Competency To Stand Trial Research Articles

A - 85 Neuropsychological and Cultural Elements in the Assessment of Competency to Stand Trial.

Research has highlighted how key cognitive functions underlie abilities within the construct of Competency to Stand Trial (CST). This case study examines the impacts of Mild Neurocognitive Disorder and culture on a physician found incompetent to stand trial. A 62-year-old African-born male physician charged with Health Fraud who was referred for an examination of his CST. His attorneys raised concerns about his rational understanding of the proceedings and his ability to collaborate constructively with them. The client underwent comprehensive forensic, neuropsychological and neurological assessment. Neuropsychological testing revealed low-average intellectual abilities which likely reflected a decline from estimated premorbid levels. Contrary to expected performance given cultural factors, nonverbal intellectual abilities were markedly lower than verbal intellectual abilities. Compromises in multiple domains of cognition including memory were also noted. A referral to neurology revealed moderate atrophy and a mass in the right temporal fossa, in line with a diagnosis of Mild Neurocognitive Disorder with Multiple Etiologies. A causal connection between his cognitive deficits (e.g., compromised reasoning) and competence-relevant abilities (e.g., capacity to waive constitutional rights) was established. The subject was adjudicated incompetent to stand trial and, largely due to neurologic findings, unlikely to attain competency (i.e., non-restorable). This study demonstrates the value of neuropsychological assessment in both the clinical recognition of brain pathology and cognitive dysfunction in the setting of complex legal and cultural issues. Guidelines to address complex competency cases that warrant comprehensive assessment are needed.

COVID-19, Mink-Bowman, and Court-Ordered Psychiatric Services in Oregon.

COVID-19 strongly affected referral of individuals from Oregon's courts and the ability of Oregon State Hospital (OSH) to accept patients. Despite acceleration in the decline in civil commitment, competency to stand trial (CST) admissions increased, causing a bed crisis at OSH, which in turn affected community hospitals and jails. In 1993, the Ninth Circuit Court of Appeals mandated admission of jail detainees to OSH within seven days after a judicial order for CST evaluation or restoration. During COVID, as the number of such patients increased to crisis proportions, average jail detention times exceeded seven days. An inevitable judicial process intensified in the U.S. District Court of Oregon after OSH requested a COVID-related modification of the seven-day limit. This commentary demonstrates more clearly than in the past that there is a negative correlation between civil commitment and competency restoration as components of an interrelated system. After updating the situation in Oregon, this article ends with suggested interventions to improve Oregon's civil and criminal commitment processes, hoping for better care of patients and improved administration of justice.

Towards a Heuristic Neuropsychological Model of Adjudicative Competency.

This study sought to delineate the neuropsychological processes that undergird the psycho-legal concept of competency to stand trial (CST). Accordingly, we retrospectively examined the relationship between clinical judgments of competence or incompetence of defendants committed to a maximum-security psychiatric facility and neuropsychological measures of cognitive and social intelligence and declarative memory. Results indicated that both groups (competent and incompetent) showed similar levels of depressed cognitive intelligence with Wechsler full-scale IQ levels falling in the upper end of the borderline range. Compared with defendants clinically judged as incompetent, defendants recommended as competent scored significantly higher on measures of social intelligence and episodic memory, with the most pronounced advantage occurring on tests of verbal memory that place heavy demands on encoding, consolidation, and retrieval of aurally presented narrative material. Cognitive capacities in areas of social intelligence and episodic memory may play critical roles in developing a heuristic neuropsychological model of CST. The evaluation of these domains offers implications for the assessment, restoration, and understanding of CST.

Evaluations of competence to stand trial are evolving amid a national "competency crisis".

Across the United States, court orders for competence to stand trial (CST) evaluations and competence restoration services have been increasing much more rapidly than states can provide these services, prompting what has been called a national "competency crisis." The challenge in providing timely competence restoration services has, in several jurisdictions, prompted a change in competence evaluations. Evaluators are more often required to address broader clinical issues-such as recommending placement or addressing the urgency of hospitalization-rather than addressing only CST. This marks an evolving practice in forensic evaluation, which moves evaluators beyond the very narrow forensic question of competence and into more traditionally clinical recommendations. We describe several state examples of changing practice in order to highlight the initial barriers, and potential benefits, to addressing additional clinical issues in competence evaluations, amid a national competence crisis.

