Artigo Doutrinário
FORENSIC PSYCHIATRY AS A SHARED AREA OF PRACTICE WITH LEGAL MEDICINE AND MEDICAL EXPERTISE (FORENSIC MEDICINE): A NORMATIVE, COMPETENCY, AND SOCIAL NEED ANALYSIS IN LIGHT OF INTERNATIONAL LITERATURE
Como citar: Santana AMD, Nunes DDN, Maia SPS. FORENSIC PSYCHIATRY AS A SHARED AREA OF PRACTICE WITH LEGAL MEDICINE AND MEDICAL EXPERTISE (FORENSIC MEDICINE): A NORMATIVE, COMPETENCY, AND SOCIAL NEED ANALYSIS IN LIGHT OF INTERNATIONAL LITERATURE. Persp Med Legal Pericia Med. Vol. 11, 2026; 260414.
https://dx.doi.org/10.47005/260414
Recebido em 14/01/2026
Aceito em 22/02/2026
The authors report no conflict of interest.
FORENSIC PSYCHIATRY AS A SHARED AREA OF PRACTICE WITH LEGAL MEDICINE AND MEDICAL EXPERTISE (FORENSIC MEDICINE): A NORMATIVE, COMPETENCY, AND SOCIAL NEED ANALYSIS IN LIGHT OF INTERNATIONAL LITERATURE
Resumo
Introdução: A organização das especialidades médicas no Brasil deve refletir a evolução do conhecimento e as demandas sociais. A Psiquiatria Forense, atualmente exclusiva da Psiquiatria, apresenta interseção substancial com a Medicina Legal e Perícia Médica (MLPM), justificando sua reclassificação como área de atuação compartilhada. Métodos: Realizou-se análise hermenêutica das Resoluções CFM nº 2.380/2024 e nº 2.148/2016, e das Matrizes de Competência dos programas de residência em MLPM e Psiquiatria Forense. Adicionalmente, revisou-se a literatura internacional para identificar evidências que corroboram a natureza interdisciplinar do campo. Resultados: As matrizes revelam que a formação em MLPM inclui explicitamente o domínio da perícia psiquiátrica, demonstrando sobreposição quase total de competências com a Psiquiatria Forense. A literatura reforça a interdisciplinaridade da avaliação forense e destaca a crise global de recursos humanos na área. Discussão: A exclusividade vigente ignora a robusta formação do médico legista e prejudica o sistema judiciário, agravando o déficit de peritos. O reconhecimento da prática compartilhada é medida de justiça técnica, coerência normativa e necessidade social, alinhando o Brasil às melhores práticas internacionais. Conclusão: A inclusão da Psiquiatria Forense como área compartilhada é plenamente justificada por critérios normativos, pedagógicos e sociais. Esta reclassificação representa uma solução eficaz para a escassez de peritos e é essencial para o aprimoramento da qualidade da justiça.
Palavras Chave: Psiquiatria Forense; Medicina Legal e Perícia Médica; Área de Atuação; Competências; Resoluções CFM; CNRM; Déficit de Peritos; Interdisciplinaridade.
Abstract
Introduction: The organization of medical specialties in Brazil must reflect evolving knowledge and social demands. Forensic Psychiatry, currently exclusive to Psychiatry, intersects substantially with Legal Medicine and Medical Expertise (MLPM), justifying its reclassification as a shared area of practice. Methods: A hermeneutic analysis was performed on CFM Resolutions (No. 2.380/2024 and No. 2.148/2016) and the Competency Matrices of Medical Residency Programs in MLPM and Forensic Psychiatry. Additionally, a review of international literature was conducted to identify evidence supporting the interdisciplinary nature of the field. Results: The competency matrices reveal that MLPM training explicitly includes the mastery of forensic psychiatric expertise, demonstrating an almost total overlap in final competencies with Forensic Psychiatry. International literature reinforces the interdisciplinary nature of forensic evaluation and highlights a global crisis regarding the shortage of psychiatric experts. Discussion: The current exclusivity of Forensic Psychiatry ignores the robust training of legal medical experts and negatively impacts the Brazilian judiciary by exacerbating the deficit of experts. Recognizing shared practice is a measure of technical justice, normative coherence, and social necessity, aligning Brazil with international best practices. Conclusion: The inclusion of Forensic Psychiatry as a shared area of practice is fully justified by normative, pedagogical, and social criteria. This reclassification represents an effective solution for the shortage of experts and is essential for improving the quality of justice.
