The relationship between Feigned psychiatric symptoms and Feigned lack of Legal knowledge among a multi-site sample of forensic Inpatients.

An key part of forensic examination is the appropriate judgment of faking. Gottfried, Vitacco, and Steadman (2017) investigated two pretending tactics that defendants can use to ensure they are declared incompetent to stand trial. The study looks at defendants’ methods such as simulating psychiatric problems and claiming a lack of legal understanding.  Within the field of forensics, the most common type of mental referral is the need for evaluation on the competency to stand trial.

The hypothesis of the paper is the potential of a defendant malingering or feigning impairment (Gottfried, Vitacco, & Steadman, 2017). The need for accuracy in examining the ability of individuals to stand trial has become fundamental which is evidenced by the popularity gained by the Miller Forensic Assessment of Symptoms Test (Miller, 2004). The method is preferred since it has an ability of quickly detecting the possibility of feigned psychiatric symptoms. The method is mostly used in a brief assessment of screening for the individuals who need a more comprehensive assessment on feigning. The method has been evaluated for use among individuals from specific groups with a set of diagnostic classifications and literacy. The M-FAST has been determined to be most effective at differentiating feigning from genuine schizophrenia since they have psychotic focused content (Gottfried, Vitacco, & Steadman, 2017).

Cognitive feigning has various forms including the impairment of memory, deficit in intellect among others (Gottfried, Vitacco, & Steadman, 2017). When assessing psychiatric feigning, different detection strategies are employed when faking is suspected in an individual. These strategies are classified into either unlikely presentation or excessive impairment. The study draws from available evidence which suggests that pre-trial defendants who are scheduled to undergo trial evaluations many feign a psychotic symptom, a cognitive deficit or both. The study, therefore, sought to investigate the frequency of defendants exaggerating or fabricate psychiatric symptoms while at the same time feigning deficits in competency which include legal knowledge, individually and simultaneously.

Gottfried, Vitacco & Steadman (2017), used forensic data of patients who had either been termed as incompetent to be tried and were in the process of treatment for competency restoration or were undergoing a pretrial patient competency evaluation. The study was undertaken in two state facilities for forensic psychiatry in the South Eastern United States. They examined 203 forensic patients who have been administered with ILK and M-FAST during the same assessment (Gottfried, Vitacco, & Steadman, 2017). They then qualified the protocols to be psychiatric feigning when they acquired a score of above six using the MFAST assessment. If the was equal or above 16 on the M-Fast, they were considered as conservative psychiatric feigning. Using the ILK, a total score of 47 or less was classified as feigning the lack of legal knowledge and conservative feigning if the score was 35 or less (Gottfried, Vitacco, & Steadman, 2017).

The study applied the use of instruments that are considered more competent in the screening of feigning among defendants who are referred for a fitness evaluation before they stand trial (Gottfried, Vitacco, & Steadman, 2017). These methods help reduce the probability of false positives which are common in the use of screening techniques. They come up with results that showed that defendants who met the basic cut score which was 6 on the M-FAST were 2.23 more likely to be feigning the lack of legal knowledge on the ILK (Gottfried, Vitacco, & Steadman, 2017). When the more conservative scores are used for both measures the results showed that pretrial defendants who met the highest threshold of M-FAST were 4.18 times more likely to feign legal knowledge deficits on the ILK. This was the same case for the likelihood of feigning psychiatrist symptoms on the M-FAST once information was discovered concerning feigned legal knowledge on the ILK (Gottfried, Vitacco, & Steadman, 2017).

Gottfried, Vitacco & Steadman (2017) shed light on the appropriate evaluation of the possibility of feigned presentation on competency to stand trial evaluations. This finding when used together with existing research which shows the overlap on approaches to feigning have the ability to heighten the sensitivity of evaluators to the likelihood that a defendant is feigning to appear impaired then there is a high possibility they are feigning in other areas. The results can then be successfully implemented in findings of feigning with forensic patients and they should, therefore, inform strategies for the assessment of response styles. Those involved in forensic evaluation should ensure they routinely used the instruments that are innovated for screening incidences of feigning (Gottfried, Vitacco, & Steadman, 2017). This should be especially so due to their effectiveness at identifying individuals in need of additional testing. This will increase the effectiveness of their work as they can provide accurate results for the assessment of psychiatric and cognitive aspects of feigning.

Article 2

Bender, S.C., Roger, R. (2004). Detection of neurocognitive Feigning: development of a multi-strategy assessment. Archives of Clinical Neuropsychology. Vol. 19.

