Scandinavian forensic psychiatric practices – an overview and evaluation

Abstract

The Scandinavian countries share a social-democratic and humanistic view in that mentally disturbed offenders should not be punished or sentenced to prison if they are considered unaccountable for their actions. The countries differ, however, for example regarding referrals for medico-legal examinations. This article gives: 1) an overview of the Scandinavian forensic psychiatric practices regarding organization, legislation, resources and use of methods, and 2) a study of forensic psychiatric assessment as they are done in the Scandinavian countries. From each country 20 forensic psychiatric court reports concerning male murderers were examined. Each report was scored in five sections: characteristics of the defendant, setting of the observation, acting professions, methods used and premises for the experts' conclusions. Data were summarized with descriptive measures. Danish and Swedish experts had a more frequent use of tests and instruments than Norwegian experts. Swedish experts used the Global Assessment of Functioning Scale (GAF), and they diagnosed the observant according to DSM-IV. The Scandinavian experts rarely referred to the tests they had applied nor did they refer to any kind of theory or literature as a basis for their conclusion. Only a few reports expressed doubt concerning the validity of the conclusion. Stating all the premises of the forensic psychiatric examination might improve the quality of the reports by doing them more explicit and verifiable. More use of standardized actuarial-based methods and more attention to knowledge about clinical judgmental processes is recommended.

A study of forensic psychiatric screening reports and their relationship to full psychiatric reports

“…The main tool for the forensic expert is the clinical interview (Grøndahl, 2005). It could be argued that the clinical interview is not a sufficient tool to achieve acceptable reliability among experts.…”

The Magic or Myth of Expertise: A Comparison of Judgment Processes between Forensic Experts and Lay Persons Based on Psychiatric Case Vignettes

“…It has also been suggested that experienced clinicians are more able than less experienced judges to know when they are most likely to be correct and most likely to be wrong (Garb, 1989). Basic knowledge about decision theory and willingness to obtain feedback on their work can reduce potential errors made by forensic experts (Grøndahl, 2005;Rabinowitz, 1994). As long as the expert witnesses are aware of the limitations of their expertise, we believe, as Garb (1992) states, that they will be able to provide valuable expert testimony for the courts.…”

“…The study did not address questions regarding the basis of the decision processes, that is, why and how the judgment processes differed between the groups. Research on forensic psychiatric and psychological expertise is rather scarce (Grøndahl, 2005;Wettstein, 2005). More knowledge on judgment processes within this field of expertise can yield valuable data on how experts actually process or Forensic Psychiatric Judgments 663 judge clinical vignettes in contrast to inexperienced lay persons.…”

The Breivik case and what psychiatrists can learn from it

“…Offenders found “not legally accountable” are sentenced to compulsory treatment. It is the court's obligation to evaluate if an accused person is legally accountable and two forensic psychiatric experts are usually appointed to conduct a psychiatric evaluation. To what extent the report meets prerequisite formal requirements is evaluated by the Norwegian Board of Forensic Medicine, a part of the Norwegian Civil Affairs Authority.…”