Assessment of competency for execution? A guide for mental health professionals

Assessment of competency for execution presents two compelling ethical questions for mental health professionals: whether clinicians can ethically provide such assessment, and if so, how it should be done in order to maximize quality and minimize ethical conflict. In this article we address the issue of whether to participate and, if so, how. The question of whether to participate is discussed by summarizing the arguments for and against participation and offering guidelines for making a decision. The question of how to proceed is discussed in two contexts: preadjudication (before a formal decision about competency) and postadjudication (following a determination of "incompetent" and transfer of the offender to another facility for treatment and further assessment). Finally, recommendations are made regarding research that would improve the quality of execution competency assessments.     

Comparing females acquitted by reason of insanity,convicted, and civilly committed in Florida 1977–1984

Females who had been acquitted by reason of insanity (N=41), convicted of comparable offenses (N=41), and involuntarily hospitalized without criminal involvement (N=41) were matched for age and race. The psychiatric histories of the acquitted and civilly committed women were similar, and significantly more extensive than the convicted group. The acquitted women had been arrested significantly more often than the civilly committed women but less frequently than the convicted women. Total length of stay (hospitalization or imprisonment) reflected a similar pattern, with civilly commited women hospitalized for the shortest period, acauitted women an intermediate period, and convicted women the longest. Regression-based prediction of length of stay reflected a number of common predictors for the acquitted and convicted women, with offense type one of the most powerful for both groups.     

Expert Approaches to Communicating Violence Risk

There has been virtually no empirical study of the way in which evaluating clinicians communicate their conclusions about the risk of violence toward others. Risk communication has become particularly important in recent years, serving as the link between empirical data from recent studies and the understanding and use of such data by evaluators and decision makers. The present study considered how psychologists and psychiatrists, identified as experts in violence risk assessment, responded to eight vignettes that systematically measured preferences for risk communication. The vignettes involved the presentation of the following factors in a 2 × 2 × 2 within-subjects design, counterbalanced for order: (1) risk model (prediction vs. management), (2) risk level (high vs. low risk of the individual being assessed), and (3) risk factors (the predominance of static vs. dynamic risk factors). A total of 71 individuals (41 psychologists, 2 sociologists, and 28 psychiatrists) responded to a survey mailed to 100 individuals, for a response rate of 71%. Participants were asked to rate the value of six forms of risk communication for each of the eight vignettes. There were few significant differences between the ratings assigned by psychologists and those assigned by psychiatrists. The most highly valued form of risk communication involved identifying risk factors applicable to the individual and specifying interventions to reduce risk. A repeated-measures multivariate analysis of variance yielded a main effect for risk level and an interaction between risk level and risk factors. The implications of these findings for research and practice are discussed.