Keywords (MeSH): Forensic Psychiatry; Legal Medicine; Medical Expertise; Area of Practice; Competencies; CFM Resolutions; CNRM; Expert Deficit; Interdisciplinarity.
1. INTRODUCTION
The organization of medical work in Brazil, as well as the recognition of its specialties and areas of practice, is a dynamic process that must reflect not only the evolution of scientific knowledge but also social demands and the reality of professional practice. The Mixed Commission of Specialties (CME), established by Decree No. 8,516/2015 and composed of representatives from the Federal Council of Medicine (CFM), the Brazilian Medical Association (AMB), and the National Medical Residency Commission (CNRM), holds the legal competence to regulate these matters (1).
This article aims to comprehensively and irrefutably substantiate the need to revise the status of Forensic Psychiatry, currently classified as an exclusive Area of Practice for the specialty of Psychiatry, so that it becomes a Shared Area of Practice with the specialty of Legal Medicine and Medical Expertise (LMME). This proposition does not aim to suppress the competence of psychiatrists but rather to recognize the technical, historical, and pedagogical qualification of Legal Medical Experts for the exercise of this function, aligning Brazilian regulation with the principles of administrative efficiency and public interest.
The analysis undertaken here is based on a hermeneutic interpretation of current resolutions, specifically CFM Resolution No. 2.380/2024, which updates the list of specialties (2), CFM Resolution No. 2.148/2016, which establishes criteria for creating areas of practice (1), and, fundamentally, on a comparative analysis of the Competency Matrices of Medical Residency Programs (MRP) approved by the CNRM. Additionally, the proposal is strengthened by a review of recent international medical literature, which corroborates the interdisciplinary nature of Forensic Psychiatry and the urgency of solutions for the global deficit of experts.
We will demonstrate that Legal Medicine and Medical Expertise is not merely an related specialty, but the very epistemological genesis of forensic practice, and that the exclusion of LMME specialists from access to certification in Forensic Psychiatry constitutes a technical anomaly that harms the Brazilian judiciary system, exacerbating the deficit of experts and procedural delays (3).
2. NORMATIVE CONTEXT AND THE CONCEPT OF AREA OF PRACTICE
To understand the legitimacy of the claim, it is imperative to revisit the legal definition of “Area of Practice.” According to Article 1, § 2 of CFM Resolution No. 2.148/2016, an area of practice is defined as a “modality of organization of medical work, developed by professionals trained to perform specific medical actions, being derived from and related to one or more specialties” (1).
This definition inherently carries the principle of transversality. Unlike a specialty, which has a verticalized core of training, an area of practice represents an intersectional field where different knowledge converges to solve specific problems. The Brazilian specialty system already recognizes this reality in several areas, such as Sleep Medicine, shared by Neurology, Otorhinolaryngology, Pulmonology, and Psychiatry (2,4); Pain, shared by Anesthesiology, Internal Medicine, Neurology, Orthopedics, among others (2); and Palliative Medicine, shared by Internal Medicine, Geriatrics, Oncology, among others (2).
Forensic Psychiatry, by its nature, is the application of psychiatric knowledge to the ends of justice. It simultaneously requires mastery of psychopathology (the core of Psychiatry) and mastery of forensic propaedeutics, legislation, and forensic reasoning (the core of Legal Medicine). Restricting this area solely to Clinical Psychiatry ignores that forensic competence — the ability to translate medical language into legal language — is the central competence of the Legal Medicine and Medical Expertise specialty.
3. ANALYSIS OF COMPETENCY MATRICES: LEGAL MEDICINE AND MEDICAL EXPERTISE VS. FORENSIC PSYCHIATRY
The conclusive proof of the technical qualification of Legal Medical Experts for practice in Forensic Psychiatry is found in the very legislation that regulates their training.
