Douglas Mossman

• MD
• Managing Director at University of Cincinnati

Ethics guidelines recommend that forensic mental health professionals begin in-person assessments by explaining the nature and purpose of the examination. To learn whether evaluees have understood and can give consent, forensic practitioners may ask evaluees to paraphrase the explanation. This article explores how a forensic evaluee's disclosure re...

Just as baseball provides fans with endless topics for discussion and debate, risk assessment provides mental health professionals with limitless questions about what factors really matter and how to sort through them. This article uses our national pastime to illustrate types of risk assessment and to explain how risk assessment tools apply statis...

Although many defendants referred for evaluations of competence to stand trial (CST) attempt to feign mental illnesses or cognitive impairment, most structured CST assessment tools contain no measure designed to screen for malingering. To address this, Gothard and colleagues (1995) created the Atypical Presentation Scale (APS), an eight-item instru...

This study examines the accuracy of the Test of Memory Malingering (TOMM), a frequently administered measure for evaluating effort during neurocognitive testing. In the last few years, several authors have suggested that the initial recognition trial of the TOMM (Trial 1) might be a more useful index for detecting feigned or exaggerated impairment...

The ethics guidelines for forensic mental health professionals direct practitioners to begin their in-person assessments by explaining the nature and purpose of the examination. To learn if evaluees have understood and can give consent, forensic practitioners may ask evaluees to paraphrase the explanation. Yet whether an evaluee can do this is itse...

Most medical diagnoses take the form of statements such as " Mr. Jones has D, " or " Mr. Jones does not have D, " where D represents some disease, disorder, condition, or syndrome. But such " has " and " does not have " declarations do not capture the real state of a physician's typical beliefs, which lack certainty and might better be expressed as...

Mental health professionals often use structured assessment tools to help detect individuals who are feigning or exaggerating symptoms. Yet estimating the accuracy of these tools is problematic because no "gold standard" establishes whether someone is malingering or not. Several investigators have recommended using mixed group validation (MGV) to e...

Civil commitment is the mechanism used by courts to order individuals to receive psychiatric treatment, usually within a hospital. Although jurisdictions vary, the legal criteria for commitment generally include the presence of mental illness and a resulting risk of harm to oneself or others if not hospitalized. Civil commitment may be authorized o...

Probability plays a ubiquitous role in decision-making through a process in which we use data from groups of past outcomes to make inferences about new situations. Yet in recent years, many forensic mental health professionals have become persuaded that overly-wide confidence intervals render actuarial risk assessment instruments virtually useless...

Mental health professionals often use structured assessment tools to help detect individuals who are feigning or exaggerating symptoms. Yet estimating the accuracy of these tools is problematic because no "gold standard" establishes whether someone is malingering or not. Several investigators have recommended using mixed-group validation (MGV) to e...

Background: Receiver operating characteristic (ROC) analysis allows investigators to quantify and describe how well a diagnostic system discriminates between two mutually exclusive conditions. The conventional “binormal” (CvB) curve-fitting model usually produces ROCs that “improper” in that they do not have the ever-decreasing slope required by si...

In their work on the MacArthur Treatment Competence Study, Paul Appelbaum, Thomas Grisso, and their colleagues warn that their "experimental measures" of decisional capacity "should not be interpreted as though they provide determinations of legal incompetence to consent to treatment." The authors of this article do not believe that Appelbaum et al...

Background: Receiver operating characteristic (ROC) analysis is the standard method for describing the accuracy of diagnostic systems where the decision task involves distinguishing between 2 mutually exclusive possibilities. The popular binormal curve-fitting model usually produces ROCs that are improper in that they do not have the ever-decreasi...

Aggression is a common management problem for child psychiatry hospital units. We describe an exploratory study with the primary objective of establishing the feasibility of linking salivary concentrations of three hormones (testosterone, dehydroepiandrosterone [DHEA], and cortisol) with aggression. Between May 2011 and November 2011, we recruited...

The last two decades have witnessed major changes in the way that mental health professionals assess, describe, and think about persons' risk for future violence. Psychiatrists and psychologists have gone from believing that they could not predict violence to feeling certain they can assess violence risk with well‐above‐chance accuracy. Receiver op...

The Brief Rating of Aggression by Children and Adolescents (BRACHA) is a 14-item instrument scored by emergency room staff members to assess aggression risk during an upcoming psychiatric hospitalization. In this study, we investigated the inter-rater reliability of the BRACHA 0.9, the latest version of the instrument. After receiving training base...

Previous investigators have suggested that bias might account for the disparate rates at which examiners conclude that defendants are competent to stand trial (CST). This article describes three computer studies of how biases and imperfect accuracy might affect rates of disagreement. Study 1 assumed that examiners could discriminate between compete...