Persistent, poor quality competency to stand trial reports: Does training matter?

Consistent with nationwide trends, the number of defendants judicially ordered to the California Department of State Hospitals (DSH) for competency restoration has nearly doubled in recent years. Previous research has shown that the majority of the time, judicial rulings on competency reflect forensic evaluators' opinions. Thus, the quality of competency to stand trial (CST) reports is critical. We examined 388 CST reports from defendants who were ultimately found incompetent to stand trial and admitted to a state hospital for restoration in 2012-2013. We evaluated the reports for adherence to both professional guidelines and current literature on the appropriate conduct of CST evaluations. Consistent with previous studies, our results showed that the reports evidenced overall poor quality and evaluators were largely unable to accurately describe the nature of the mental illness or explain how clinical factors (i.e., diagnoses or symptoms) impacted CST abilities. Notably, we found that experts board certified in psychiatry or psychology produced reports of higher quality. These findings demonstrate the continued poor quality of CST reports and highlight the importance of training. As in previous similar studies, we recommend mandatory training for experts conducting CST evaluations. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Characteristics and outcomes for defendants charged with misdemeanors referred for court-ordered competency evaluations.

Recent research has suggested nationwide increases in the rates of referral for competence to stand trial (CST) evaluations across the United States. Many of these evaluations are for defendants charged only with misdemeanor offenses and for whom diversion programs are most appropriate. The present study was designed to analyze the characteristics of, and re-arrest outcomes for, defendants charged with misdemeanors ordered to undergo CST evaluations in a large metropolitan area. Overall, there was a high base rate of incompetent to stand trial (IST) opinions (over 70% of defendants) in this sample, with the greatest impairments in rational understanding and ability to assist counsel. Defendants opined IST were more likely to have a psychotic disorder, a history of psychiatric hospitalization, and greater abnormalities in thought content relative to their competent counterparts. Of concern, defendants opined IST, and especially those referred for crisis evaluations upon dismissal of the charges, were significantly more likely to be re-arrested than their counterparts. These data support the criminalization hypothesis, suggesting that criminal justice involvement for this subset of defendants inappropriately reflects psychiatric instability, supporting the need for more options for inpatient and outpatient treatment to effectively intervene in this process. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Re-Envisioning the Competency to Stand Trial Evaluation and Report Based on Ethical, Legal, Data Integrity, and User-Friendliness Considerations

ABSTRACT The format and content of competency to stand trial reports are influenced by traditional practices of psychological assessment and report writing that are outmoded for forensic practice. Many such reports include irrelevant, prejudicial information that unnecessary invades the privacy of the examinee, in violation of APA ethical guideline 4.04, and may also contain much data that are unreliable and prejudicial. Traditional report formats are organized around the psychologist’s concerns and topic areas rather than what is most useful to the trier of fact and parties. This article discusses these issues and offers a rationale for radically revising the standard competency to stand trial (CST) report template to make it more focused and objective for readers, more ethically compliant, and with less prejudicial information that may compromise the objectivity of the trier of fact. It also substantially reduces the amount of time required of report-writing.

Estimating Annual Numbers of Competency to Stand Trial Evaluations across the United States.

In the United States, criminal proceedings must be halted or suspended if a defendant is determined to be incompetent to stand trial. Competency to stand trial (CST) is one of the most notable intersections between psychiatry and criminal law, and evaluating defendants for CST is a key role for many forensic psychiatrists and other mental health professionals. Despite the significance of CST evaluations in U.S. criminal justice, the number of CST evaluations conducted across the country each year remains largely unknown. National estimates dating back to the 1970s have ranged from approximately 19,000 to 94,000 CST evaluations each year, but these numbers vary considerably and often stem from imprecise calculations. This article examines estimates of annual numbers of CST evaluations across the United States, the need to develop more accurate statistics, and ways to implement systems for tracking the numbers of CST evaluations across the country.

Evaluation and Restoration of Competence to Stand Trial: Intercepting the Forensic System Using the Sequential Intercept Model.