3.1. TRAINING IN LEGAL MEDICINE AND MEDICAL EXPERTISE (R1, R2, R3)
CNRM Resolution No. 19, of July 6, 2021, which approves the competency matrix for the Medical Residency Program in Legal Medicine and Medical Expertise, establishes a 3 (three) year direct access curriculum, intensively focused on the interface between medicine and law (5). By dissecting this matrix year by year, we observe that training in mental health and forensic psychopathology is not optional or peripheral, but structural.
In the first year of residency (R1), the focus is on forming the propaedeutic and humanistic basis necessary for forensic evaluation. The matrix requires that the resident, at the end of this year, master “the psychological and social aspects of the patient” (5). This competence is fundamental, as it establishes the physician’s ability to understand the individual not only as a biological organism but as a biopsychosocial being, a basic premise for any psychiatric evaluation. Furthermore, the R1 matrix emphasizes “mastery of care for women victims of sexual violence” (5), which requires the ability to assess psychic impact and trauma, elements of forensic sexology and judicial psychology. Training in “understanding concepts related to the end of life” and “respecting cultural values, beliefs, and religion” (5) reinforces ethical and humanistic training, essential for assessing civil capacity and autonomy of will.
In the second year (R2), training advances to areas of greater complexity. The matrix requires “mastery of the clinical examination of drunkenness” (5), which is, in essence, an acute psychopathological evaluation. The expert must be able to identify alterations in consciousness, orientation, memory, attention, and behavior, differentiating exogenous intoxication from organic or functional mental disorders. Also in R2, “mastery of social knowledge regarding health conflicts, of assisted individuals attended in the Federal Special Court” (5) is required, which implies the evaluation of work incapacity resulting from mental pathologies, one of the main functions of Forensic Psychiatry in the civil/administrative sphere.
It is in the third year (R3) that the LMME matrix becomes irrefutable regarding the overlap with Forensic Psychiatry. CNRM Resolution No. 19/2021 explicitly establishes, as a competence to be acquired at the end of the program: “Master forensic psychiatric expertise” (5). This legal determination is clear and direct. The Brazilian State, through the Ministry of Education and the CNRM, determines that to be a Legal Medical Expert, the professional must master psychiatric expertise. The use of this verb implies expertise, autonomous execution capacity, and technical responsibility. Furthermore, R3 requires “knowledge of the follow-up of aggressors and minors on assisted liberty,” directly inserting the legal medical expert into criminal enforcement and socio-educational measures, nuclear areas of Criminal Forensic Psychiatry (5). “Psychological follow-up of victims” and “synthesis capacity in the elaboration of medico-forensic documents” (5) complete the training, with the elaboration of the forensic psychiatric report being an integral part.
3.2. TRAINING IN FORENSIC PSYCHIATRY (R4)
To validate the shared area thesis, it is necessary to demonstrate the symmetry between the training proposed for the psychiatrist and the existing training of the legal medical expert. CNRM Resolution No. 33/2021 establishes the matrix for the Additional Year (R4) in Forensic Psychiatry (6). The general objective of the program is to “train and qualify medical psychiatrists in the area of practice in Forensic Psychiatry to identify forensic psychiatric situations (in civil, criminal, administrative, and labor areas)” (6).
The listed competencies include: determining limits of civil capacity and criminal imputability; assessing risk of violence and psychopathy; preparing medical documents (reports, opinions); and criminal and civil expertise, covering examinations of criminal responsibility, toxicological dependence, and civil capacity (6). All these expertises are included in the scope of duties of the Legal Medical Expert and in their competency matrix (R2 and R3) (5).
