Clinical Psychology

sexually abuse a child, or otherwise behave so as to
lead the lay public to question the competence (and
often the common sense) of the psychiatrist or psy-
chologist involved in the release decision. All this
leads to the conclusion that predicting dangerous-
ness is very, very difficult. Although it is perhaps
true that all of us have the potential to commit
dangerous acts, given the right conditions, the fact
remains that unless someone has previously behaved
in a dangerous fashion, the ability to accurately pre-
dict such behavior is extremely limited.
Difficult though such predictions are, psycho-
logical evaluation for this purpose may constitute
the largest single category of evaluation requested
of the clinician by the criminal justice system (Blau,
1998). Evaluations can range from predicting sexual
violence, child abuse, and workplace violence to

predicting suicidal or homicidal behavior. These

evaluations are used for many decisions, ranging

from holding a prisoner without bail, to granting

work-release status to hospitalized defendants, to

invoking special sentencing options for violent

offenders, just to name a few. As noted by Greene

and Heilbrun (2011), research suggests that the fol-

lowing types of predictions of violent behavior are

likely to be the most accurate:

1. Predictions for specific kinds of violent
   behavior


2. Predictions for certain settings or circumstances
   that the clinician already has historical data on


3. Predictions based on the clinician’s knowledge
   of the individual’s past history of violent
   behavior

BOX19-3 Focus on Clinical Applications

Legal Controversies: Forcible Medication

Over 20 years ago,Perry v. Louisiana(1989) raised the

issue of whether state officials may forcibly administer

psychotropic medications to a death row inmate to

render him mentally competent for his own execution.

A macabre yet real-life question!

Who should decide whether prison inmates may be

administered antipsychotic drugs against their will? This

question has been argued before the U.S. Supreme

Court. In the case ofWashington v. Harper(1990), the

Supreme Court ruled that a mentally ill prisoner could

not be medicated without his or her consent unless

there was a consensus of professional opinion that

safety would otherwise be compromised. More recently,

however, the Supreme Court has ruled that an individ-

ual could be forcibly medicated in an attempt to make

him competent to stand trial (Sell v. United States, 2003).

Charles Sell, a dentist, had a long history of men-

tal illness, including multiple psychotic episodes. In May

1997, he was charged with insurance fraud. At that

time, he was deemed“currently competent,”but the

federal judge noted that Sell might have a psychotic

episode in the future. Sell was released on bail. In early

1998, Sell was charged with trying to intimidate a wit-

ness, and a bail revocation hearing followed. At this

hearing, Sell’s behavior was irrational, bizarre, and

physically threatening. Further, a psychiatrist reported

that Sell was psychotic and that his condition had

worsened. Sell’s bail was revoked. In 1998, Sell was also

charged with attempting to murder an FBI agent who

had arrested him as well as for attempting to murder

an associate who might testify in Sell’s fraud trial. In

early 1999, Sell requested that the judge reconsider his

competency to stand trial. Based on a psychiatric eval-

uation at a federal prison, the magistrate found Sell

incompetent to stand trial. The medical staff recom-

mended that Sell take antipsychotic medication, but he

refused to do so. The medical staff then sought per-

mission to medicate Sell against his will.

The main issue addressed in theSell v. United States

decision was whether involuntary medication violated

Sell’s constitutional rights.TheU.S.SupremeCourt upheld

the trial court’s ruling that Sell could be involuntarily

medicated for the purposes of attempting to restore his

competency to stand trial. In addition, the court set out

the following criteria for future decisions on this issue:

1. In such cases, the interest of the government must
   outweigh the individual’s interest in remaining
   medication-free.


2. There must be no less intrusive way of fulfilling
   this interest.


3. The medication must be medically appropriate
   (e.g., likely to render the defendant competent,
   benefits outweigh the risks, and it is in the best
   medical interests of the defendant).

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