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

Abstract

Insanity definition and the threshold for satisfying its legal criteria tend to vary depending on the jurisdictions. Yet, in Western countries, the legal standards for insanity often rely on the presence of cognitive and/or volitional impairment of the defendant at crime time. Despite some efforts having been made to guide and structure criminal responsibility evaluations, a valid instrument that could be useful to guide forensic psychiatrists’ criminal responsibility assessments in different jurisdictions is lacking. This is a gap that needs to be addressed, considering the significant forensic and procedural implications of psychiatric evaluations. In addition, differences in methodology used in insanity assessments may also have consequences for the principle of equal rights for all citizens before the law, which should be guaranteed in the European Union. We developed an instrument, the Defendant’s Insanity Assessment Support Scale (DIASS), which can be useful to support, structure, and guide the insanity assessment across different jurisdictions, in order to improve reliability and consistency of such evaluations.

Forensic considerations in the assessment of disordered thought and perception.

“…The PANSS has an associated structured clinical interview (SCI-PANSS; Opler et al, 1992), useful in developing postulates relating to delusions, hallucinations, hostility, and potential for violence. In the inference development and data-linkage steps, two SPJ forensic assessment instruments are relevant: the Rogers Criminal Responsibility Assessment Scale (R-CRAS; Rogers, 1984;Rogers & Shuman, 2000) and the recently developed Defendant's Insanity Assessment Support Scale (DIASS; Parmigiani et al, 2019). The R-CRAS is a decision tool specifically designed for criminal responsibility assessments that assists in systematically assessing relevant clinical and offense factors.…”

Validation of a new instrument to guide and support insanity evaluations: the defendant’s insanity assessment support scale (DIASS)

“…The DIASS is a tool that has been developed on the theoretical model of competent decision-making and reflects core issues relevant to legal insanity in many jurisdictions in Western Countries [21]. It is composed of 9 binary items (present/absent) grouped into 4 dimensions: "Knowledge/ understanding of the crime" (3 items), "Appreciating of the crime" (1 item), "Reasoning" (3 items), and "Control of voluntary motor activity" (2 items).…”

“…To overcome these limits, theoretical models, some practice guidelines and forensic assessment instruments have been developed to assist the criminal responsibility evaluation [1,[13][14][15][16][17][18][19][20][21]. Among the tools used to perform insanity evaluations, are included the "Mental State at the Time of the Offense Screening Evaluation" (MSE) [22], the "Rogers Criminal Responsibility Assessment Scales" (R-CRAS) [23,24], the "Rating scale of criminal responsibility for mentally disordered offenders" (RSCRs) [25], and the "Criminal Responsibility Scale" (CRS) [26].…”

“…Among the tools used to perform insanity evaluations, are included the "Mental State at the Time of the Offense Screening Evaluation" (MSE) [22], the "Rogers Criminal Responsibility Assessment Scales" (R-CRAS) [23,24], the "Rating scale of criminal responsibility for mentally disordered offenders" (RSCRs) [25], and the "Criminal Responsibility Scale" (CRS) [26]. In addition to those previously mentioned, there is the "Defendant's Insanity Assessment Support Scale" (DIASS) [21]. Differently from the MSE, which is structured to screen out defendants whose criminal conduct clearly was not caused by significant mental abnormality, and the RSCRs, which evaluates defendants' cognitive and volitional dimension through a hypothetical scenario based on clinical vignettes, the R-CRAS, RSCRs, and DIASS evaluate defendants' criminal responsibility associated with the alleged crime.…”

Translational Application of a Neuro-Scientific Multi-Modal Approach Into Forensic Psychiatric Evaluation: Why and How?

“…Moreover, the American Academy of Psychiatry and Law (AAPL) has published guidelines based on a comprehensive review of legal and psychiatric factors to be taken into account to perform insanity defense evaluations (Journal of AAPL, 2014). Finally, a recent work proposed an insanity assessment support scale based on clinical criteria (36). This instrument, however, still has to be validated.…”