Legal outcome and clinical findings: a study of insanity evaluations.

Little research has examined agreements and disagreements between clinical evaluations of sanity and the subsequent legal dispositions. Few studies have examined the level of agreement between clinical evaluation of sanity and subsequent legal disposition. For example, Fukunaga and his associates I found an exceptionally high concordance rate of93 percent, which may be partially explained by Hawaii's nonadversarial system in which one or more examiners are appointed by the court. Further, Williams and Miller found a better than 90 percent agreement between hospital staffs conclusions regarding defendant's competency to stand trial and the court's decision; although data is reported with respect to not guilty by reason of insanity (NGRI) findings. the level of agreement was not reported. Given this paucity of empirical research, the primary focus of this study is to establish (1) the concordance rate between clinical findings and legal dispositions on insanity cases and (2) determine in cases of disagreement which psychological. sociodemographic. and legal variables may account for these differences in judgment. The very process of making a legal determination of sanity is complicated by its multifaceted process that restrospectively addresses the multidetermined behavior of an individual during the commission of an alleged crime. It is therefore important to establish what role if any sociodemographic and psychological variables play in making the actual legal disposition. As an analog. studies of sentencing have demonstrated that physical attractiveness of the defendanfl as well as race4 have been significant determinants of the length of incarceration. The examination of agreement/disagreement between forensic experts and triers of fact is of particular importance in the examination of the insanity defense. Concern about how the two professions interact on this complicated psycholegal issue has been highlighted in a comprehensive stUdy of the New York state approach to insanity evaluations. 5 Further. psychiatrists themselves have expressed disfavor toward their colleagues' Involvement in insanity evaluations as something possibly beyond their expertise. 6 More recently. however. the American Psychiatric Association 7