Forensic mental health evaluations are a routine part of court proceedings in criminal cases. The courts rely on these examinations to make determinations about competency, sentencing, treatment, and rehabilitation. Forensic professionals need to be able to accurately classify and diagnose mental health disorders so that the court can rely on their recommendations. Gowensmith, Sessarego, McKee, Horkott, MacLean, and McCallum (2017) examined the issue of diagnostic field reliability in these pretrial evaluations. They define diagnostic reliability as “the measure of how accurate symptoms and test results can be in the identification of disease,” (Gowensmith et al., 2017, p. 692). Court outcomes can have severe implications for defendants and communities; thus, diagnoses need to be accurate so that the appropriate treatment recommendations and prognoses can be effectively communicated. Gowensmith et al. (2017) discussed that the literature on field reliability, or the reliability of diagnoses made in real practice, is sparse. They noted that the diagnostic field reliability rates in forensic mental health assessments (FMHAs) are unknown, yet critical in that competency to stand trial and legal insanity cases depend upon these evaluations and accurate diagnoses that reflect competency or sanity versus insanity.
Gowensmith et al. (2017) reviewed 240 felony cases in the state of Hawaii, where it is required that three independent forensic evaluators assess the defendant. A total of 720 reports were analyzed for rates of agreement or disagreement on diagnoses. The researchers found that out of the 240 cases, 44 (18.3%) had total agreement amongst the evaluators across all diagnostic categories (Gowensmith et al., 2017). The percentage is much higher than chance but still considered low. Similarly put, the evaluators agreed on a defendant’s diagnoses fewer than one in five cases.
Explain the parts of this study that you believe might be important for a forensic psychology professional working in a court setting.
Several parts of this study can be considered vital for a forensic professional in a court setting. For instance, the researchers found that the timing of the evaluation was correlated with how much or little evaluators agreed on a diagnosis. The earlier the evaluation was conducted from the time of arrest, the higher the rate of disagreement. The researchers concluded that completing an assessment too early may affect outcomes across diagnostic categories if the defendant is still under the influence of drugs or other substances. Allowing time to pass and the defendant to be sober from substances and for medication to take effect, appeared to lead to more agreement among evaluators as symptoms were less likely to be correlated with substance use (Gowensmith et al., 2017). Second, the researchers noted that psychotic and substance-related disorders are the most relevant diagnostic categories in insanity evaluations; therefore, it is critical for these diagnoses to be accurate. The researchers found that at times, it is difficult for evaluators to tease apart the two, but it is important to remember that the difference between a “free-standing” psychotic disorder and a substance-induced psychotic disorder is substantial (Gowensmith et al., 2017). Differing opinions on these diagnoses can have serious consequences for a defendant.
Explain how a forensic psychology professional might use the results of the study in a court setting.
Forensic professionals have an essential role in helping the court make informed decisions. Dr. Walters explains that this role includes making psychological ideas and principles understood to the court so that legal decisions can be made (Laureate Education, 2009). Psychological research needs to be translated for the court to inform best practices. Dr. Walters emphasizes that recommendations in evaluations need to be guided by research that is empirically based, otherwise, conclusions that are drawn could be misleading or erroneous. In the current study, the results are helpful for forensic professionals to understand the value of accurate diagnostic processes and that specific factors make for better diagnostic field reliability. For example, Gowensmith et al. (2017) found that the evaluators disagreed most often on personality disorder diagnoses. This finding is important to take into consideration, and perhaps in practice, it means spending more time on a determination in this category and seeking more information via collateral contacts, as personality disorder symptoms can be more subjective. Next, the researchers suggested that forensic practitioners should obtain more continuing education on diagnostic formulation, especially in preparing evaluations for the court that have far-reaching implications (Gowensmith et al., 2017). Lastly, quality improvement systems can help monitor diagnostic field reliability, thus ensuring higher reliability and validity of forensic mental health evaluations. In a court setting, forensic professionals are called upon to give expert, diagnostically sound, and empirically based opinions.
Gowensmith, W. N., Sessarego, S. N., McKee, M. K., Horkott, S., MacLean, N., & McCallum, K. E. (2017). Diagnostic field reliability in forensic mental health evaluations. Psychological Assessment, 29(6), 692–700. doi: 10.1037/pas0000425
Laureate Education, Inc. (Executive Producer). (2009). Understanding forensic psychology research: Application of psychological research – Court settings. Baltimore: Author.