Reports reveal an increase in the number of individuals with serious mental illness in jails, prisons and forensic hospitals. Despite the wide-ranging and devastating consequences of this 'criminalization' of mental illness, there remains a lack of information on the subject as well as on the provision of care for these patients. This important new book fills a gap in the literature by examining topics such as: the history and policy factors related to criminalization; original research on forensic populations; pharmacological and psychological treatment strategies; and principles and guidelines for diversion out of the criminal justice system.
Tipping the Scales Of Justice: The Role of Forensic Evaluations in the Criminalization of Mental Illness
Katherine E. McCallum and W. Neil Gowensmith
For psychologists or psychiatrists conducting forensic evaluations, a forensic psychological report is a work product – one of many reports they will author over the course of their careers. Many forensic evaluators conduct a large number of evaluations per year; for example, Colorado state evaluators conduct an average of 144 competency to stand trial (CST) evaluations per year.1 For psychologists or psychiatrists who author a large volume of evaluations, some cases may seem routine. Evaluators may fall into a pattern in which many evaluations appear mundane and typical.
However, for the individual being evaluated, each report holds a tremendous amount of influence. Forensic evaluations cover a wide swath of psycholegal referral questions, and they carry a great deal of influence over the lives of those under evaluation. Although forensic evaluators are not triers of fact, judicial decisions are overwhelmingly correlated to opinions of forensic evaluators;2 studies have shown that judges follow the opinions of evaluators in 76%–99% of cases.3–6 These opinions can be far-reaching. For example, evaluations of adjudicative competency or sanity can influence whether a defendant is temporarily detained in a correctional facility, hospital, or released to the community – and they may also ultimately lead to charges being dismissed.7 Criminal responsibility evaluations can provide the tipping point between acquittal and hospital commitment versus a guilty verdict and imprisonment.8 Other forensic mental health evaluations may influence whether a parent maintains custody of his/her child, a person is released from a locked facility, a teenager is tried as an adult, a confession is valid, or a plaintiff receives monetary awards. In capital cases, a forensic mental health evaluation can influence whether a defendant is executed.
In addition to the impact on the individual, forensic evaluations have systemic impact. Forensic evaluations that are not conducted within a certain time period can result in a backlog of cases. Many states are currently in the throes of federal lawsuits centered around these delays in evaluation time frames, as defendants with mental illnesses languish in county jails awaiting their evaluations.9,10 However, when evaluations are conducted too quickly, emerging research shows that forensic opinions are often subject to inaccuracies.11,12 Further, the quality of reports from state evaluators has been shown to be of mediocre quality in some settings.13 Reports of poor quality can result in appeals or second opinion requests, compounding the backlog even more. Finally, a great deal of research demonstrates that many evaluators are biased by multiple internal and external factors.14–24 Biased, unreliable, or low quality forensic mental health evaluations deteriorate the fairness of the justice system overall. Given the important systemic and individual impacts of forensic evaluations, it is critical that they are efficient, valid, reliable, and held to high standards of quality. However, an accumulating body of literature suggests that the efficiency, validity, reliability, and quality of these reports have substantial room for improvement.