Background: Previous investigators have suggested that bias might account for the disparate rates at which examiners conclude that defendants are competent to stand trial (CST). This article describes three computer studies of how biases and imperfect accuracy might affect rates of disagreement. Methods: Study 1 assumed that examiners could discrim...

Psychologists frequently use symptom validity tests (SVTs) to help determine whether evaluees' test performance or reported symptoms accurately represent their true functioning and capability. Most studies evaluating the accuracy of SVTs have used either known-group comparisons or simulation designs, but these approaches have well-known limitations...

Forensic mental health assessment (FMHA) has grown into a specialization informed by research and professional guidelines. This series presents up-to-date information on the most important and frequently conducted forms of FMHA. Each title contains a thorough discussion of the relevant legal and psychological concepts, followed by a step-by-step de...

This study evaluated the Brief Rating of Aggression by Children and Adolescents-Preliminary Version (BRACHA 0.8), an actuarial method of assessing the risk of aggressive behavior by hospitalized children and adolescents. Licensed psychiatric social workers used a 16-item questionnaire to assess all patients seen in the emergency department (ED) of...

Recently, several authors have suggested that only by incorporating findings from actuarial risk assessment instruments (ARAIs) can mental health experts provide evidence-based testimony in mental health commitment hearings. Determining eligibility for involuntary hospitalization seems like an appropriate, natural, obvious application of ARAIs. Sim...

Background: In medicine, diagnostic accuracy is usually evaluated against a near-infallible criterion - a "gold standard" - for true disease status. Most mental health classifications have no gold standard, however, and absence of agreed-upon truth is common for psycholegal assessments. Aims: To show that even without a gold standard, accuracy of...

The law has well-established provisions for handling divorce actions initiated on behalf of persons already adjudged incompetent or by competent petitioners against incompetent spouses. But how should a court respond if a mentally ill petitioner who is competent to manage most personal affairs seeks to divorce a spouse for bizarre, very odd, or cra...

This study asked whether latent class modeling methods and multiple ratings of the same cases might permit quantification of the accuracy of forensic assessments. Five evaluators examined 156 redacted court reports concerning criminal defendants who had undergone hospitalization for evaluation or restoration of their adjudicative competence. Evalua...

Ineffectiveness of prescription drugs, hidden drug hazards, and advertising violations have led to several drug recalls and numerous lawsuits against pharmaceutical companies in recent years. These suits have involved several varieties of medications, but psychoactive medications have figured especially prominently. A recent $1.4 billion settlement...

This article reviews what we currently know about the accuracy of risk assessments and the ability of mental health professionals to “connect the dots” that foreshadow violence. The problem with anticipating and intervening to stop rare but serious violence is not really a matter of connecting dots, but of having dots (more precisely, “risk factors...

Doctors typically think about medical errors as potential causes of malpractice litigation, as failures by individuals, and as evidence of personal incompetence that may deserve sanctions. Other professions take a different view: designing of safer systems, rather than criticism and punishment, is the way to prevent unintentional mishaps. In his ar...

This article describes a mathematical framework for conceptualizing the accuracy of forensic experts' opinions on competence to stand trial (CST) and explains how an expert's expressed opinion about CST can be decomposed into four elements: (1) contextual requirements of the defendant (determined partly by the defendant's past actions) that lie out...

Letters Section Editor: Robert M. Golub, MD, Senior Editor.

When discussing actuarial risk assessment instruments (ARAIs), Hart et al ([2007][1]) acknowledge that \`prediction' may refer to probabilistic statements (e.g. a \`prediction' that an individual \`falls in a category for which the estimated risk of violence was 52%': p. s60). For unclear reasons,

In a recent article, Vrieze and Grove (Law Hum Behav, doi:doi.org/10.1007/s10979-007-9092-x, 2007) argue that, because of low recidivism base rates and limited predictive accuracy, an actuarial risk assessment instrument (ARAI) may produce decisions about sex offenders that are worse than simply predicting that no one will commit another sex offens...

Over the last two decades, stalking has received increasingly widespread attention. The establishment of anti-stalking legislation has helped to spur interest in stalking research and the forensic assessment of stalkers. Popular representations of stalking have made the public more aware of this phenomenon. It has long been the responsibility of me...

This article provides a psychiatric perspective on the problems Atkins raises for courts that handle death penalty cases. In contrast to the overarching aim of the majority's opinion in Atkins - making the administration of capital punishment more equitable - the Supreme Court's latest prescription of psychiatric help may only add a new layer of co...

This Article takes a critical approach to the assumptions underlying current practices of violence risk assessment. The Article first explicates a fundamental difference between how mental health researchers now interpret the phrase violence prediction and how they understood that phrase in the 1970s. Applying a critical approach, the Article then...

