The quality of forensic evaluations: an interdisciplinary study

Use of assessment instruments in forensic evaluations of criminal responsibility in Norway

OBJECTIVES

Assessment instruments are often used to enhance quality and objectivity in therapeutic and legal settings. We aimed to explore the use of instruments in Norwegian reports of forensic evaluations of criminal responsibility; specifically, whether this use was associated with diagnostic and forensic conclusions.

METHODS

Our study has an exploratory cross-sectional design. We examined 500 reports filed with the Norwegian Board of Forensic Medicine in 2009-2018 regarding defendants indicted for the most serious violent crimes. The first author coded data from all reports according to a registration form developed for this study. Two co-authors then coded a random sample of 50 reports, and inter-rater reliability measures were calculated. The first author coded 41 reports for calculation of intra-rater reliability. Descriptive statistics are presented for the use of assessment instruments, and a generalized linear mixed model (GLMM) was used to estimate associations between the use of instruments and diagnostic and forensic conclusions.

RESULTS

Instruments were used in 50.0% of reports. The Wechler's Adult Intelligence Scale (WAIS), Historical Clinical Risk-20 (HCR-20), and the Structured Clinical Interview for DSM disorders (SCID I), were used in 15.8, 13.8, and 9.0% of reports, respectively. The use of instruments increased from 36% in 2009 to 58% in 2015; then decreased to 49% in 2018. Teams of two experts wrote 98.0% of reports, and 43.4% of these teams comprised two psychiatrists. In 20.0% of reports, the diagnostic conclusion was schizophrenia, and in 8.8% it was other psychotic disorders. A conclusion of criminal irresponsibility was given in 25.8% of reports. Instruments were more often used in reports written by teams that comprised both a psychiatrist and a psychologist, compared to reports by two psychiatrists. The use of instruments was strongly associated with both diagnostic and forensic conclusions.

CONCLUSION

Instruments were used in 50% of reports on forensic evaluations of criminal responsibility in Norway, and their use increased during the study period. Use of instruments was associated with diagnostic and forensic conclusions.

Tipping the scales of justice: the role of forensic evaluations in the criminalization of mental illness

An unprecedented number of individuals with mental illness are represented in the criminal justice system. The unending growth of mentally ill populations in the justice system has led to jails and court dockets being increasingly overwhelmed with cases involving mental illness, state hospitals devoting far more beds and resources to forensic cases, and people without a criminal commitment left waiting for mental health services as forensic cases are prioritized. Although a forensic mental health evaluation is only one component of this larger system, common problems with forensic mental health evaluations can exacerbate the criminalization of persons with mental illness in many ways. This article reviews the current literature regarding issues of quality, reliability, and validity of forensic mental health evaluations, discusses the broader impact of these issues, and offers potential solutions for the field.

Competency to stand trial evaluations: A state-wide review of court-ordered reports

Competence to stand trial (CST) evaluations are a critical part of certain criminal proceedings, and competence-related evaluation and treatment are an increasing part of public mental health services. Whereas more research describes the defendants undergoing competence evaluations, less research has examined the actual reports detailing those competence evaluations. This study reviewed 3,644 court-ordered CST evaluation reports submitted by 126 evaluators in Virginia since Virginia initiated an oversight system allowing for comprehensive review. The base rate of incompetence opinions was 38.8%, but these rates varied significantly across evaluation type (initial versus post-restoration efforts) and evaluators (ranging from 9.1% to 76.8% incompetence rate). Results suggest generally strong compliance with state statutes guiding CST evaluations, but also highlight marked variability in forensic conclusions and reveal a few areas in which some reports fell short of statutory requirements and practice guidelines.

A life's work in the Children's Court Clinic: the historical development of the Clinic in the forensic field and the politics impacting on the Court Clinic and now on the law

Over 50 years' experience at the Children's Court Clinic of Victoria informs this valedictory account of its director. Changes over time to the model of service at the Clinic are detailed; an independent practitioner model (psychologist/psychiatrist) with oversight now endures, while the Clinic works exclusively for the Court. Clinic operations, clinicians, clients, reputation, the nature of referrals and the need for kindness in report writing are discussed. An integral theme is the politics of the child protection field, which can affect the Clinic, and lately - through new child law - has also affected the powers of the Court and the lives of children on care applications (and the purview of the Clinic's protection assessments). New child protection legislation is discussed along with its impacts on the care of a growing number of children, signalling the need to revisit the legislation, promote better engagement of families and greatly increase coordinated expert services to them.

