Tuesday, August 28, 2012

Prisoner "reentry": Paradigm shift or empty rhetoric?

  Vindictive "imagined public" a barricade to real reintegration   

For many who have broken the law, the real punishment begins not when they are processed into prison, but when they are finally ejected from their concertina-enclosed cages into a vengeful society that won't allow them to redeem themselves, branding them as forever bad.

Despite the stacked deck, some former prisoners do manage to find a sense of hope and turn their lives around. Such desistance is especially likely when society welcomes prisoners and restores their status as full citizens. Indeed, a study by Florida's Parole Commission found that prisoners whose civil rights were restored were far less likely to reoffend than those who remained unable to vote, hold public office, sit on juries, or obtain certain state licenses.

This process of criminal desistance is the topic of a new film out of Scotland. The Road from Crime -- a 48-minute film that can be viewed by clicking on the image below -- is narrated by Allan Weaver, a Scottish ex-offender turned probation officer and author of the book So You Think You Know Me? The script was co-written by my friend Shadd Maruna of the Institute of Criminology and Criminal Justice at Queen's University Belfast, who wrote the groundbreaking book, Making Good: How Ex-Convicts Reform and Rebuild Their Lives.




Study: Reentry doesn’t equal reintegration

The film strikes an optimistic note, citing increasing government interest in alternatives to incarceration in these lean economic times. But a new study out of Colorado is less sanguine, at least as far as the USA is concerned. Even as policy makers give lip service to facilitating prisoners' successful "reentry" into the community, they cling to a risk reduction model that hamstrings true reintegration, the researchers found.

The researchers tracked the work of a Colorado state commission tasked with recommending changes in sentencing policies aimed at reducing sentencing costs while increasing efficacy. Analyzing the commission's discourse, study co-authors Sara Steen, Traci Lacock and Shelby McKinzey of the University of Colorado discovered that a powerful "imagined public" held these public servants hostage, forcing them to look over their shoulders and censor their humanistic impulses lest they be perceived as soft on crime.

The public of the commissioners' imaginations is a vengeful one, which promotes "victims’ rights" as antithetical to the rights of offenders. In this "zero-sum" wordlview (as David Garland labeled it in The Culture of Control), "concerns about offenders translate into attacks on victims and vice versa, so that actors have to forge an allegiance with one group or the other."
"This narrative implies that the real reentry problem is that this population is reentering society at all (if it were not for the expense, the reentry problem could be solved by keeping people who commit crimes in prison forever). The moral undertone to this narrative is one of anger and disgust toward (or, more mildly, frustration with) a group of dangerous people who need to be watched. [Former prisoners] are not people we want to help -- in part because they are, in some sense, beyond help…. [It] is clear that there is some interest in improving offenders' lives, but the main story driving the recidivism reduction narrative is that we (nonoffenders) should invest in reentry to make ourselves safer."
Indeed, risk-driven discourse has so become so naturalized that it takes a very active effort to step back and realize that it is only one of several possible ways of thinking about citizens who have committed crimes. Indeed, Shadd Maruna and Thomas LeBel (in an article available online) identified two dominant recidivism-reduction narratives:
  • The CONTROL NARRATIVE views ex-prisoners as dangerous creatures who require close supervision at all times.
  • The SUPPORT NARRATIVE regards ex-convicts as bundles of deficits with “needs” that must be attended to.
Although these narratives are superficially dissimilar, in essence they are fundamentally alike in that both dehumanize and problematize former offenders. Indeed, the so-called "risk/needs" paradigm so popular in forensic psychology circles arose squarely from the recidivism reduction discourse that overarches both the control and support narratives. As the researchers discovered in the Colorado case, much more time and energy is put into risk assessment than in providing the external resources necessary for change; “no matter how precisely one can measure an individual’s needs, without resources to attend to those needs the measurement is in some sense meaningless.”

Source: Steen et al (2012)
Imagined public: More vitriolic than actual public opinion?

