Improving forensic tribunal decisions: the role of the clinician

Abstract

Three empirical investigations of forensic decision-making were conducted: a study of 104 hearings by a forensic tribunal; an evaluation of which aspects of forensic patients' clinical presentation were empirical predictors of violence; and a survey of forensic clinicians to determine which factors they said they used to assess risk of violent recidivism and which they actually used. Results showed a significant correlation between actuarial risk and clinical advice to the tribunal, and a nonsignificant trend for patients higher in actuarial risk to receive more restrictive dispositions. Psychotic diagnoses and symptoms were not indicators of increased risk of violent recidivism. Clinicians endorsed some empirically valid indicators of risk, but also relied on some invalid indicators. There was also inconsistency between factors clinicians said they used and factors actually related to their hypothetical decision-making. An automated system is presented as an illustration of how the consistency and validity of forensic decisions could be enhanced.

Predictors of Mental Health Review Tribunal (MHRT) outcome in a forensic inpatient population: a prospective cohort study

“…Our finding that patients held on a restricted MHA section were significantly more likely to be discharged is consistent with the statistics for England and Wales [16], this is important as the majority of forensic patients in the UK are held on restricted MHA sections [26]. Our finding that a recent episode of acute illness was negatively associated with discharge was unsurprising and is consistent with Canadian research into dynamic variables associated with outcome at tribunal [7, 25]. Results with regards to the HCR-20 violence risk assessment are also consistent with previous forensic research; similar to Davoren and colleagues [21], we found that total scores on the HCR-20, along with scores on the C and R subscales, were significant predictors of outcome at tribunal.…”

“…Yet only three previous studies have attempted to explore the relationship between dynamic factors and outcome at MHRT. These studies, based in Canada and Ireland, reported that institutional management problems, treatment compliance, active psychotic symptoms, treatment success [7, 25], and scores on the Historical Clinical Risk-20 (HCR-20), a widely-used violence risk assessment tool [21], were all associated with outcome at tribunal. These findings are yet to be replicated within a UK sample and there are a number of potentially important dynamic factors, such as violent or sexually inappropriate behaviour, and leave status, which have not yet been explored in the literature.…”

International Trends in Demand for Forensic Mental Health Services

“…Instead, recommendations were related to the nature of the index offense, medication compliance, and other factors that are not strongly related to long-term risk to reoffend. Long-term risk was significantly related to tribunal decisions in a subsequent study (McKee, Harris, & Rice, 2007), suggesting improvement, but other factors were still involved. In a recent study, we found that established risk variables (e.g., historical and risk management items of the HCR-20) were rarely mentioned in written or oral testimony provided at tribunal decisions in Québec (Crocker, Braithwaite, Côté, Nicholls, & Seto, 2011).…”

Education in forensic psychiatry

“…McKee et al [32 ] offer suggestions on how the consistency and validity of forensic decisions could be enhanced. Oldham [33] cites an important paper showing the lack of training relating to carrying out and documenting violence risk screening in psychiatric emergency departments.…”