Alec Buchanan, PhD, MD
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Research Summary
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 discussed along with other aspects of forensic psychiatric care in the second edition of Care of the Mentally Disordered Offender in the Community (A. Buchanan, L. Wootton eds., Oxford, 2017).
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.
Coauthors
Research Interests
Behavior and Behavior Mechanisms; Mental Disorders; Behavioral Disciplines and Activities; Psychological Phenomena
Selected Publications
- Psychosocial function, legal involvement and violence in mental disorder – CORRIGENDUMBuchanan A, Moore KE, Pittman B, McKee SA. Psychosocial function, legal involvement and violence in mental disorder – CORRIGENDUM European Psychiatry 2022, 65: e13. PMID: 35156594, PMCID: PMC8853852, DOI: 10.1192/j.eurpsy.2022.6.
- Psychosocial function, legal involvement and violence in mental disorderBuchanan A, Moore KE, Pittman B, McKee SA. Psychosocial function, legal involvement and violence in mental disorder European Psychiatry 2021, 64: e75. PMID: 34859762, PMCID: PMC8715282, DOI: 10.1192/j.eurpsy.2021.2250.
- Uses of video recorded interviews in court by clinical expert witnessesGunn J, Calcedo A, Albrecht H, Nedopil N, Schiltz K, Buchanan A, Kennedy H, Davoren M, Taylor PJ. Uses of video recorded interviews in court by clinical expert witnesses Criminal Behaviour And Mental Health 2021, 31: 226-230. PMID: 34392576, DOI: 10.1002/cbm.2209.
- An 18-month longitudinal study of suicidality in patients diagnosed with schizophreniaBuchanan A, Sint K, Stefanovics E, Rosenheck R. An 18-month longitudinal study of suicidality in patients diagnosed with schizophrenia Schizophrenia Research 2020, 224: 102-107. PMID: 33046335, DOI: 10.1016/j.schres.2020.09.019.
- Correlates of Future Violence in People Being Treated for SchizophreniaBuchanan A, Sint K, Swanson J, Rosenheck R. Correlates of Future Violence in People Being Treated for Schizophrenia American Journal Of Psychiatry 2019, 176: 694-701. PMID: 31014102, DOI: 10.1176/appi.ajp.2019.18080909.
- Violence Risk Assessments and ManagementParke S, Baranoski M, Buchanan A, Norko M. Violence Risk Assessments and Management Psychiatric Annals 2018, 48: 109-114. DOI: 10.3928/00485713-20180122-01.
- Correlates of Reduced Violent Behavior Among Patients Receiving Intensive Treatment for Posttraumatic Stress DisorderBuchanan A, Stefanovics E, Rosenheck RA. Correlates of Reduced Violent Behavior Among Patients Receiving Intensive Treatment for Posttraumatic Stress Disorder Psychiatric Services 2017, 69: 424-430. PMID: 29241432, DOI: 10.1176/appi.ps.201700253.
- Resource Document on Psychiatric Violence Risk AssessmentBuchanan A, Binder R, Norko M, Swartz M. Resource Document on Psychiatric Violence Risk Assessment FOCUS The Journal Of Lifelong Learning In Psychiatry 2015, 13: 490-498. DOI: 10.1176/appi.focus.130402.
- Respect for dignity and forensic psychiatryBuchanan A. Respect for dignity and forensic psychiatry International Journal Of Law And Psychiatry 2015, 41: 12-17. PMID: 25888501, DOI: 10.1016/j.ijlp.2015.03.002.
- Rates of violence in patients classified as high risk by structured risk assessment instrumentsSingh JP, Fazel S, Gueorguieva R, Buchanan A. Rates of violence in patients classified as high risk by structured risk assessment instruments The British Journal Of Psychiatry 2014, 204: 180-187. PMID: 24590974, PMCID: PMC3939440, DOI: 10.1192/bjp.bp.113.131938.
- Respect of dignity as an ethical principle in forensic psychiatry. Commentary on ‘not just welfare over justice: Ethics in forensic consultation’Buchanan A. Respect of dignity as an ethical principle in forensic psychiatry. Commentary on ‘not just welfare over justice: Ethics in forensic consultation’ Legal And Criminological Psychology 2013, 19: 30-32. DOI: 10.1111/lcrp.12040.
- Psychiatric Violence Risk AssessmentBuchanan A, Binder R, Norko M, Swartz M. Psychiatric Violence Risk Assessment American Journal Of Psychiatry 2012, 169: 340-340. PMID: 22407122, DOI: 10.1176/appi.ajp.2012.169.3.340.
- Report structureBuchanan A, Norko M. Report structure 2011, 93-97. DOI: 10.1017/cbo9780511895074.010.
- Violence risk assessmentBuchanan A, Norko M. Violence risk assessment 2011, 224-239. DOI: 10.1017/cbo9780511895074.020.
- IntroductionNorko M, Buchanan A. Introduction 2011, 1-10. DOI: 10.1017/cbo9780511895074.003.
- Editors’ prefaceBuchanan A, Norko M. Editors’ preface 2011, xix-xx. DOI: 10.1017/cbo9780511895074.002.
- Forensic psychiatry and public protectionBuchanan A, Grounds A. Forensic psychiatry and public protection The British Journal Of Psychiatry 2011, 198: 420-423. PMID: 21628701, DOI: 10.1192/bjp.bp.111.095471.