The sequential intercept model (SIM) is used to reduce the penetration of persons with mental illness and substance use disorders in the criminal legal system. Its framework recommends identifying individuals with mental illness at various decision points of criminal case processing, from arrest to return from incarceration, so that they can be diverted toward treatment rather than permeate deeper into the criminal justice system. Communities frequently use the model to augment and inform jail diversion services. Despite the model's widespread adoption, individuals with serious mental illness, intellectual and developmental disabilities, and disorders affecting neurocognition and behavior are often found ineligible for such diversion because their competence to stand trial (CST) warrants evaluation, which effectively pauses their criminal case processes. If found incompetent to stand trial, these people can be ordered for competence restoration treatment, creating a pathway that is different from jail diversion options. Traditional community mental health services and courts await resolution by the "forensic system" before linking these individuals to needed services, and often these linkages are lacking. This review aims to describe and demystify these forensic processes and to highlight the potential use of the SIM to decrease jail stays and maximize community service connections for individuals with some of the most impairing mental health conditions who are involved in the justice system and for whom diversion is a safe option. The authors offer specific examples of intercept opportunities at each step involved in evaluations of CST and in the competence restoration processes.

Challenges to Reforming the Competence to Stand Trial and Competence Restoration System.

Many mental health and justice professionals have noted that the system that manages both competence to stand trial (CST) evaluation and competence restoration (CR) processes in criminal cases is in crisis. Public mental health services often are inundated with court referrals and are challenged to address them in a timely manner, resulting in waits for competence-related services for people in jail as well as substantial risks to criminal defendants for whom competence issues are raised. In this review, the authors describe the current CST-CR system and offer preliminary solutions to its challenges. In addition, they examine published works on the legal foundation of CST to help support the basis for this analysis. The results of this review point to the need to more effectively address the complexities of the CST-CR systems and highlight the importance of collaboration across legal and clinical systems. Guidance to states can be best facilitated by support for empirical research on the individual- and system-level factors that contribute to the waitlists and system paralysis that have a negative impact on people with serious mental illness in the criminal justice system.

Competency to stand trial evaluations: A state-wide review of court-ordered reports.

Competence to stand trial (CST) evaluations are a critical part of certain criminal proceedings, and competence-related evaluation and treatment are an increasing part of public mental health services. Whereas more research describes the defendants undergoing competence evaluations, less research has examined the actual reports detailing those competence evaluations. This study reviewed 3,644 court-ordered CST evaluation reports submitted by 126 evaluators in Virginia since Virginia initiated an oversight system allowing for comprehensive review. The base rate of incompetence opinions was 38.8%, but these rates varied significantly across evaluation type (initial versus post-restoration efforts) and evaluators (ranging from 9.1% to 76.8% incompetence rate). Results suggest generally strong compliance with state statutes guiding CST evaluations, but also highlight marked variability in forensic conclusions and reveal a few areas in which some reports fell short of statutory requirements and practice guidelines.

An Examination of PTSD and Criminal Responsibility among US Servicemembers.

This retrospective study evaluated the prevalence of posttraumatic stress disorder (PTSD) diagnosis among military servicemembers referred for Sanity Boards (n = 229), which is a military evaluation for competence to stand trial (CST) and criminal responsibility (CR). This study further explored the degree to which PTSD was considered a "severe mental disease or defect," the degree to which PTSD was associated with an opinion of not criminally responsible (NCR), and the degree to which PTSD was associated with incompetence to stand trial (IST). Completed Sanity Board evaluations were the source of data. This study used an empirical approach to reviewing the Sanity Boards. Sanity Boards diagnosed 13.1% of referrals with PTSD. Of those diagnosed with PTSD, no participants (0%) were opined to meet criteria for incompetence to stand trial (IST), 30% were opined to meet the insanity criteria of "severe mental disease or defect," and one person (0.4%) was found not criminally responsible (NCR) based on PTSD. In the single case in which the person was recommended as NCR based on PTSD, the criminal behavior was deemed to be related to dissociation. PTSD is often considered a "severe mental disease or defect" during Sanity Board evaluations, which differs from the legal standard for "severe mental disease or defect" used by the military justice system. Forensic practitioners consulting with the military justice system acknowledge that PTSD is a "severe mental disease or defect" often, but they rarely opine that PTSD renders a servicemember NCR. In the rare instance where PTSD was opined to render a servicemember NCR, the symptom of dissociation caused an inability to appreciate the nature and quality or wrongfulness of the action.

