Le recours aux dossiers des patients est-il nécessaire pour l’évaluation du risque de récidive sexuelle, violente et générale ?

Abstract

IntroductionSexual, violent and general recidivism risk scales are widely used in a number of countries. Their psychometric qualities are generally considered to be good. However, in practice they may vary in the quality of prediction of risk of sexual, violent and general recidivism, in particular because of the sources of the information collected. In France, the medical records of incarcerated patients are kept by health-care professionals. Although regulated, the content and quality of these records vary widely from one patient to another. The criminal justice system holds the criminal records of convicted and imprisoned persons. There is no set list of documents contained in these records. For caregivers and researchers, access to criminal records is difficult because of the confidentiality to which legal professionals are subject. The aim of our study was to investigate whether using medical files in addition to structured interviews can improve the assessment and management of the risks of sexual, violent and general recidivism. Material and MethodA total of 128 perpetrators of violence were assessed using three scales of risk of sexual, violent and general recidivism. Scores for the items of the scales were compared between (a) those that were based on medical records and an interview, and (b) those based only on an interview. Results and discussionFirst, differences in scores between the two groups (assessed through interview only, and assessed through interview and use of medical records) were observed on the RSVP, HCR-20 and LS/CMI scales. Secondly, most of the results indicate that the overall level of risk was perceived as lower when medical records were used, which would, indirectly, lead to a reduction in false positives when evaluating perpetrators of sexual violence. Thirdly, the point-by-point analysis shows that the use of information contained in the medical records reduces the weight of present and future factors (e.g. the physical and psychological stress of recent events), increases the weight of past factors (e.g. history of sexual violence), and can increase the weight of certain factors that can lead to more negative emotions in the assessor (e.g. deviance). These results can be explained by (i) the emotional functioning of the persons assessed (particularly defensive processes or memory difficulties), (ii) the attitude of the aggressor (particularly the presence of emotional and cognitive biases), (iii) the nature of the information (particularly “hot” cognitions or those leading to greater social desirability). The limitations of the study concern the relatively small number of participants, the environment in which the file was transmitted and the very heterogeneous and sometimes relatively incomplete composition of the files. ConclusionThe use of information contained in medical files impacts the results of recidivism risk scales and restores a balance to the factors. In France, risk scales are currently being introduced, although their use is still limited in the health field. However, ethical use of these scales raises the issue of the homogenisation of the content of medical records and access to criminal records in order to enable future research to confirm whether the use of information provided in medical and criminal records can improve the quality of assessment and treatment of offenders.