Forensic Mental Health Assessment Research Articles

Fitness to stand trial: 415 consecutive defendants assessed by a New Zealand forensic psychiatry service.

New Zealand defendants found unfit to stand trial following a Court-ordered forensic mental health assessment cannot be detained in prison and must either be released, or made subject to a mental health or intellectual disability order. There is increasing awareness of the need to identify these people and protect their rights. Retrospective audit of 8years of Court-ordered health assessor reports addressing fitness to stand trial prepared by a New Zealand regional forensic mental health service with a catchment area of around 850,000. Between 2014 and 2022, Courts referred 415 defendants for assessment of fitness to stand trial. The number of reports requested increased by 20% between 2014 and 2022. Report subjects were 81% male and had a median age of 31. Commonest primary diagnoses were psychotic disorders (37%), intellectual disability (13%) and acquired neurocognitive disorders (15%). Few people with foetal alcohol spectrum disorder were identified. Despite the increase in assessments, the number of defendants considered unfit by report writers remained stable over time. The increasing number of referrals for assessment of fitness to stand trial has resourcing implications for forensic mental health services.

Widening the net: Use of social media data in personal injury and disability evaluations.

A central tenet of forensic mental health assessment is the use of multiple sources of data. Traditionally, these sources have included clinical interviews with and observations of the examinee, written records review, psychological test data, and interviews with collateral sources. Data from social media and social networking sites (SNS) is now widely used in civil litigation. However, existing professional practice standards and guidelines do not specifically address the use of SNS data. This leaves forensic mental health evaluators with little guidance as to why, when and how to incorporate SNS data into their evaluations. We review the extant literature on the use of SNS and other social media data in personal injury and disability cases, including legal, ethical, and practical considerations, with the goal of providing forensic mental health practitioners with a framework for making decisions about when and how to incorporate these data into their evaluations and opinions. We advocate caution in conducting independent searches of social media and the Internet, and in making inferences about internal states based on SNS postings. To illustrate these points, we include a case study.

The Internet is a scary place: How does evidence source and examinee race or ethnicity influence determinations of threat?

Violent rhetoric online is becoming increasingly relevant to the practice of forensic mental health assessment as examinee's virtual lives may transform into real-world acts of violence. With the rise of a diverse subculture of violent online communities, the aim of the present study was to inform how concerns with online sources of collateral data and racial/ethnic biases may influence determinations of violence potential. Using an experimental design, jury-eligible participants (N=278) and forensic mental health experts (N=78) were presented with mock Twitter (now referred to as X) posts that varied by data source (i.e., how information was accessed) and the examinee's race/ethnicity. Results showed no differences in participants' ratings of data credibility, how much weight they would place on the posts in a threat assessment, or how likely the examinee was to act violently against his intended target. Implications regarding the interpretation of social media evidence, relevant limitations, and future research are discussed.

Forensic mental health assessments of juvenile misdemeanor cases involving demoralization (status offenses) and delinquency

PurposeThe role of evidence-based psychological knowledge in cases of juvenile offending is essential to make appropriate decisions relating to youth who violate legal or social norms, as it carries implications for treatment, intervention and practice. Psychological expert opinions therefore need to meet high formal and methodological requirements while maintaining ethical standards. The purpose of this study is to investigate psychological expert opinions in cases of juvenile misbehavior reported to regional courts in Poland. Juvenile court proceedings concern cases of demoralization and/or delinquent offenses. Demoralization is a legal concept described in the Act of June 9, 2022 on juvenile support and resocialization. This concept was not defined; it was only described through examples of behaviors indicating demoralization. These include the following: violations of the principles of community life; evading compulsory education or schooling; use of alcohol, narcotic drugs, psychotropic substances, their precursors, substitutes or new psychoactive substances; and prostitution.Design/methodology/approachTo reach these goals, court records of juvenile cases in six district courts (N = 253) were gathered and analyzed. A semistructured questionnaire was used to examine the cases in which psychologists were appointed and to analyze the procedures used by these experts for assessing adolescents and their families.FindingsFindings revealed that family judges appoint psychologists both in cases of “demoralization” (i.e. status offenses) and in cases of juvenile delinquency. The opinions were delivered by psychologists who were mostly members of diagnostic teams. Results indicate that such opinions generally comply with the minimal standards recommended by the Ministry of Justice, yet a few problems were observed with the determination of levels of demoralization.Originality/valueThe limitations of diagnostic tools used by psychologists are discussed, and recommendations for future practice are provided.

