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The Effect of Risk Assessment Data and Colleagues' Consensus on Clinical Decisions to Discharge Insanity Acquittees


Every day, in psychiatric institutions, forensic clinicians face the complex task of making decisions to discharge violent mentally disordered offenders back into the community. Because unaided violence risk prediction can be faulty and the process of discharge determination is poorly understood, clinicians are left to make judgments under uncertainty. This study sought to answer two research questions: (1) Does the presence of and information presented in an actuarial risk assessment influence clinicians' discharge readiness decisions and their confidence in such decisions? and (2) Does the suggestion effect presented by the recommendation of the community transition program and/or treatment team affect discharge decisions? The study utilized a web-based clinical vignette that was presented to clinicians at Patton State Hospital. The vignette presented a realistic scenario and was varied in 18 ways, based on risk assessment data, treatment team consensus, and community transition program consensus. The absence of a risk assessment or the presence of a high-risk assessment was a significant predictor of a negative discharge recommendation, while a positive community transition program consensus or positive treatment team consensus was a significant predictor of a positive recommendation. A positive recommendation from the community transition program was the strongest predictor overall. Most clinicians felt moderately to very confident in their discharge decisions. None of the possible mediating variables provided complete mediation between the predictor variables and discharge decision.

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