Risk Prediction in Forensic Psychiatry: A Path Forward

Abstract

Background: Actuarial risk estimates are considered the gold-standard way to assess whether forensic psychiatry patients are likely to commit prospective criminal offences. However, these risk estimates cannot individually predict the type of criminal offence a patient will subsequently commit, and often simply assess the general likelihood of crime occurring in a group sample. In order to advance the predictive utility of risk assessments, better statistical strategies are required. Aim: To develop a machine learning model to predict the type of criminal offense committed in forensic psychiatry patients, at an individual level. Method: Machine learning algorithms (Random Forest, Elastic Net, SVM), were applied to a representative and diverse sample of 1240 patients in the forensic mental health system. Clinical, historical, and sociodemographic variables were considered as potential predictors and assessed in a data-driven way. Separate models were created for each type of criminal offence, and feature selection methods were used to improve the interpretability and generalizability of our findings. Results: Sexual and violent crimes can be predicted at an individual level with 83.26% sensitivity and 77.42% specificity using only 20 clinical variables. Likewise, nonviolent, and sexual crimes can be individually predicted with 74.60% sensitivity and 80.65% specificity using 30 clinical variables. Conclusion: The current results suggest that machine learning models have accuracy comparable to existing risk assessment tools (AUCs .70-.80). However, unlike existing risk tools, this approach allows for the prediction of cases at an individual level, which is more clinically useful. The accuracy of prospective models is expected to only improve with further refinement.