The irony is that, in their hearts, many public officials and practitioners would like to do more for paroling prisoners, but are paralyzed by fear of a public that in reality may be less vengeful than they imagine. As Steen and her colleagues note:
"Commissioners routinely raised the specter of public discomfort with their recommendations, and they always assumed that the public was punitive and would oppose reforms that benefited offenders in any significant way. While the commissioners themselves had complex views of crime and punishment, they  almost universally assumed a deeply simplistic view on the part of the public, a view based on retribution  to the exclusion of all other considerations. Despite its mandate to continually draw on evidence to support its conclusions, the Commission completely ignored (or was unaware of) recent social scientific evidence of a shift in public opinion about crime and punishment."
They cited a 2002 poll conducted for the Open Society Institute in which the majority of those surveyed believed that the primary goals of the criminal justice system should be rehabilitation and crime prevention.

In other words, public officials may be generalizing about the public's attitudes based on a skewed perception created by handful of vocal -- and often rabid -- constituents. Because of this, public policy remains firmly entrenched in an irrational, hysterical loop tape from which escape is nigh impossible. As the Colorado researchers conclude:
"Many academics equate reentry with rehabilitation, and assume that the popularity of the reentry concept has resulted in discourse and policy that are friendly toward offenders, decreasing the distance between 'us' and 'them'. Our analysis suggests that reentry has not significantly changed the discourse, and we show how practitioners and policy-makers have molded the reentry concept to fit comfortably within the existing punitive discourse by focusing on recidivism reduction rather than reintegration…. In the end, we rather pessimistically conclude that the high hopes of many that reentry could fundamentally change the nature of punishment discourse in the 21st century is to date misplaced."
Resources:

For more information about The Road from Crime and the wider desistance project visit the Discovering Desistance Blog. An evidence summary on desistance, How and why people stop offending, is also available online. The film was funded by the Economic and Social Research Council and George Mason University.  In addition to Shadd Maruna, project members include Fergus McNeill of the Scottish Centre for Crime and Justice Research at the University of Glasgow, Stephen Farrall of the University of Sheffield and Claire Lightowler of the Institute for Research and Innovation in Social Services.

The featured article is: Unsettling the discourse of punishment? Competing narratives of reentry and the possibilities for change by Sara Steen, Traci Lacock and Shelby McKinzey Punishment and Society 2012 14: 29 DOI: 10.1177/1462474511424681. Click HERE to request a copy from the first author.

Related blog posts: 

Tuesday, August 21, 2012

Evaluating vets for disability: Recommended reading

As thousands of U.S. vets stream back from the battlefields of the Middle East with physical and/or psychological problems, more and more forensic practitioners are being called into service to perform disability evaluations. Veterans who suffered illness or injury due to military service are eligible for disability compensation. But first, they must meet eligibility requirements, which typically include undergoing a disability evaluation (referred to as a "Compensation and Pension examination" or "C and P" in VA parlance).

Not surprisingly, the majority of psychiatric evaluations are for PTSD.

A group of psychologists and psychiatrists who conduct such evaluations has put together a reading list of recommended resources for evaluators. Although one obvious audience is the mental health staff of the Veteran's Administration, the group is also reaching out to clinicians in private practice who conduct mental disability evaluations with veterans, either directly for the veteran or via private companies who have contracts with the VA.

For questions about this reading list, please contact Mark D Worthen, PsyD, who has blogged here before and led the effort to compile the list. Dr. Worthen is also co-author of the only article published in a peer-reviewed journal that describes how to conduct mental disability evaluations with veterans.

Best of all, many of these resources are available online; just click on the embedded links.

ARTICLES AND BOOK CHAPTERS ON PSYCHOLOGY AND PSYCHIATRY

Foote, W. E. (2008). Evaluations of individuals for disability in insurance and Social Security contexts. In R. Jackson (Ed.), Learning forensic assessment (international perspectives on forensic mental health) (pp. 449–479). New York: Taylor and Francis Group.

