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Psychological assessment.docx

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Richard B Day

October 28 , 2013 Psych 3CC3: Forensic Psychology Psychological Assessment Categorizing of Assessment - Past mental state: insanity/criminal responsibility  The mental state of the defendant at the time of the crime  In Canada, not criminally responsible by reason of mental disorder  Insanity is a legal judgment not a psychological one - Present mental state: fitness to stand trial - Future mental state: future risk of violence October 29 , 2013 Fitness to Stand Trial - Is unable on account of mental disorder to conduct a defence at any stage of the proceeding before a verdict is rendered or to instruct counsel to do so, and in particular unable on account of mental disorder to a) understand the nature or object of the proceedings, b) understand the possible consequences of proceedings, or c) communicate with counsel – Canadian Criminal Code - The test must be whether he has sufficient present ability to consult with his attorney with a reasonable degree of rational understanding and a rational as well as factual understanding of proceedings against him – Dusky v United States, 1960 Specific Issues in Fitness 1. Understand charges  Possible sentences  Understand their behaviours 2. Give pertinent information to counsel  Describe and explain the nature of his behaviours around the time of the offense  Describe mental state at the time of the event  Describe the polices point of view 3. Understand range, nature of penalties  Is he aware of the potential consequences of punishments 4. Understand legal strategies and options  Understand pled bargain 5. Help choose legal strategies and options 6. Understand adversarial nature of trial  Role and responsibilities of the individuals involved in the trials  Understand that his counsel is his ally and that the counsel cannot repeat anything incriminating 7. Show appropriate courtroom behaviour 8. Follow trial events, challenge witnesses  Notice inconsistencies in the witnesses statements  Provide guide to the attorney 9. Give relevant testimony 10.Maintain relationship with counsel Conducting Fitness Assessments - Many procedures that assist in fitness assessments - Involves personal interview - Common for instruments and assessment tools to be used in conjunction to the interview – high number of instruments - 5 days allowed; extension possible to 30 days; detention not to exceed 60 days - Only medical practitioners, e.g. psychiatrists, can conduct fitness assessments - Even if medical practitioner has no training or experience in psychiatry or psychology - No psychologist can assess individuals - Mostly forensic psychiatrists Four Types of Fitness Instruments - Test different reasons for lack of fitness - Tests for psychopathology (mental disorders)  MMPI  Most widely used  MCMI  Personality disorders - Neuropsychological batteries (physical brain damage)  Luria-Nebraska  Halstead-Reitan - Intelligence tests (diagnosis of intellectual disabilities)  WAIS (Wechsler Adult Intelligence Scale  Stanford-Binet - Fitness-specific tests  MacCAT-CA  FIT-R - Lally (2003):  Presented with a list of possible assessments – are these appropriate assessments  All instruments listed which fell above 50% acceptability  MacCAT-CA: specifically designed to assess fitness to stand trial  WAIS-III  CAI  CST  MMPI-2  GCCT  Halstead-Reitan  IFI-R  Stanford-Binet-R  PAI  Luria-Nebraska  Least acceptable  ProjDraw: draw our unconscious mechanisms and processes and by looking at the nature of the drawing we can assess the fitness  TAT: say what’s happening in the picture, what lead to the situation and what is going to happen next  Sentence: sentence completion task  Rorschach: individuals respond to a series of symmetrical ink blots  16PF: 16 personality factor scale  MCMI-II Other Fitness Instruments - Do not need to know - Georgia Court Competency Test (GCCT) - GCCT – Mississippi version revieed - Competency screening test - Competency assessment instrument - Interdisciplinary fitness interview - Computer-assisted determination of competency to proceed - Evaluation of competency to stand trial – revised - MacArthur competence assessment tool – criminal adjudication - Used with interview Fitness Interview Test – Revised - 16-item semi-structured clinical interview  More freedom to ask for clarifications or follow ups - Questions divided into 3 sections:  Understanding nature object of proceedings  Understanding possible consequences of proceedings  Ability to communicate to counsel  Vignettes to assess whether the individual has an understanding - Zapf & Roesch (1997): 86% agreement between FIT-R and institutional assessments. No false negatives (saying the individual is fit when he is not) Assessment Process Diagram - Assessment Ordered 1. Fitness trial - Concern of crown or defendant a) Fit = return to court b) Unfit = Judge Decides 2. Judge Decides a) Conditional discharge = fit and return to court b) Hospital custody = fit and return to court c) Review board = unfit 3. Review Board a) Fit = return to court b) Unfit = conditional discharge or hospital custody – occur in cases where they are a danger to themselves Two Elements of a Crime - Both must be present - Actus reus: the criminal act itself - Mens rea: intent to commit a criminal act History of Insanity Verdict - Hadfield case (1800): planned assassination of king, believed it would bringthe second coming of Christ. Suffered from brain injuries.  