According to Bender and Rogers (2004), neuropsychological assessment can be completely invalidated as a result of an increase in the number of persons who successfully feign results of the assessment. Researchers have recommended the use of a multi-strategy evaluation in decreasing the difficulty of sidestepped performance in defendants’ evaluation. The methods that have been recommended consist of the inspection of strange performance between and within tests, recording any unusual and incongruent behavior and the application of specific tests to feigning (William, 2011). The tests that are applied to detect feigning evaluate the performance of individuals in easy items and are restricted to a single domain. More tests have been identified which include a test of performance curves and magnitude of error. The large amount of data has however not led to the support of a single strategy over another. Researchers, however, recommend the use of multiple measures and strategies. Bender and Rogers (2004), examined the medical utility of scales based on the discovery strategies, determined whether a single or multiple strategies had a possibility of achieving higher rates of classification concerning genuine and feigned presentations. Additionally, the study explored the effect of a cautioning on the performance of stimulators. The study concluded that the magnitude of error is a useful tool as a detection strategy. This strengthens the findings of Gottfried, Vitacco & Steadman (2017) concerning the differences in score as a method for detecting possibilities of feigning. The researchers found that malingers are more likely to emphasize on what to fail rather than the method of failing and this may have a negative effect. The researchers recommend the further testing to be conducted to complex SVT techniques with equal alternatives. Cautions are known not to harm the detection strategies and the researchers observed that a sight trend was observed which suggested the probability of a few simulators performing worse when cautioned (Bender & Roger, 2004). The study, therefore, concluded that persons who feign neurocognitive impairment are less likely to have an accurate appraisal of their success. The study did not find any significant differences in their performance when they compared the perceptions of the participants concerning whether it was successful or unsuccessful. Additionally, self–evaluation of accomplishment or effort did not appear to affect performance on exposure strategies (William, 2011). The study is important for this case as it sheds more light on the effectiveness of using more than one technique in neuropsychological assessments. It strengthens the findings of (Gottfried, Vitacco & Steadman (2017) and thus it is important for it to be selected.

Article 3

Gowensmith, W., Murrie, D., and Boccaciniin, M. (2013). Forensic Mental Health Evaluation: Reliability, Validity, Quality and other minor details.

Gowensmith, Murrie, and Boccaciniin (2013), in their research sort to answer questions on the reliability of forensic experts, factors that influence them and the disagreements rate in various cases. The study makes a review of 305 court cases where multiple evaluators in their routine practices were required to evaluate the similar defendants to respond to questions of proficiency to stand trial, criminal responsibility and the willingness to be released from a psychiatric institution (Gowensmith, Murrie, and Boccaciniin, 2013). The study therefore aimed at examining the frequency of forensic evaluators to agree on most common psycho-legal questions. The researchers also sort to explain some of the factors that increase evaluator agreement. Their findings showed that 71% of cases concerning primary evaluation of proficiency to stand trial, all the three assessors employed were unanimous in their report concerning the ability of the defendant (Gowensmith, Murrie, and Boccaciniin, 2013). It was determined that cases with unanimous agreement, were those where the defendant was termed as competent, which was 59%; only 12% involved an agreement that the defendant was incompetent (Gowensmith, Murrie, and Boccaciniin, 2013). Once the defendant was treated and re-evaluation conducted, the agreement rates reduced to 61% (Gowensmith, Murrie, and Boccaciniin, 2013). The judges in this cases relied on the majority opinion concerning the competency and incompetency of defendants. In the situations where the court chose to rule against the majority, it involved a situation where the defendant was found to be incompetent to stand trial. This shows that the courts have a conservative stance towards competency (Gowensmith, Murrie, and Boccaciniin, 2013). They were reluctant to find a defendant competent in situations where there were doubts among evaluators. There was also a higher likelihood of ruling against the majority in situations where the evaluators presented a split decision on competency (Nguyen, Acklin, Fuger, Gowensmith, & Ignacio, 2011). The study explored various factors that could influence the agreement of the evaluators which included the age, gender, and ethnicity of the defendant, the offense, location of evaluation, the court, the employer of the evaluate, the judge and the defendant’s literacy level (Gowensmith, Murrie, and Boccaciniin, 2013). The results, however, showed that these factors were not influential to an agreement among the evaluators. However, in situations where the evaluators concluded that a defendant was psychotic, they portrayed better agreement concerning competency. Additional research, however, showed that evaluators did not simply conflate a psychotic diagnosis with the finding of incompetence (Tombaugh, 1997).

