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Psychological Assessment Categorizing of Assessment - Past mental state: insanity/criminal responsibility - Present mental state: fitness to stand trial - Future mental state: risk of violence Fitness to Stand Trial: Canadian Criminal Code - “Is unable on account of mental disorder to conduct defence at any stage of the proceeding before a verdict is rendered or to instruct counsel to do so, and in particular, unable on account of mental disorder to a) understand the nature or object of the proceedings, b) understand the possible consequences of the proceedings, or c) communicate with counsel.” Domains of Adjudicative Competence - Capacity to comprehend and appreciate the charges or allegations o Factual knowledge of the charges (ability to report charge label) o Understanding the behaviours to which the charge refers o Comprehension of police version of events - Capacity to disclose to counsel pertinent facts, events, and states of mind o Able to provide reasonable account of behaviour around time of offense o Able to provide information about state of mind around time of offense o Able to provide account of behaviour - Capacity to comprehend and appreciate range and nature of possible penalties o Knowledge of penalties that could be imposed o Comprehension of seriousness of charges and possible sentences - Basic knowledge of legal strategies and options o Understanding of the meaning of alternative please (e.g. guilty and NCRMD) o Knowledge of the plea bargaining process - Able to engage in reasoned choice of legal strategies and options o Able to comprehend legal advice and participate in planning a defense strategy o Able to appraise likely outcome (i.e. likely disposition for own case) o Understanding of implications of guilty plea or plea bargain (e.g. rights waived after guilty plea) o Able to make reasoned choice of defense options without distortion attributable to mental illness - Capacity to understand the adversary nature of the proceedings o Understanding role of courtroom personnel (i.e. judge, jury, crown attorney) o Understanding courtroom procedure (i.e. basic sequence of trial events) - Capacity to show appropriate courtroom behaviour o Understanding of appropriate courtroom behaviour and ability to manage own emotions and behaviour - Capacity to participate in trial o Able to track events as they occur o Able to challenge witnesses (i.e. to recognize distortions in witness testimony) - Capacity to give relevant testimony - Appropriate relationship with counsel o Awareness that counsel is an ally o Appreciation of attorney-client privilege; trust and confidence in one’s attorney - Medication issues o Able to track proceedings and communicate with counsel given level of sedation o Possible negative effects of medication on courtroom behaviour Conducting Fitness Assessments - 5 days allowed for psych evaluation; extension possible to 30 days; detention not to exceed 60 days o Only medical practitioners (e.g. psychiatrists) can conduct fitness assessments

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Even if medical practitioner has no training or experience in psychiatry or psychology

Four Types of Fitness Instruments - General tests for psychopathology (MMPI, )MCMI - Neuropsychological batteries to detect brain damage (Luria-Nebraska, Halstead-Reitan) - Intelligence tests to detect retardation (WAIS (Weschler Adult Intelligence Scale), Stanford-Binet) - Tests specific for the fitness criteria (MacCAT-CA, FIT-R) o Fitness Interview Test – Revised (FIT-R)  Understanding nature/object of proceedings  Understanding possible consequences of proceedings  Ability to communicate to counsel  Zapf & Roesch (1997): 86% agreement between FIT-R and institutional assessment; no false negatives Two Elements of a Crime - Actus reus: the criminal act itself - Mens rea: intent to commit a criminal act History of Insanity Verdict - Hadfield case (1800): planned assassination of King George III o Standard: “lost to all sense, incapable of forming a judgement upon the consequences of the act which he is about to do.” o Erksine: Hadfield lost to reality; his delusions “unaccompanied by frenzy or raving madness” were insanity o Judge acquits, orders confinement o Parliament passes Criminal Lunatics Act, mandating detention for the insane - M’Naughten case (1843): planned murder of PM o Not guilty by reason of insanity o Standard: “at the time of committing the act, he was laboring under such a defect of reason from disease of the mind as not to know the nature and quality of the act he was doing, or if he did know it, that he did not know what he was doing was wrong.” (right/wrong test) o Key aspects of the M’Naughten definition  Suffering from a defect of reason due to disease of the mind  Ignorant of natural and quality of the act; or  Unaware, or unable to determine, that the act was wrong - American Law Institute (1962) o If at the time of his conduct as result of mental disease or defect he lacks substantial capacity either to appreciate the criminality (wrongfulness) of his conduct or to conform his conduct to the requirements of the law.  Bolded above section is less restrictive than M’Naughten rule - Canada Criminal Code (C-30) of 1992: Not Criminally Responsible on Account of Mental Disorder (NCRMD) o Standard: “no person is criminally responsible for an act committed or an omission made while suffering from a mental disorder that rendered the person incapable of appreciating the nature and quality of the act or omission or of knowing that it was wrong.” Not Criminally Responsible on Account of Mental Disorder (NCRMD) - Defendant can raise it as a defense and Crown can argue it - Crown can raise following a guilty verdict, if Crown thinks defendant requires psychiatric treatment in a facility - Proof standard: “beyond a balance of the probabilities” - NCRMD = unconditional release unless defendant poses risk to the public