Moering, R. G. (2011). Military service records: Searching for the truth. Psychological Injury and Law, 4(3-4), 217-234. doi:10.1007/s12207-011-9114-3

Rubenzer, S. (2009). Posttraumatic stress disorder: Assessing response style and malingering. Psychological Injury and Law, 2(2), 114–142. doi:10.1007/s12207-009-9045-4.

Strasburger, L. G., Gutheil, T. G. and Brodsky, A. (1997). On wearing two hats: Role conflict in serving as both psychotherapist and expert witness. American Journal of Psychiatry, 154(4), 448–456. (Available online.)

Worthen, M. D. and Moering, R. G. (2011). A practical guide to conducting VA compensation and pension exams for PTSD and other mental disorders. Psychological Injury and Law, 4(3-4), 187-216. doi:10.1007/s12207-011-9115-2.

ARTICLES ON THE LAW

Allen, M. P. (2011). The law of veteran's benefits 2008-2010: Significant developments, trends, and a glimpse into the future. Veterans Law Review, 3, 1-66. (Available online.)

Ogilvie, B. and Tamlyn, E. (2012). Coming full circle: How VBA can complement recent changes in DoD and VHA policy regarding military sexual trauma. Veterans Law Review, 4, 1-40. (Available online.)

Ridgway, J. D. (2011). The splendid isolation revisited: Lessons from the history of veterans’ benefits before judicial review. Veterans Law Review, 3, 135-219. (Available online.)

Ridgway, J. D. (2012). Erratum to: Mind reading and the art of drafting medical opinions in veterans benefits claims. Psychological Injury and Law, 5(1), 72-87. doi:10.1007/s12207-012-9119-6. (Available online.)

BOOKS

Cocchiarella, L. and Gunnar, B. J. A. (2001). Mental and behavioral disorders. In Guides to the Evaluation of Permanent Impairment, 5th Edition. Chicago: American Medical Association Press. [Although there is a 6th edition of this text, most jurisdictions still refer to the 5th edition]

Institute of Medicine and National Research Council (2007). PTSD compensation and military service. Washington, DC: National Academies Press. (Available online.)

Kennedy, C. H. and Zillmer, E. A. (Eds.) (2012). Military psychology: Clinical and operational applications, 2nd Edition. New York: Guilford Press.

Rogers, R. (Ed.). (2008). Clinical assessment of malingering and deception (3rd ed.). New York: Guilford Press.

COURT CASES

Jones v. Shinseki, 23 Vet. App. 382 (2010). (Available online.)

Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008). (Available online.)

GUIDELINES

American Academy of Psychiatry and the Law (2008). AAPL practice guideline for the forensic evaluation of psychiatric disability. Journal of the American Academy of Psychiatry and the Law, 36(4), S3–S50. (Available online.)

Committee on Ethical Guidelines for Forensic Psychologists (2011). Specialty guidelines for forensic psychologists. (Available online.)

VA PUBLICATIONS

Department of Veterans Affairs (2001). C and P clinicians guide. (Available online.)

Department of Veterans Affairs (2002). Best practice manual for posttraumatic stress disorder (PTSD) compensation and pension examinations. (Available online.)

WEBSITES

National Center for PTSD

MST SharePoint (VA intranet only). In particular, see the PowerPoint presentation, MST C and P exams and the VBA Training Letter - Adjudicating Posttraumatic Stress Disorder Claims Based on Military Sexual Trauma.

Veterans Law Library

Caveat: This list is not an official recommendation of the U.S. Department of Veterans Affairs.

Tuesday, August 14, 2012

Mass Shootings and Mental Illness: KQED Forum 9:00 a.m. Wednesday

If you’re free at 9:00 a.m. PST this Wednesday morning (Aug. 15), I invite you to listen to KQED's Forum show, where I will be a featured guest discussing the topic of MASS SHOOTINGS AND MENTAL ILLNESS: “Can anything be done to predict and prevent such violent acts, and what do we know about what causes people to commit them?” Also featured will be Dave Cullen, journalist and author of the book Columbine, and David Eagleman, director of the Initiative of Neuroscience and the Law at the Baylor College of Medicine. The guest host is Spencer Michaels of PBS NewsHour.

