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Diagnostic field reliability in forensic mental health evaluations
W Neil Gowensmith1, Stephanie N Sessarego1, Meghan K McKee1
1Graduate School of Professional Psychology, University of Denver.
Psychological Assessment
|June 9, 2017
Summary
Forensic evaluators showed varying diagnostic agreement. While agreement on individual disorders like psychosis or mood was high, combined diagnoses and evaluations in jails showed lower consensus, impacting forensic mental health assessments.
Area of Science:
- Forensic Psychology
- Psychiatry
- Mental Health Law
Background:
- Diagnostic agreement among forensic evaluators is crucial for consistent legal and clinical decision-making.
- Previous research has not extensively documented inter-rater reliability in routine, field-based forensic mental health evaluations.
Purpose of the Study:
- To quantify the extent of diagnostic agreement among multiple independent forensic evaluators in routine mental health evaluations.
- To identify factors influencing diagnostic agreement and disagreement in forensic settings.
Main Methods:
- Analysis of 720 evaluation reports from 240 cases, each with diagnoses from 3 independent forensic evaluators.
- Examination of agreement across 6 diagnostic categories and specific diagnostic combinations.
Main Results:
- Perfect agreement across all categories occurred in 18.3% of cases.
- High agreement (over 64.7%) was observed for individual psychotic, mood, or substance disorders.
- Agreement decreased significantly for combined diagnoses (e.g., psychotic and substance-related, 46.5%) and was lower in jail evaluations.
- Psychiatrists and contracted evaluators showed higher disagreement rates than psychologists and state-employed evaluators.
Conclusions:
- Diagnostic agreement in forensic mental health evaluations is variable, particularly for complex diagnostic profiles.
- Factors such as evaluator type, employment status, and evaluation setting (e.g., jail) influence diagnostic consistency.
- Findings support the need for practice and policy recommendations to enhance diagnostic reliability in forensic mental health assessments.
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