3.3. CONVERGENCE OF COMPETENCIES
The comparison between the two resolutions reveals an almost total overlap in final competencies. While the psychiatrist arrives at expertise bringing the baggage of clinical and therapeutic knowledge, the legal medical expert arrives at the same expertise bringing the baggage of forensic propaedeutics, criminalistics, and legislation. Legal Medicine provides the form (the forensic method, the legal-causal reasoning) and the necessary psychopathology content to answer justice questions. Clinical Psychiatry provides the content (nosology) and acquires the form during R4. Both paths lead to the same competence: assisting justice in understanding mental phenomena. The matrix analysis proves that the training of the Legal Medical Expert is not merely “compatible” with Forensic Psychiatry; it fully encompasses it. Denying access to certification is denying the validity of the residency program approved by the CNRM itself.
4. EVIDENCE FROM INTERNATIONAL LITERATURE: INTERDISCIPLINARITY AND SOCIAL NEED
Recent international medical literature robustly validates the central arguments of the project, reinforcing the interdisciplinary nature of Forensic Psychiatry and the urgency of solutions for the deficit of experts.
4.1. PSYCHOMEDICOLEGAL COMPETENCIES AND THE QUALITY OF REPORTS
A 2023 study developed 60 competency items in psychomedicolegal analysis, through the Delphi technique with specialists from various disciplines (general psychiatrists, forensic psychiatrists, forensic psychologists, lawyers, and medical education directors) (7). These competencies were categorized into four stages: case preparation, evaluation conduct, report writing, and court testimony. The study emphasizes that the inconsistency in the quality of forensic psychiatric reports has been criticized for years due to the lack of standardized guidelines, which impacts both forensic service and competency development among general psychiatrists (7). This finding directly reinforces the argument that training in Legal Medicine, with its structural emphasis on forensic propaedeutics and the elaboration of medico-legal documents, provides essential competencies for the practice of forensic psychiatry.
4.2. FORENSIC CLINICAL REASONING AS A TRANSVERSAL PROCESS
A 2021 review demonstrates that clinical reasoning in forensic psychiatry is not limited to diagnosing mental disorders but extends to determining mental capacities as required by law (8). The study applies theories of clinical reasoning to elucidate how forensic psychiatrists use clinical reasoning both to diagnose and to determine legal capacities (8). This evidence supports the argument that Legal Medicine, by training its specialists in legal-causal reasoning and the medicine-law interface, develops competencies parallel and complementary to those of clinical psychiatry.
4.3. THE GLOBAL DEFICIT OF EXPERTS AND THE IMPACT ON THE JUSTICE SYSTEM
Literature confirms the crisis of human resources in forensic psychiatry globally. A 2020 study on competence to stand trial in the United States documents that the exponential increase in competence evaluations has resulted in overburdened forensic systems unable to meet demands in a timely manner, with defendants waiting months in pretrial detention (9). This situation has reached a “near-national crisis” level in the US, with multiple lawsuits for rights violations (9). In Europe, a 2023 study revealed extreme variation in the capacity of forensic services among European Union countries (from 0.9 to 23.3 beds per 100,000 inhabitants), with a frequent lack of clear definitions and data on expert availability (10). These international data validate the argument that expanding the pool of qualified specialists through shared recognition is an urgent social need, as already pointed out in the Brazilian context (3).
4.4. THE MULTIDISCIPLINARY NATURE OF FORENSIC EVALUATION AND THE IMPORTANCE OF TRAINING
A 2021 study on a multidisciplinary approach to insanity assessment demonstrates that the convergence of multiple indices (clinical, neuropsychological, neuroscientific) produces more robust evidence and minimizes cognitive biases (11). The study argues that forensic discussion should move from the presence/absence of psychopathology to the impact of psychopathology on the legal issue (11). This evidence reinforces that forensic psychiatry is not the exclusive domain of one specialty, but an intersectional field where different knowledge converges. Additionally, a 2021 study from Indonesia demonstrated that general psychiatrists exposed to structured educational modules in forensic psychiatry during residency showed greater confidence in conducting forensic evaluations in cases of insanity, fitness to stand trial, malingering, civil capacity, and risk of recidivism (12). Those with greater self-confidence experienced fewer difficulties in evaluations (12). This evidence supports the argument that structured and specific training (such as the CNRM 19/2021 competency matrix for LMME) is the determining factor for forensic competence, not necessarily the original specialty.