If you are not local to the San Francisco Bay Area, you can still listen live, by clicking HERE.

If you missed this Forum episode, listening is easy: Simply click on the below arrow icon. Or you can download an MP3 audio podcast at the show's website (HERE).

 .

Thanks very much to those of you who listened and sent me feedback via email. I appreciate the support.

Related blog posts:

Arizona rampage: Analyzing the analyzers (Jan. 23, 2011)

 Can school shootings be prevented? (April 19, 2007)

Aurora massacre: To speak or not to speak? (July 22, 2012)

Thursday, August 9, 2012

Mental health expert witnesses slammed in court

A pint-sized hired gun
Are accusations of bias on the rise?

Hired gun.
Charlatan.
Quack.
Hack.

It's every expert witness's worst nightmare. Vitriolic accusations of bias hurled at us on the witness stand, just because the cross-examining attorney doesn't like our opinion, or we have the audacity to charge for our services. (Have you heard of auto mechanics, plumbers or attorneys being called "whores" because they don't work for free?)

Unfortunately, it goes with the territory.

Now, a group of psychologists has tried to figure out just how big a part of the legal landscape accusations of bias against mental health expert witnesses are. The researchers scoured the LexisNexis legal database for insinuations of bias, with an eye to quantifying and categorizing the name-calling. In an article just published online in the journal Psychological Services, prominent forensic psychologists John Edens and John Petrila and four colleagues divided accusations of bias into five major categories:
    Starting with a list of 46 different ways of calling an expert biased, the authors searched and found 160 legal cases in which attorneys and judges made disparaging comments about forensic mental health experts. In these cases, 185 individual case participants made a total of 245 separable statements asserting a lack of objectivity and impartiality among mental health experts and/or the fields of psychology and psychiatry more generally.
    • FOR SALE: In the largest category, 28 percent of the total, experts were disparaged as financially biased (e.g., "hired guns" or "prostitutes").

    • PARTISANSHIP: Following close behind, with 27 percent  of cases, were accusations of advocacy, or having an "axe to grind."

    • PSEUDOSCIENCE: About 14 percent of cases involved accusations of non-scientific testimony (e.g., "charlatans" or "junk science").

    • MYSTICISM: Psychologists and psychiatrists were accused of babbling nonsense (e.g., "witch doctor," "voodoo" or "hocus pocus") in 6 percent  of the cases.

    • NONSPECIFIC BIAS: About one fourth, or 24 percent, of cases involved nonspecific accusations or other types of allegations of bias. 
    Interestingly, in more than a fourth of the cases, the disparaging comments were a basis for an appeal, typically by the defense calling foul over prosecutorial slurs against mental health experts. Such appeals were relatively unsuccessful, with only 18 percent of cases being reversed in part due to on-the-record accusations of expert bias. All of the successful appeals were in criminal trials, eight involving sanity or diminished capacity. 

    Uptick in nasty name-calling?

    Similar to a 1999 study by Doug Mossman, which was the only other known study to look at this issue, the researchers noticed a steady upward trend in disparaging comments in more recent years.

    It might be tempting to get depressed by this study, which at first blush seems to validate what we all know and fear. However, if we think about it, the results could be seen as mildly encouraging.

    First of all, if a thorough search of the massive LexisNexis database could locate only 160 cases, then blatant accusations of bias may be rarer than we think.

    Secondly, there are a heck of a lot more expert witnesses in court these days than ever before. Courts and attorneys increasingly rely on forensic psychologists and psychiatrists to assist in a wide range of psycholegal areas, from child custody to tort damages to criminal sentencing and civil commitment. As well, we are increasingly called upon to explain broader social science research, such as the accuracy of eyewitness identification, to judges and juries. So, as the authors acknowledge, any increase in accusations of bias could just be an artifact of our growing presence in court.

    Third, and perhaps most importantly, there really are hacks and quacks, charlatans and hired guns among are ranks. The methodology of the current study did not enable analysis of whether the accusations of partiality or bias were legitimate. In other words, attorneys may not have been just engaging in legal gamesmanship in some of these cases; they might have been righteously upset over actual bias or pseudoscientific methodology on the part of forensic psychologists or psychiatrists.

