Competency to stand trial: a conceptual model for its proper assessment

The assessment of competency to stand trial is frequently fraught with conceptual confusion resulting from a failure to properly apply the data of the clinical examination to the relevant legal criteria. A basic question scheme that encompasses (1) the defendant's psychiatric status, (2) the effects of that status on his functioning, and (3) his apparent ability to participate in legal proceedings, is introduced to clarify the evaluation of fitness to stand trial. The way in which combinations of answers to three "basic questions" generate a scheme that clarifies the difficulties encountered in most competency evaluations is shown. Eight paradigm cases are generated. Five of these (competence, incompetence, mentally ill but competent, malingering, and impaired but competent) are frequently straightforward. However, the three possibilities in which a defendant meets criteria entailed by two of the three questions are inherently subject to controversy. These situations (circumscribed psychosis related to the charges, malingering in the context of mental illness, and functional deficits in the context of minor mental illness) are discussed in detail and illustrated with case material.     

Restoration of competency to stand trial: Assessment with the Georgia Court Competency Test and the Competency Screening Test

Evaluations of the Georgia Court Competency Test—Mississippi Version Revised (GCCT-MSH) and the Competency Screening Test (CST) have supported their use with pretrial defendants in initial assessment of competency to stand trial. The present study evaluated the efficacy of these measures, as well as the Texas Competency Instrument, with an inpatient sample of defendants involved in a competency restoration program. Both measures were factor analyzed in an attempt to replicate previously identified factor structures. Neither factor structure was replicated; however, a distinct factor structure was identified for the GCCT-MSH. The relationships among sociodemographic variables, clinical variables, current symptomatology, and competency status (as measured by the GCCT-MSH) were evaluated using discriminant function analyses. The best predictors of GCCT-incompetency in this sample are a diagnosis of either a psychotic disorder or a nonpsychotic affective disorder as well as a low measured IQ. Current symptomatology, as measured by the SCL-90-R, was not an effective predictor of competency status.     

An evaluation of procedures for assessing competency to stand trial

In a field experiment involving 120 defendants at Bridgewater State Hospital in Massachusetts, the authors evaluated three instruments for assessing competency to stand trial: the Competency Screening Test (CST), Competency Assessment Instrument (CAI), and Interdisciplinary Fitness Interview (IFI). The CST (a paper-and-pencil test) was administered by a research assistant and scored by trained graduate students. Lawyers, psychologists, and social workers were recruited and trained in the use of the other instruments, then assigned as individuals (CAI) or teams (IFI) to conduct interviews and assess subjects. The performance of the project interviewers was compared against two yardsticks: (1) actual decisions reached by the regular Bridgewater staff, and (2) a consensus of two nationally respected experts who reviewed the cases and formed independent competency judgments. Both the CAI and IFI performed well under these conditions, indicating that one-time interviews by well-trained persons can lead to accurate competency decisions in the majority of cases. The authors conclude that hospitalization for competency assessment is rarely necessary.     

Assessment and conceptualization of competency to stand trial

Based on an examination of current methods used to define and assess a defendant's competency to stand trial, the authors propose an assessment and research instrument, referred to as the Interdisciplinary Fitness Interview (IFI). The IFI is a structured interview and rating scale designed to take into account both legal and mental health issues, and calls for an interdisciplinary approach to the assessment of competency. The purpose of the present study was to provide preliminary reliability and validity data on the use of the IFI in one jurisdiction. The results are discussed in terms of policy implications and the development of methods for evaluating competency with brief screening interviews in less restrictive settings.Support for this project was provided by a grant from the National Institute of Mental Health, Center for Studies in Crime and Delinquency (Grant No. 1 RO 1 MH 33669-01) to the Social Science Research Institute. The data reported here are taken from a larger research project designed to assess the use of a number of methods for assessing competency. Our principal concern in this article is with preliminary analyses of the Interdisciplinary Fitness Interview, a measure developed expressly for this project. The authors thank William Glackman and George Tien for their assistance in data analysis and Amiram Elwork and anonymous reviewers for their helpful comments on earlier drafts.     

AIDS-related dementia and competency to stand trial: a potential abuse of the forensic mental health system?

Public health officials, hospital administrators, forensic directors, jail wardens, judges, prosecutors, and defense attorneys must confront the issue: how should cases of individuals with AIDS dementia be treated when they are found to be permanently incompetent to stand trial? Although charges are sometimes dismissed in advanced cases of dementia, the more common pattern involves placement of the defendant in a public facility while awaiting trial. The refusal of some state facilities to accept these patients raises a host of legal, moral, and medical questions that virtually every urban state's forensic system will have to consider in the near future.     

