Record-breaking fee for competency report?

Forensic psychologists: If someone ever complains about your bill, you might want to share this little factoid:

A psychiatrist's competency report in the Brian David Mitchell case (Elizabeth Smart kidnapping in Utah) cost a whopping half million dollars.

And that was just for the report. It doesn't include the cost of expert testimony at Mitchell's competency hearing, currently in progress. And, believe it or not, that was the discounted rate.

Granted, Michael Welner's report was 206 pages long, and took 1,000 hours to produce. That makes the hourly fee $500, not inordinately high for a prominent forensic psychiatrist. But 1,000 hours is an awful lot of time to devote to any one case.

In testimony today, the prosecution's expert testified that in addition to evaluating Mitchell, he also did research on polygamy, the Mormon church, and related issues of revelation, prophets and Joseph Smith.

His bottom-line conclusion: Mitchell was motivated more by lust than religion or psychosis.

If anyone knows of a higher fee for a forensic report, or even a fee that comes close to this one, please let me know and I'll post your response.

Desert News coverage is HERE. An interesting commentary on Welner's controversial role -- and his fee -- in Andrea Yates' sanity trial is HERE. For more background on both Welner (author of the "Depravity Scale") and the Mitchell competency hearing, see my Sept. 1 post.

Bank account: A simple solution to crime?

Ever thought about how hard it would be to take care of basic business without a bank account or credit cards?

In the UK, an experimental project to open bank accounts for paroling prisoners has led to a remarkable finding: The ex-cons who got bank accounts were only half as likely as other parolees to reoffend.

And here's another remarkable finding: Four out of five of these guys had never had a bank account before.

What's the magic of banking?

The magic lies in being treated like a human being, says prison correspondent Eric Allison (himself an ex-prisoner) in today's Guardian of UK:

Some things are so blindingly obvious, their very dazzle prevents us from seeing them; of course having a bank account will go a long towards preventing reoffending; try getting a job, or accommodation, without one…. Prison service and the public take note, the more you do to integrate prisoners back into society, the less likely they are to reoffend. Treat those leaving our jails as normal human beings and you may be pleasantly surprised by the results.

Allison quotes a couple of prisoners saying pretty much that:

• "Having an account gave me a sense of self-respect, made me feel part of society."

• "It [the account] opened many doors and gave me a sense of identity."

Of course, science-minded readers will recognize that correlation does not equal causation. Perhaps there was some type of selection bias. Maybe prisoners motivated to "go straight" were more interested in bank accounts.

Nonetheless, just like restoring prisoners' right to vote, it is a pretty low-cost measure considering the potential benefits.

More information on the study is available from the Research Unit for Financial Inclusion at Liverpool John Moores University. Other interested articles on prison issues in the UK by Eric Allison are here.

Hat tip: Robert Forde

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Can we tell which juveniles will sexually reoffend?

Juvenile recidivism is a hot topic in the sex offender field these days. It would be great if we could figure out which young sex offenders are at high risk to offend again. After all, the federal SORNA law mandates that certain juvenile sex offenders be listed on public registries and report to law enforcement every 90 days for a full quarter-century.

But predicting which adolescents are at risk to sexually reoffend as adults is no easy task. Perhaps the biggest impediment is the low base rate: The large majority of underage males who commit a sex crime will not be charged for another sex crime as an adult. So, any prediction that a juvenile will sexually reoffend is likely to be wrong -- what we in the field call a "false positive."

Although several new instruments have popped up with the express goal of increasing the accuracy of juvenile sex offender risk prediction, none has the established reliability or validity to be ready for prime time, according to a new article in Behavioral Sciences and the Law.

"At this time, research does not support the use of any of the specialized risk assessment instruments for the task of predicting sexual recidivism in adolescents…. Unfortunately, legislatures enacting laws regarding civil detainment and registration of adolescent sexual offenders have not been dissuaded by studies demonstrating an inability to accurately predict which adolescents are most at risk for subsequent sex offenses."

Scientifically proven instruments or not, we will still be called upon to conduct such evaluations. And if we refuse, the article's authors point out, courts will just rely upon flawed data or the recommendations of prosecutors.

With that in mind, Michael Vitacco, associate director of research at the Mendota Mental Health Institute in Wisconsin, and his colleagues provide a set of recommendations for forensic psychologists who conduct risk assessments of juvenile sex offenders. These include:

• First and foremost, remember the low base rates and the consequently high risk of false positives, with devastatingly dire consequences to young people's futures.

• Understand adolescent sexual development, including hormonal issues and the brain's structural maturation. Adolescent sexual behavior is fluid, and any risk prediction should be very short-term.

• Be familiar with the literature on treatment efficacy with youth (such as that conducted by Michael Caldwell, Elizabeth Cauffman, and others). Much more so than adults, even the most serious adolescent offenders are amenable to high quality, empirically validated treatments.

• Give proper weight to a youth's social context, including peers, family, community, and school factors. These are enormously influential in youth behavior.

The entire issue of Behavioral Sciences & the Law is focused on adolescent sex offending. The abstract of the article, Assessing risk in adolescent sex offenders: Recommendations for clinical practice, by Vitacco, M.J., Caldwell, M., Ryba, N.L., Malesky, A., & Kurus, S.J. (2009), is online. 

Readers may also be interested in an appellate ruling of first impression on the retroactivity of the Sex Offender Registration and Notification Act (SORNA) as applied to former juvenile offenders. In the aptly titled case of US v. Juvenile Male, No. 07-30290, the 9th Circuit ruled that the new federal law is unconstitutional as applied to juveniles who committed their crimes before the law was enacted.

