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Background: Since the 1990s, standardized competency to stand trial assessment measures have been developed to improve the reliability and validity of expert assessment and opinion in legal settings. This study aimed to meta-analyze the psychometric properties of the four 'second generation' assessment tools: the MacCAT-CA, MacCAT-FP, ECST-R and CAST*MR., Method: A systematic search of published and unpublished studies was undertaken on PsycNet, PubMed, Scopus, Web of Science and Science Direct up until February 2018. Test manuals were sourced and attempts at finding grey literature included contacting study authors and test developers., Results: Eleven studies were included in the final analysis. The MacCAT-CA, ECST-R and CAST*MR demonstrated acceptable subscale internal consistencies and interrater reliability. The MacCAT-CA and CAST*MR discriminated between competent and incompetent defendants with large effects. The MacCAT-FP had insufficient reliability data and poor discrimination. There was insufficient data to meta-analyze the factor structure, sensitivity, specificity, or effect sizes between types of clinical presentation on any tool., Conclusions: Very few studies have investigated the psychometric properties of the selected tools. Many studies were excluded for not providing original data or simply re-reporting the psychometric properties stated in test manuals. Whilst the MacCAT-CA and ECST-R have promising psychometric properties, ongoing construct validation is required., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Background: Criteria to determine in which level of security forensic patients should receive treatment are currently non-existent in Belgium. Courts largely rely on the evaluations of the prison psychiatrists and psychologists to form their decision. None of the few available instruments - e.g., the DUNDRUM-1 - is currently used to provide structured clinical judgment when determining security level., Method: DUNDRUM-1 scores were collected for 150 forensic patients. Security levels according to DUNDRUM-1 assessment were compared to security levels as decided by the court., Results: There was little agreement between DUNDRUM-1 scores and proposals for secure care made by the court. The DUNDRUM-1 predicted eventual admission to a high security setting, but not a medium security setting., Conclusion: The DUNDRUM-1 is an instrument that can help clinicians and judges to make more reliable and transparent decisions regarding secure care. However, further research with regard to practical applicability is needed., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Severely mentally ill jail detainees require an adequate spectrum of mental health services during detainment. For some this means a limited period of treatment in a mental hospital, just as some mentally ill individuals in the community occasionally require hospital treatment. Unfortunately, this appropriate level of treatment is often denied or neglected for jail detainees with adverse consequences for them. Among the reasons for this neglect, may be standards for hospital transfer that are no longer practical and can be easily skirted by policymakers and administrators with little interest in ensuring this level of care for mentally ill jail inmates. A more realistic standard and justification would recognize the need for hospitalization for the mentally disordered detainee who because of psychotic anosognosia refuses appropriate treatment including medications and/or whose severely decompensated condition is worsening or failing to improve despite attempts at treatment in the jail., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Fetal Alcohol Spectrum Disorders (FASD), an umbrella term for neurodevelopmental conditions caused by prenatal alcohol exposure, is overrepresented in the U.S. juvenile and adult criminal justice systems. The brain damage in FASD manifests in a combination of cognitive and adaptive impairments that potentially reduce ability to function adequately during the criminal justice process, including capacity to stand trial (CST). Despite the high risk of arrest and conviction in this population, relatively little research guides CST assessment for defendants who have or may have FASD. Therefore, the purpose of this article is to describe how FASD may affect CST and suggest ways forensic professionals might modify assessment protocols to address possible effects of FASD-associated impairments on adjudicative capacity., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

This study examined if a macro-, meso-, and micro outcome measurement instrument that constitutes the evaluation stage of a Dutch forensic psychiatric outcome monitor, the Hoeven Outcome Monitor (HOM), can provide a first step towards a more evidence based groundwork in forensic mental health. General, serious, very serious, special, and tbs meriting recidivism during treatment, after treatment, and overall were charted for forensic psychiatric patients discharged from a Dutch forensic psychiatric centre between 1999 and 2008 (N=164). Re-conviction data were obtained from the official Criminal Records System, and the mean follow-up time was 116.2months. First, the results showed that the macro-measurements provide comparative outcome measures to generate insight into the overall effectiveness of forensic psychiatric treatment. Second, the meso-measurements yielded clinically relevant treatment outcome data for all discharged patients to generate a complete view of treatment effectiveness. Finally, the micro-measurements allowed access to detailed patient and treatment effectiveness assessments that provides the empirical foundation to conduct aetiological research into the prediction and control of high-risk behaviour. Thus, an outcome measurement instrument in line with Evidence Based Medicine and best practice guidelines was designed that provides an empirically sound evaluation framework for treatment effectiveness, and an impetus for the development of effective interventions to generate an evidence based groundwork in forensic mental health., (Copyright © 2017. Published by Elsevier Ltd.)

