Diagnostic field reliability in forensic mental health evaluations.

Abstract

How likely are multiple forensic evaluators to agree on defendants' diagnoses in routine forensic mental health evaluations? A total of 720 evaluation reports were examined from 240 cases in which 3 evaluators, working independently, provided diagnoses for the same defendant. Results revealed perfect agreement across 6 independent diagnostic categories in 18.3% of cases. Agreement for individual diagnostic categories was higher, with all 3 evaluators agreeing on the separate presence of psychotic, mood, or substance disorders in more than 64.7% of cases and agreeing on the presence of cognitive or developmental disorders in more than 89.7% of cases. However, evaluators agreed about the combination of psychotic and substance-related diagnoses in only 46.5% of cases. Agreement was enhanced by diagnoses with low base rates, and it was suppressed in evaluations conducted in jails. Psychiatrists and contracted evaluators were more likely to provide dissenting diagnostic categories than psychologists and state-employed evaluators. These results are among the first to document diagnostic agreement among nonpartisan practitioners in forensic evaluations conducted in the field, and they allow for practice and policy recommendations for evaluators in routine forensic practice to be made. (PsycINFO Database Record

Taking forensic mental health assessment “out of the lab” and into “the real world”: Introduction to the special issue on the field utility of forensic assessment instruments and procedures.

“…Another group of studies examined important diagnostic, personality, or trauma assessment topics as they relate to legal issues among adult and youth populations. For example, Gowensmith, Sessarego, et al (2017) examined diagnostic reliability across a large sample of forensic mental health evaluations conducted in the field. Although reliability for individual psychiatric disorders was low, broader categories (i.e., psychotic, mood, substance, cognitive, developmental disorders) showed much higher rates of convergence overall.…”

Assessing psychotic symptoms in forensic evaluations of criminal responsibility – a pilot study using Positive And Negative Syndrome Scale

“…Certain mental conditions may lead to a person being acquitted from the charges. Though legislation differs between nations, psychotic conditions are the mental conditions most often leading to legal insanity (Cochrane et al, 2001;Gowensmith et al, 2017). Descriptions of psychotic conditions are important in forensic psychiatric evaluations of criminal responsibility in most nations.…”

“…Disagreement on the assessment of psychotic symptoms may lead to disagreement on the diagnosis (Aboraya, Rankin, France, El-Missiry & John, 2006), as well as disagreement on the legal conclusions of criminal responsibility (Fuger et al, 2014). Making the premises for the diagnostic conclusion testable and open for review is essential (Gowensmith et al, 2017). It is crucial that psychotic symptoms are described in a reliable and testable way.…”

How Do Legal Experts Cope With Medical Reports and Forensic Evidence? The Experiences, Perceptions, and Narratives of Swiss Judges and Other Legal Experts

“…However, the specific diagnosis is the “entry criterion” for further medical and legal considerations, including that for therapeutic measures. Thus, disagreement between raters has crucial consequences (89). It seems clear that legal experts should be aware that expert opinions may differ in quality and content and that they should try to understand and, if possible, evaluate them.…”