An integrative review exploring decision-making processes in forensic psychopathology investigations

Forensic psychopathology assessments play a critical role in legal decisions, particularly those related to criminal responsibility. However, despite their influence, the decision-making processes behind these assessments remain largely underexplored and inconsistently supported by empirical evidence. Emerging literature suggests that these decisions are shaped by multiple factors, including individual reasoning styles, team dynamics, and the influence of cognitive biases.

To explore the factors that influence expert decision-making in forensic psychopathology evaluations, with a focus on cognitive bias, procedural complexity, and the use of structured tools.

An integrative review guided by Cooper's framework was conducted. Eight studies meeting inclusion criteria were analyzed using narrative synthesis and thematic coding.

Three key themes were identified: (1) cognitive bias as a pervasive influence on expert judgment, (2) the iterative and context-dependent nature of forensic decision-making, and (3) inconsistencies between subjective clinical reasoning and structured assessment tools. While structured professional judgment tools and validated instruments showed potential for increasing accuracy and inter-rater reliability, their use remained uneven. Additionally, experienced clinicians often favored subjective judgment over formalized methods, which may limit transparency and reproducibility. The review highlights the need to reframe forensic evaluation as a reflective, evidence-informed process grounded in transparency and standardization. Integrating structured methods and debiasing strategies from other medical disciplines may enhance the validity and fairness of forensic judgments. These findings have implications for clinical training, interdisciplinary collaboration, and legal policy, and underscore the urgency of further research in this underdeveloped area of forensic mental health.