Forensic Competency Assessment with Digital Technologies.

We review the application of videoconferencing (VC) to pretrial forensic assessments of competence to stand trial (CST). We summarize the benefits, legal considerations, and reliability of VC evaluations. Based on our experience with VC in forensic settings, we provide illustrations of challenges and recommendations regarding this capability to meet increasing demands for services. CST evaluations are the most frequent type of forensic mental health assessment within the American legal system. VC can be a reliable method for conducting interviews with most defendants, including those with psychotic symptoms. Videoconferencing can improve the overall efficiency of evaluations while also improving the safety of the professionals involved with the competency evaluation. VC provides an opportunity to meet the increasing demand for evaluations and improve their efficiency. Forensic clinicians should become familiar with the uses of VC in delivering services so that VC is implemented ethically and effectively.

Fetal Alcohol Spectrum Disorder (FASD) and Competency to Stand Trial (CST): A Call on Forensic Evaluators to Become Informed

ABSTRACTFetal Alcohol Spectrum Disorder affects an estimated 3–5% of the population and results in numerous functional deficits in cognitive, social, and adaptive skills. Additionally, it is estimated that 60% of those who have FASD will become involved in the criminal justice system at some point in their life. Given the high percentage of those with FASD who become involved in the criminal justice system and the significant functional deficits that they experience, it is essential that forensic evaluators become familiar with FASD. It is also important that evaluators are familiar with how this disorder may impair an individual’s ability to participate adequately in the criminal justice system, including competency to stand trial. This article will provide some basic information about the need for forensic evaluators, and those who may refer defendants to forensic evaluators (e.g., attorneys, social workers, jail mental health staff), to become informed about FASD in order to conduct thorough and complete evaluations of competence to stand trial. Because little research has been completed on this issue, information presented in this article is based on literature review and clinical experiences. Basic information about the symptoms of FASD that impact competence to stand trial (CST) as well as proposed techniques for conducting a thorough assessment of CST when relevant FASD symptoms are present will be discussed. Finally, recommendations for training forensic mental health professionals about FASD and its potential impact on a defendant’s competency-related abilities are offered and suggestions for future research are presented.

Defense Referral Patterns Associated with Competency to Stand Trial, Mental State at the Time of the Offense, and Combined Evaluations

ABSTRACTAlthough research highlights the influence of individual and case characteristics on outcomes of competence to stand trial (CST), mental state at the time of the offense (MSO), and combined evaluations (CST and MSO), we know little about differences in these characteristics across referral type. Using a sample of 2,655 evaluations in Virginia over a 15-year span, we examined demographic, clinical, and legal characteristics associated with whether defense attorneys referred individuals for CST-only, MSO-only, or combined evaluations. Multinomial regression revealed that Non-White individuals and those diagnosed with psychotic disorders were more often evaluated for CST-only, relative to MSO-only or combined evaluations. Individuals with organic or developmental disorders were more often seen for CST-only or combined evaluations. Violent charges were associated with MSO evaluations, either alone or with CST. Individuals who were under the influence of a substance at the time of the offense or had a prior conviction were more likely to be seen for combined evaluations compared to CST-only evaluations. There was more differentiation in CST-only from MSO-only and combined evaluations than from MSO-only versus combined evaluations. Findings are interpreted while considering legal professionals’ potential referral motives. We discuss important implications within the context of fundamental fairness for all individuals in the criminal justice system, particularly given results on racial differences.

Factors that predict murder defendants' competence to stand trial

One hundred sixty-three homicide case files from The Center for Forensic Psychiatry in Ypsilanti, Michigan were examined for evidence of factors associated with the outcomes of Competency to Stand Trial (CST) evaluations. Of the socio-demographic, legal, and clinical factors investigated, only three were significant. Defendants with lower IQs were more likely to be found incompetent to stand trial, and those with more property crime arrests were more likely to be found competent to stand trial. Additionally, defendants who were found incompetent to stand trial were more likely to be accused of killing an intimate or relative.