Standard: lost to all sense…incapable of forming a judgment upon the consequences of the act which he is about to do  Knew the consequences of his actions  Erskine: Hadfield lost to reality. His delusions unaccompanied by frenzy or raving madness were insanity  Judge acquits, orders confinement  Parliament passes Criminal Lunatics Act, mandating detention for the insane – individuals found in trial had to be detained and could not be released as they were before - M’Naughten case (1843): planned murder of PM  Not guilty by reason of insanity  M’Naughten standard: at the time of committing the act, he was labouring under such a defect of reason from disease of the mind as not to know the nature and quality of the act he was doing, or if he did know it, that he did not know what he was doing was wrong. Right/wrong test  Defect of reason due to disease of the mind  Simply having a mental disorder does not meet this criteria as many do not make you defective in reasoning  Ignorant of nature and quality of the act  Unaware, or unable to determine, that act was wrong  Right/wrong is the classical definition of criminal responsibility  It is possible for individuals with severe mental disorders, such as schizophrenia or bipolar affective, to not meet the criteria for not criminally responsible by reason of mental disorder - American law institute (1962)  Standard” if at the time of his conduct as a result of mental disease or defect he lacks substantial capacity either to appreciate the criminality (wrongfulness) of his conduct or to conform his conduct to the requirements of law  Irresistible impulse that must be acted upon  Deviation from the M’Naughten standard - Three states in the west Montana, Utah, and Idaho that do not contain mental disorder in their law; however, the treatment may differ - M’Naughten standard vs. American Law Institute standard - Canada Criminal Code (C-30) of 1992  Not criminally responsible on account of mental disorder (NCRMD)  Standard: no person is criminally responsible for an act committed or an omission made while suffering from a mental disorder that rendered the person incapable of appreciating the nature and quality of the act or omission or of knowing that it was wrong  The M’Naughten rule th November 4 , 2013 NCRMD - Raised by defense, argued by Crown  Hard to judge individuals state of mind 3-4 months prior to the case when the offense was committed - Raised by Crown after guilty verdict: require treatment and not incarceration  Cases where both the Crown and defense agree on NCRMD - Proof standard: beyond a balance of the probabilities  Major crimes: beyond a reasonable doubt is a very high standard  Beyond a balance of probabilities: 51% certain should lead you to vote not guilty - NCRMD = unconditional release unless defendant poses risk to the public  Committed to mental facility until such time that they no longer pose a risk to themselves and the public - Review boards oversee disposition of NCRMD defendant Assessment Methods for NCRMD - Trying the assess a past mental state not a present mental state - Clinical interview (structure or unstructured)  SADS: schedule for affective disorder and schizophrenia  Presence of severity of depression and schizophrenia  SIRS: structure interview of reported symptoms  Broad scale assessment of disorders  Less widely used  Interviewed for hours over a period of days  Tools for structuring the questions asked during assessment - Objective personality tests  Can be scored by computer  Limited number of fixed alternatives that the individual can choose from  MMPI-2  Most widely used  Largest literature base  MCMI  Designed to detect personality disorders but also provides information about other more serious disorders that would be relevant for NCRMD - Projective personality tests  Differ from objective  Do not have a standard set of answers or responses: Cannot be scored by computers  Projected are based on psychodynamic perspectives: that our unconscious mind is more prominent  Rorschach inkblot test - Cognitive and intelligence tests - Neuropsychological tests  Disorders in the nervous system  Not very widely used - Specific forensic instruments  R-CRAS *Rogers Criminal Responsibility Assessment Scales) Borum & Grisso - Most useful and most appropriate - Psychologists and psychiatrists tend to agree - Psychiatrists seldom used RCRAS, WMS-R and SIRS - Most widely used by both are MMPI and WAIS - MMPI, RCRAS, ROR and MCMI Clinical Interview - Especially at the time of the crime - Medical/psychiatric history  When? What? What done?  Before and including up to when the offense was committed - Simple, open-ended questions  Asked about the time of the offense and days following  What was happening?  What were you aware of?  What caught your attention?  What thoughts do you remember?  