Psychological Reports, 1990, 67, 1076-1078. O Psychological Reports 1990
OFFENDERS' KNOWLEDGE ABOUT COURT MANDATED PSYCHIATRIC EVALUATIONS ' JOGUES R. PRANDONI
SHAVAUN M. WALL
Forensic Services Administration DC Commission on Mental Healih Seruices
Department of Education The Catholic University of America
Strmmary.-This investigation of offenders' knowledge about court mandated mental health evaluations indicated [he 30 adult probationers had significant knowledge deficits. The implications for clinical practice are discussed.
Lack of knowledge generally contributes to noncompliance with outpatient mental health services (6, 16, 19). The knowledge of disadvantaged and nontraditional populations in particular needs explication due to their greater risk for mental disorders (7, 17) and underutilization of services (10, 11, 20). I n this study at the District of Columbia's Forensic Services Administration we assessed offenders' knowledge about court-mandated mental health evaluations. We hypothesized that offenders lacked information about a psychiatric evaluation (basic information) and the options available for appropriately asserting their freedom while responding to the court's mandate (reactance-reducing information). Subjects were 30 volunteers selected from adult probationers referred for nonemergency, court-ordered psychiatric evaluations. Eligible probationers spoke fluent English, had no gross cognitive impairments, had fixed m&ng addresses and known telephone numbers, and had not been evaluated previously by the clinic while in posttrial status. Participants were typically black men in their midtwenties, with 11.7 yr. of education. Most had prior involvement with the criminal justice system and were on probation for property crimes. Half had hstories of substance abuse, and 40% had previous contact with a mental health resource. The Forensic Mental Health Information Survey' was developed from the literature (2, 3, 4, 5 ) and previous client inquiries. Its 15 items were ordered to reflect questions that might arise as clients progressed through the referral and evaluation process. Objective criteria were used to score probationers' free responses as either 2 (correct), 1 (partial), 0 (incorrect) or 2 (correct), O (incorrect) if partial credit was not permitted. Content validity was determined by eight forensic clinicians who assessed the relevance of survey items. The mean interrater agreement for a l l retained items was 91%. Livingston's Criterion-referenced Coefficient Alpha (12, 13) was used to 'Correspondence concerning this article should be addressed to Jogues R. Prandoni, Forensic Services Administration, 5th Floor, 605 G Street NW, Washington, DC 20001. Copies of the survey, its scoring criteria, validity, and reliability are available from Jogues R. Prandoni or Microfiche Publications, PO Box 3513, Grand Central Station, New York, NY 10017. For Document NAPS-04819, remit $12.55 for photocopy or $4.00 for fiche.
COURT MANDATED PSYCHIATRIC EVALUATIONS
1077
assess reliability. With the cut-off score set at 22.2, the coefficient was .88. After probationers were notified of their appointments using the clinic's standard letter, eligible probationers were telephoned about participation in the study. Volunteers were then questioned, and their responses written down. The results support the hypothesis that offenders lack both basic and reactance-reducing information. Volunteers' mean total score was 15.1 out of 30 points or an average of 50% correct information. Probationers scored somewhat higher on basic items (mean score 56%) than on reactance-reducing items (mean score 45%; t,, = 3.30, p < .002). O n the positive side, probationers realized people see psychiatrists for varied personal problems and that seeking services is not necessarily an indication of major mental illness. Most (87%) also understood that an intake evaluation involved a dialogue with a psychiatrist exploring various aspects of a client's life. Probationers did have four striking deficits in their knowledge. Despite consenting to the referral, most (70%) believed they had no choice about participating in the evaluation. Probationers were unclear about the cost. Only 36% were aware they did not have to pay. Subjects were also confused about the clinic's willingness to negotiate appointment dates and times. Half felt they must accept whatever appointment they were given. Finally, most failed to differentiate between evaluation and treatment. When asked: "How many times d o most people have to come to the clinic to complete their exam," 60% described an ongoing therapeutic process lasting from three months to several years. These findings suggest that without adequate information, probationers develop misperceptions and faulty expectations about court-mandated mental health referrals and evaluations. The ethical obligation to ensure informed consent (1) dictates that probationers be provided appropriate information prior to their evaluation. In addition, expectations affect emotional reactions and performance (8, 9, 15, 18). Such distortions likely influence probationers' w a n g n e s s to participate in court-mandated mental health evaluations. Other research (14) supports this possibihty and indicates that providing probationers relevant information can improve compliance with initial diagnostic appointments. Although modifications might be necessary to reflect jurisdictional differences, this survey should assist clinicians in examining offenders' knowledge of court-mandated mental health services. Results from local surveys would delineate essential information to provide clients prior to their evaluations and could be used to develop appointment letters or an information sheet. The present findings also underscore the need for further research on offenders' and other disadvantaged populations' understanding of various mental health services. Then we can explore how knowledge deficits affect
1078
J. R. PRANDONI
& S.
