DETERMINE DIFFICULTIES HERE THE RISK OF VIOLATION AND EVALUATION IN THE EVALUATION HERE FORENSIC PSYCHIATRY

• DOI: 10.22533/at.ed.1593202327032

• Palavras-chave: Forensic Medicine; Psychiatry; Risk assessment; Violence

• Keywords: Forensic Medicine; Psychiatry; Risk assessment; Violence

• Abstract:

  The forensic psychiatrist is the branch of medicine responsible for dealing with the psyche and its eccentricities, its meticulous evaluation has a profound legal value in terms of understanding the complex relationship between the mind and human feelings. There is an unknown dimension in approaching the assessment of violent behavior, as several risk factors need to be understood objectively, absent judgments and personal values. Ethical and moral precepts clash with the subjective assessment of experts, which leads to conflicting and dubious decisions despite the professionalism imbued in practice.
  That said, the Ministry of Health made available in November 2021 the Psychosocial and Violence Risk Assessment Model, a document that aims to guide and contribute to the assessment of risk factors associated with violence, applied mainly to people with mental disorders and in conflict with the law.

  However, in Brazil, this instrument has not yet been validated and its score should not be used exclusively and justified as the sole decision-making process in a trial. Therefore, associating the risk of violence with psychiatric illness should not be done lightly, but with adequate risk stratification to avoid misunderstandings of inadequate correlations in the association between violence and mental disorders. In order to identify and summarize the difficulties encountered in this approach, a search was carried out in electronic databases Scielo, Pubmed, Google Scholar and Lilacs with the following descriptors: forensic medicine; psychiatry; risk assessment; violence. Articles from the period between 2004 and 2021 that met the criteria for assessing the risk of violence in forensic psychiatry were selected. Despite the existing clinical and systematized criteria, the forensic assessment of the degree of risk of violence is still quite enigmatic due to the high degree of subjective dependence on the evaluator. The professional's belief will inherently affect their evaluative criteria, for example, social maladjustment or family history of mental disorder may indicate an important risk factor for some, while for others the determination of an antisocial personality or dissociative personality disorders are most important with regard to violent behavior. In addition, factors such as difficulty in maintaining interpersonal relationships, early school leaving, recidivism in criminal practices can help to determine the pre-criminal history. Another way of assessing is whether there is cruelty in the act of crime, a correlation between the perpetrator and the type of crime committed, which are post-crime parameters. Added to this, assessment instruments are needed to make the assessment more assertive, such as the VRAG method, which assesses the patient's history, the HCR-20 method assesses the environment in which it operates, the PCL-R assesses the individual himself, about his personality and possibilities of relapses. The PCL-SV method is only an abbreviated version of the previous method. The presumption of crime based on pathologies that increase the risk of violence can lead to a false perspective of accusation, generating an undue conviction. Despite the high relationship between criminality and psychiatric disorder, it cannot be directly related that this is an isolated factor for a greater risk of violent behavior, so the existing metrics should only be used as a reference associated with a group of evaluators from different professional areas to cause determination.