What were you feeling? - Work through the day of the offense  When did you get up?  What happened next? - Work through days before offense  Work forward and backward to distinguish between real memories and made up stories Schedule for Affective Disorders and Schizophrenia - Can vary the order of the questions depending on the individuals responses - Semi-structure diagnostic interview:  Assess many Axis I disorders – non personality disorders  Specific for mood disorders and schizophrenia  Takes about 90 to 150 minutes - Part I:  Curent symptoms and level of functioning  What were they like at their worst?  Now and at the time of the offense? - Part II:  Past episodes  What diagnoses, what treatments? - Supplement, not replace, clinical judgment  Subjective assessment  Still take into account other supplemental evidence Projective Tests - Rorschach - Based on psychodynamic perspective: assume primacy of unconscious factors in personality, behaviour - Projection of unconscious factors onto ambiguous stimulus (ink blots)  Asking to interpret an ambiguous situation will be done using unconscious processes - Tests involve minimal structure, minimal restriction on responses - Standardized administration and scoring: but interpretation of scores depends on clinical judgment Rorschach Inkblot Tests - 10 symmetrical inkblots - Oldest standardized personality test developed in 1921 by Swiss psychoanalyst Hermann Rorschach - Involves 10 standardized symmetrical inkblots - 5 blots are black and gray - 2 blots black, gray, and red - 3 blots multi-colored - Inkblots always shown in the same order - Free association phase: What do you see in the blot  First phase - Inquiry phase: where do you see it  What aspect of the blot led to this particular percept  Is it whole blot or specific blot response  Most important phase  Shape vs. colour  What is actually scored - Testing the limits: do you see a…  Given a non standard response: can you elicit standard responses for the individual  Useful for NCRMD as you may not be able to get the standard responses - Test time: 45-60 minutes November 5 , 2013 Rorschach Inkblot Test: Scoring - Location: whole or part?  What part did the individual use to record? - Determinants: colour, shape, movement? - Content: object, animal, human? - Original or popular: common response or not? - Form level: is percept congruent with the blot?  Does the percept match the form of the blot? - Relationships: themes in precepts across blots? - Organized in order of importance - Content is not one of the most significant - Location and determinants are the most important - Test is reliable but does it have validity? - Never use just the Rorschach results to assess - Used as input to clinical judgement along with other clinical information - Incremental validity: assessment with the Rorschach is more valid when added to other information than if the Rorschach was not added Objective Tests - Not based on specific perspective: no assumption about models of personality - Overt feelings, attitudes, characteristics - Tests restrict kind, number of responses - Clear and standardized administration and scoring: little clinical judgment required; computerization possible Minnesota Multiphasic Personality Inventory (MMPI) - Designed to have empirical validity - Oldest of the objective tests - Mid 1940s - Help diagnose and identify psychopathology - Face validity: questions directly tap into the symptoms that we are interested in - Discriminate between those who have disorders and those who don’t; and between disorders - Collected statements from previous tests and clinical interviews and gave those statements to patients who had different disorders - Answers distinguish between disorders - Hataway & McKinley (1942), Univ. of Minnesota Hospitals: to assist in diagnosis of psychiatric patients - Selected many yes/no/can’t say items - Gave items to 200 patients, 724 non-patients - Choose items that discriminated between patient groups for scales: little clinical judgment required; computerization possible - 550/567 yes/no/can’t say statements about individual:  I am very energetic  People are out to get me  I am happy most of the time  I believe I am a condemned person  I find it difficult to get out of bed in the morning  I have never been in trouble with the law  I hardly even lose an argument - Adolescents tend to answer yes to the statements skewing the results - 10 clinical scales - 3 validity scales  Set of items whose responses tend to distinguish people who are doing something weird: lies, not responding to the question well, reflects honest understanding  MMPI-2 has 8 validity scales MMPI Scoring - Raw scale scores transformed into standard scores: mean = 50, standard deviation = 10 - All of the scales are normalized - High scores = 70+ (+2 s.d.) - Results displayed as graph MMPI Clinical Scales - Remember that the scales on the MMPI - Scale 1: Hypochondriasis (Hs): high = cynical, critical, demanding, self- centered  I do not tire quickly  I feel weak all over much of the time  I have very few headaches - Scale 2: Depression (D): high = moody, despondent, pessimistic, shy  My
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