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The correlates of legally significant outcomes that have been identified in people with mental disorders are of limited value in understanding the mechanisms by which these outcomes occur.
Aims
To describe the relationships between mental disorder, impaired psychosocial function, and three legally significant outcomes in a representative sample of the US population.
Methods
We used a population survey, the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC-III, sample size 36,309), to identify people who self-reported serious trouble with the police or the law over the past 12 months and two lifetime outcomes, being incarcerated and engaging in violence to others. DSM-5 categories were generated using the Alcohol Use Disorder and Associated Disabilities Interview Schedule-5. Psychosocial function was assessed using social and role-emotional function scores of the 12-Item Short-Form Health Survey Version 2.
Results
Participants with mental disorder, but not people with no diagnosis, who reported serious trouble with the police or with the law during the previous 12 months reported significantly worse psychosocial function than those who did not report such trouble. The size of the statistical effect varied by diagnosis, moderate for some forms of mental illness and for alcohol abuse and nonsignificant for drug abuse and the personality disorders. Effect sizes were largest for diagnoses where legally significant outcomes were least common.
Conclusions
The effect of impaired psychosocial function, for instance in disrupting family and social networks that would otherwise protect against these legally significant outcomes, warrants further investigation in studies with longitudinal designs.
Rates of violence in persons identified as high risk by structured risk
assessment instruments (SRAIs) are uncertain and frequently unreported by
validation studies.
Aims
To analyse the variation in rates of violence in individuals identified
as high risk by SRAIs.
Method
A systematic search of databases (1995–2011) was conducted for studies on
nine widely used assessment tools. Where violence rates in high-risk
groups were not published, these were requested from study authors. Rate
information was extracted, and binomial logistic regression was used to
study heterogeneity.
Results
Information was collected on 13 045 participants in 57 samples from 47
independent studies. Annualised rates of violence in individuals
classified as high risk varied both across and within instruments. Rates
were elevated when population rates of violence were higher, when a
structured professional judgement instrument was used and when there was
a lower proportion of men in a study.
Conclusions
After controlling for time at risk, the rate of violence in individuals
classified as high risk by SRAIs shows substantial variation. In the
absence of information on local base rates, assigning predetermined
probabilities to future violence risk on the basis of a structured risk
assessment is not supported by the current evidence base. This
underscores the need for caution when such risk estimates are used to
influence decisions related to individual liberty and public safety.
The written report is central to the practice of psychiatry in legal settings. It is required of mental health professionals acting as expert witnesses in criminal cases, civil litigation situations, child custody proceedings and risk assessments. This book provides a theoretical background to psychiatric writing for the law and a practical guide to the preparation of the report. The first section addresses practical and ethical concerns, including the conduct of the forensic psychiatric evaluation, conflicts of interest, record keeping and confidentiality. The second section contains practical and detailed advice on preparing various types of report, including reports for use in criminal and civil litigation, civil commitment hearings and child custody proceedings. A final section covers special issues arising during report preparation including the use of psychological tests and the detection of malingering. This is an essential guide for anyone required to write a psychiatric report.
Reviews of style and content in psychiatric writing take a range of positions on basic questions such as whether a report should be couched in the first person and the value, or otherwise, of stating a diagnosis. By contrast, the report structure has been stable, and recent suggestions resemble those of East. Reviews of report writing note the value of structure to both reader and author. Reviewers differ greatly in their recommendations regarding length. The length of the report varies with the question, the circumstances, and the writer. Three points seem important. First, the report should provide sufficient data to support the opinion. Second, the purpose of the report is to present that opinion. Third, the information contained in a report can have consequences for the client or others that the author does not intend. When the information is superfluous, those consequences are harder to justify.