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Autonomy, flexibility, meaningful work, and feeling valued draw residents into forensic psychiatry and help keep professionals in the field. However, when these are missing, or there is a heavy workload, lack of administrative support, and ineffective leadership, staff experience burnout and leave the field. When that happens, the remaining staff are left with even heavier workloads and a lack of control.
Drs. Treena Wilkie and Sumeeta Chatterjee discussed the current challenges and future directions for forensic psychiatry during their presentation as part of the International Forensic Psychiatry Lecture Series. (You can watch a recording of their February 27, 2025, lecture online.)
Scope of Health Human Resources Issues
Psychiatrists, psychologists, nurses, and allied health professionals often provide care to individuals with severe mental health conditions, histories of trauma, and complex needs, and may have committed violent crimes.
Staff also face the dual demands of the mental health and criminal justice systems. Each system has its own culture and policies, which may not be aligned with each other.
“Given those challenges in a system that many of us work in, the recruitment, the retention, the training, and the well-being of the staff who are working within our system are pivotal,” Dr. Wilkie said.
Staff well-being is at the core of quality care, ensuring high-quality assessments and treatment outcomes. However, these challenges can lead to stress and burnout.
Burnout
“While individual factors were previously thought to drive wellness and burnout, in actuality, the greater impact may come from organizational and system-related factors,” Dr. Chatterjee said.
With the Canadian Academy of Psychiatry and the Law, Drs. Wilkie and Chatterjee’s team conducted a survey of forensic psychiatrists in 2022. Nearly half of respondents reported experiencing some level of burnout. Women, physicians with fewer than 10 years in practice, individuals who reported having little control of their workload, and people who had different values than their organization experienced higher rates of burnout.
Burnout was most often linked to heavy workload; lack of autonomy, flexibility, and administrative support; and the complexity of the work. Wellness was linked to autonomy, leadership and culture, and a sense of meaning.
Recruitment
More than a quarter of respondents had been practising for more than 26 years, and more than a third were older than 61. This raises concerns about whether recruitment will be enough to offset retirement.
Key factors affecting recruitment include the stigma of mental health generally and forensic mental health specifically and the risks of working in high-security hospitals.
Drs. Wilkie and Chatterjee’s team conducted another survey in 2024, which included general psychiatry residents and practising forensic psychiatrists.
When it came to the field, residents cited working with a specific patient population (for example, youth or women), autonomy and flexibility, intellectual stimulation and complexity, meaning and impact, and multidisciplinary collaboration.
When choosing a job after graduation, residents prioritized location; a balance among pay, opportunity and freedom; and work-life balance. They valued meaningful, intellectually stimulating work with specific patient populations. Practising psychiatrists highlighted the same factors for job satisfaction.
Retention
The survey also found that more than half of responding forensic psychiatrists reported being stressed but not burned out, 18% reported one or more symptoms of burnout, and 5% reported being burned out. Despite about three-quarters reporting being stressed or burned out, a similar number reported overall job satisfaction. Only a third reported considering leaving their job during the previous year.
Supportive leadership, positive feedback, flexibility, autonomy, limited bureaucracy, and administrative support contributed to job satisfaction.
Staff turnover disrupts the continuity of care and recommendations made at tribunals; creates knowledge and skills gaps, which undermines the quality of assessments and court reports; and increases workload and stress on remaining staff, which worsens burnout.
Solutions
Retention and Burnout
A 2024 review paper found that reducing workload had the greatest impact on the retention of physicians in general. For example, clerical staff can reduce the administrative burden.
Leadership that actively prioritizes staff wellness makes a difference.
Policies should support flexibility, eliminate discrimination, and facilitate wellness. A strong equity, diversity, and inclusivity policy and practice are important as women and people in racial and ethnic minorities face additional stressors that can affect wellness and burnout.
Individual strategies had a small but significant effect size. Leadership can support staff by encouraging professional development, recognizing achievements, and creating a culture of learning from mistakes.
Recruitment
Dr. Chatterjee emphasized the importance of active recruitment, including building relationships with potential recruits by meeting with them, frequently communicating with them, showing enthusiasm for their careers, and providing clear job offers and mentorship opportunities.
Multiple studies in Canada and Europe identified the need to better communicate about the field of forensic psychiatry to reduce stigma and increase recruitment. They also found that exposure to forensic psychiatry during pre-clerkship training in the first two years of medical school improved forensic psychiatry recruitment, as students had already decided on their subspecialty before becoming residents.
Written by Virginia St-Denis and approved by Drs. Treena Wilkie and Sumeeta Chatterjee.