In its June 2003 decision in Sell v. United States, the Supreme Court issued guidelines for forcible administration of medication to restore competence to stand trial. Among those guidelines is a requirement that the proposed treatment be medically appropriate. This requirement forces both testifying and treating physicians to consider some under-a...

U.S. courts frequently require forensic examiners to offer opinions concerning the likelihood that criminal defendants found incompetent to stand trial can have their competence "restored" through treatment. Yet no jurisdiction has established legal guidelines for testimony concerning restorability, and several authors have suggested that mental he...

Competence to stand trial is a legal construct used to identify those criminal defendants who have the requisite mental capacity to understand the nature and objective of the proceedings against them and to participate rationally in preparing their defense. This Practice Guideline has described how psychiatrists should evaluate individuals concerni...

The practice of child forensic psychiatry takes place amid ever-changing clinical, social, and legal issues, and a society whose work habits, family life, and communities are in constant flux. This chapter provides basic background information about the legal matters that child psychiatrists commonly encounter in their practices; it does not provid...

In the treatment of substance use disorders, it is advantageous to identify patients with comorbid (nonsubstance) psychiatric disorders because treating comorbid disorders improves outcome. Because accurate psychiatric diagnosis is time-consuming, there is a need for strategies to screen for these comorbid conditions. This study used receiver opera...

Several studies over the past decade have shown that simple rating scales can accurately rank sex offenders' long-term risk of recidivism. But when using these scales as prediction tools, evaluators often wish to translate categories of risk into probabilities of recidivism. D. M. Doren (2004) has recently suggested that evaluators may use the reci...

Daubert v. Merrell Dow Pharmaceuticals (1993) held that trial judges should permit expert scientific testimony only when "the reasoning or methodology underlying the testimony is scientifically valid, and ... properly can be applied to the facts in issue." Vallabhajosula and van Gorp ("V & vG," 2001) have suggested that when the Daubert standard is...

The insanity defense is a legal construct that excuses certain mentally ill defendants from legal responsibility for criminal behavior. This practice guideline has delineated the forensic psychiatric evaluation of defendants raising the insanity defense. The document describes acceptable forensic psychiatric practices. Where possible, standards of...

Antipsychotic medications figure prominently in the rapidly-growing field of mental disability law. Although the properties of antipsychotic medications are medical matters, legal scholars, judges, and practicing attorneys often need to understand what these drugs do. Yet the legal database - the principal or sole information source cited and consu...

Several medical articles discuss methods of constructing confidence intervals for single proportions and the likelihood ratio, but scant attention has been given to the systematic study of intervals for the posterior odds, or the positive predictive value, of a test. The authors describe 5 methods of constructing confidence intervals for posttest p...

In the United States, an accused person has a constitutionally protected right to serve as his or her own lawyer, even if this means he or she has "a fool for a client." In the current study, information from more than 2,700 articles in the LEXIS "U.S. New, Combined" database was used to produce what the authors believe is the psychiatric literatur...

Novel or atypical antipsychotic medications appear to offer patients the benefits of conventional neuroleptics with lower risks of side effects, but the newer drugs cost much more than the older drugs. Many U.S. psychiatrists have concluded that the novel antipsychotic drugs should be first-line therapy and represent an emerging standard of care in...

A previous Behavioral Sciences and the Law article (Mossman & Hart, 1996) asserted that information from malingering tests is best conceptualized using Bayes' theorem, and that courts therefore deserve Bayesian interpretations when mental health professionals present evidence about malingering. Mossman and Hart gave several examples of estimated Ba...

Customary ways of reporting on or testifying about malingering have shortcomings. Stating an opinion "with reasonable medical certainty" tells fact-finders little about how much confidence the opinion deserves; stating that an individual's behavior is similar to that of known malingerers does not convey the information that fact-finders really need...

Olanzapine's structural similarities to clozapine and the results of premarketing clinical trials suggested potential usefulness in treating patients with treatment-refractory psychoses. Sixteen inpatients from the state hospital with severe, refractory schizophrenic or schizoaffective psychoses received olanzapine in a prospective, 12-week, open-l...

The "hired gun phenomenon" is a recurrent topic in forensic psychiatric shop talk, but scholars have conducted very little systematic investigation of how courts respond to the suggestion that mental health testimony is "for sale." This article examines the issue using findings from a computer search of court decisions that make, or refer to, derog...

Receiver operating characteristic (ROC) analysis traditionally has dealt with dichotomous diagnostic tasks (e.g., determining whether a disorder is present or absent). Often, however, medical problems involve distinguishing among more than two diagnostic alternatives. This article extends ROC concepts to diagnostic enterprises with three possible o...

Mental health professionals who serve as expert witnesses are repeatedly characterized as (in the words of one recent author) "Whores of the Court." However, scholars have published little systematically gathered data about why attorneys seek mental health opinions and the criteria they use for selecting experts. We investigated these issues using...