4.5. INTERDISCIPLINARY COLLABORATION AND IMPARTIALITY
A 2012 study on collaboration between forensic psychiatry and forensic psychology demonstrates that professionals from both fields can serve as expert witnesses in court and face similar challenges (13). The study concludes that “collaboration between these two professions has the potential to increase both the credibility and usefulness of forensic services for the courts, the individuals served, and the general public” (13). This evidence supports the proposed shared area model, demonstrating that interdisciplinary collaboration strengthens the quality of expert services. In line with this, a 2019 international study with 131 forensic psychiatrists from three continents revealed a unified view on impartiality in medicolegal psychiatry, regardless of country or practice conditions (14). The factors considered most important for increasing impartiality were training in forensic psychiatry and prior professional experience (14). This finding reinforces that forensic competence primarily derives from specific training and experience, not the base specialty, validating the proposal for shared access through adequate training.
5. ANALYSIS OF CERTIFICATION EXAM NOTICES AND ADMINISTRATIVE PRECEDENTS
The certification exam is the instrument that validates the specialist’s competence before society. The comparative analysis of the notices from the Brazilian Association of Legal Medicine and Medical Expertise (ABMLPM) and the Brazilian Association of Psychiatry (ABP) reinforces the thesis of the identity of required knowledge.
The 2025 Certification Exam Notice in Legal Medicine and Medical Expertise (15) is a robust document that demonstrates the complexity of the specialty. In Stage 2, the candidate must choose a specific area, including Criminal and Civil (15). The choice of the Criminal area necessarily requires knowledge of Criminology, Forensic Psychopathology, Criminal Imputability, and Chemical Dependence. The choice of the Civil and Labor area requires knowledge of Civil Capacity (interdiction), Psychic Damage, and Causal Link in Work-Related Mental Disorders (Burnout, PTSD) (15). The elaboration of the medico-legal report has a weight of 6 in the score of the second stage (15), demonstrating that the capacity for forensic argumentation and answering legal questions are more valued than mere theoretical memorization.
In turn, the 2025 ABP Notice No. 010 for the Certificate of Practice in Forensic Psychiatry (16) lists a programmatic content that extensively overlaps with that of Legal Medicine: evaluation of criminal responsibility and civil capacity; rights of the mentally ill and psychiatric ethics; expertise in criminal, civil, administrative, and social security matters; and simulation of mental illness (16). All these topics are covered by the classic bibliography of Legal Medicine and are part of the daily routine of Medical-Legal Institutes. Simulation, for example, is an exhaustively studied topic in Legal Medicine, given the frequency with which examinees attempt to manipulate the forensic examination in search of benefits or impunity.
The proposed shared area foresees that candidates from LMME submit to the same certification exam as psychiatrists, thus ensuring equality and technical quality of certified professionals, as advocated by Article 10 of CFM Resolution 2.148/2016 (1).
The request for sharing an area of practice finds solid support in the recent history of decisions by the Mixed Commission of Specialties. Sleep Medicine is the paradigmatic example. Initially claimed by various specialties, it was recognized as a shared area of practice by Otorhinolaryngology, Pulmonology, Neurology, and Psychiatry (2,4). The CME understood that, although each specialty has a different focus, they all converge on the diagnosis and treatment of sleep disorders. Forensic Psychiatry bears a perfect analogy to these cases. The Psychiatrist brings deep knowledge of mental illness and acquires legal knowledge. The Legal Medical Expert brings deep knowledge of the legal and forensic system and acquires psychopathological knowledge. Both converge to the same point: the ability to answer judicial questions about mental health. Maintaining exclusivity is denying the interdisciplinary nature of forensic practice.
6. SOCIAL JUSTIFICATION AND IMPLEMENTATION PROPOSAL
The justification for normative change is not merely corporate or academic; it is, above all, social. Brazil faces a critical bottleneck in performing psychiatric expertises, with serious consequences for citizenship and human rights (3). Data indicate that psychiatric expertise is an essential instrument in criminal, civil, and social security processes, but thousands of cases are paralyzed due to a lack of qualified professionals (3). The scarcity of experts causes procedural delays, with defendants waiting months or years in pretrial detention for a report that defines their imputability (3). Furthermore, in the absence of certified specialists, judges appoint physicians without specific training, which can result in technically deficient reports and judicial errors (3).
