Forensic Methods and Procedures Applied to Child Custody Evaluations: What Judges Need to Know in Determining a Competent Forensic Work Product

Judges are seeing an increase in the number of forensic reports in the area of child custody. This increase in forensic mental health involvement suggests that judges need to better understand the application of current forensic mental health methodology to assist them in determining a competent forensic work product. Recent literature has argued that child custody evaluators need to craft their reports consistent with scientific methods and procedures as well as legal standards governing admissibility of scientific evidence. This paper provides a framework for judges to assist in determining whether a child custody evaluation has been crafted consistent with current behavioral science literature pertaining to use of forensic mental health methods and procedures.     

Creating a State‐Academic Partnership to Advance a Forensic Teaching Service: Benefits and Barriers

In Washington State, like many states, there is a shortage of forensically trained mental health clinicians to work with criminal justice‐involved individuals. At the direction of the state legislature, a collaborative project was undertaken by the University of Washington, the state Department of Social and Health Services, and a state psychiatric hospital to develop a proposal for a jointly sponsored forensic teaching service. The authors reviewed the literature, surveyed and interviewed forensic psychiatry and psychology training directors, and conducted site visits of selected training programs that offer multidisciplinary training or have affiliations with state hospitals. The authors conducted focus groups of additional stakeholders, including clinicians and patients in forensic settings, to better understand the needs in Washington. The authors report on several common benefits and barriers to establishing forensic teaching services. Other states and forensic programs may find this article useful in identifying common considerations for forensic mental health teaching services.     

The Criminogenic,Clinical, and Social Problems of Forensic and Civil Psychiatric Patients

Forensic psychiatric patients consume an increasing proportion of mental health resources in Canada and the United States. To inform mental health policy and practice, we compared the criminogenic, clinical, and social problems of forensic patients to those of civilly committed psychiatric patients in two Canadian studies. We predicted that forensic patients would score higher on criminogenic problems and lower on clinical and social problems than civil patients in two studies: one comparing 83 forensic and 189 civil inpatients on a clinician-completed form, the Resident Assessment Instrument--Mental Health, at an urban mental health center, and the second comparing 423 forensic and 178 civil patients assessed at different times using the Patient Problem Survey. The two studies were quite similar in their findings, despite differences in their samples, measures, and data collection methods. In both studies, forensic patients were similar to or lower than civil psychiatric patients in all criminogenic, clinical, and social problems. We conclude that forensic mental health services would benefit greatly by drawing from knowledge accumulated in the general psychiatric literature. This finding also supports the idea that many forensic patients can be appropriately diverted to nonforensic mental health services.     

EMPIRICAL ANALYSIS OF REFERRAL ISSUES AND “ULTIMATE ISSUE” RECOMMENDATIONS FOR PARENTS IN CHILD PROTECTION CASES*

Mental health professionals frequently respond to requests for clinical information on parents in child protection cases; however, little data exist on the issues precipitating requests or on the controversial practice of offering “ultimate issue” recommendations in forensic clinical reports. We investigated 243 requests for clinical information on parents and 204 clinician reports submitted for use in child abuse and neglect proceedings in a large, urban juvenile court system. We coded 56 objective and qualitative characteristics regarding referral questions, pending legal issues, and four levels of recommendations. We found that the most common referral questions related to service planning, parenting ability, and/or parents' mental health functioning, and the most common pending legal issues were selection or change of a permanency goal and visitation arrangements. Levels of recommendations varied with type of legal decision, in that clinicians always offered direct recommendations for narrow, statute‐based issues (e.g., termination of rights, adoption) and less so for other issues. Community‐based evaluators were more likely to offer direct recommendations than court‐based clinicians. Based on the findings, we offer practice recommendations and directions for further research in forensic parenting assessment.     

Quality of criminal responsibility reports submitted to the Hawaii judiciary

This paper is the third in a series of research reports on quality of forensic mental health evaluations submitted to the Hawaii judiciary. Previous studies examined quality of reports assessing competency to stand trial (CST) and post-acquittal conditional release, in felony defendants undergoing court-ordered examinations. Utilizing a 44-item quality coding instrument, this study examined quality of criminal responsibility reports in a sample of 150 forensic mental health evaluations conducted between 2006 and 2010 by court-appointed panels. Raters attained high levels of agreement in training and quality coding. Similar to the previous studies, overall quality of reports was mediocre, falling below the .80 quality criterion score for report elements, regardless of evaluator professional identification or employment status. Level of agreement between evaluators and judicial sanity determinations was “fair” using Cicchetti's (1994) standards for interpretation of intra-class correlations. Level of agreement was lower than previously published findings for CST reports and better than conditional release reports. Reasons for mediocre report quality and “fair” inter-rater agreement are discussed, including the fact that criminal responsibility evaluations are complex, retrospective in nature, and involve significant degrees of inference. In contrast to CST evaluations, assessment of criminal responsibility involves a mental state at the time of the offense evaluation. Threats to reliability in forensic reports are discussed. Suggestions for improvement of report quality are proffered, including standardization of procedures and report format and use of forensic assessment instruments.     

