Challenges to court room mental health decision-making in the face of uncertainty

Mental health professionals are frequently faced with the challenge of not only having to make decisions that have far-reaching consequences for the individual being assessed, but having to do so with inevitable degrees of uncertainty. Acknowledging and attempting to quantify this uncertainty ought therefore to be central to such an endeavour but, we argue, it is insufficiently recognised by the professionals involved. Specifically, ‘experts’ who rely on scientific evidence in providing an opinion need to be aware of the challenges of applying such group data to an individual case. In this paper, first, we consider some criticisms of current practice in this respect. Second, we offer a rejoinder that considers the place of tacit knowledge in the clinical practice, the contribution of both Bayesian reasoning and an adapted epidemiological criteria for causal inference, all of which we believe would strengthen the provision of a forensic ‘expert’ opinion, in a courtroom setting.