Use of assessment instruments in forensic evaluations of criminal responsibility in Norway

Abstract

Objectives Assessment instruments are often used to enhance quality and objectivity in therapeutic and legal settings. We aimed to explore the use of instruments in Norwegian reports of forensic evaluations of criminal responsibility; specifically, whether this use was associated with diagnostic and forensic conclusions. Methods Our study has an exploratory cross-sectional design. We examined 500 reports filed with the Norwegian Board of Forensic Medicine in 2009–2018 regarding defendants indicted for the most serious violent crimes. The first author coded data from all reports according to a registration form developed for this study. Two co-authors then coded a random sample of 50 reports, and inter-rater reliability measures were calculated. The first author coded 41 reports for calculation of intra-rater reliability. Descriptive statistics are presented for the use of assessment instruments, and a generalized linear mixed model (GLMM) was used to estimate associations between the use of instruments and diagnostic and forensic conclusions. Results Instruments were used in 50.0% of reports. The Wechler’s Adult Intelligence Scale (WAIS), Historical Clinical Risk-20 (HCR-20), and the Structured Clinical Interview for DSM disorders (SCID I), were used in 15.8, 13.8, and 9.0% of reports, respectively. The use of instruments increased from 36% in 2009 to 58% in 2015; then decreased to 49% in 2018. Teams of two experts wrote 98.0% of reports, and 43.4% of these teams comprised two psychiatrists. In 20.0% of reports, the diagnostic conclusion was schizophrenia, and in 8.8% it was other psychotic disorders. A conclusion of criminal irresponsibility was given in 25.8% of reports. Instruments were more often used in reports written by teams that comprised both a psychiatrist and a psychologist, compared to reports by two psychiatrists. The use of instruments was strongly associated with both diagnostic and forensic conclusions. Conclusion Instruments were used in 50% of reports on forensic evaluations of criminal responsibility in Norway, and their use increased during the study period. Use of instruments was associated with diagnostic and forensic conclusions.

An Overview of Criminal Responsibility Reports in the Light of Supreme Court Decisions: Cross-Sectional Research

“…10,11 Sonuç olarak, ceza sorumluluğunun etkilenmesi için sanıkta ciddi bir ruhsal bozukluk varlığı yeterli olmayıp, bulgularının sanığın suç anındaki bilişsel yeteneklerine ve davranışlarına etkisinin belirlenmesi gerekir. [12][13][14] Nitekim Yargıtayın, akıl hastalığı raporu olan sanığa, ceza sorumluluğu raporu alınmadan cezaya yer olmadığı kararı verilmesini bozma gerekçesi kabul ettiği görüldü. Bazı ruhsal tanıların ceza sorumluluğunu etkilemeyeceği yönünde genel bir yaklaşım olduğu bilinmektedir.…”

“…Ceza sorumluluğu raporu hazırlanmasında, sabıka kayıtları, suç anındaki kayıtlar, sanıkla yapılan görüşmeler, tıbbi kayıtların incelenmesi, aile bireyleriyle görüşmelerin yapılması ve erkek sanığın varsa askerlik dönemine ait kayıtlarının incelenmesi önerilmektedir. 12,[15][16][17] Yargıtay kararlarında, akıl hastalığıyla ilgili bir durum varlığında tek hekimin düzenlediği ceza sorumluluğu raporlarının kabul edilmediği görülmektedir. Bununla birlikte, Yargıtayın heyet şeklinde düzenlenen raporlarda tek psikiyatri uzmanı olmasını yetersiz gördüğü, başka bir kararda psikiyatri uzmanlarının olduğu sağlık kurulundan rapor alınması yönünde karar verdiği görüldü.…”

Are symptoms assessed differently for schizophrenia and other psychoses in legal insanity evaluations of violent crimes?

“…We calculated interrater reliability measures for the diagnostic and forensic conclusions and found a Gwet's AC 1 value above 0.90, which is considered almost perfect or very good agreement [41,46]. All symptom variables from the MSE and the PANSS items from the MSO had Gwet's values above 0.93, which is almost perfect, or very good agreement.…”

“…This exploratory, cross-sectional study of registry data was based on 500 anonymized reports of forensic evaluations of criminal responsibility in court cases of severe violent offenders, and were collected from the archives of the Norwegian Board of Forensic Medicine (NBFM). We selected 100 reports per year for the years 2009, 2011, 2013, 2015, and 2018, to reach a sufficient sample size per year and cover a longer period [41]. The selection criterion for the reports was the index offense, which the NBFM uses as one of the sorting systems in their archives.…”

“…In Norway, the law only requires an assessment of the presence of a severe mental illness at the time of an offense; no connection between that illness and the act must be proven. This is often referred to as the medical or biological principle [10,41,69,70]. Some have expressed concerns that the medical principle in Norwegian legislation, with its emphasis on psychosis, might lead to an even stronger connection between diagnosis and insanity than in legislations with other principles of insanity.…”