The Value of Crime Scene and Site Visitation by Forensic Psychologists and Psychiatrists

Site visits and crime scene visitation by forensic psychologists and psychiatrists may enhance the accuracy and credibility of their forensic work in criminal, civil, and other important contexts. This ethically sound technique of after‐the‐fact data collection and verification offers numerous potential benefits to the forensic mental health professional: clarifying the subject's actions, assessing the reliability of witness reports, identifying contextual determinants of behavior, and more fully illuminating subject motivation and decision‐making. Limitations and suggested guidelines for conducting site visits are offered. Guidelines include preplanning, arranging for an informed guide to accompany and narrate the visit, and conducting the site visit prior to forensic examinations.     

Homicides with Mutilation of the Victim's Body

Abstract:  Information on homicide offenders guilty of mutilation is sparse. The current study estimates the rate of mutilation of the victim's body in Finnish homicides and compares sociodemographic characteristics, crime history, life course development, psychopathy, and psychopathology of these and other homicide offenders. Crime reports and forensic examination reports of all offenders subjected to forensic examination and convicted for a homicide in 1995–2004 ( n  = 676) were retrospectively analyzed for offense and offender variables and scored with the Psychopathy Check List Revised. Thirteen homicides (2.2%) involved mutilation. Educational and mental health problems in childhood, inpatient mental health contacts, self-destructiveness, and schizophrenia were significantly more frequent in offenders guilty of mutilation. Mutilation bore no significant association with psychopathy or substance abuse. The higher than usual prevalence of developmental difficulties and mental disorder of this subsample of offenders needs to be recognized.     

PSYCHIATRISTS IN BLUE: POLICE APPREHENSION OF MENTAL DISORDER AND DANGEROUSNESS*

This article examines the discretionary judgments and reporting practices of police officers, in their apprehension of 528 defendants subsequently remanded for psychiatric assessment in a forensic unit located in Toronto, Canada. Analysis of arrest documents indicated that police routinely invoked labels of mental illness and dangerousness, and that they recommended psychiatric assessment in over a third of cases that eventuated in clinical remands. A significant relationship was yielded between police judgments and clinical assessments concerning the dangerousness of defendants. The police reports of forensic patients demonstrated the tendency of arresting officers to recommend psychiatric assessment as a vehicle for ensuring the dual application of judicial and therapeutic interventions. These police records were replete with moral assessments about mentally disordered defendants and with a number of strategies designed to influence the subsequent decisions of other legal and psychiatric authorities. In this study the police functioned as forensic gatekeepers, alerting clinicians and other officials to signs of mental disorder and criminality and to appropriate courses of action. At the initial point of arrest, the police assisted in laying the groundwork for the subsequent institutional careers of medicolegal subjects.     

Three faces of justice: Competing ethical paradigms in forensic psychiatry

Respect for justice has traditionally been an essential principle of health care ethics. However, many bioethical accounts of justice focus only on distributive justice, and how resources for health care should be allocated. In this article, I will argue that the practice of forensic mental health care requires clinicians to engage with justice in three additional and different ways: justice as liberty and fairness; retributive justice and protection of the vulnerable; and justice as the promotion of virtue. I will argue that British forensic psychiatry favours retributive and protective justice; in contrast to a libertarian approach to forensic practice in the United States. I discuss how respect for justice as support for virtue complements therapeutic work with offenders, which aims at the development of pro‐social character. I will conclude that without respect for justice as virtue, there is a danger that clinical forensic psychiatry risks doing harm to patients and bringing the profession into disrepute.     

Finding a voice – the feasibility and impact of setting up a community choir in a forensic secure setting

This study reports on the feasibility and impact of running a choir for forensic psychiatric inpatients, staff and members of the local community, within the confines of a medium secure psychiatric unit. The choir ran between October and December 2013. Eight weekly workshops and a final concert performance were evaluated through participant observation and focus groups held with the participants. Between 12 and 16 male and female patients attended each workshop and the final concert. All participating patients had received a diagnosis of schizophrenia, schizo-affective disorder or personality disorder, all had committed serious violent or sexual offences and all were legally detained and receiving treatment in a forensic medium or low secure ward, under the Mental Health Act (England and Wales). Considerable benefits were reported by patients, as well as by the participating community choir members and staff. Primary benefits reported by patients included the following: improved happiness and well-being; increased confidence and self-esteem; greater emotional connectedness and reduced sense of stigma. Participating staff also reported increased feelings of well-being and happiness, greater tolerance and more positive perceptions of the functioning and capabilities of forensic psychiatric patients. The longer term benefits of music participation on the mental health and social functioning of forensic psychiatric patients require further investigation.     