Towards the development of a forensic psychology training curriculum in South Africa

With the growing need for forensic mental health services and the call for increasing rigour in clinical practice, the development of specialised training programmes appears to be increasing globally. In South Africa, the licencing authority has also been focusing on this issue, and its task group has been investigating specialty training models in regard to future developments in licensure, training, qualifications, and related registration matters. The present investigation was undertaken as a way of informing this process, especially in the area of curriculum content and development. The authors undertook a survey of existing accredited forensic psychology training programmes in the United States, the United Kingdom, Australia, and Canada. The aim was to examine the qualification level, period of study, admission criteria, online study option, field placement, and the module content. The results are presented for the 62 programmes surveyed and discussed with reference to the South African context and local needs.

Psychology and psychiatry in Singapore courts: A baseline survey of the mental health landscape in the legal arena

Despite the increasing prevalence and involvement of mental health professionals in local courts, there has been no systematic study of the role played by these expert witnesses in Singapore courtrooms. An empirical study of all existing recorded cases on Lawnet (Singapore's legal database of all court trial cases) from 1975-2014 involving psychologists and psychiatrists was conducted. Results revealed that, not only were these mental health experts increasingly dotting the landscape of the legal arena, the variety of their contributions has also been gradually growing. Furthermore, there were marked differences across criminal, civil and custody cases with regards to the issues of how these experts were consulted and how their inputs utilized and appreciated by judges. Differences between psychology and psychiatry were also apparent. A future with more assistance rendered by these professions to courts, as well as greater synergy between law and mental health, was predicted for Singapore courts.

Fitness to stand trial evaluation challenges in the United States: Some comparisons with South Africa

Like the Republic of South Africa, the United States faces serious challenges regarding fitness to stand trial evaluations, including long waitlists for individuals awaiting such evaluations. Some similarities exist between the RSA and US evaluation systems, including an increasing number of referrals for fitness to stand trial evaluations, limited evaluator resources, and concerns about the significant restrictions on civil liberties for those awaiting evaluation. Recently, the United States has implemented several different solutions to address these issues. These have included broadening the eligibility requirements for fitness to stand trial evaluators, utilizing localized and short-term settings for fitness to stand trial evaluations, and a host of other ideas. This article examines these different solutions, discusses their relevance and potential effectiveness for the RSA evaluation system, and makes recommendations for consideration by policy makers and mental health professionals.

Freedom in paradise: quality of conditional release reports submitted to the Hawaii judiciary

Annually thousands of insanity acquitees are released from mental hospitals when they are no longer determined to be dangerous. This research examined quality of post-acquittal Conditional Release (CR) reports submitted to the Hawaii Judiciary. Hawaii utilizes a "three panel" system for assessing trial felony competency, criminal responsibility, and conditional release, where typically two psychologists (one Department of Health and one community-based) and one community-based psychiatrist submit independent reports to the Court. One hundred fifty CR reports were rated using a 44-item report quality measure. Interrater reliability trials indicated good to excellent agreement between quality ratings. Overall level of report quality was poor regardless of examiners' professional discipline, employer, or board certification status. Concordance rates for CR opinions were poor. Level of agreement between the judicial determination and majority recommendations was also poor. Reasons for the poor quality and level of agreement are discussed with recommendations for report quality improvement, including standardization of procedures and use of forensic risk assessment instruments.

Fitness in paradise: quality of forensic reports submitted to the Hawaii judiciary

This paper examined quality of forensic reports submitted to the Hawaii Judiciary. Hawaii utilizes a three panel system for assessing fitness to proceed, where two psychologists and one psychiatrist submit independent reports to the Court. Utilizing a survey instrument based on previous research and nationally-derived quality standards, 150 competency to stand trial (CST) reports were examined. Reports demonstrated pervasive mediocrity with respect to quality (Mean QC=68.95, SD=15.21). One quarter (N=38) of the reports scored at or above 80% of the maximum possible score. Levels of CST agreement between evaluators and evaluators and judges were high. Report quality did not differ as a function of evaluator professional identity. Full-time employed evaluators submitted a greater number of reports above the quality criterion. For those evaluators who attended the March training, reports demonstrated significantly improved quality. Suggestions for enhancing report quality are offered with a special attention to inclusion of report elements, focus on inclusion of historical elements, and clearly described rationales supporting forensic opinions. (7664 words. Competency to stand trial, inter-rater agreement).

