficult to do justice to the full presentation of ideas in this format; members are encouraged to attend carefully to this paper when it is published in the Journal. To give a flavor of Dr. Faulkner’s presentation, some of his proposals are listed below, arranged by the associated requirement.
1) Effective, efficient and responsible organizations. Forensic psychiatry should plan for ways to contribute to the overall goals of medicine and specific medical systems. We must document our effectiveness in forensic education, research and service in meeting community needs. Our programs must be fiscally responsible and respond to legal requirements in exemplary fashion.
2) Quality educational programs. We should demonstrate the need for forensic psychiatrists at local, state and national levels. We should be concerned more about the quality of our programs and trainees than the quantity. Our educational endeavors should be expanded to the public sector, to medical students, residents in other specialties and to other mental health disciplines.
3) Participation in health care networks. Forensic psychiatrists should contribute medical-legal and educational services to networks that will increase their value to potential customers. Forensic contacts can also be a source of referrals to the network from outside sources, such as departments of mental health, corrections and juvenile justice.
4) Primary care. We should provide education to primary care clinicians regarding forensic and ethical issues, and facilitate linkages between public forensic systems and primary care clinicians in the network. Forensic psychiatrists should accept forensic referrals from primary care clinicians and refer forensic patients to primary care clinicians in the network.
5) Restructured systems for research. Forensic psychiatry will need to be part of multidisciplinary research collaborations and establish research linkages with state and federal institutions. The foci of research will need to include health services research, including non-traditional systems of care, such as HMOs. Researchers will also need non-traditional sources of funding, and should link to private industry.
6) Effective leadership. Forensic programs should implement innovative administrative processes such as strategic planning, budgeting and financial management and assessment of faculty productivity. Forensic psychiatrists should consult with medical leaders about legal and ethical issues, and should actively participate in administrative processes and leadership positions in medical systems.
In this section of his presentation, Dr. Faulkner described a number of possible implications of the opportunities outlined above for AAPL, for forensic practitioners and forensic academicians. He organized these implications into the acronym "APPLE," representing "Assess, Participate, Provide, Lead and Educate."
With regard to AAPL’s role in assisting forensic psychiatrists in their efforts to survive as a medical specialty, Dr. Faulkner offering the following suggestions:
Assess – Evaluate forensic educational, research and service needs of modern medical systems. Participate – Increase liaison activities with other national medical organizations, and promote forensic psychiatrists as leaders within medical systems. Provide – Develop practice guidelines and establish an education and research institute to support focused educational and research projects. Lead – Advocate for a broadening of the scope of forensic practice to include medical administration, and promote collaborations that demonstrate the value of forensic psychiatry to medical systems. Educate – Develop education programs that are specifically designed to teach pertinent leadership, administrative, educational, research and clinical knowledge and skills required in modern medical systems.
For practitioners, Dr. Faulkner asserted the need to do such things as: evaluate personal readiness to meet needs of modern medical systems; become involved in forensic services in medical systems; embrace new multidisciplinary interactions with other medical and mental health professionals; assume leadership roles and advocate for an expanded role for forensic psychiatry; and participate in educational programs in medical systems. Dr. Faulkner likewise provided a list of implications for forensic academicians.
In his concluding remarks, Dr. Faulkner expressed his view that "new knowledge, skills, and attitudes will be required to effectively participate in and lead modern medical systems." Although this new health care era will bring many challenges, it will also bring new opportunities for physicians ready to confront them constructively. This will, however, require that practitioners, academicians and AAPL prepare themselves now to take advantage of such opportunities. Dr. Faulkner shared his optimism about this future:
"It is my firm belief that forensic psychiatry can indeed solidify an important role for itself within the mainstream of medicine in the 21st century."