Forensic criteria, clinical and theoretical issues of the indication of court-ordered treatment: A comparative survey among experts in forensic psychiatry and sentencing judges in France

• Published in: International journal of law and psychiatry 2024-07, Vol.95, p.102006, Article 102006
• Main Authors: Roux, Bénédicte, Giravalli, Pascale, Tuchtan, Lucile, Delteil, Clémence, Bartoli, Christophe, Guivarch, Jokthan
• Format: Article
• Language: English
• Subjects: Adult; Antisocial/psychopathic personality disorder; Commitment of Mentally Ill - legislation & jurisprudence; Court-ordered treatment; Dangerous Behavior; Dangerousness; Denial; Expert Testimony - legislation & jurisprudence; Female; Forensic Psychiatry - legislation & jurisprudence; France; Humans; Male; Mental Disorders - psychology; Mental Disorders - therapy; Penal psychiatric expert report; Recidivism - legislation & jurisprudence; Recidivism - prevention & control; Risk of recidivism; Surveys and Questionnaires
• ISSN: 0160-2527; 1873-6386; 1873-6386
• DOI: 10.1016/j.ijlp.2024.102006

Following the French law n° 98–468 of 17 June 1998 relative to the prevention of sexual offenses and the protection of minors, social and judicial follow-up and court-ordered treatment were introduced with the aim of reinforcing the prevention of recidivism. Court-ordered treatment is one of the possible obligatory measures provided for by social and judicial follow-up. However, there is no consensus between the different professionals concerning the criteria of indication and the final purpose of this measure. Most of the few available studies are retrospective. Only rare studies have assessed the influence of criminological factors on the indication of court-ordered treatment. We carried out a nation-wide qualitative comparative study in two populations, psychiatric experts and sentencing judges, by means of e-mail questionnaires. The aim was to determine the criteria for court-ordered treatment according to psychiatric experts and to sentencing judges, to identify the criteria that gave rise to differences in appreciation between these professionals, and to attempt to explain these differences. The secondary aim of the study was to determine the methods and tools used in expert practice to evaluate dangerousness and risk of recidivism. We obtained 20 responses in each of the two populations. The great majority of psychiatric experts and sentencing judges considered that court-ordered treatment was appropriate when the offender presented with psychiatric dangerousness, and so with an underlying mental disorder. When a subject had no identified mental disorder, the psychiatrists were divided in their opinion, whereas the majority of sentencing judges were in favor of court-ordered treatment. Opinions differed particularly significantly between the two populations in four circumstances: a subject with an antisocial/psychopathic personality disorder, a subject who denied the alleged acts, the influence of precarious social circumstances and the influence of instability in intimate relationships. The majority of experts used international classifications (DSM-5 and ICD-10) as a basis for their psychiatric diagnosis. Just under half of those surveyed used structured or semi-structured interview guides and only a few stated that they used standardized actuarial tools to assess risk of recidivism. The concepts of care, dangerousness and mental disorder are associated with multiple representations that certainly play a part in the disagreements between the diffe