Approaches to forensic report writing in psychiatry, psychology, and related mental health disciplines have moved from an organization, content, and stylistic framework to considering ethical and other codes, evidentiary standards, and practice considerations. The first part of the article surveys different approaches to forensic report writing, including that of forensic mental health assessment and psychiatric ethics. The second part deals especially with psychological ethical approaches. The American Psychological Association's Ethical Principles and Code of Conduct (2002) provide one set of principles on which to base forensic report writing. The U.S. Federal Rules of Evidence (2014) and related state rules provide another basis. The American Psychological Association's Specialty Guidelines for Forensic Psychology (2013) provide a third source. Some work has expanded the principles in ethics codes; and, in the third part of this article, these additions are applied to forensic report writing. Other work that could help with the question of forensic report writing concerns the 4 Ds in psychological injury assessments (e.g., conduct oneself with Dignity, avoid the adversary Divide, get the needed reliable Data, Determine interpretations and conclusions judiciously). One overarching ethical principle that is especially applicable in forensic report writing is to be comprehensive, scientific, and impartial. As applied to forensic report writing, the overall principle that applies is that the work process and product should reflect integrity in its ethics, law, and science. Four principles that derive from this meta-principle concern: Competency and Communication; Procedure and Protection; Dignity and Distance; and Data Collection and Determination. The standards or rules associated with each of these principles are reviewed., (Crown Copyright © 2016. Published by Elsevier Ltd. All rights reserved.)

The quality of forensic mental health assessment has been a growing concern in various countries on both sides of the Atlantic, but the legal systems are not always comparable and some aspects of forensic assessment are specific to a given country. This paper describes the legal context of forensic psychological assessment in France (i.e. pre-trial investigation phase entrusted to a judge, with mental health assessment performed by preselected professionals called "experts" in French), its advantages and its pitfalls. Forensic psychiatric or psychological assessment is often an essential and decisive element in criminal cases, but since a judiciary scandal which was made public in 2005 (the Outreau case) there has been increasing criticism from the public and the legal profession regarding the reliability of clinical conclusions. Several academic studies and a parliamentary report have highlighted various faulty aspects in both the judiciary process and the mental health assessments. The heterogeneity of expert practices in France appears to be mainly related to a lack of consensus on several core notions such as mental health diagnosis or assessment methods, poor working conditions, lack of specialized training, and insufficient familiarity with the Code of Ethics. In this article we describe and analyze the French practice of forensic psychologists and psychiatrists in criminal cases and propose steps that could be taken to improve its quality, such as setting up specialized training courses, enforcing the Code of Ethics for psychologists, and calling for consensus on diagnostic and assessment methods., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

This paper is the third in a series of research reports on quality of forensic mental health evaluations submitted to the Hawaii judiciary. Previous studies examined quality of reports assessing competency to stand trial (CST) and post-acquittal conditional release, in felony defendants undergoing court-ordered examinations. Utilizing a 44-item quality coding instrument, this study examined quality of criminal responsibility reports in a sample of 150 forensic mental health evaluations conducted between 2006 and 2010 by court-appointed panels. Raters attained high levels of agreement in training and quality coding. Similar to the previous studies, overall quality of reports was mediocre, falling below the .80 quality criterion score for report elements, regardless of evaluator professional identification or employment status. Level of agreement between evaluators and judicial sanity determinations was "fair" using Cicchetti's (1994) standards for interpretation of intra-class correlations. Level of agreement was lower than previously published findings for CST reports and better than conditional release reports. Reasons for mediocre report quality and "fair" inter-rater agreement are discussed, including the fact that criminal responsibility evaluations are complex, retrospective in nature, and involve significant degrees of inference. In contrast to CST evaluations, assessment of criminal responsibility involves a mental state at the time of the offense evaluation. Threats to reliability in forensic reports are discussed. Suggestions for improvement of report quality are proffered, including standardization of procedures and report format and use of forensic assessment instruments., (Copyright © 2013 Elsevier Ltd. All rights reserved.)

Research has suggested questionable reliability of diagnosing mental abnormality during Sexually Violent Predator (SVP) evaluations, despite this being a necessary requirement for SVP commitment. Findings have been inconsistent across studies, and little is known about the extent of such trends across diagnoses and clinicians. The current study includes data from 375 sex offenders referred for evaluation for SVP commitment in New Jersey. Clinicians (n = 128) rendered a variety of diagnoses, most commonly Pedophilia. Results suggested questionable agreement across paraphilic and non-paraphilic diagnoses, although agreement was fair for diagnoses of Pedophilia. Further analyses of cases (n = 49) involving clinicians receiving a large number of referrals (n = 14) were generally consistent with these findings, with no outlier effect apparent. Findings suggest questionable diagnostic reliability to be a widespread issue in SVP evaluations, present across a variety of diagnoses and across the general body of clinicians involved in evaluations., (Copyright © 2013 Elsevier Ltd. All rights reserved.)