Collateral Consequences for Third-Party Interviewees in Forensic Contexts.

Collateral interviews can be an integral source of third-party information used in a range of forensic mental health assessments. Although family members and spouses often have the most knowledge about the evaluee, research suggests that they may also experience distress related to the legal proceedings. This article discusses the nature and purpose of collateral interviewing with close collateral contacts, comparing collateral interviews with direct interviews with evaluees. The secondary consequences of having a justice-involved family member are considered, including the possibility of vicarious trauma. Finally, the responsibilities of evaluators are considered, especially in the context of trauma-informed principles applied to collateral interviewing. Recommendations regarding consent, the use of empathy, and feedback to collateral are provided.

A guide to feedback in forensic mental health assessment.

A guide to feedback in forensic mental health assessment.

Developing consensus for culturally informed forensic mental health assessment: Experts' opinions on best practices.

Individuals with minoritized identities are overrepresented in legal system contexts; thus, forensic mental health professionals conduct evaluations of examinees with a diversity of identities. Professional and ethical guidelines direct that these evaluations be completed in a culturally informed manner, yet many professionals still identify a need for specific guidance on how to do so. In the present study, we sought to establish consensus regarding best practices in incorporating culture into forensic mental health evaluations. Given the exploratory nature of this research, no formal hypotheses were tested. We expected that participants would concur that some practices are important to completing culturally informed forensic evaluations. We recruited two samples. Nine people with joint expertise in cultural considerations and forensic evaluations participated in a Delphi-type poll. More than half reported a minoritized racial/ethnic identity, and all identified as a man (56%) or woman (44%). Experts were surveyed regarding importance (two rounds) and relevance (one round) of recommended practices. They contributed seven additional relevant practices. Twenty-one board-certified forensic psychologists completed a one-time survey of their perceptions of best practices. These psychologists primarily identified as White (90%), and most did not identify as Hispanic or Latine (80%). They all identified as men (45%) or women (55%). This sample was asked to rate the importance of a list of practices refined during the Delphi-type poll. The majority of practices were considered important or very important by experts and board-certified psychologists. Consensus is most clear for 28 practices with means, medians, and modes all in the "important" to "very important" range at all time points. There is wide agreement on the importance of particular methods for incorporating cultural considerations in each phase of the forensic evaluation process. Forensic psychologists can use this information to self-evaluate and improve their practice and to inform training. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Examiners' perceptions of forensic mental health assessments conducted via videoconferencing.

The COVID-19 pandemic led to an acceleration in the adoption of videoconferencing (VC) for conducting forensic mental health evaluations (forensic mental health assessments [FMHA]). Two years into the COVID-19 pandemic, we administered a survey to 71 Minnesota-licensed forensic evaluators. Approximately two-thirds (65.7%) had started using VC for FMHA only after the pandemic, though a combined 84.5% reported performing FMHA via VC frequently at present. A striking 43.7% of respondents preferred VC for FMHA over in-person evaluation, and another 22.5% expressed no preference between modalities. Further, nearly 70% of respondents denied there were any populations for which they would never use VC to complete an FMHA. We conclude that the widespread adoption of VC for FMHA with the advent of the COVID-19 pandemic has induced a lasting change in the practice of FMHA. We postulate that with further advancements in technology and the development of testing instruments that can be administered online, the use of VC for FMHA will become standard practice.