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Assessment Methods for NCRMD - Clinical interview (structured or unstructured): SADS (schedule for affective disorders and schizophrenia), SIRS - Objective personality tests: MMPI-2 (multiphasic personality inventory), MCMI (multiaxial inventory) - Projective personality tests: Rorschach inkblot test, TAT (thematic apperception test) - Cognitive and intelligence tests: WAIS-R, WMS-R (Weschler memory scale) - Neuropsychological tests: Luria-Nebraska neuropsychological battery, Halstead-Reitan neuropsychological battery o Five scales: patient reliability, organicity, psychopathology, cognitive control, behavioural control - Specific forensic instruments: R-CRAS (Rogers Criminal Responsibility Assessment Scales) Test % Psychologists Using % Psychiatrists Using MMPI-MMPI-2 94% 80% MCMI 32% 17% Rorschach 32% 30% TAT 8% 10% WAIS 78% 57% WMS-R 16% 0% Bender VMGT 12% 20% R-CRAS 41% 10% SIRS 12% 0% Clinical Interview - Begins with simple medical/psychiatric history (When? What? What done?) - Minimize clinician influence on defendant’s recall with simple, open-ended questions - Work through the day of the offense (When did you get up? What happened next? What were you thinking when…?) - Work through days before offense - Rogers strategies for getting more recall, and disrupting memorized or rehearsed narratives o Ask subject to re-experience the day or time, as though a video camera were recording it: What would the camera have recorded? o Ask about events in reverse chronological order: What happened before that? Schedule for Affective Disorders and Schizophrenia (SADS) - Goes beyond DSM-IV to assess clinical characteristics and associate features of psychotic and mood disorders; also partly covers anxiety, abuse and substance disorders - Semi-structured diagnostic interview: assesses many axis I disorders (takes about 90 to 150 minutes) - Part I addresses current episode from two perspectives: the worst time and the past week or so - Part II designed to assess past episodes, nature of diagnoses and treatments - Supplement, not replace, clinical judgement Projective Tests - Based on psychodynamic perspective: assume primacy of unconscious factors in personality, behaviour - Projection of unconscious factors onto ambiguous stimulus - Tests involve questions with minimal structure, minimal restriction on responses - Standardized administration, less standardized scoring: interpretation of scores depends on clinical judgement Rorschach Inkblot Test - Oldest standardized personality test: developed in 1921 by Swiss psychoanalyst; intended for use in clinical diagnosis - Series of ten symmetrical inkblots: five are black and grey, two are black, grey, and red, three multi-coloured - Blots are presented in specific order prescribed by Rorschach: o Free association: blots shown to the subject who is asked to indicate what they see in the blot o Inquiry phase: clinician goes through blots again to ascertain what aspects of the blot led to that response o Testing the limits: examiner tries to elicit the usual or typical responses to each blot - Test time: 45-60 minutes

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Scoring the Rorschach - Location: what part of blot used (whole or part) - Determinants: forms, shading, colour, or apparent movement - Content: object, animal, human - Original or popular response: are perceptions bizarre/unusual for this blot? - Form level: is percept congruent with the characteristics of the blot? - Relationships: thematic similarities between objects seen in several blots (e.g. aggression, submission to authority, danger, etc.)

