The nature and consequences of forensic psychiatric decision-making

Data collected from the Metropolitan Toronto Forensic Service (METFORS) were examined to determine factors affecting psychiatric assessments completed for the courts. Psychiatric history is found to be a salient factor for fitness to stand trial decisions; prior violence and the type of charge influence dangerousness to others determinations. Variables affecting whether or not a patient is recommended for further assessment include fitness: 78% of those found fit and 100% of those for whom fitness was unclear were recommended for further assessment in 68% of the cases. Patients who were threatening or acting out were not for the most part hospitalized. Relatively high correlations between psychiatric recommendations derived from these assessments and the actual judicial dispositions suggest that knowledge of the extra legal factors and biases which enter into the decisions should be more widely considered in the legal setting.