Current views of solicitors on psychiatric court reports

This survey evaluates current views of non-medical professionals on the style of court report writing. A random sample of 120 solicitors who worked in the criminal field in London participated in this survey. The usable return was 72%. Up to 76% favoured changes in standards of report writing because of problems concerning clarity of style and use of jargon. The majority objected to reports being prepared by nonconsultant psychiatrists.

Psychiatric reports are addressed to non-medical professionals. A few studies, such as Prins' (1975). examined the views on reports of nonmedical groups in the past. These studies suggested that non-medical professionals were generally dissatisfied with psychiatric court reports. Educators encouraged psychiatrists to adopt a more adequate style of report writing. The effectiveness of that effort has not been monitored for many years and this survey intends to fill in the gap. This study was based on the hypothesis that non-medical profes sionals still maintained unfavourable views on reports, and the belief that the evaluation of their present views would have educational and practical benefits to psychiatrists.
A sample of solicitors was used in this survey, as previous studies had not included this group of professionals. This study intends to system atically assess solicitors' general views on psy chiatric court reports.

The study
The study population comprised of the solicitors who worked in the criminal field whose names appeared in the Law Society Director List (Law Society, 1994). A random sample of 120 solicitors received a questionnaire in 1995. A computer generated sequence (uniform func tion) of random numbers, and a similarly generated seeded number to start the selection, was used. The sample included 37 (31%)women solicitors.
Solicitors were asked to give their opinion of court reports they had received, particularly in the previous 12 months. The first part of the questionnaire had 11 sections that looked into items of typical reports: introduction, family history, personal history, psychiatric history, medical history, forensic history, drug and alcohol history, account of index offence, treat ments and progress, psychiatric assessment, and conclusions and recommendations. The usual content of the above items was briefly described. For ease of completion, each section had only two out of three variables to be measured. A ranking scale level of measurement was used. The definitions were: first, the variable Importance Very important' (item must always be present in the report); 'relevant' (item is not essential but makes the report more thorough); 'uncertain' (between 'relevant' and 'not import ant'); 'not important' (item adds little to the aim of the report); and 'irrelevant' (item adds nothing to the report and should not be present). Second, the variable Clarity Very clear' (item is always/ almost always easy to understand): 'clear' (item is often easy to understand); 'unclear' (item is often difficult to understand); and Very unclear' (item is always/almost always difficult to under stand). Third, the variable Technicality Very technical' (most of the time the item has too much psychiatric jargon with little/no explanat ion of its meaning): 'technical' (most of the time the item has a lot of psychiatric jargon often not well explained); 'simple' (most of the time the item has some psychiatric jargon that is usually well explained); and Very simple' (most of the time the item has almost no psychiatric jargon but the relevant topics are written in layman's terms).
Solicitors were also asked to indicate whether they objected to reports being prepared by nonconsultant psychiatrists: to specify whether current standards of report writing needed changes, and to state their preferred length of reports measured in A4 pages (approximately 500 words per page). Last, they were invited to comment on the subject.
The data were analysed using the sample as a whole and subgroups that did and did not support changes in standards of report writing. The Mann-Whitney [/-test was used as appro priate.

Variables: importance, technicality and clarity
In general, solicitors considered introduction, psychiatric history, psychiatric assessment and treatments and progress Very important' items.
They also considered psychiatric assessment, treatments and progress, and to a lesser extent psychiatric history, 'technical items'. Account of index offence and conclusions and recommen dations were considered 'clear' items (Table 1). The other variables are outlined in Table 2.
Two-thirds objected to reports being prepared by trainee psychiatrists and by psychiatrists not approved under Section 12 of the Mental Health Act 1983. A small minority objected to reports being prepared by trained non-consultant psy chiatrists. Two-thirds preferred reports of three to four A4 pages in length. Three-quarters indicated that changes in current standards of report writing should be implemented. Those who did not support changes placed more importance on personal history. Both groups shared similar views on the technicality of the items examined in the study. The item psychi atric assessment, found more technical by those who supported changes, was the exception. There was a highly significant difference between the two groups' views on the clarity of the items examined, particularly in the case of conclusions and recommendations.
Thirty-two (37%) solici tors made further comments. Some extracts of the solicitors 'free text' responses follow: ' . . . psychiatrists will often fail to respond to specific (relevant) questions set out in the letter of instruc tions.' "... matters often have to be adjourned for clarifica tion or new reports, due to the original being badly prepared.' 'Often you send reports with comments on the offences which trivialise the offence or make matters more difficult in the presentation of the defence.' ' . . . frequently reports come overall muddled and badly organised, or sometimes as simply rushed.' ' . . . reports need to progressively lead to the conclu sion and each part support the conclusion and then give good supported reasons for the recommenda tions. All too often courts are "influenced" by the conclusions and don't always read all the earlier details.' Table 1. Responses of all the solicitors (n=87) and of the subsets who did (n=66) and did not (n=21) favour changes in report writing (P values: Mann-Whitney U-test)

Comment
This study has a simple design. The use of a more complex design and measurement tools would have been desirable. However, such de sign might have militated against reaching a sample size as large as this study's. This survey purports to measure the general attitude of the population studied on court reports according to their understanding of what good standards are. It does not intend to differentiate from the variety of legal cases involving the mentally disordered. It is argued that support to the last statements comes from the fact that the distribution of the total scores on importance is approximately normal with 72% of its frequencies contained within one standard deviation of its mean. It is then concluded that solicitors' general views on reports is reflected in this survey's data.
Most solicitors considered family history, personal history and forensic history less rel evant items. One possible explanation is that their content is often given in more detail by other sources (police records, social and proba tion services reports, etc.).
As expected, the findings suggest that most solicitors place great importance on specialist topics like psychiatric history, treatments and progress and psychiatric assessment. The data show that those who support changes differ highly significantly from the other group on their views on the usual clarity of the item conclusions and recommendations, a fundamental part of court reports (Gibbens, 1974). Solicitors find that the report items they consider most im portant are written with considerable jargon. This issue was addressed by Scott (1953) and by Bluglass (1979) and this survey demonstrates that this situation remains unchanged.
This study shows that solicitors are generally dissatisfied with psychiatric court report writing. This situation calls for a more effective and ongoing rectification process. The following are a few suggestions of what such a process might include. First, clarification of jargon, when its use cannot be avoided, in layman's terms. Second, detailed and clear elaboration of the most important items. Third, encouragement of trainees preparing reports to seek supervision from consultants. Four, promotion of feedback communication with legal professionals for them to give their views (length of report, style of writing, use of jargon, etc.) on reports in hand. Last, improvement on the teaching of the practical aspects of court report writing to psychiatric trainees.