The study evaluated rates of agreement concerning criminal responsibility. This is a condition that is static and historic and therefore requires determination of defendants functioning at the moment of crime (Gowensmith, Murrie, and Boccaciniin, 2013). An evaluation of 468 sanity reports showed that evaluator’s agreement on the legal sanity of a defendant was 55% where 38% agreed that the defendant was sane and 17% of the cases had the agreement that the defendant was insane (Gowensmith, Murrie, and Boccaciniin, 2013). In situations of disagreement the evaluators in most cases agreed that the defendant was sane rather than insane. Factors that influenced this decision included agreement that the defendant warranted a diagnosis of a psychotic disorder or when he or she had been in a psychiatric institution six months prior to committing the crime. Disagreements were more common when the defendant had been engaging in drug and substance abuse and in situations where the crime committed was a violent felony. This paper sheds more light on forensic mental disorder and the variations in assessment of defendants by evaluators. It, therefore, emphasizes the need for the establishment of methods that are more reliable in assessing the competence of a criminal to stand trial. The rate of disagreements among forensic evaluators is relatively high, indicating incompetence.

Article 4

Miller, H. (2004). Examining the use of M-FAST with criminal defendant’s incompetent to Stand Trial. International Journal of offender therapy and comparative criminology.

Miller (2004) discusses the M-FAST method applied in defendants’ evaluation; the method provides evaluators with a method that is brief. Liable and valid for the screening and testing of malingered mental illness. The instrument was tested among 50 criminal defendants who were termed as incompetent to stand trial based on issues of mental illness. The aggregate score of the method was items were then matched with the Structured Interview of Reported Symptoms and the false indicators in the Minnesota Multiphasic Personality Inventory 2 (Miller, 2004). The results showed that the method was valid in terms of idea and principle validity which was shown by t-tests, receiver operating features analysis and the high correlation between the M-FAST, SIRS and the fake bad indices on the MMPI-2 (Miller, 2004). The M-FAST total scores established great utility with trial defendants who were termed as incompetent to stand trial (Miller, 2004). The paper provided more information concerning the M-FAST assessment method which would, therefore, add more information concerning the assessment instruments.

Article 5

Sharf, A. Roger, R. Williams, M and Henry, S. (2017). The effectiveness of the MMPI-2_RF in Detecting Feigned Mental Disorder and Cognitive Deficits: A Meta-Analysis. Journal of Psychopathology and Behavior assessment. Volume 39, issue 3. 441-445.

According to Sharf, Roger, Williams, and Henry (2017), forensic assessment includes the valuation of reaction styles which include shamming and malingering. The MMPI-2 comprises entrenched over recording measures which include feigned mental disorders, feigned intellectual impairment and feigned medical illnesses. The study involves a meta-analysis research of 30 studies which examine the usefulness of recognition strategies and cut scores for MMPi-2 (Sharf, Roger, Williams, & Henry, 2017). This is an important clinical apprehension and the study showed that several feigning scales exhibited market elevations for honest responders who were identified with major depressive disorders. However, a Fp-r-a method which is rarely applied showed a rare symptom detection strategy and was effective in discriminating feigned from genuine mental disorders (Sharf, Roger, Williams, & Henry, 2017). When feigned cognitive impairment was examined, the results showed a very large effect for feigned TBI. The article provides information on the application of MMPI-2 in the determination of feigned mental disorders and genuine among defendants before standing for trial (Sharf, Roger, Williams, & Henry, 2017).

These sources have contributed to the original literature review by providing information on the various assessment tools used in the evaluation of competency to stand trial among criminal defendants. They provide more information on the effectiveness of various methods in identifying feigned disorders among defendants. Additionally, the article discusses the major pitfall of forensic evaluators and the various factors that lead to differences in their evaluations (Sharf, Roger, Williams, & Henry, 2017). More importantly, they stress on the use more than one instrument in the screening of defendants to determine issues of feigning which is made possible by the variations in scored acquired using different methods of testing. This will improve the effectiveness of competency screening for criminal defendants which will also aid the forensic process. These sources, therefore, contribute in making the reasons for the study clearer through an outline of the various gaps that exist in the screening of forensic mental disorders (Rogers & Shuman, 2000).