Opinion formation in evaluating the adjudicative competence and restorability of criminal defendants: a review of 8,000 evaluations

Evaluations of competence to stand trial (CST) are the most common type of criminal forensic evaluation conducted, and courts tend to defer to clinician opinions regarding a defendant's competence. Thus, it is important to study the ways in which clinicians arrive at opinions regarding adjudicative competence and the data they consider in forming their opinions. We reviewed 8,416 evaluations conducted by forensic evaluators in Virginia over a 12 year period, and examined (a) the clinical, demographic, and criminal characteristics of a defendant as related to opinions regarding competence, predicted restorability, and impairment on "prongs" of the Dusky standard, (b) process and outcome differences in evaluations conducted by psychiatrists versus psychologists and inpatient versus outpatient evaluators, and (c) the consistency of incompetence base rates over a 10 year period. Overall, clinicians opined that 19% of defendants were incompetent and considered 23% of these unlikely to be restored to competence. Not surprisingly, psychotic and organic/intellectual disorders were most strongly associated with findings of incompetence. However, there were some notable differences between evaluations by psychologists versus psychiatrists and between evaluations conducted in inpatient versus outpatient settings.

Interrater reliability of the Fitness Interview Test across 4 professional groups

OBJECTIVE

This study investigated the interrater reliability of the Fitness Interview Test (FIT), revised edition, a semistructured interview that assesses fitness to stand trial.

METHOD

Physicians, forensic psychologists, nurses, and graduate students in psychology were trained in the FIT, and they subsequently viewed 2 videotaped interviews of actual fitness assessments. Using the FIT, they rated the fitness of each defendant portrayed in the videotapes.

RESULTS

For overall judgment of fitness, the average intraclass correlation based on the full samples of raters was found to be 0.98, and for most items on the FIT, intraclass correlations fell within the 0.80 s and 0.90 s. Reliability estimates were high across professional groups.

CONCLUSIONS

Overall, this study provides further support for the psychometric properties of the FIT, as well as for the ability of various professionals to conduct reliable fitness assessments using the FIT.

Pretrial evaluations for criminal courts: contemporary models of service delivery

Pretrial forensic evaluations are provided for the criminal courts throughout the United States. A variety of models of service delivery exists, and these models vary in ways that are important to the organization and finding of state mental health services. The first part of this paper describes several models of service delivery, which vary primarily in terms of centrality (central state institution vs. community service provider) and the use of inpatient vs. outpatient procedures. The second part compares these models on a number of important measures, including cost and efficiency. The final section of the paper indicates the importance of specialized forensic training and describes important components of such training.

Outcomes assessment for forensic neuropsychology: recommendations and considerations

Neuropsychologists are frequently retained by attorneys or the courts to assist in the resolution of legal disputes. Yet, an outcomes assessment demonstrating the utility of neuropsychological evaluations in the forensic arena has not been implemented, nor has a method for conducting an outcomes assessment of forensic neuropsychology been delineated. This article offers recommendations and considerations for the formulation of outcomes assessments. These include defining an outcomes assessment, identifying the consumers of forensic neuropsychological assessments, and specifying potential moderator and dependent variables in the context of study designs that may be feasibly implemented. Moreover, the ethical implications of outcomes assessments are discussed.

Forensic psychology: an empirical review of experimental research

The present paper evaluated the first 11 years of experimental research (1973-1983) publications, with a focus on forensic psychology, that were cited in Psychological Abstracts. Articles were reviewed for type of methodology and statistical analyses employed as well as the relationship between the number of empirical and nonempirical articles. Trends in publications are presented, and the type of empirical research is evaluated. Results indicate: a paucity of experimental research; a significant difference between empirical and nonempirical publications; and a transition--albeit based on a limited number of research publications--from descriptive to correlational and experimental research over time.

Use of the SADS diagnostic interview in evaluating legal insanity

Examined clinical usefulness of the SADS diagnostic interview in evaluations of criminal responsibility. Findings, based on 78 SADS evaluations from a specialized forensic clinic, indicated that SADS successfully differentiated between sane and insane evaluatees. These differences were found primilarily in the severity of psychotic symptoms and overall level of psychological impairment. In addition, preliminary data on institutionalized and outpatient Ss suggested the potential applicability of the SADS for assessing the general psychological functioning of insane patients in treatment.