Response to Disclosure as an Indicator of Competence to Stand Trial.

Ethics guidelines recommend that forensic mental health professionals begin in-person assessments by explaining the nature and purpose of the examination. To learn whether evaluees have understood and can give consent, forensic practitioners may ask evaluees to paraphrase the explanation. This article explores how a forensic evaluee's disclosure response (DR) reveals substantive information relevant to the purposes of a forensic examination. We examined archival data from 255 reports on competence to stand trial (CST) that a Midwest public sector hospital had previously submitted to courts. We classified each evaluee's DR at one of three levels: DR = yes (accurate paraphrasing), DR = no (inability to paraphrase or provide a relevant response), or DR = other (an intermediate level implying a less-than-accurate response). None of the 28 DR = no evaluees was CST, and only 7 (17%) of the 48 DR = other evaluees were CST. Thus, a CST evaluee who cannot paraphrase an examiner's explanation is likely to be incompetent to stand trial, and an examiner would need to adduce a strong argument to support any opinion to the contrary.

The impact of defendants' race in competency to stand trial referrals

In the United States, competency to stand trial (CST) evaluations ensure that criminal defendants are capable of participating in their defenses, thus ensuring an important legal right. However, some research has suggested that the CST process may be impacted by legally irrelevant factors such as a defendant's race and cultural background. However, the majority of researchers examined factors that are predictive of CST recommendations and decisions. Few studies have focused on potential racial discrepancies in attorney referrals for CST evaluations and whether they are exacerbated by professional experience. The current study examined potential racial disparities in referrals for CST evaluations among 322 law students and 102 attorneys. Participants were randomly assigned to read vignettes describing either African American or Caucasian defendants who varied in their fitness to stand trial. The participants were asked to indicate whether they would refer the client for a CST evaluation and to describe their reasoning. The results indicated that both law students and attorneys were generally more likely to refer unfit rather than fit defendants, indicating an understanding of the legal criteria. Law students displayed a racial bias, only when referring the defendants who were unfit due to the lack of a rational understanding of the relevant legal case, χ2(1) = 4.90, p = 0.03, Φ = 0.13. Fitness condition was the only significant predictor of attorney referrals. The generally encouraging results indicated that professional experience did not increase racial biases.

Клинико-психологические аспекты экспертной оценки уголовно-процессуальной дееспособности у несовершеннолетних обвиняемых

The article deals with issues of clinical-psychological criteria of expert evaluation of competency to stand trial (CST) in juvenile offenders. Using the material of joint forensic psychiatric-psychological evaluations of 100 male juvenile offenders the authors singled out statistically significant indices of psychic activity, which differentiated groups of juveniles with and without CST. Three blocks of parameters for the CST expert evaluation are described. The first block includes the functioning character of the main cognitive processes, the second – the adequacy of social meanings understanding and of the ability to build logical conclusions on their basis, the third – the ability of social behavior regulation. The general controlling component of the system is critical thinking. Concrete empirical indices of the parameters are presented. The authors outline perspectives of the future development of the clinical-psychological analysis of the CST.

Using the MMPI-2-RF to Characterize Defendants Evaluated for Competency to Stand Trial and Criminal Responsibility

ABSTRACTThis study sought to provide more specific comparison groups for examiners using the MMPI-2-RF in criminal forensic evaluations, as well as to expand upon the existing literature by comparing defendants evaluated for Competency to Stand Trial (CST) and Criminal Responsibility (CR) on psychological functioning. In a large pre-trial criminal defendant sample (n = 486), significant differences were observed between defendants evaluated for CST and those evaluated for CR on scales reflecting emotional and externalizing dysfunction, but not thought dysfunction. Moreover, those opined competent to stand trial by forensic examiners scored lower than those opined incompetent on measures of psychoticism/paranoia, whereas those opined not criminally responsible were less likely to exhibit externalizing psychopathology relative to those opined to be criminally responsible. Implications for forensic psychology practice are discussed.