Methodology

The research methodology has changed to a simulation design with the quasi-random assignment of contributors to experimental and control factors. The experimental design will then be argued in comparison to psychiatric comparison samples to improve its relevance in forensic mental health. This provision is critical to determine the difference between genuine impairment and feigned. The new hypothesis examines the effectiveness of multi-strategy assessment in reducing incidences of defendant feigning of impairment which will, therefore, require an experimental research methodology that will be more effective in providing the findings for the study.

The sample characteristics that have been altered are in terms of the sample size since more methods in examining the defendants the sample size will be increased to increase the efficiency of the data collected. Additionally, the method will borrow from various forensic evaluators in different regions so guarantee the credibility of the results. One area could be affected by biases from the evaluators thus the need for different regions to be examined to aid the effectiveness of the research study. The variables in have also changed since the hypothesis has been changed. The previous hypothesis investigated the possibility of defendants malingering or feigning impairment while the later hypothesis investigates the effectiveness of multi-strategy assessment in reducing incidences of defendants feigning impairment. Therefore the independent variables have been introduced in the hypothesis to be the effectiveness of multi-strategy assessment. The dependent variable, on the other hand, is incidences of defendants feigning impairment. Data collection methods will not change as it will involve evaluating defendants using various cognitive assessment tools to determine their competency to stand trial and comparing the results of each assessment to identify cases of feigning. The internal and external validity increases. This is because the methodology that will be applied minimizes threats to internal validity and the results will report the relevant data and any biases is reduced while any other possibilities are reported.

The result anticipated using the new methodology will show that the use of multi-strategy assessment will be effective in reducing the incidences of defendants feigning impairment. Since more than one method will be applied the defendants’ scores will vary greatly which will indicate possibilities of feigning. Those defendants who will have varying results for more than three tests will then be taken through further testing to ensure the assessment method is effective and efficient. The use of multi-strategy will eventually be effective in the development of a strategy that is easy and quick in the identification of possibilities of feigning of impairment among defendants (William, 2011). This will improve the effectiveness and efficiency of forensic mental health activities.

Conclusion

The assessment of the mental health of defendants is important to determine their competency is standing for trial. They should be evaluated to determine their knowledge of legal issues and their mental health before they can be tried in a court of law. Various strategies are applied in the evaluation of the defendants to determine their competency. Gottfried, Vitacco, and Steadman (2017) examined two feigning strategies that can be applied by defendants for the purposes of ensuring they are found incompetent to stand trial. The hypothesis for their research paper was to determine the potential for defendants feigning impairment. However, with additional research on the topic, the hypothesis changes to the effectiveness of multi-strategy assessment in reducing incidences of defendants feigning impairment. This results to a change in methodology where an experimental model will be more effective in the study. Additionally, it changes the sampling, the variables and the results anticipated.

References

Bender, S.C., Roger,R. (2004). Detection of neurocognitive Feigning: development of a multi-strategy assessment. Archives of clinical Neuropsychology. Vol. 19.

Gottfried,E.D., Vitacco, M.J. & Steadman, J.A. (2017). The relationship between Feigned psychiatric symptoms and Feigned lack of Legal knowledge among a mult-site sample of forensic Inpatients. International journal of Forensic Mental Health. Vol. (16).

Gowensmith, W., Murrie, D., and Boccaciniin, M. (2013). Forensic mental Health Evaluation: Reliability, Validity, Quality and other minor details.

Miller, H. (2004). Examining the use of M-FAST with criminal defendants incompetent to Stand Trial. International Journal of offender therapy and comparative criminology.

Rogers , R., & Shuman, D.W. (2000). Conducting Insanity evaluations. New York: Guiford Publications

Sharf, A. Roger, R. Williams, M and Henry, S. (2017). The effectiveness of the MMPI-2_RF in Detecting Feigned Mental Disorder and Cognitive Deficits: A Meta-Analysis. Journal of Psychopathology and Behavior assessment. Volume 39, issue 3. 441-445.

Slack, M.K. (2001). Establishing the internal and external validity of experimental studies.

Tombaugh, T.N.(1997). The test of Memory Malingering (TOMM): Normative data from cognitive intact and cognitive impaired individuals. Psychological assessment, 9 (3) 104-116.

William, K, M. (2011). The use of Meta-Analysis to Compare and Select offender Risk Instruments: A commentary on Sing, Grann and Fazel (2011).

Nguyen, A.H. Acklin, M.A. Fuger, K., Gowensmith, W.N. & Ignacio, L.A. (2011). Freedom in paradise: Quality of conditional release reports submitted to the Hawaii Judiciary. International Journal of Law and Psychiatry. 34, 314-348.