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Clinicians can play an integral role in the ultimate determination of defendants’ criminal responsibility, given that information gleaned from mental state at the time of the offense (MSO) evaluations influence judges and jurors’ decision-making about a particular case. Such evaluations are particularly complicated due to their retrospective nature, lack of a standardized assessment approach, and variability in criminal responsibility statutes across jurisdictions and time. Yet several legal, clinical, and contextual factors appear to impact clinicians’ decision-making when tasked with these evaluations. In this chapter, we examine the existing literature regarding MSO evaluation referrals, including combined evaluations, to help inform practitioners’ expectations. Next, we review critical components of an MSO evaluation and identify challenges for clinical decision-making. Then we discuss forensic report writing and testifying, as informed by the literature regarding best practices. Lastly, we suggest how field reliability of mental state evaluations might improve through research and policy.
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