The influence of actuarial risk assessment in clinical judgments and tribunal decisions about mentally disordered offenders in maximum security.
Research has shown that actuarial assessments of violence risk are consistently more accurate than unaided judgments by clinicians, and it has been suggested that the availability of actuarial instruments will improve forensic decision making. This study examined clinical judgments and autonomous review tribunal decisions to detain forensic patients in maximum security. Variables included the availability of an actuarial risk report at the time of decision making, patient characteristics and history, and clinical presentation over the previous year. Detained and transferred patients did not differ in their actuarial risk of violent recidivism. The best predictor of tribunal decision was the senior clinician's testimony. There was also no significant association between the actuarial risk score and clinicians' opinions. Whether the actuarial report was available at the time of decision making did not alter the statistical model of either clinical judgments or tribunal decisions. Implications for the use of actuarial risk assessment in forensic decision making are discussed.
Hilton
N Z
NZ
Hilton-Research Department, Mental Health Centre, Penetanguishene, Ontario, Canada. zhilton@mhcp.on.ca
Simmons
J L
JL
D001294:Attitude to Health; D003657:Decision Making; D006801:Humans; D007298:Insanity Defense; D007600:Judgment; D007603:Jurisprudence; D001523:Mental Disorders / Q000523:psychology*; D011330:Prisons; D018570:Risk Assessment; D014754:Violence