Texas medical schools can keep growing and sustaining their forensic psychiatry fellowship programs thanks to another $5 million appropriation from lawmakers, who continue to prioritize improved mental health services statewide.
The Texas Higher Education Coordinating Board (THECB) received initial authority during the 2023 legislative session to issue grants to eligible medical schools for accredited one-year fellowship programs in forensic psychiatry that serve correctional or inpatient psychiatric facilities. Specifically, in the general appropriations act (GAA) from the 2023 legislative session, an initial $5 million was made available to the THECB for biennial grants during 2024 and 2025.
A second biennial appropriation of $5 million in the GAA from the 2025 legislative session enabled a second round of grants. THECB awarded grants in March to nine individual medical schools in the amount of $555,555 each.
“We were woefully behind in the number of forensic psychiatrists in general and training positions in the state of Texas,” said David Lakey, MD, the chief medical officer for the University of Texas System.
Dr. Lakey, chair of the Texas Medical Association Council on Medical Education, credited Joseph Penn, MD, and the Federation of Texas Psychiatry for their tireless pursuit of funding. State Sen. Judith Zaffirini (D-Laredo) was instrumental in shepherding the second $5-million grant over the goal line and into the GAA last session.
Dr. Penn has long championed the need for more forensic psychiatrists in Texas. The chief resident of psychiatry at UTMB John Sealy School of Medicine (JSSOM) helps coordinate weekly lectures on the subject with faculty at JSSOM, Baylor College of Medicine, and UT Southwestern Medical School.
Before lawmakers established the new state grant program, Texas had one forensic psychiatry fellowship program at UT Southwestern Medical School. This program produced one fellow each year. Now, the numbers are growing in Texas.
Dr. Penn estimated that out of the 176 medical school seniors and previous medical school graduates who matched with psychiatry residency programs in Texas on March 21, about “one-fifth” may follow a forensic pathway.
“There’s a shortage of us,” Dr. Penn said. After four years of medical school and another four of residency training, some psychiatry graduates prefer to work to pay down medical debt or start a family, he says. Forensic psychiatry is a one-year fellowship, like some other subspecialties. But the job has different work environments outside of traditional hospitals or clinics.
In courtrooms, forensic psychiatrists provide impartial testimony, in the form of an opinion, on issues regarding the intersection of mental health and the law before judges, conduct assessments, and help determine what is needed from state services. During training, fellows get comfortable working with patients who are incarcerated and may need mental health care, he adds, along with hearing cases and working with judges and attorneys.
Dr. Penn hopes the financial backing given to Texas medical schools empowers future psychiatrists to pursue a much-needed position in forensics.
“It really does take a special person to work behind bars,” Dr. Penn said. Without the additional specialists in this field, court dockets get backed up with cases awaiting the availability of a forensic psychiatrist. “A lot of our people view it as kind of a calling or serving the underserved. So, I think that’s what we have going for us.”
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