Treatment Evaluation in Forensic Psychiatry. Which One Should Be Used: The Clinical Judgment or the Instrument-based Assessment of Change?

Abstract

In forensic psychiatry, it is common practice to use an unstructured clinical judgment for treatment evaluation. From risk assessment studies, it is known that the unstructured clinical judgment is unreliable and the use of instruments is recommended. This paper aims to explore the clinical judgment of change compared to the calculated change using the Instrument for Forensic Treatment Evaluation (IFTE) in relation to changes in inpatient violence This study shows that the clinical judgment is much more positive about patient’s behavioral changes than the calculated change. And that the calculated change is more in accordance with the change in the occurrence of inpatient violence, suggesting that the calculated change reflects reality closer than the unstructured clinical judgment. Therefore, it is advisable to use the IFTE as a base to make a structured professional judgment of the treatment evaluation of a forensic psychiatric patient.