Cultural competence is an essential aspect of competence as a mental health professional. In this article, the framework of cultural competence developed in general psychiatry-acquiring knowledge, attitudes, and skills necessary to understand the interaction between culture and the individual-is applied to the prison setting. Race and ethnicity, extremes of age, gender, and religion are highlighted and examined as elements of the overall culture of prisons. The model of the cultural formulation from the DSM-IV is then adapted for use by clinicians in the correctional setting, with particular emphasis on the interaction between the inmate's culture of origin and the unique culture of the prison environment., (Copyright © 2013 Elsevier Ltd. All rights reserved.)

In early 2008 the penal system of Lower Saxony established a specialised department responsible for risk assessment regarding all prison inmates in that state. The department generates approximately 200 risk assessment expert reports per year, mainly on questions such as the inmates' aptitude for social therapy, relaxation of imprisonment conditions, and transfer to an open prison. Prof. Dr. Konrad and Dr. Heering (from the Charité's Institute for Forensic Psychiatry) have been accompanying the work of this department scientifically for at least 2 years by offering a scientific exchange and by reviewing random samples of the risk assessments and verifying the application of current standards. It is of particular interest to examine which methods are used and which topics are discussed with the inmates during the exploration for risk assessment expert reports, whether or not standardised risk scales are applied, and finally which conclusions are drawn from the results of the exploration and the information which could be gathered from court and prison files., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

Annually thousands of insanity acquitees are released from mental hospitals when they are no longer determined to be dangerous. This research examined quality of post-acquittal Conditional Release (CR) reports submitted to the Hawaii Judiciary. Hawaii utilizes a "three panel" system for assessing trial felony competency, criminal responsibility, and conditional release, where typically two psychologists (one Department of Health and one community-based) and one community-based psychiatrist submit independent reports to the Court. One hundred fifty CR reports were rated using a 44-item report quality measure. Interrater reliability trials indicated good to excellent agreement between quality ratings. Overall level of report quality was poor regardless of examiners' professional discipline, employer, or board certification status. Concordance rates for CR opinions were poor. Level of agreement between the judicial determination and majority recommendations was also poor. Reasons for the poor quality and level of agreement are discussed with recommendations for report quality improvement, including standardization of procedures and use of forensic risk assessment instruments., (Copyright © 2011 Elsevier Ltd. All rights reserved.)

This paper examined quality of forensic reports submitted to the Hawaii Judiciary. Hawaii utilizes a three panel system for assessing fitness to proceed, where two psychologists and one psychiatrist submit independent reports to the Court. Utilizing a survey instrument based on previous research and nationally-derived quality standards, 150 competency to stand trial (CST) reports were examined. Reports demonstrated pervasive mediocrity with respect to quality (Mean QC=68.95, SD=15.21). One quarter (N=38) of the reports scored at or above 80% of the maximum possible score. Levels of CST agreement between evaluators and evaluators and judges were high. Report quality did not differ as a function of evaluator professional identity. Full-time employed evaluators submitted a greater number of reports above the quality criterion. For those evaluators who attended the March training, reports demonstrated significantly improved quality. Suggestions for enhancing report quality are offered with a special attention to inclusion of report elements, focus on inclusion of historical elements, and clearly described rationales supporting forensic opinions. (7664 words. Competency to stand trial, inter-rater agreement).

Objective: At national, state, and local levels, there is increasing recognition of the importance of identifying and responding to the mental health needs of youths in the juvenile justice system, as policymakers and practitioners struggle to find ways to address causes and correlates of juvenile crime and delinquency. The proposed guidelines for mental health assessment provide explicit information about how, why, and when to obtain mental health information on justice youths at each important juncture in processing., Method: A national group of expert researchers and practitioners convened in April 2002. Experts derived six recommendations, following the expert consensus method, for conducting mental health assessments in juvenile justice settings. Experts had broad experience creating collaborations between juvenile justice, mental health, and child welfare systems and understood the policy and health implications of conducting such assessments in juvenile justice settings., Results: Consensus Conference recommendations regarding screening for emergent risk, screening and assessment of mental health service needs, comprehensive mental health assessment components, assessment before community re-entry, need for periodic reassessment, and staff training are presented., Conclusion: Deriving specific recommendations that can be implemented systematically is a necessary first step toward policy changes that will optimize the standard of care for this vulnerable population.