The observation of mental disorder and dangerousness in arsonists: a contemporary appraisal of changes in Dutch forensic mental health cases

In the Netherlands pre-trial forensic mental health assessments are conducted to examine whether a mental disorder was present at the time of the offence that affected the free will of a person, in which case criminal accountability is considered diminished or absent. This study aims to investigate societal changes over time in forensic mental health recommendations in arson cases. Seventy-two reports of male arsonists assessed in 1950–2010 were included in this study, 36 arsonists were assessed in the first time period (1950–1979) and 36 in the second period (1980–2010). Results show an association between DSM classification and the conclusion on criminal accountability only in the first period and an association between recidivism risk and the forensic mental health recommendation only in the later period. It is concluded that mental disorder was of greater influence on the conclusion on accountability in the first time period, whilst dangerousness played a more important role on the forensic mental health recommendation in the later time period. Our findings reflect a shift from paternalistic principles to principles of risk control and show that societal changes influence the field of forensic mental health.     

Barriers to the operation of mental health legislation in Australian emergency departments: a qualitative analysis

This study aimed to describe the perceived barriers faced by emergency clinicians in utilising mental health legislation in Australian hospital emergency departments. A semi-structured interview methodology was used to assess what barriers emergency department doctors and nurses perceive in the operation of mental health legislation. Key findings from the interview data were drawn in accordance with the most commonly represented themes. A total of 36 interviews were conducted with 20 members of the Australasian College for Emergency Medicine and 16 members of the College for Emergency Nursing Australasia representing the various Australian jurisdictions. Most concerning to clinicians were the effects of access block and overcrowding on the appropriate use of mental health legislation, and the substandard medical care that mental health patients received as a result of long periods in the emergency department. Many respondents were concerned about the lack of applicability of mental health legislation to the emergency department environment, variation in legislation between States and Territories causing problems for clinicians working interstate, and a lack of knowledge and training in mental health legislation. Many felt that clarification of legislative issues around duty of care and intoxicated or violent patients was required. The authors conclude that access block has detrimental effects on emergency mental health care as it does in other areas of emergency medicine. Consideration should be given to uniform national mental health legislation to better serve the needs of people with mental health emergencies.     

Nonsexual boundary violations: sauce for the gander

Numerous articles in the mental health literature concern sexual contact between therapists and patients, which is explicitly prohibited by all four mental health professions' ethical codes. There is relatively little about nonsexual boundary violations, which are often covert and much more difficult to recognize (particularly in their early stages) than sexual violations; what little there is assumes that the clinician has the power in the relationship and uses that power for personal advantage. In this article the authors discuss the situation, rare in civil mental health facilities but common in correctional and forensic mental health facilities, in which personality-disordered patients manipulate and coerce clinicians to cross appropriate professional nonsexual boundaries for the patients' benefit; this reversal of the usual power dynamics between treaters and patients requires recognition of the role reversals present and requires different strategies for preventing such violations (hence "sauce for the gander").     

The gendered construction of expert discourse: An analysis of psychiatric evaluations in criminal court

According to critical literature, psychiatrization is a central feature of gendered social control. It operates in a twofold process: by orienting women to medical institutions rather than the penal system, and, for those women who do enter the criminal justice system, by favoring an interpretation of their behavior in terms of mental health problems. However, the production of gendered social control cannot be reduced to institutional decision-making; it also leaves its traces in various discursive forms. One such form is forensic psychiatrists' discourse on the offenders they evaluate. Our study analyzes these forensic reports as units of a computerized database. Our goal is to gain insight into the text by means of systematic quantitative and qualitative procedures. Even though the expert discourse is shaped by specifications requested by the court, the discourse examined here constructs two very distinct identities that do not correspond to stereotyped conceptions about femininity and masculinity.     

Current issues in state mental health forensic programs

The major current issues facing state and local forensic mental health programs are presented in this paper. Debates over forensic patients' rights and the insanity defense are discussed, together with many administrative problems such as the pros and cons of correctional versus mental health system program control and payment incentives for treatment. The authors cite the differing goals of correctional and mental health systems, i.e., security and treatment, as reasons for difficulties in developing needed collaboration. Guidelines are suggested to address such important issues as mixing civil with criminal patients, developing units for special populations, defining patients who can respond to treatment, and follow-up after discharge.     

