Insanity findings and evaluation practices: A state‐wide review of court‐ordered reports

Abstract

Evaluations of legal sanity are some of the most complex and consequential mental health evaluations that forensic clinicians perform for the courts. Thus, there is strong reason to monitor the wide-scale process and conclusions of sanity evaluations. In this study, we review 1,111 court-ordered sanity evaluation reports submitted by 74 evaluators in Virginia from the first year after the state initiated an oversight system that allowed for such comprehensive review. Overall, the base rate of insanity findings was 16.9%, although base rates of insanity findings among individual evaluators varied from 0% to 50%. Similarly, most evaluators cited the cognitive (rather than volitional) criteria of the insanity defense as the basis for their insanity findings, although evaluators varied in their patterns of citing these underlying insanity criteria. Our review revealed other trends in practice, such as the rarity of psychological testing (2% of cases) and the frequency of conveying conclusions in "ultimate issue" format (76%). Overall, findings reveal that a majority of reports seem reasonably consistent with practice guidelines, but also reveal some idiosyncratic practices or patterns that suggest there is opportunity for improvement.

Preliminary examination of an insanity defense typology: Prevalence rates and correlates

“…This finding echoes the concern identified by Gardner et al. (2018) that few evaluators clearly explained the nexus between psychiatric symptoms and the criteria for insanity, identifying this as an area in clear need of improvement.…”

“…The present study also addressed one of the gaps identified by Gardner et al. (2018) by including an examination of cases through disposition of the charge(s).…”

“…In a review of 1,111 court‐ordered evaluations in Virginia, Gardner et al. (2018) identified significant variance in the base rates of insanity defense findings among evaluators within the same jurisdiction (i.e., 0%–50%), with an overall base rate of 16.9%. Although slightly higher than the base rate reported by Kois and Chauhan (2018; i.e., 11%), this may be due to differing statutory definitions of insanity among states.…”

Competency to stand trial evaluations: A state‐wide review of court‐ordered reports

“…These results shed further light on the wide-scale practice of CST evaluation in one state, particularly with respect to the characteristics of evaluation reports, rates of competency findings, and evaluator differences in competence opinions. Similar to Virginia sanity evaluations conducted during the same time frame (see Gardner, Murrie, & Torres, 2018), most CST reports were submitted by evaluators in private practice (66.9% of CST reports; 80.9% of sanity reports), rarely used psychological testing (5.4% of CST reports; 2.0% of sanity reports), 13 and usually provided an "ultimate-issue" opinion (67.7% of CST reports; 75.8% of sanity reports).…”

Translating clinical findings to the legal norm: the Defendant’s Insanity Assessment Support Scale (DIASS)

“…Insanity evaluations are among the most complex and controversial mental health assessments that psychiatrists and psychologists perform 1,2 . A forensic evaluator is expected to perform a retrospective evaluation of the defendant’s state of mind at the time of crime, to ascertain the presence of a mental disease or defect and to further verify the existence of a possible relationship between that state of mind and the criminal behavior.…”