The Sell decision: Implications for psychological assessment and treatment.

Abstract

This article describes 2 important practice considerations affirmed in the U.S. Supreme Court's Sell v. United States (2002) decision: (a) the importance of providing least restrictive services prior to interventions that violate patients' liberty interests, and (b) contextual and environmental factors may be considered in clinical determinations of dangerousness. The psychological treatment of behavior disorders fall within the purview of least restrictive or intrusive interventions compared with the involuntary administration of psychoactive medications. To legitimately comply with the least restrictive criterion, the provision of psychological services is essential. This long-held criterion is rarely acknowledged today as providers use restricted service arrays and attempt to resolve complex and co-occurring behavior problems with medications and restraints. Less restrictive psychological interventions are required for effective treatment of challenging behaviors. A 2nd significant implication lies in the court's affirmation that it is legitimate to consider contextual factors such as history and current environmental conditions in determining dangerousness.

Integrating Risk Context Into Risk Assessments

“…Much of this case focused on the use of psychotropic drugs against a client's wishes to restore competency to stand trial, but the court's emphasis on considering the contextual circumstance of current environmental conditions (i.e., length incarceration) was a key component in the decision. In examining the implications of the Sell decision for risk assessments, Hunter, Ritchie, and Spaulding (2005) commented that risk assessments need to make judgments beyond "right here and right now" and take into consideration the risk context. In addition to emphasizing risk context, the court also noted that changes in clinical circumstances need to be taken into consideration.…”