Behavior and Behavior Mechanisms; Mental Disorders; Behavioral Disciplines and Activities; Psychological Phenomena and Processes
Dr. Buchanan publishes a) empirical research on the assessment of the risk of harm to others in psychiatric populations and theoretical work on the role of risk assessment in clinical management in psychiatry and b) empirical and theoretical research on the principles of law as they apply to the mentally disordered.
Specialized Terms: Psychiatric risk assessment and risk management; Services for mentally disordered offenders; Psychiatric jurisprudence
Extensive Research Description
The management of the risk of harm to others is an essential aspect of psychiatric care. While psychiatric patient populations, as a whole, do not show substantially higher rates of violence than the general population, it is possible, as with the general population, to identify sub-groups who have a higher risk. This is usually done using information derived from a clinical interview and from the patient's background, including details of illness, drug use and past violence. Some of our research has been designed to measure the relative contributions of each of these to accurate predictions. At least when predictions are made over the long term, a history of violence seems to carry the greatest weight.
The next question that arises is to what extent psychiatric services are likely to be able to use these predictions to prevent violence. Here the most important factor seems to be the base rate of violence in the population (see Psychiatric Services 2008; 59, 184-190). At the base rates of violence seen in most psychiatric patient populations, the limits to predictive accuracy are such that most violent acts could only be prevented by admitting to hospital large numbers of people most of whom would not, in fact, have gone on to cause harm. Even then, many of those who would have acted violently would have been left in the community. Psychiatric services do not have the option of ignoring the risk of harm to others. But our research suggests that admission to hospital, whether compulsory or voluntary, should be based on a range of clinical considerations, not just violence risk.
Risk assessment and management in the context of out-patient psychiatric treatment is one subject of Care of the Mentally Disordered Offender in the Community (A. Buchanan, ed., Oxford, 2002).
Psychiatric jurisprudence is the philosophy of law as it applies to the mentally disordered. It forms the theoretical basis for the clinical sub-specialty of forensic psychiatry. Mentally disordered people encounter the law in proceedings relating to hospital commitment, in criminal trials and in civil cases, including medical malpractice and negligence. A recurring question has been whether legal standards, such as those relating to competence to stand trial or make a will, should change according to what is at stake (see Journal of the American Academy of Psychiatry and the Law 2006; 34, 458-465). There are several possibilities and the answer may not be the same for criminal and civil cases. Other aspects of our research have concerned the "ultimate issue" question in criminal testimony and the use of psychiatric diagnoses in authorizing the detention of those convicted of sexual offenses.
Psychiatric jurisprudence is the subject of Psychiatric Aspects of Justification, Excuse and Mitigation (A. Buchanan, Jessica Kingsley, 2000). The preparation of psychiatric reports for courts is the subject of The Psychiatric Report (A. Buchanan, M. Norko, eds., Cambridge, 2011), which won the American Psychiatric Association's Guttmacher Award in 2013.
- J. Singh, S. Fazel, R. Gueorguieva, A. Buchanan. Rates of violence in patients classified as high risk by structured risk assessment instruments. British Journal of Psychiatry (2014) 204, 180-187.
- A. Buchanan. Violence risk assessment in clinical settings: being sure about being sure. Behavioral Sciences and the Law (2013) 31, 74-80.
- A. Buchanan, R. Binder, M. Norko, M. Swartz. Psychiatric violence risk assessment. American Journal of Psychiatry (2012) 169, 340 and data supplement at http://ajp.psychiatryonline.org/article.aspx?articleid=1028576.
- A. Buchanan and A. Grounds. Forensic psychiatry and public protection. British Journal of Psychiatry (2011) 198, 420-423.
- A. Buchanan. Risk of violence by psychiatric patients: beyond the “actuarial versus clinical” assessment debate. Psychiatric Services (2008) 59, 184-190.
- A. Buchanan and M. Leese. Quantifying the contributions of three types of information to the prediction of criminal conviction using the receiver operating characteristic. British Journal of Psychiatry (2006) 188, 472-278.
- A. Buchanan and M. Leese. Detention of people with dangerous severe personality disorders. Lancet (2001) 358, 1955-1959.
- A. Buchanan. Respect for dignity and forensic psychiatry. International Journal of Law and Psychiatry (2015) 41, 12-17