Objective Tests - No specific assumption about the appropriate perspective on personality - Taps overt, conscious factors: feelings, attitudes, and personal characteristics (taken as true indication of those) - Are distinguished from projective tests by restricting the number of alternatives (primary difference) - Always have clear and standardized administration and scoring procedures - More likely than projective tests to have a clear, standardized, and relatively objective and interpretation process Minnesota Multiphasic Personality Inventory (MMPI-2) - Originally published by Hathaway and McKinley in 1942 as a device to assist in diagnosis of psychiatric patients - Unlike previous tests in which content validity was used to choose items, author used empirical validity to select items - Authors chose large number of items from variety of sources (psychiatric texts, descriptions of psychiatric exams) - Chose items whose answers differentiated between one pathological group and others; between that group and normal - Subject indicates whether each statement applies to them by responding “YES,” “NO,” or “CAN’T SAY” - Little clinical judgement required, computerization possible - Items selected for empirical validity o “People are out to get me,” “I am hoppy most of the time,” “I believe I am a condemned person.” MMPI Scoring - Item is scored as a plus on a scale if test-taker answers it in the same way as those in the clinical group o “I am very energetic,” “People are out to get me,” “I hardly ever lose an argument” - Results (scored by hand or computer) presented as profile, connecting the scores on each scale - Raw scores transformed to standard scores (T scores), with mean of 50 and standard deviation of 10 - High scores are typically those over 70; same score may mean different levels of abnormality on different scales MMPI Clinical Scales - Each scale has name indicating original clinical group it was designed to detect; but since high scores on single scale do not correlate well with specific disorder, clinicians generally use scale number rather than name - Scale 1 – Hypochondriasis (Hs): high scorers described as cynical, critical, demanding, and self-centered; not good candidates for psychotherapy o “I do not tire quickly,” (F) “I feel weak all over much of the time,” (T) “I have very few headaches” (F) - Scale – Depression (D): high scorers are moody, shy, despondent, pessimistic, distressed o “My sleep is fitful and disturbed,” (T) “I certainly feel useless at times,” (T) “I brood a great deal” (T) - Scale – Hysteria (Hy): high scorers outgoing, but repressed, naïve, psychologically immature o “It takes a lot of argument to convince most people of the truth,” (F) “I think most people would lie to get ahead,” (F) “What others think of me does not bother me” (F) - Scale 4 – Psychopathic Deviate (Pd): high scorers impulsive, hedonistic, antisocial, often have trouble with authority; low scorers are conventional, conforming, moralistic o “I believe that my home life is as pleasant as that of most people I know (F),” “I have never been in trouble with the law (F),” “I have used alcohol excessively (T)”

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Scale 5 – Masculinity-Femininity (MF): measures identification with culturally conventional sex-typed interest patterns (items are obvious and easy to fake); high males are sensitive, aesthetic, passive, feminine (highly educated males show up higher), high females are aggressive, rebellious, unrealistic o “I would like to be a florist,” “I like science,” “I enjoy reading love stories” - Scale 6 – Paranoia (Pa): high scorers suspicious, aloof, shrewd, guarded, overly sensitive; sometimes paranoid persons get very low scores, since they are being defensive o “I am sure that I get a raw deal from life (T),” “I believe I am being followed (T)”, “I have no enemies who really wish to harm me (F)” - Scale 7 – Psychasthenia (Pt): reflects chronic or trait anxiety, self-doubt, general dissatisfaction, agitated concern about self; high scorers tense, anxious, ruminative, preoccupied, obsessional, phobic; feel inferior and inadequate o “Life is a strain for me much of the time,” (T) “Almost every day something happens to frighten me,” (T) “I have more trouble concentrating than others seem to have” (T) - Scale 8 – Schizophrenia (Sc): reflects feelings of being different, of isolation, bizarre or peculiar thought processes and perceptions, tendency to withdraw into fantasy; high scorers withdrawn, shy, unusual thoughts/ideas o “I have strange and peculiar thoughts,” (T) “No one seems to understand me,” (T) “I often feel as if things were not real” (T) MMPI Clinical Scales (cont’d) - Scale 9 – Mania (Ma): high scorers sociable, outgoing, optimistic, restless, impulsive; sometimes flighty, confused o “Once a week or more often I become very excited,” “I do not blame a person for taking advantage of someone who lays himself open to it,” “I have periods of great restlessness” - Scale 0 – Social Introversion-Extraversion (Si): high scorers modest, withdrawn, inhibited; low scorers sociable, outgoing, confident o “I find it hard to make talk when I meet new people (T),” “I like to be in a crowd who plays jokes on one another (F),” “I seem to make friends about as quickly as others do (F)” MMPI Validity Scales - In addition to clinical scales, test items are grouped on 8 validity scales, designed to detect individuals not answering appropriately, possibly due to: o Inattention, carelessness o Problems reading, understanding questions o Boredom, lack of motivation o Deliberate attempts to look good or bad - Eight validity scales (three main scales) o Lie Scale (L): 15 items to detect simple attempts to ‘fake good;’ contains items rationally chosen to reflect common weaknesses, and usually answered a certain way if the respondent is honest:  “Sometimes I get so mad I want to cry (F),” “I always tell the truth (T),” “I do not like everyone I know (F)”, “I get angry sometimes” (F) o Defensiveness Scale (K): 30 items to detect more subtle defensiveness than L scales; high score indicates defensiveness, low score may indicate excessive self-criticism or attempt to ‘fake bad’; high scores usually indicate faking good, or a reluctance to admit psychopathology (hysterical patients have elevated K scores)  “I certainly feel useless at times (F),” “At times I feel like smashing things (F),” “At times I feel like swearing (F)” o Careless Scale (F): 60 items rarely agreed to; can be seen as reflecting the number of seriously psychopathological items endorsed, designed to detect deviant or atypical ways of responding  “My soul sometimes leaves my body (T),” “Someone has control over my mind (T),” “I see things, animals, or people around me that others do not see (T)”  Reasons for high F score: reading difficulty, faking bad, psychosis, plea for help through exaggeration of symptoms, adolescent defiance/hostility/negativism o Superlative presentation scale (S), 50 items: used in personnel testing to identify individuals who claim high moral values, few or no personal faults, no adjustment problems o Infrequency-back scale (F(B)), 40 items: rarely endorsed items near the end of the MMPI-2; F scale items are all at the beginning (within first 370 items) o Psychiatric infrequency scale (F(P)): to detect malingering of psychological symptoms

