Encyclopedia of Psychology and Law

acknowledgment of illness and the potential value of

treatment, while choice determines whether patients

make a selection consistent with their reasoning.

Intended for the comparison of patient groups, the

MacCAT–T has been tested in a variety of popula-

tions, including patients diagnosed with schizophre-

nia, psychosis, dementia, and depression. It has shown

strong interrater reliability and good agreement with

the assessment of clinicians.

The MacCAT–T has been instrumental in demon-

strating important correlations between symptoms,

cognitive variables, and decision-making capacity. In

a number of studies, it has underscored the relevance

of specific variables such as thought disorganization

and attention while demonstrating that patients with

mental illness nonetheless overlap with control popu-

lations in many of their abilities.

Criticized for its reliance on a cognitive-based

assessment of capacity, the instrument does in fact go

beyond cognition in its assessment. The appreciation

standard, for example, is more than a simple cognitive

standard, including, as it does, the treatment’s signifi-

cance and relevance to the patient. Moreover, even

emotional capacity relies on cognition to assess the

meaningfulness of a situation. Indeed, in one direct

comparison of capacity assessment tools, the MacCAT–T

was clearly found to address the common construct

underlying different competence standards.

One of a number of semistructured interviews to

come out of the MacArthur studies, the MacCAT–T is

now part of an entire generation of commonly used

tools assessing specific decision-making capacities.

Philip J. Candilis

See alsoCapacity to Consent to Treatment; Capacity to

Consent to Treatment Instrument (CCTI); Competency,

Foundational and Decisional; MacArthur Competence

Assessment Tool for Clinical Research (MacCAT–CR);

MacArthur Competence Assessment Tool for Criminal

Adjudication (MacCAT–CA)

Further Readings

Appelbaum, P. S., & Grisso, T. (1988). Assessing patients’

capacities to consent to treatment. New England Journal

of Medicine, 319(25), 1635–1638.

Grisso, T., Appelbaum, P. S., & Hill-Fotouhi, C. (1997). The

MacCAT–T: A clinical tool to assess patients’ capacities

to make treatment decisions. Psychiatric Services,

48 (11), 1415–1419.

Vollmann, J., Bauer, A., Danker-Hopfe, H., & Helchen, H.

(2003). Competence of mentally ill patients: A

comparative empirical study. Psychological Medicine,

33 (8), 1463–1471.

MACARTHURVIOLENCE

RISKASSESSMENTSTUDY

Violence risk assessment is now widely assumed by

policy makers and the public to be a core skill of the

mental health professions and plays a pivotal role in

mental health law throughout the world. Dangerousness

to othersis a principal standard for inpatient commit-

ment, outpatient commitment, and commitment to a

forensic hospital. The imposition of tort liability on

mental health professionals who negligently fail to

anticipate and avert a patient’s violence to others has

become commonplace. Despite the pervasiveness of

violence risk assessment in mental health law, research

continues to indicate that the unaided abilities of men-

tal health professionals to perform this task are mod-

est at best. Many have suggested that making available

to clinicians statistical information on the relation-

ships between various risk factors and subsequent vio-

lent behavior is the only way to reduce the disconnect

between what the law demands and what clinicians

are able to provide. The MacArthur Violence Risk

Assessment Study was one attempt to generate the

necessary empirical information to improve clinical

practice in the area of violence risk assessment. The

approach to risk assessment developed in this project

appears to be highly accurate when compared with

other approaches to assessing risk among people hos-

pitalized in acute-care psychiatric facilities. But it is

also much more computationally complex than other

approaches. Therefore, software has been developed

to ease the administration of the MacArthur proce-

dures in clinical practice.

The MacArthur Study’s

General Research Strategy

The MacArthur Violence Risk Assessment Study had

two core goals: to do the best “science” on violence risk

assessment possible and to produce an actuarial vio-

lence risk assessment “tool” that clinicians in the world

of managed mental health services could actually use.

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