Emerging problems for staff associated with the release of potentially dangerous forensic patients

Mental health professionals have been concerned recently about their liability for the actions of patients in their outpatient practices. The history of suits against clinicians for negligent release of inpatients extends back several decades since before the Tarasoff decision. The authors suggest that the same consumerism/victims' rights trends that resulted in Tarasoff and its progeny are likely to rebound again on forensic clinicians and that such pressures are likely to add to other political and social pressures that already complicate the treatment of forensic inpatients. They present three cases to illustrate the dilemmas involved in the release of forensic patients and argue that clinicians must bear significant responsibility for their current plight because of overstated claims of capacities to predict and treat aggressive behavior.     

'Your personality is the intervention': a grounded theory of mental health nurses’ beliefs about hope and experiences of fostering hope within a secure setting

Hope is an important factor in psychological resilience and change, and recovery from mental health difficulties. Recently, there has been an increased focus on recovery-oriented practice within forensic mental health settings. Several policies include calls for mental health practitioners to inspire hope for recovery in the individuals they work with. However, there is little suggestion of how to implement such recommendations in practice or research exploring how staff foster hope in forensic settings. This study used grounded theory to explore nurses’ perspectives and experiences of hope within a medium secure setting. A model was developed from the data that integrated nurses’ beliefs about hope, practices to develop service users’ hope and the emotional impact of this work. The nurses’ values played a significant role in their work to develop hope. Recommendations are made to help manage the emotional impact and address challenges unique to fostering hope within forensic settings.     

An initial evaluation of the Global Review Form as an approach to measuring individual change

Background: Routine assessment of individual change in forensic mental health services is increasingly recognised as important. However, existing tools have been criticised and their periodic use make them unsuited to directly measure the impact of interventions. This paper describes the initial evaluation of the Global Review Form (GRF) as a framework for measuring change over time. Specifically, measurement properties, feasibility and usefulness in routine practice are examined. Method: 28 male service users in three distinct areas of an adult secure service (low secure, locked rehabilitation and high relational support housing) were rated over a 20-week period by their multidisciplinary teams. Findings: The GRF showed promising construct validity and appropriate stability and sensitivity to change across time. It enabled measurement and understanding of individual change over time. Staff feedback suggested the GRF is a useable and practical outcome measuring tool. Conclusions: The GRF shows promise for use as a routine outcome monitoring tool within forensic mental health services.     

Stigma and discrimination in mentally disordered offender patients – a comparison with a non-forensic population

High levels of stigma and discrimination are reported by individuals with mental health problems. Aim: To assess self-reported levels of stigma and discrimination in forensic psychiatric patients, with psychotic illness, compared with general adult psychiatric patients with psychosis. Hypothesis: Individuals with a history of violent offending, as well as severe mental illness, report more stigma and discrimination, than non offender patients, as a result of them being perceived as dangerous and unpredictable. Method: Experiences of stigma and discrimination were compared in 32 forensic and 32 non-forensic general psychiatric patients, with schizophrenia or schizoaffective disorder, using the Stigma and Discrimination Scale (DISC). Results: Stigma and discrimination were widely reported by all patients, particularly affecting relationships with family, intimate relationships and friendships. No significant difference emerged between the forensic and non-forensic patients, in experienced or anticipated stigma. Conclusions: We suggest that the lower level of psycho pathology, longer inpatient stays and intensive rehabilitation for forensic patients may reduce the extent to which these patients experience stigma and discrimination.     

Play by the Rules: why States Should Adopt Uniform Court Rules for Forensic Psychologists in Child Custody Evaluations

It is not uncommon for children to fall victim to the stress and tension of a contentious custody dispute. If a party seeks a mental health evaluation and the opposing party challenges the results, the child then endures a series of evaluations until a valid report is produced. The court will often remedy this situation by appointing a neutral forensic psychologist to perform the evaluation independent from a previous party‐hired forensic psychologist. 1 This Note proposes that the court instead appoint the forensic psychologist first to conduct an evaluation and draft a report. Only at the judge's discretion may the parties hire a private forensic psychologist to challenge the report. Additionally, states should codify court rules that enumerate standards for forensic psychologists in child custody evaluations. These rules should set forth criteria that shall be required and highlighted throughout each mental health evaluator's report, allowing judges to compare and contrast each evaluation more effectively. This legislation will not only reduce the child's exposure to excessive testing, but will also provide a more efficient way of arriving at a just result.