An International Snapshot of Assessment Practices and Expert Judgment in Forensic Psychology and Psychiatry

Introduction

This article by Tess M. S. Neal and Thomas Grisso describes forensic examiners’ use of structured assessment tools internationally. An online survey of $434$ experts reporting on $868$ cases found that most evaluations ($74.2\%$) used, on average, four tools per case, with high diversity among $286$ unique tools. This highlights implications for the reliability and validity of expert judgments, suggesting a move toward structured decision methods.

Core Concepts

Forensic mental health assessments use both Actuarial tools (mechanically combined data using fixed rules) and Structured Professional Judgment (SPJ) tools (evidence-based factors with guidelines but no fixed algorithm), despite ongoing debate about intuition versus structured approaches in some cases.

Study Design and Findings

The study aimed to examine self-reported tool use in recent forensic evaluations across civil and criminal contexts, uniquely employing a case-based reporting method. Participants were primarily doctoral-level psychologists ($51\%)$ and psychiatrists ($6\%)$ from the U.S. ($44.7\%$), Canada, Australia/NZ, and Europe.

Key Results:

• The most common referral was Competence to Stand Trial (CST).

• While overall tool use was high ($74.2\%$), it varied by referral type, being common in criminal risk assessments ($\ge 89\%$) but less so in CST evaluations ($\approx 58.4\%$).

• Common information sources included examinee interviews ($\sim 99\%$) and mental health/medical records.

• Frequently used tools included MMPI variants, WAIS variants, HCR-20, PCL-R, and PAI, categorized into Forensic Assessment Instruments (FAIs), Forensically Relevant Instruments (FRIs), and Clinical Assessment Instruments (CAIs).

Discussion and Implications

The observed diversity of tools suggests flexible, case-specific selection, but could reduce interrater reliability and create burdens for courts. The authors advocate for standardizing practice by favoring psychometrically sound tools (e.g., using the Heilbrun et al. checklist) and developing structured decision-making approaches. This approach aims to optimize data collection given cognitive limits (human integration of about four to six essential data points) and improve consistency and efficiency.

Limitations

The study's limitations include potential generalization issues due to the sample being members of forensic associations, an unknown response rate, and small cell sizes for some referral categories.

Conclusion

The field has transitioned from relying solely on unstructured clinical judgment to widespread use of diverse structured tools. The primary challenge is to refine tool use and data gathering to enhance efficiency, decision quality, reliability, and validity through targeted, psychometrically grounded approaches and structured decision methods.