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Variable response inconsistency scale (VRIN): used to detect random responding True response inconsistency scale (TRIN): detects tendency to answer true, or answer false, without regard to item content

MMPI Interpretation - Done by looking at the overall profile and/or at the 1, 2, or 3 scales with highest scores - A number of specific two-point and three-point profiles have been described - Usually in trouble with law, or with families - Impulsive, unable to delay gratification; little respect for social standards; may abuse alcohol, drugs - Energetic, social, outgoing; feel introverted, self-conscious, inadequate Data on Forensic Reliability - Test-retest reliability over short periods of time is good o Over a single day or less, about .80-.85 for normal and higher for psychiatric patients (less for criminals) o Over 1-2 weeks, .70-.80 for normal, higher for psychiatric cases lower (.60-.70) for criminals o Long-term test-retest reliability not too high: over a year or more, .35-.45 for normal, .50-.60 for psychiatric patients, no data for criminals Data on Forensic Validity - The validity of the MMPI for making clinical judgements is not high, but is better than most other single measures - Many studies show correlates between individual scale scores and non-test variables for a variety of populations o Studies also show correlates between configurations of two or more scales and non-test variables for an equal variety of populations - Rogers and Shuman do not support the use of the MMPI-2 in insanity evaluations Criticisms of MMPI - Original norming sample limited, outdated (non-patients might respond differently today) - Cultural, subcultural difference on some scales - Meaning of scores varies with age, sex: - Some items outdated, sexist, offensive (“Streetcar,” “I like to take a bath,” “I like mechanics magazines”) - Some items emphasized Christian beliefs (“I go to church almost every week”) - Takes a long time to complete (60-90 minutes) for normal, sometimes over 2 hours for others - Some items found on several scales – as many as six, so ten clinical scales are highly intercorrelated MMPI-2 Changes - New normative sample: o 2600 participants from 7 states; better racial/ethic mix o More representation from higher SES o Included large adolescent sample - Offensive, outdated items dropped - New scoring forms for adults, adolescents - Statements added: drug abuse, suicide risk, Type A behaviour, marital adjustment, work attitudes Millon Clinical Multiaxial Inventory (MCMI) - Developed by Millon in late 1970s, based on his model of psychopathology/personality disorders - Chose large number of true/false items based on theoretical considers o “I often think of ending my life,” “I feel sad all the time,” “I do not care if I win or lose” - Normed on 200 clinical patients - 175 items, 20 clinical scales; 22 on MCMI-II (1987) MCMI-III Development (1994) - Has 24 clinical scales in four clusters: personality, severe personality, clinical syndrome, severe clinical syndrome - 175 T/F items taking ~30 minutes to complete; designed to be used with emotionally disturbed patients

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MCMI-III Personality Disorder Scales - 11 Moderate Disorder Scales o 1 – Schizoid (16 items): aloof, apathetic, problem relationships o 2A – Avoidant (16): socially anxious, expecting rejection o 2B – Depressive (15): downcast, gloomy o 3 – Dependent (16): passive, submissi...