- Mental health and incapacity legislationBuchanan A. Mental health and incapacity legislation The British Journal Of Psychiatry 2007, 190: 176-177. PMID: 17267938, DOI: 10.1192/bjp.190.2.176a.
- Mental capacity of inpatientsHOTOPF M, RAYMONT V, DAVID A, BUCHANAN A. Mental capacity of inpatients The Lancet 2005, 365: 569-569. DOI: 10.1016/s0140-6736(05)70789-3.
- Mental capacity of inpatientsHotopf M, Raymont V, David A, Buchanan A. Mental capacity of inpatients The Lancet 2005, 365: 569. DOI: 10.1016/s0140-6736(05)17897-0.
- Mental Capacity, Legal Competence and Consent to TreatmentBuchanan A. Mental Capacity, Legal Competence and Consent to Treatment Journal Of The Royal Society Of Medicine 2004, 97: 415-420. DOI: 10.1177/014107680409700902.
- Does ‘like predict like’ when patients discharged from high secure hospitals re-offend? An instrument to describe serious offencesBUCHANAN A, REISS D, TAYLOR P. Does ‘like predict like’ when patients discharged from high secure hospitals re-offend? An instrument to describe serious offences Psychological Medicine 2003, 33: 549-554. PMID: 12701675, DOI: 10.1017/s0033291703007396.
- Detention of people with dangerous severe personality disorders: a systematic reviewBuchanan A, Leese M. Detention of people with dangerous severe personality disorders: a systematic review The Lancet 2001, 358: 1955-1959. PMID: 11747920, DOI: 10.1016/s0140-6736(01)06962-8.
- Changing patterns in the use of the Mental Health Act 1983 in England, 1984–1996Hotopf M, Wall S, Buchanan A, Wessely S, Churchill R. Changing patterns in the use of the Mental Health Act 1983 in England, 1984–1996 The British Journal Of Psychiatry 2000, 176: 479-484. PMID: 10912226, DOI: 10.1192/bjp.176.5.479.
- Independent inquiries into homicide.Buchanan A. Independent inquiries into homicide. BMJ (Clinical Research Ed.) 1999, 318: 1089-90. PMID: 10213696, PMCID: PMC1115493, DOI: 10.1136/bmj.318.7191.1089.
- Risk and dangerousnessBUCHANAN A. Risk and dangerousness Psychological Medicine 1999, 29: 465-473. PMID: 10218938, DOI: 10.1017/s0033291798008101.
- Criminal conviction after discharge from special (high security) hospitalBuchanan A. Criminal conviction after discharge from special (high security) hospital The British Journal Of Psychiatry 1998, 172: 472-476. PMID: 9828985, DOI: 10.1192/bjp.172.6.472.
- Tinder-Box Criminal Aggression By Nathaniel J. Pallone and James Hennessy. New Jersey: Transaction Publishers. 1996. 401 pp. £39.95 (hb). ISBN 1-56 000253-0Buchanan A. Tinder-Box Criminal Aggression By Nathaniel J. Pallone and James Hennessy. New Jersey: Transaction Publishers. 1996. 401 pp. £39.95 (hb). ISBN 1-56 000253-0 The British Journal Of Psychiatry 1997, 171: 589-589. DOI: 10.1192/s0007125000148883.
- The investigation of acting on delusions as a tool for risk assessment in the mentally disorderedBuchanan A. The investigation of acting on delusions as a tool for risk assessment in the mentally disordered The British Journal Of Psychiatry. Supplement 1997, 170: 12-16. PMID: 9328517, DOI: 10.1192/s0007125000298668.
- Assessing risk: limits to the measurement of the target behavioursBuchanan A. Assessing risk: limits to the measurement of the target behaviours International Review Of Psychiatry 1997, 9: 195-200. DOI: 10.1080/09540269775394.
- Compliance and the reduction of dangerousnessBuchanan A, David A. Compliance and the reduction of dangerousness Journal Of Mental Health 1994, 3: 427-429. DOI: 10.3109/09638239409003813.
- Acting on Delusions. I: PrevalenceWessely S, Buchanan A, Reed A, Cutting J, Everitt B, Garety P, Taylor P. Acting on Delusions. I: Prevalence The British Journal Of Psychiatry 1993, 163: 69-76. PMID: 8353703, DOI: 10.1192/bjp.163.1.69.
- Acting on Delusions. II: The Phenomenological Correlates of Acting on DelusionsBuchanan A, Reed A, Wessely S, Garety P, Taylor P, Grubin D, Dunn G. Acting on Delusions. II: The Phenomenological Correlates of Acting on Delusions The British Journal Of Psychiatry 1993, 163: 77-81. PMID: 8353704, DOI: 10.1192/bjp.163.1.77.
- Acting on delusion: a reviewBuchanan A. Acting on delusion: a review Psychological Medicine 1993, 23: 123-134. PMID: 8475199, DOI: 10.1017/s0033291700038915.
- The Assessment of Insight in PsychosisDavid A, Buchanan A, Reed A, Almeida O. The Assessment of Insight in Psychosis The British Journal Of Psychiatry 1992, 161: 599-602. PMID: 1422606, DOI: 10.1192/bjp.161.5.599.
- Do schizophrenics act on their delusions?Wessely S, Buchanan A, Reed A, Everitt B, Garety P, Taylor P. Do schizophrenics act on their delusions? Schizophrenia Research 1992, 6: 169. DOI: 10.1016/0920-9964(92)90272-7.