M. WALL
clients' attitudes toward and participation in mental health services and strive for more effective communication with and delivery of mental health services to special populations. REFERENCES 1. AMERICAN PSYCHIATRIC ASSOCIATION. (1986) The principles of medical ethics with annotations especially applicable to psychiatry. Washington, DC: Author. 2. BREHM,J. W. (1966) A theory of psychological reactance. New York: Academic Press. J. W. (1972) Responses to loss of freedom: a theory of psychological reactance. New 3. BREI-LM, York: General Learning Press. 4. BRWM, S. S. (1976) The application of social psychology to clinical practice. New York: Wiley. 5. BREHM,S. S., & BREHM,J. W. (1981) P~ychologicalreacbnce: a theory of freedom and control. New York: Academic Press. 6. CLARK,R., & ~ T I K E G. , (1978) The image of psychiatry today. Psychiatric Opinion, 15(11). . ., 10-16. 7. DOHRENWEND, B. P., & DOHRENWEND, B. S. (1974) Social and cultural influences on psychotherapy. Annual Review of Psychology, 25, 417-452. 8. FOREYT,J. P., & RATHJEN,D. P. (Eds.) (1981) Cognitive behavior therapy: research and application. New York: Plenum. 9. KANFER,F. H., & GOLDSTEIN,A. P (Eds.) (1980) Helping people change: a textbook of methods. New York: Pergamon. 10. KULKA,R., VEROFF,J., & DOWAN,F. C. (1979) Social class and the use of professional help lor personal problems: 1957 and 1976. Journal of Health and Social Behavior, 2O(March), 2-17. 11. LARSEN,D. L. (1978) Enhancing client utilization of community mental health outpatient services. Dissertation Abstracts International, 39, 4041B. 12. LIVINGSTON, S. A. (1972) Cciteeion-referenced applications of classical rest theory. Journal of Edtrcational Measurement, 9 , 13-26. 13. LNINGSTON, S. A. (1977) Psychometric techniques for criterion-referenced testing and behavioral assessment. In J. D. Cone & R. F? Hawkins (Eds.), Behavioral assessment: new directions in clinical psychology. New York: Bmnner/Mazel. Pp. 308-329. 14. PRANDONI, J. R., & WALL,S. M. (1990) Effects of mental health and reactance-reducing information on offenders' compliance with court-mandated psychiatric evaluations. Profersional Psychology: Research and Practice, 21, 204-209. 15. R O S E N ~ I AT.L ,(1980) Social cueing rocesses In M Hersen, R. M. Eisler, & P. M. Miller (Eds.), Progress in behavior molfication.' Vol. i 0 . New York: Academic Press. Pp. 111-146. 16. RUSH,A. ., & WATKINS,J. T. (1981) Cognitive therapy with sychologically naive depressedoutpatients. m G . Emery, S. D. HoUon, & R. C. ~ e B o s i a n(Eds.), New directions in cognitive therapy. New York: GuiEord. Pp. 5-28. 17. SCI-IWM, J. J., & SCHWAB, M. E. (1983) Psychiatric epidemiology: some clinical implications. Psychosomatics, 24, 95-103. 18. SHAPIRO, A. K. (1971) Placebo effects in medicine, psychotherapy, and psychoanalysis. In A. E. Bergin & S. L. Garfield (Eds.), Handbook ofpsychotherapy and behavior change. New York: Wiley. Pp. 439-473. 19. VEROFF,J., KULKII,R. A,, & DOWAN,E. (1981) Mental health in America: patterns of help-seekingfrom 1957 to 1976. New York: Basic Books. 20. WILLIAMS,S. J., DIE~IR, P., DRUCKER, W. L., & RICHARDSON, W. C. (1979) Mental health services: utilization by low income enrollees in a prepaid group practice plan and in an independent practice plan. Medical Care, 17, 139-151.
