The precarious practice of forensic psychiatric risk assessments.
The development of forensic psychiatric risk assessments is discussed from a clinical point of view using the example of Sweden. A central task in forensic psychiatry has traditionally been to identify dangerous, mentally disordered subjects considered to be prone to commit violent acts. Over time, "dangerousness" has been reworded into "risk". Nevertheless, such assessments have generally been based on the psychiatric factors characterising the individual patient, while group interaction, situational factors, or social and cultural circumstances, such as the availability of alcohol and drugs, have been largely overlooked. That risk assessments have a focused on people with a diagnosis of "mental disorder" and been used as grounds for coercive measures and integrity violations has somehow been accepted as a matter of course in the public and political debate. Even the basic question whether offenders with a mental disorder are really more prone to criminal recidivism than other offenders seems to have been treated light-handedly and dealt with merely by epidemiological comparisons between groups of persons with broad ranges of psychosocial vulnerability and the general population. Legal texts, instructions and guidelines from the authorities in charge are often vague and general, while actors in the judicial system seem to put their trust in psychiatric opinions. The exchange of professional opinions, general public expectations, and judicial decision processes poses a huge risk for misunderstandings based on divergent expectations and uses of terminology.
Forensic Psychiatry, Institute of Neuroscience and Physiology, the Sahlgrenska Academy, University of Gothenburg, Sweden. thomas.nilsson@neuro.gu.se
Thomas
T
Nilsson
Christian
C
Munthe
Christina
C
Gustavson
Anders
A
Forsman
Henrik
H
Anckarsäter
D003134:Commitment of Persons with Psychiatric Disorders / Q000331:legislation & jurisprudence; D003415:Crime / Q000331:legislation & jurisprudence / Q000517:prevention & control / Q000523:psychology; D003617:Dangerous Behavior; D004992:Ethics, Medical; D005555:Forensic Psychiatry / Q000941:ethics / Q000331:legislation & jurisprudence*; D006801:Humans; D007298:Insanity Defense; D016743:Mental Competency / Q000331:legislation & jurisprudence; D001523:Mental Disorders / Q000175:diagnosis* / Q000523:psychology; D011329:Prisoners / Q000331:legislation & jurisprudence / Q000523:psychology; D018570:Risk Assessment / Q000941:ethics / Q000331:legislation & jurisprudence*; D012308:Risk Management; D013548:Sweden; D014754:Violence / Q000941:ethics / Q000331:legislation & jurisprudence* / Q000517:prevention & control / Q000523:psychology