The precarious practice of forensic psychiatric risk assessments |
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Authors: | Thomas Nilsson Christian Munthe Christina Gustavson Anders Forsman Henrik Anckarsäter |
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Affiliation: | 1. Forensic Psychiatry, Department of Clinical Sciences, Malmö, Lund University, Sweden;2. Institute of Neuroscience and Physiology, Centre of Ethics, Law and Mental Health (CELAM), University of Gothenburg, Sweden;3. Department of Psychiatry, Autism Research Centre, Cambridge University, UK;1. Institute for Study of the Medical Profession Oslo, Norway;2. Center for Medical Ethics Department of Health and Society University of Oslo, Norway |
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Abstract: | The development of forensic psychiatric risk assessments is discussed from a clinical point of view using the example of Sweden. A central task in forensic psychiatry has traditionally been to identify dangerous, mentally disordered subjects considered to be prone to commit violent acts. Over time, “dangerousness” has been reworded into “risk”. Nevertheless, such assessments have generally been based on the psychiatric factors characterising the individual patient, while group interaction, situational factors, or social and cultural circumstances, such as the availability of alcohol and drugs, have been largely overlooked. That risk assessments have a focused on people with a diagnosis of “mental disorder” and been used as grounds for coercive measures and integrity violations has somehow been accepted as a matter of course in the public and political debate. Even the basic question whether offenders with a mental disorder are really more prone to criminal recidivism than other offenders seems to have been treated light-handedly and dealt with merely by epidemiological comparisons between groups of persons with broad ranges of psychosocial vulnerability and the general population. Legal texts, instructions and guidelines from the authorities in charge are often vague and general, while actors in the judicial system seem to put their trust in psychiatric opinions. The exchange of professional opinions, general public expectations, and judicial decision processes poses a huge risk for misunderstandings based on divergent expectations and uses of terminology. |
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