Race-informed Forensic Mental Health Assessment: A Principles-Based Analysis

Existing models of forensic mental health assessment (FMHA) do not explicitly address the role of race or ethnicity in data collection, interpretation, report writing, and testimony. This omission can be a barrier to gathering information relevant to the forensic question and reaching culturally informed opinions. By adapting established principles of FMHA, we propose a culturally responsive model of FMHA emphasizing race and ethnicity (“Race-informed FMHA”). This model systematically assesses the impact of race, ethnicity and intersectional identities. We also describe how to determine how racial and ethnic considerations may be relevant to FMHA generally and in specific cases. Race-informed FMHA expands the scope of 12 of 38 foundational principles of FMHA to include racial identity, ethnicity, oppression, and privilege. We explain how evaluators can apply these principles to interpret and present information about race and ethnicity as objectively as possible. This paper identifies existing tools to obtain information regarding race and ethnicity in FMHA and describes a framework to conceptualize identity and its relevance. We discuss the importance of increasing evaluators’ comfort and fluency in discussing their own race and ethnicity – and those of others - in FMHA as well as implications for research and modified practice.

Supplemental Material for Developing Consensus for Culturally Informed Forensic Mental Health Assessment: Experts’ Opinions on Best Practices

Supplemental Material for Developing Consensus for Culturally Informed Forensic Mental Health Assessment: Experts’ Opinions on Best Practices

Forensic Mental Health Assessment as a Critical Intercept for Enhancing Mental Health Care.

Rates of psychiatric diagnosis, medical morbidity, and suicide risk are notably high among incarcerated individuals. However, engaging these individuals in community-based health care settings can be a challenge. Among justice-involved individuals who do access services, community-based health care settings may lack available resources to effectively conduct comprehensive assessments that inform evidence-based conceptualization. We propose forensic mental health assessment (FMHA) as a critical opportunity to enhance service delivery for this at-risk population. In particular, within the scope of their role, forensic mental health evaluators are able to conduct a comprehensive review of records across health (eg, inpatient and outpatient health care settings), social (eg, homeless shelter), and correctional (eg, jail or prison) settings. Moreover, FMHA often includes specialized batteries that are able to assess and differentially diagnose myriad clinical presentations that may have overlapping symptomatology. We present 2 case vignettes to illustrate the utility of FMHA for enhancing service delivery. Finally, we conclude by noting challenges to integrating FMHA into conceptualization and necessary next steps in research and programing.

The Law Meets Psychological Expertise: Eight Best Practices to Improve Forensic Psychological Assessment

We review the state of forensic mental health assessment. The field is in much better shape than in the past; however, significant problems of quality remain, with much room for improvement. We provide an overview of forensic psychology's history and discuss its possible future, with multiple audiences in mind. We distill decades of scholarship from and about fundamental basic science and forensic science, clinical and forensic psychology, and the law of expert evidence into eight best practices for the validity of a forensic psychological assessment. We argue these best practices should apply when a psychological assessment relies on the norms, values, and esteem of science to inform legal processes. The eight key considerations include ( a) foundational validity of the assessment; ( b) validity of the assessment as applied; ( c) management and mitigation of bias; ( d) attention to quality assurance; ( e) appropriate communication of data, results, and opinions; ( f) explicit consideration of limitations and assumptions; ( g) weighing of alternative views or disagreements; and ( h) adherence with ethical obligations, professional guidelines, codes of conduct, and rules of evidence.

Trauma-informed forensic mental health assessment: Practical implications, ethical tensions, and alignment with therapeutic jurisprudence principles.

Trauma-informed forensic mental health assessment: Practical implications, ethical tensions, and alignment with therapeutic jurisprudence principles.

The Importance of Racial Identity in Forensic Mental Health Assessment.

The Importance of Racial Identity in Forensic Mental Health Assessment.

Current Practices in Incorporating Culture into Forensic Mental Health Assessment: A Survey of Practitioners

Forensic evaluators conduct assessments of individuals with a wide range of sociocultural identities. Although recommendations regarding how to incorporate cultural considerations in forensic evaluations have been published over the past decade, there is no clear consensus on best practices nor is it clear how evaluators interpret and apply the available recommendations. The current survey represents a replication and extension of a previous survey regarding self-reported culturally-informed practices among forensic evaluators. Subjects were forensic mental health professionals (n = 258; 64.7% women, 69.4% PhD or PsyD) recruited through listservs and training events to complete a survey online or by hard copy. Evaluators reported significant challenges in conducting culturally-informed evaluations, including lack of appropriate tests for their examinees, lack of guidelines for their evaluations, lack of colleagues from diverse backgrounds, and lack of relevant research. Evaluators reported engaging in a wide range of culturally-informed practices across all domains, some being nearly universal (e.g., considered cultural context when forming diagnosis). In contrast, other practices were relatively uncommon (e.g., referred the evaluation to another professional with more knowledge/experience regarding examinees with particular identities). Results indicate a need for more research, more practice guidelines, and diversification of the forensic mental health workforce.