Legal Medical Experts, public servants hired through competitive exams and allocated to IMLs, are already responsible for performing these expertises in many jurisdictions where forensic psychiatrists are not available. By recognizing Forensic Psychiatry as a shared area, the CFM would allow hundreds of qualified Legal Medical Experts to obtain certification, immediately expanding the supply of qualified experts for the judiciary and society (3).
Aiming at the safe and technically rigorous operationalization of this inclusion, the following model is proposed, in accordance with Article 10 of CFM Resolution No. 2.148/2016 (1):
- Amendment of CFM Resolution No. 2.380/2024: An amendment to the annex of CFM Resolution No. 2.380/2024 is requested to include Legal Medicine and Medical Expertise (36) as a prerequisite for the Forensic Psychiatry area of practice (54) in Section C (Certifications) (2).
- Unified Certification: Certification must be carried out through a unified exam, under the aegis of the AMB, with the participation of the ABP and ABMLPM in the elaboration of questions and the examining board.
- Eligibility Criteria for the Area of Practice in Forensic Psychiatry (for Legal Medical Experts): For a physician with a Specialist Title in Legal Medicine and Medical Expertise (RQE registered with the CFM) to obtain the Specialist Qualification Register (RQE) in the area of practice in Forensic Psychiatry, they must meet one of the following criteria:
- Qualification by Medical Residency in LMME (Eligibility for R4 and Certification Exam): Have completed a 3 (three) year Medical Residency Program in Legal Medicine and Medical Expertise (LMME). This training, which, according to the CNRM competency matrices (CNRM Resolution No. 19/2021), already qualifies the professional for mastery of forensic psychiatric expertise, confers eligibility for:
- Approval in a selective process and completion of a 1 (one) year Medical Residency Program in Forensic Psychiatry (R4), leading to direct obtaining of the RQE in the area of practice.
- OR Taking the certification exam for the area of practice in Forensic Psychiatry, according to the norms established by the Brazilian Medical Association (AMB) and the Brazilian Association of Psychiatry (ABP) for certification.
- Qualification by Specific Professional Experience (Eligibility for Certification Exam): Prove specific and substantial practical experience in Forensic Psychiatry, within the scope of Legal Medicine and Medical Expertise (evidenced, for example, by work in Medical-Legal Institutes, Judicial Psychiatric Hospitals, or in conducting Judicial Expertises), for a minimum period of 2 (two) years. This period corresponds to double the residency training time in the Forensic Psychiatry area (1-year R4), in strict conformity with the general rules of the Brazilian Medical Association (AMB) for certification by experience.
- Qualification by Medical Residency in LMME (Eligibility for R4 and Certification Exam): Have completed a 3 (three) year Medical Residency Program in Legal Medicine and Medical Expertise (LMME). This training, which, according to the CNRM competency matrices (CNRM Resolution No. 19/2021), already qualifies the professional for mastery of forensic psychiatric expertise, confers eligibility for:
7. CONCLUSION
The inclusion of Forensic Psychiatry as a shared area of practice with Legal Medicine and Medical Expertise is a measure of technical justice, normative coherence, and social necessity. It has been demonstrated that the Competency Matrix of the LMME Residency (CNRM 19/2021) requires the legal medical expert to “master forensic psychiatric expertise,” equating their training, in this aspect, to that of the forensic psychiatrist. There is a total overlap of areas of practice (criminal, civil, administrative) and technical competencies (reports, imputability, capacity) between the two areas. The deficit of experts in Brazil, corroborated by a global crisis of human resources in psychiatric expertise, demands the expansion of the pool of qualified specialists to prevent impunity and social injustice. CME precedents support the creation of shared areas when there is a convergence of competencies, and international literature reinforces that structured training and experience are more determining factors for forensic competence than the original specialty, in addition to highlighting the benefits of a multidisciplinary approach. This is what is proposed and requested to the Mixed Commission of Specialties.
References
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