    Hopefully, that's a study someone else will take up on another day.

    For now, we're left with a couple of take-home messages:

    First, this is not a field for the thin-skinned. We must steel themselves to have our objectivity challenged, sometimes very rudely and without basis.

    More fundamentally, assuming that these accusations are tapping into popular perceptions and prejudices, forensic professionals need to work harder to reduce both actual bias and the perception of bias in our work.

    The articles are:

    " 'Hired Guns,' 'Charlatans,' and Their 'Voodoo Psychobabble': Case Law References to Various Forms of Perceived Bias Among Mental Health Expert Witnesses" by John F. Edens, Shannon Toney Smith, Melissa S. Magyar, Kacy Mullen, Amy Pitta and John Petrila, Psychological Services, 2012. 

    " 'Hired Guns,' 'whores,' and 'prostitutes': Case law references to clinicians of ill repute" by Doug Mossman, Journal of the American Academy of Psychiatry and the Law, 1999. 

    Sunday, August 5, 2012

    Psychiatrist accused of faking dementia to thwart retrial

    Ayres found competent to stand trial in long-running molest case

    William Ayres
    In a dramatic twist to a case that's already had as many twists and turns as a roller coaster, allegations surfaced this week that psychiatrist William Ayres faked severe dementia in order to avoid a retrial on multiple charges of child molestation.

    Ayres used his knowledge of psychiatry to circumvent psychological testing in an elaborate, two-year hoax, according to a report by state hospital psychologist John McIlnay. Around-the-clock observation at Napa State Hospital uncovered discrepancies between the dementia diagnosis and the day-to-day conduct of the former president of the American Academy of Child and Adolescent Psychiatry, the psychologist reportedly wrote in a report filed under seal with the San Mateo County, California court.

    Ayres, 80, was arrested in 2007 on suspicion of sexually abusing six boys, some of them sent to him by the juvenile courts, between 1988 and 1996. As I reported at the time, his 2009 criminal trial ended with a hung jury.

    After that trial, a new lawyer took over the case and raised the issue of competency to stand trial. A jury trial on competency last year ended with another hung jury. The defense and the prosecution eventually stipulated that Ayres was incompetent and should be sent to Napa State Hospital. He was there for about nine months.

    Vincent "The Chin" Gigante
    Faking dementia is not commonplace or easy, but it can be done. The most famous case of a defendant faking dementia in order to avoid criminal trial was that of Vincent "The Chin" Gigante, a Mafia don who for years wandered the streets of New York City in a bathrobe. He fooled a bevy of eminent forensic psychologists for psychiatrists into believing he was both insane and demented.

    Due to his medical training, a psychiatrist would have an advantage in faking a dementia and in avoiding obvious mistakes. But never letting down one's guard would be difficult in an environment of 24/7 observation. According to news reports, line staff such as nurses and janitors were among those who noticed discrepancies between Ayres's day-to-day functioning and his purported dementia. This was also what eventually tripped up Vincente Gigante; forensic evaluators who interviewed line staff in that case learned that "The Chin" had dropped his guard in jail, when outside the presence of evaluating psychologists and psychiatrists.

    On the other hand, state hospital clinicians are rather notorious in local circles for being quick to label defendants as malingering, a topic on which I published a peer-reviewed case study a few years ago. The diagnosis helps open up space in the overcrowded competency restoration wards, which are under pressure from California judges to become more efficient and reduce long waiting periods for beds, and can rid staff of nettlesome criminal patients.

    Also, as regular blog readers know, reasonable clinicians often differ as to whether someone is incompetent. In this case, the competency trial featured a 2-2 split of experts. The two original court-appointed psychologists, Paul Good and Jatinder Singh, both initially opined that Ayres was competent to stand trial. However, Singh later changed his mind, which prompted the appointment of a third, "tie-breaker" evaluator, psychiatrist George L Wilkenson, who also thought Ayres was competent. Joining those three as witnesses at last year's competency trial was a defense-retained neuropsychologist, Amanda Gregory, who opined that Ayres was incompetent.