Б.В. Шостакович: психиатр-учёный и человек

The purpose of this scientific review is to consider the contribution to science of the prominent Russian forensic psychiatrist B.V. Shostakovich. The article presents the stages of his biography, analysis of his main scientific works. B.V. Shostakovich’s contribution to the study of methodological, theoretical and scientific-practical problems of forensic mental health assessment, limited responsibility, and forensic sexology are analyzed. Forensic psychiatry is shown as an interdisciplinary scientific discipline in the context of philosophical anthropology. B.V. Shostakovich’s legacy is presented against the background of the genealogy of the Shostakovich family which has a number of outstanding contributors to world culture.

Detecting Coached Feigning of Schizophrenia with the Inventory of Problems – 29 (IOP-29) and Its Memory Module (IOP-M): A Simulation Study on a French Community Sample

Evaluating the credibility of the respondent’s cognitive and psychological complaints is a core component of forensic mental health assessment. The Inventory of Problems-29 (IOP-29) and a new IOP-Memory module (IOP-M) are designed specifically for that purpose. Initial research suggests that they might provide practitioners with a quick and thus potentially efficient check of an examinee’s presentation credibility, based on the integration of both symptom and performance validity indicators. To contribute to emerging research on this topic, this study used a simulation design to examine the validity of the IOP-29 and IOP-M and their robustness in detecting coached feigning of schizophrenia. It is the first to extend this duo of measures to a French sample. Results from 115 volunteers supported the effectiveness of both IOP instruments. Because all participants were male, however, our findings may not generalize to females.

At Risk of What? Understanding Forensic Psychiatric Inpatient Aggression through a Violence Risk Scenario Planning Lens

Violence risk assessment is an essential component of forensic mental health services designed to help mitigate and manage the re-occurrence of violence. Although there is large body of evidence supporting structured risk assessments, there is no empirical evidence regarding scenario planning—a specific component of the structured professional judgment approach to violence risk assessment. The purpose of this study was to investigate the base rates and concurrent validity of inpatient aggression scenarios to provide information about risk scenarios. Among a large representative sample of forensic psychiatric patients (N = 1240), the prevalence of risk scenarios (Repeat, Escalation, Twist, and Improvement scenarios) was investigated by retrospectively coding changes in inpatient aggression. The results suggested that Improvement scenarios, including a continued desistance of aggression, were common. Aggression scenarios shared significant pattern of associations with the Historical-Clinical-Risk Management-20 and the Psychopathy Checklist—Revised. Overall, this study presents initial empirical evidence related to violence risk scenario planning. Implications from these findings include how scenario planning may intersect with evaluator bias in forensic mental health assessments.

Acquisition and Interpretation of Digital Information in Forensic Assessments

Despite the now ubiquitous presence of technology in everyday life, there is little written on the subject of personal digital data as it pertains to forensic mental health evaluations. Ethical concerns and limited consensus guidance on this issue have previously made it challenging to use this information in a responsible way. This Perspectives article elaborates on the different types of personal data that exist and the practical aspects of acquiring such information, including data location and legal considerations. Incorporation of personal digital information into the forensic assessment as a form of collateral information is discussed, along with the current state of the literature on technology use and its relationship to psychopathology and risk. Given the important role of technology in the life of the modern individual, deeper research into this topic will be necessary in the immediate future to establish practice standards for the safe and ethical use of digital information in both forensic and non-forensic mental health assessments.

Trauma-Informed Forensic Mental Health Assessment: Practical Implications, Ethical Tensions, and Alignment with Therapeutic Jurisprudence Principles

Trauma-Informed Forensic Mental Health Assessment: Practical Implications, Ethical Tensions, and Alignment with Therapeutic Jurisprudence Principles