Effects of advanced age and dementia on restoration of competence to stand trial

Elderly defendants (age 65+) and defendants with dementia adjudicated incompetent to stand trial and hospitalized for restoration to competence (RTC) often present unique challenges to clinicians charged with their restoration. In this study, we attempted to better identify predictors of successful RTC by building upon previous research correlating increased age with decreased likelihood of RTC. We identified elderly non-demented defendants (n = 31) and defendants diagnosed with dementia (n = 47) from a state database of 1380 individuals hospitalized for competence restoration from 1988–2004. Using regression analysis and correcting for demographic variables and common admission psychiatric diagnoses, we studied the relationship of age at hospital admission and dementia diagnosis on the likelihood of successful RTC. Both advanced age and dementia diagnosis were associated with decreased RTC. After correcting for dementia diagnosis, increased age retained its negative correlation with restoration success. Both elderly non-demented defendants and defendants diagnosed with dementia were significantly less likely to be restored to competence than all other RTC admissions (n = 1302). However, a substantial percentage of both demented and elderly non-demented defendants were successfully restored to competence, potentially justifying restoration attempts for both of these groups of defendants.     

Incompetency to stand trial: As status,as label,and as potential source of sentencing disparity

Criminal defendants are considered to be incompetent to stand trial if they are unable to understand the proceedings against them and unable to cooperate adequately with their attorneys. The purpose of this study was to compare the sentencing patterns of a group of defendants who had raised this issue and been returned to court as competent, with those of a group of defendants who had not raised the issue. Results showed that raising the issue of incompetency seemed to be a significant factor in the consumption of court resources, and lessened a defendant's likelihood of having his or her case dismissed. It did not make a significant contribution to the explanation of the variance associated with sentence length or with the granting of probation.     

The differential impact of deinstitutionalization on white and nonwhite defendants found incompetent to stand trial

Previous studies have reported that state mental hospital deinstitutionalization has resulted in the processing of the mentally ill through the criminal justice system. Using pre- and postdeinstitutionalization samples of defendants found incompetent to stand trial (IST) selected from three states, this study examines changes in the mental health and arrest histories of white and nonwhite ISTs. These data reveal a significant increase in the number of nonwhite ISTs. Also, after deinstitutionalization, nonwhite ISTs had significantly more prior arrests and hospitalizations than white ISTs. There were, however, no differences in the offenses for which whites and nonwhites were arrested.     

Competency Restoration: An Examination of the Differences Between Defendants Predicted Restorable and Not Restorable to Competency

According to the U.S. Supreme Court's decision in Jackson v. Indiana (1972), examiners must determine if a defendant has substantial probability of regaining competency through treatment in the foreseeable future. Previous research has indicated that, given the low base rate of defendants unable to be restored to competency, examiners are relatively poor at predicting which defendants will regain competency. Determining the characteristics of not restorable incompetent defendants and restorable incompetent defendants is a necessary first step toward improving examiners' ability to predict a defendant's likelihood of regaining competency. This study examined the competency evaluation reports of 468 defendants evaluated for competency to stand trial. Incompetent defendants significantly differed from competent defendants with regard to age, employment status, ethnicity, criminal charges, and psychiatric diagnosis. Few significant differences existed between defendants predicted restorable and those predicted not restorable by mental health examiners—the differences that did exist were related mainly to nonpsychiatric variables.     

Plastic face reconstruction as a possibility for identifying unknown skulls (II). An evaluation of the reliability of the reconstruction technic by a double-blind trial

In a double blind-trial two examiners reconstructed the soft tissue on lifelike casts of 12 skulls. They worked independently after having been given information about age, sex and constitution of the person in question and following a reconstruction plan based on the morphology of the skull. The comparison of the completed reconstruction with each other chiefly showed approximate to far-reaching degrees of resemblance and conformity. The comparison of reconstructions and photographs of the individuals also showed predominantly approximate to far-reaching likeness of the general impression, and, with one exception, at least little likeness was achieved. The reconstruction of soft tissue on the skull proved to be a relatively useful method of identifying unknown skulls, provided information on the colour and length of the hair, and possibly on the hairstyle as well, is at the examiner's disposal.     

Evaluation of a computer-assisted monitoring (CAMO) project: Some measurement issues

This article investigates the effect of Computer Assisted Monitoring of Offenders (CAMO) on probation outcome. In a comparison sample, the effect of CAMO treatment is compared to the effect of “regular” probation. In addition to testing the effects of CAMO as an intermediate treatment, methodological issues, such as level of probation restrictiveness and the effects of prior criminal involvement on probation outcome, are tested. Although the results are mixed, they indicate that level of probation restrictiveness and prior criminal involvement have a greater effect on probation outcome than does CAMO. These findings have ramifications for researchers comparing CAMO probationers to “regular” probationers and for those comparing different CAMO programs. An earlier version of this paper was presented at the Western Social Science Association’s 1992 annual conference.