Asperger's ruling: Judge should have allowed experts

In the latest of several recent forensic cases involving Asperger's, an appellate court has ruled that a judge committed a reversible error in excluding expert evidence on the condition.

The 9th U.S. Circuit Court of Appeals overturned seven counts of arson against a California physicist who with his buddies had vandalized and torched more than 130 vehicles back in 2003.

William "Billy" Cottrell is described in news accounts as a talented young physicist who was diagnosed with Asperger's, a high-functioning form of autism, during his 2004 trial for arson and conspiracy.

In its ruling, the appellate court let stand a conviction for conspiracy. But the court held that aiding and abetting of arson requires a specific intent in that Cottrell must have knowingly participated in the crimes and tried through his actions to make them succeed. Thus, it was reversible error not to allow expert evidence of a mental condition that might have impacted the defendant's subjective judgments.

The defense had proposed a theory in which Asperger's prevented Cottrell from understanding what his friends were up to until it was too late; once he figured it out, he supposedly tried to stop them.

Local mental health professionals quoted in the Pasadena Star-News differed as to whether an Asperger's defense might have succeeded in mitigating Cottrell's culpability.

On the one hand, psychologist Bruce Hirsch said Asperger's could have reduced Cottrell's ability to understand the situation, as people with the condition often cannot tell when they are being lied to.

"What you're really talking about is a social naivete and, yes, people with Asperger's can be very socially naive," Hirsch is quoted as saying. "They are so bound to the truth that the concept of lying doesn't even exist in their mind. Somehow the social reasoning of people with Asperger's is very concrete, very black and white, and they don't get that people tell lies."

On the other hand, marriage and family therapist Amy Keller said the defense theory of Asperger's does not take into account the rigid morality of most Asperger's patients.

"I find that, after working with a lot of Asperger's patients, that they are so stubborn," Keller told the newspaper. "They're not that easily influenced. If anything, they're very clear about right and wrong."

Either way, the appellate reversal will not have a practical import on Cottrell. Prosecutors decided not to retry him, because it would not have impacted his 100-month federal prison term.

Cottrell will soon be taking the bus back to the Arizona federal prison where he teaches physics and cosmology classes to fellow prisoners.

The unpublished opinion in U.S. v. William Cottrell is HERE; the most recent Pasadena Star-News story is HERE.

Hat tip: Ken Pope

Further resources:

• Asperger’s: Here today, gone tomorrow: Would erasure from DSM impact forensic use? (Nov. 3, 2009 blog post)
• The short life of a diagnosis (Nov. 9, 2009 New York Times op-ed by Simon Baron-Cohen)
• Forensic aspects of Asperger's Syndrome, Barry-Walsh, J.B., & Mullen, P.E., Journal of Forensic Psychiatry, 2004, Volume 15, pages 96-107.

Wales: Another prime-time automatist

In my last post, I blogged about the Toronto sexual assault case in which a man was acquitted on the grounds that he was asleep. Now, I bring you a second high-profile case of sleep disorder, that of a Welch man acquitted in the killing of his wife because he was dreaming at the time.

Sleep experts for the prosecution and defense agreed that Brian Thomas's behavior was consistent with automatism, meaning at the time he killed his wife, his mind had no control over what his body was doing.

During last week's trial, the jury was instructed that there are two types of automatism: insane automatism and non-insane automatism. Based on which type they chose, Thomas could have either been acquitted or found not guilty by reason of insanity and hospitalized.

But suddenly, in mid-trial, the prosecutor had second thoughts and dropped his effort to obtain an NGI verdict, allowing Thomas to walk free. A prosecution psychiatrist, Dr. Caroline Jacob, had testified that Thomas was not a risk to the public.

Thomas was described as a gentle family man who had been married to his childhood sweetheart for 40 years. He called police to say he had killed his wife because he thought she was an intruder.

Click on above image to see a brief video of Thomas after the acquittal

In an odd coincidence, the Journal of Forensic Sciences had just published an article describing clinical cases with eerie similarity to Thomas's. Carlos Schenck and colleagues at the Minnesota Regional Sleep Disorders Center found about 40 cases in the literature in which people, mainly men, had engaged in complex and violent behaviors while enacting dreams. The authors found a pattern with clear forensic implications, because dream behaviors could be misinterpreted as suicidal or homicidal. That's what happened in Thomas's case: To his family's dismay, he spent 10 months in jail awaiting trial. The actual cause of such behaviors, according to the article, is not malice but Rapid Eye Movement sleep behavior disorder (RBD), in which the normal muscle atonia present during REM sleep is absent, allowing sleepers to physically enact their dreams.

In a strong similarity to Thomas's case, the majority of cases involved choking and headlocks. Thomas had gotten his wife in a headlock and then strangled her.

In another similarity, in about half the cases the patient either had a neurologic disorder or was taking medication for psychiatric disorders. Thomas had just stopped taking antidepressant medication, and the withdrawal was causing nightmares.

What were the other most common behaviors found in the study?

In second place was jumping off the bed. And in third place, with seven cases, came defenestration. That one might have been difficult here, as Thomas and his wife were vacationing in an RV at the time of the killing.

The BBC has further coverage of the case. The abstract of the Journal of Forensic Sciences article, Potentially Lethal Behaviors Associated With Rapid Eye Movement Sleep Behavior Disorder: Review of the Literature and Forensic Implications, is HERE.