    The new hospital report will prompt yet another court hearing on competency. This time, a judge rather than a jury will make the decision on competency, with the defense having the burden of proving that the defendant is unfit for trial on nine felony child molestation charges. The October hearing will include a string of lay and expert witnesses and is anticipated to last about seven days.

    My prior posts  (it's been a while) on the case

    Thursday, August 2, 2012

    Violence risk instruments overpredicting danger

    Tools better at screening for low risk than pinpointing high risk 


    The team of Seena Fazel and Jay Singh are at it again, bringing us yet another gigantic review of studies on the accuracy of the most widely used instruments for assessing risk of violence and sexual recidivism.


    This time, the prolific researchers -- joined by UK statistician Helen Doll and Swedish professor Martin Grann -- report on a total of 73 research samples comprising 24,847 people from 13 countries. Cumulatively, the samples had a high base rate of reoffense, with almost one in four reoffending over an average of about four years.

    Bottom line: Risk assessment instruments are fairly good at identifying low risk individuals, but their high rates of false positives -- people falsely flagged as recidivists -- make them inappropriate “as sole determinants of detention, sentencing, and release.”

    In all, about four out of ten of those individuals judged to be at moderate to high risk of future violence went on to violently offend. Prediction of sexual reoffense was even poorer, with less than one out of four of those judged to be at moderate to high risk going on to sexually offend. In samples with lower base rates, the researchers pointed out, predictive accuracy will be even poorer.

    What that means, in practical terms, is that to stop one person who will go on to become violent again in the future, society must lock up at minimum one person who will NOT; for sex offenders, at least three non-recidivists must be detained for every recidivist. This, of course, is problematic from a human rights standpoint. 

    Another key finding that goes against conventional wisdom was that actuarial instruments that focus on historical risk factors perform no better than tools based on clinical judgment, a finding contrary to some previous review.

    The researchers included the nine most commonly used risk assessment tools, out of the many dozens that have now been developed around the world:
    • Level of Service Inventory-Revised (LSI-R) 
    • Psychopathy Checklist-Revised (PCL-R) 
    • Sex Offender Risk Appraisal Guide (SORAG) 
    • Static-99 
    • Violence Risk Appraisal Guide (VRAG) 
    • Historical, Clinical, Risk management-20 (HCR-20) 
    • Sexual Violence Risk-20 (SVR-20) 
    • Spousal Assault Risk Assessment (SARA) 
    • Structured Assessment of Violence Risk in Youth (SAVRY) 
    Team leader Fazel, of Oxford University, and colleagues stressed several key implications of their findings:
    One implication of these findings is that, even after 30 years of development, the view that violence, sexual, or criminal risk can be predicted in most cases is not evidence based. This message is important for the general public, media, and some administrations who may have unrealistic expectations of risk prediction for clinicians. 

    A second and related implication is that these tools are not sufficient on their own for the purposes of risk assessment. In some criminal justice systems, expert testimony commonly uses scores from these instruments in a simplistic way to estimate an individual’s risk of serious repeat offending. However, our review suggests that risk assessment tools in their current form can only be used to roughly classify individuals at the group level, and not to safely determine criminal prognosis in an individual case. 

    Finally, our review suggests that these instruments should be used differently. Since they had higher negative predictive values, one potential approach would be to use them to screen out low risk individuals. Researchers and policy makers could use the number safely discharged to determine the potential screening use of any particular tool, although its use could be limited for clinicians depending on the immediate and service consequences of false positives. 

    A further caveat is that specificities were not high -- therefore, although the decision maker can be confident that a person is truly low risk if screened out, when someone fails to be screened out as low risk, doctors cannot be certain that this person is not low risk. In other words, many individuals assessed as being at moderate or high risk could be, in fact, low risk. 

    My blog post on these researchers' previous meta-analytic study, Violence risk meta-meta: Instrument choice does matter, is HERE.

     
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