Accepted November 29, 1970.
OFFENDERS' KNOWLEDGE ABOUT COURT MANDATED PSYCHIATRIC EVALUATIONS ' JOGUES R. PRANDONI
SHAVAUN M. WALL
Forensic Services Administration DC Commission on Mental Healih Seruices
Department of Education The Catholic University of America
Strmmary.-This investigation of offenders' knowledge about court mandated mental health evaluations indicated [he 30 adult probationers had significant knowledge deficits. The implications for clinical practice are discussed.
Lack of knowledge generally contributes to noncompliance with outpatient mental health services (6, 16, 19). The knowledge of disadvantaged and nontraditional populations in particular needs explication due to their greater risk for mental disorders (7, 17) and underutilization of services (10, 11, 20). I n this study at the District of Columbia's Forensic Services Administration we assessed offenders' knowledge about court-mandated mental health evaluations. We hypothesized that offenders lacked information about a psychiatric evaluation (basic information) and the options available for appropriately asserting their freedom while responding to the court's mandate (reactance-reducing information). Subjects were 30 volunteers selected from adult probationers referred for nonemergency, court-ordered psychiatric evaluations. Eligible probationers spoke fluent English, had no gross cognitive impairments, had fixed m&ng addresses and known telephone numbers, and had not been evaluated previously by the clinic while in posttrial status. Participants were typically black men in their midtwenties, with 11.7 yr. of education. Most had prior involvement with the criminal justice system and were on probation for property crimes. Half had hstories of substance abuse, and 40% had previous contact with a mental health resource. The Forensic Mental Health Information Survey' was developed from the literature (2, 3, 4, 5 ) and previous client inquiries. Its 15 items were ordered to reflect questions that might arise as clients progressed through the referral and evaluation process. Objective criteria were used to score probationers' free responses as either 2 (correct), 1 (partial), 0 (incorrect) or 2 (correct), O (incorrect) if partial credit was not permitted. Content validity was determined by eight forensic clinicians who assessed the relevance of survey items. The mean interrater agreement for a l l retained items was 91%. Livingston's Criterion-referenced Coefficient Alpha (12, 13) was used to 'Correspondence concerning this article should be addressed to Jogues R. Prandoni, Forensic Services Administration, 5th Floor, 605 G Street NW, Washington, DC 20001. Copies of the survey, its scoring criteria, validity, and reliability are available from Jogues R. Prandoni or Microfiche Publications, PO Box 3513, Grand Central Station, New York, NY 10017. For Document NAPS-04819, remit $12.55 for photocopy or $4.00 for fiche.
COURT MANDATED PSYCHIATRIC EVALUATIONS
1077
assess reliability. With the cut-off score set at 22.2, the coefficient was .88. After probationers were notified of their appointments using the clinic's standard letter, eligible probationers were telephoned about participation in the study. Volunteers were then questioned, and their responses written down. The results support the hypothesis that offenders lack both basic and reactance-reducing information. Volunteers' mean total score was 15.1 out of 30 points or an average of 50% correct information. Probationers scored somewhat higher on basic items (mean score 56%) than on reactance-reducing items (mean score 45%; t,, = 3.30, p < .002). O n the positive side, probationers realized people see psychiatrists for varied personal problems and that seeking services is not necessarily an indication of major mental illness. Most (87%) also understood that an intake evaluation involved a dialogue with a psychiatrist exploring various aspects of a client's life. Probationers did have four striking deficits in their knowledge. Despite consenting to the referral, most (70%) believed they had no choice about participating in the evaluation. Probationers were unclear about the cost. Only 36% were aware they did not have to pay. Subjects were also confused about the clinic's willingness to negotiate appointment dates and times. Half felt they must accept whatever appointment they were given. Finally, most failed to differentiate between evaluation and treatment. When asked: "How many times d o most people have to come to the clinic to complete their exam," 60% described an ongoing therapeutic process lasting from three months to several years. These findings suggest that without adequate information, probationers develop misperceptions and faulty expectations about court-mandated mental health referrals and evaluations. The ethical obligation to ensure informed consent (1) dictates that probationers be provided appropriate information prior to their evaluation. In addition, expectations affect emotional reactions and performance (8, 9, 15, 18). Such distortions likely influence probationers' w a n g n e s s to participate in court-mandated mental health evaluations. Other research (14) supports this possibihty and indicates that providing probationers relevant information can improve compliance with initial diagnostic appointments. Although modifications might be necessary to reflect jurisdictional differences, this survey should assist clinicians in examining offenders' knowledge of court-mandated mental health services. Results from local surveys would delineate essential information to provide clients prior to their evaluations and could be used to develop appointment letters or an information sheet. The present findings also underscore the need for further research on offenders' and other disadvantaged populations' understanding of various mental health services. Then we can explore how knowledge deficits affect
1078
J. R. PRANDONI
& S.
