Download Psych. 3CC3 March 20, 2009 Assessment of Competence and Criminal

Psych. 3CC3
March 20, 2009
Assessment of Competence and Criminal Responsibility (continued)
MCMI
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developed in the 1970s based on Theodore Milon’s model of psychopathology and personality
shorter than the MMPI
most of the scales are about personality disorders or styles
the 3 severe personality disorders are actually disorders in the DSM
the 7 moderate syndrome scales are close to DSM categories; but they’re not very relevant to a
judgement of criminal responsibility/insanity
the 3 severe syndrome scales would be relevant; they’re the most important to forensics
there are cases of very severe psychotic depression in which the person may be deemed NCR
it has 3 validity scales: people can try and fake being NCR (malingering), and so we need ways of
assessing this
the first validity scale is the disclosure scale: measures person’s willingness to be open and
honest; willingness to admit symptoms and problems
the desirability scale measures the person’s tendency to answer items in way that make them
look very favorable and without problems
and the debasement measures the person’s tendency to exaggerate symptoms and problems;
person wants to appear insane
validity index: choosing 2 out of 3 seldom-chosen items invalidates profile, i.e., we know the
person is lying
MCMI-III Scoring
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convert raw scale scores to Base Rates (BR)
range from 0 to 115
60 = median raw score for all patients on that scale
75 = minimum for patients meeting DSM-III criteria for disorder or condition
75 - 84 = “clinically significant personality style or syndrome”
Additional Milon Tests
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MCMI-III Corrections Report
Assesses inmates needs while in prison (eg. Mental health intervention, substance abuse
services)
Assesses individual’s risk of rejecting authority, suicide, dealing with crowding in prison, ability
to respond to treatment or correction of behavior
MCMI-III Issues
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Reliability: high test-retest reliability on personality scales, but less on clinical syndrome scales
Normative sample small, unrepresentative of minority groups
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High degree of scale overlap; high interscale correlations (.40 - .85)
Most items are scored “true” (you get a point if you answer “true”, but there are people who
have a bias towards choosing “true” or “false”); vulnerable to aquiescence bias
Weak on assessing major psychotic disorders, minor personality pathology (but this is not a
huge issue because the MCMI is only one of a number of measures you use to assess people for
criminal responsibility)
Some scales weak in diagnosing related personality disorders; better at styles
Many scales have low convergent validity with other psychiatric rating instruments
Milon’s model of personality disorders has not been validated
Test is too new to have generated supporting research
The R-CRAS
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All it does is assess criminal responsibility
The other instruments we’ve discussed measure other things as well as criminal responsibility
Published in 1984
It is a structured interview; an expert sits down with person and asks them questions and
quantify their clinical judgment about person on the R-CRAS
It can only be carried out by a trained clinician
A numerical quantification of clinician’s subjective clinical judgment of person
Assesses criminal responsibility using the American Law Institute Standard for insanity
25 – 30 variables, with each rated on a 5- or 6-point scale:
o 0 = no info. given
o 1 = not present (problem not present)
o 2 = problem present, but not clinically significant
o 3-6 = increasing gradations of clinically significant/relevant symptoms
R-CRAS Variables
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Malingering (2 scales)
Signs of an organic mental disorder (brain damage for eg.)
Mental retardation
Amnesia (inability to recall criminal event)
Anxiety
Bizarre behavior
Delusions
Depressed or elevated mood
Affective disorder
Hallucinations
Thought disturbance
Language disturbance
Awareness of criminality
Evidence of planning
You summarize all the information you get from the interview into 6 summary psychological
criteria:
o A1 – presence of malingering
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o A2 – presence of organicity
o A3 – presence of major psychiatric disorder
o A4 – ability to comprehend criminality of behavior
o A5 – loss of behavioural control
o A6 – was loss of control due to: organic disturbances? Psychiatric disturbances?
Because the R-CRAS is a structured clinical interview it makes it the same across various
clinicians (i.e. conducted the same way by all clinicians)
R-CRAS Reliability
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Test-retest reliability
o 12 variables have correlations greater than .60
o 8 variables have correlations greater than .40
o 3 variables have correlations less than .40
Inter-rater reliability (expert agreement)
o This is tested by having experts assess same person
o So it’s kind of expected they’ll assess them similarly (because interview is structured)
R-CRAS Validity
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Validity = test measures what it’s supposed to measure
Substantive validity: do the items in scale address elements of the construct? (content validity)
YES
Structural validity: do individuals judged insane by R-CRAS have characteristics of insanity? YES
o Absence of malingering
o More severe psychological impairment
o Greater loss of cognitive and behavioural control than those judged criminally responsible
But doesn’t this have to be so since these same characteristics are the basis on
which people would be assessed as being NCR???
External validity (criterion validity): are individuals judged insane by the R-CRAS found insane at
trial? YES
o 75% people judged insane by R-CRAS also found insane at trial
o 95% people judged sane by R-CRAS also found criminally responsible at trial
But R-CRAS expert testimony is part of the trial evidence: juries put high weight into
expert testimony and this could be the reason why people judged insane or sane by
R-CRAS are found insane or criminally responsible, respectively, at trial
So the verdict reached by the jury is not independent of the assessment!