ارزیابی بهداشت روانی پزشکی قانونی در فرانسه: توصیه هایی برای بهبود کیفیت

The quality of forensic mental health assessment has been a growing concern in various countries on both sides of the Atlantic, but the legal systems are not always comparable and some aspects of forensic assessment are specific to a given country. This paper describes the legal context of forensic psychological assessment in France (i.e. pre-trial investigation phase entrusted to a judge, with mental health assessment performed by preselected professionals called “experts” in French), its advantages and its pitfalls. Forensic psychiatric or psychological assessment is often an essential and decisive element in criminal cases, but since a judiciary scandal which was made public in 2005 (the Outreau case) there has been increasing criticism from the public and the legal profession regarding the reliability of clinical conclusions. Several academic studies and a parliamentary report have highlighted various faulty aspects in both the judiciary process and the mental health assessments. The heterogeneity of expert practices in France appears to be mainly related to a lack of consensus on several core notions such as mental health diagnosis or assessment methods, poor working conditions, lack of specialized training, and insufficient familiarity with the Code of Ethics. In this article we describe and analyze the French practice of forensic psychologists and psychiatrists in criminal cases and propose steps that could be taken to improve its quality, such as setting up specialized training courses, enforcing the Code of Ethics for psychologists, and calling for consensus on diagnostic and assessment methods.

In countries where Common Law applies, penal procedures are adversarial from the start, whereas countries which follow Roman Law usually entrust the investigation phase to a single judge whose mission is to gather all the evidence supporting both the prosecution and the defense and decide whether there is enough evidence to proceed with the trial, which is then adversarial and entirely oral. It is in the first investigative phase of the procedure that psychological and psychiatric forensic reports are requested. Within this particular legal framework, professionals who are called upon for an assessment have to take an oath as “experts” in their field, pledging to assist the Courts in good faith. It is important here to understand that, in France, experts are hired by the Courts and not by either the prosecution or the defense. Consequently, they are assumed to remain neutral, not to be concerned by facts and evidence, and not to take defensive or accusatory stances. In spite of, or due to this, the conclusions drawn by psychiatrists and/or psychologists carry considerable weight on the decisions of the Criminal Court. In recent years, as a consequence of the purported role played by psychiatric and psychological reports in several high profile mismanaged criminal cases (e.g. the Outreau trial in 2005), the quality and reliability of forensic mental health reports have been increasingly challenged both by the general public and by the judiciary. This concern is apparently shared in many different countries, including those where Common Law applies. Several authors have underlined the need to improve the quality of forensic mental health assessments and reports (Borum and Grisso, 1995, Borum and Grisso, 1996, Conroy, 2006, Lander and Heilbrun, 2009, Rodway et al., 2011, Wettstein, 2005 and Wettstein, 2010) or have made suggestions for improving the quality of reports (Duits et al., 2012, Giorgi-Guarnieri et al., 2002 and Robinson and Acklin, 2010). In France, various studies have shown that there is a wide disparity in the quality of both psychological and psychiatric reports (Combalbert and Andronikof, 2007 and Combalbert et al., 2011). Nevertheless, at the international level, there are very few studies in this field of research. We hope to contribute to the international scientific debate on this issue by presenting the French situation regarding forensic mental health assessment based on our clinical experience as forensic experts. For offenders, the forensic mental health assessment consists mainly of an evaluation of their personality and mental disorders, of the risk that they will reoffend, and of their potential social rehabilitation. For victims, the forensic mental health assessment consists mainly of an evaluation of their personality and of the psychological impact of the offense. These assessments are drawn up in a detailed report which is submitted to the court by the expert (psychiatrist or psychologist) during the pre-trial. Through a review of the scientific literature and parliamentary reports, we investigate the reasons for the poor quality of mental forensic health assessments and reports. We also highlight the factors which contribute to poor quality and disparity between experts in forensic assessment. Finally, we put forward recommendations to improve their quality.

In recent years, changes in French criminal justice policies have led to increasing recourse to forensic psychiatrists and psychologists by the judiciary to assess the perpetrators and victims of crime. There are no legal guidelines supporting expert witnesses, and no consensus among professionals about the methods and tools to use, and this has a profound impact on the quality of clinical forensic assessments. The reliability of assessments has recently been challenged by the law courts and the public, particularly with regard to the evaluation of responsibility (with reference to the law on insanity), of forensic risk and of allegations of abuse. A number of countries have called for improvements in mental health forensic reports, notably The Netherlands (Duits et al., 2012) and have provided models incorporating structural changes. Judiciary procedures differ between countries depending on whether their legal systems are based on Common Law or Roman Law, which means that these models may not be applicable in some European countries. In France, where Roman Law applies, mental health assessment in alleged criminal cases is performed during the pre-trial investigating phase in a non-adversarial procedure and entrusted to “experts” under oath, implying neutrality and objectiveness. Following a detailed analysis of the factors that may contribute to the recognized disparity in the quality of mental health reports by forensic experts in France, we propose a series of recommendations ranging from informing judges and lawyers about the scope and limits of psychological science, to providing specialized training to psychologists and psychiatrists who wish to become expert witnesses, in the fields of evidence-based approaches, ethics, criminology and victimology. The present article should be considered as a broad description of the current state of forensic mental health assessment in France and its pitfalls. This initial approach will be followed by empirical studies at a national level, focusing on the various issues pinpointed here, through a recently established partnership between psychology research centers and the French National School for the Judiciary (ENM), the final objective being to provide the criminal justice system with a high quality service and to clarify the indicators determining the quality of the pre-trial forensic mental health assessment and report.