M. WALL
clients' attitudes toward and participation in mental health services and strive for more effective communication with and delivery of mental health services to special populations. REFERENCES 1. AMERICAN PSYCHIATRIC ASSOCIATION. (1986) The principles of medical ethics with annotations especially applicable to psychiatry. Washington, DC: Author. 2. BREHM,J. W. (1966) A theory of psychological reactance. New York: Academic Press. J. W. (1972) Responses to loss of freedom: a theory of psychological reactance. New 3. BREI-LM, York: General Learning Press. 4. BRWM, S. S. (1976) The application of social psychology to clinical practice. New York: Wiley. 5. BREHM,S. S., & BREHM,J. W. (1981) P~ychologicalreacbnce: a theory of freedom and control. New York: Academic Press. 6. CLARK,R., & ~ T I K E G. , (1978) The image of psychiatry today. Psychiatric Opinion, 15(11). . ., 10-16. 7. DOHRENWEND, B. P., & DOHRENWEND, B. S. (1974) Social and cultural influences on psychotherapy. Annual Review of Psychology, 25, 417-452. 8. FOREYT,J. P., & RATHJEN,D. P. (Eds.) (1981) Cognitive behavior therapy: research and application. New York: Plenum. 9. KANFER,F. H., & GOLDSTEIN,A. P (Eds.) (1980) Helping people change: a textbook of methods. New York: Pergamon. 10. KULKA,R., VEROFF,J., & DOWAN,F. C. (1979) Social class and the use of professional help lor personal problems: 1957 and 1976. Journal of Health and Social Behavior, 2O(March), 2-17. 11. LARSEN,D. L. (1978) Enhancing client utilization of community mental health outpatient services. Dissertation Abstracts International, 39, 4041B. 12. LIVINGSTON, S. A. (1972) Cciteeion-referenced applications of classical rest theory. Journal of Edtrcational Measurement, 9 , 13-26. 13. LNINGSTON, S. A. (1977) Psychometric techniques for criterion-referenced testing and behavioral assessment. In J. D. Cone & R. F? Hawkins (Eds.), Behavioral assessment: new directions in clinical psychology. New York: Bmnner/Mazel. Pp. 308-329. 14. PRANDONI, J. R., & WALL,S. M. (1990) Effects of mental health and reactance-reducing information on offenders' compliance with court-mandated psychiatric evaluations. Profersional Psychology: Research and Practice, 21, 204-209. 15. R O S E N ~ I AT.L ,(1980) Social cueing rocesses In M Hersen, R. M. Eisler, & P. M. Miller (Eds.), Progress in behavior molfication.' Vol. i 0 . New York: Academic Press. Pp. 111-146. 16. RUSH,A. ., & WATKINS,J. T. (1981) Cognitive therapy with sychologically naive depressedoutpatients. m G . Emery, S. D. HoUon, & R. C. ~ e B o s i a n(Eds.), New directions in cognitive therapy. New York: GuiEord. Pp. 5-28. 17. SCI-IWM, J. J., & SCHWAB, M. E. (1983) Psychiatric epidemiology: some clinical implications. Psychosomatics, 24, 95-103. 18. SHAPIRO, A. K. (1971) Placebo effects in medicine, psychotherapy, and psychoanalysis. In A. E. Bergin & S. L. Garfield (Eds.), Handbook ofpsychotherapy and behavior change. New York: Wiley. Pp. 439-473. 19. VEROFF,J., KULKII,R. A,, & DOWAN,E. (1981) Mental health in America: patterns of help-seekingfrom 1957 to 1976. New York: Basic Books. 20. WILLIAMS,S. J., DIE~IR, P., DRUCKER, W. L., & RICHARDSON, W. C. (1979) Mental health services: utilization by low income enrollees in a prepaid group practice plan and in an independent practice plan. Medical Care, 17, 139-151.
Accepted November 29, 1970.
