Mutism, malingering, and competency to stand trial

Mutism and mental illness have had a long-standing historical relationship with regard to the issue of competence to stand trial. This article reports a defendant who remained mute for 10 months and describes his use of the symptom of mutism in his malingering. Although mutism is frequently used by defendants for malingering, clinicians must have a high index of suspicion for the possibility. We recommend a comprehensive evaluation including neurologic workup, repeat interviews, observation of the defendant at unsuspected times for communicative speech with other inmates, study of handwriting sample, collateral nursing documentation, and, if necessary, Pentothal interviews to establish authenticity of mutism. The authors review the historical background and legal considerations of the relationship between mutism and malingering.     

Domains of competency to stand trial

Attempts to improve the clinical rigor of competency to stand trial evaluations have resulted in the development of several psycholegal measures. Among the most widely used of these measures are the Competency Screening Test (CST), the Fitness Interview Test (FIT), and the Georgia Court Competency Test—Mississippi State Hospital Revision (GCCT-MSH). To examine the theoretical domains of the competency construct as assessed by these measures, a series of exploratory factor analyses were performed combining previously reported data on the FIT and GCCT-MSH with a new outpatient sample of 353 court referrals. For the CST, data from a previous sample were compared to the original validation study. Of the three measures, only the GCCT-MSH showed evidence of stable, independent factors. A comparison of the GCCT-MSH to theDusky standard suggested a need to further develop empirical measures to better represent underlying constructs related to the defendant-attorney relationship and defendant's participation in his or her defense.     

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.     

Detection of malingering in competency to stand trial evaluations

A simulation design with multiple contrast groups was used to test the effectiveness of two instruments, the Structured Interview of Reported Symptoms (SIRS) and the Georgia Court Competency Test—Mississippi State Hospital (GCCT-MSH) in detecting malingering of competency to stand trial. Thirty simulators were compared with 23 incompetent defendants, 25 competent defendants, 30 offender controls, and 7 suspected malingerers on both instruments. Results revealed that the simulators and suspected malingerers scored significantly higher on all of the SIRS primary scales and significantly lower on the GCCT-MSH than the three comparison groups. The SIRS had an overall hit rate of 97.8% using three or more primary scales as the criterion for malingering. Information concerning the simulator's strategies of deception is presented.     

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.     

A comparison of instruments for assessing competency to stand trial

The present study compared two instruments for assessing competency to stand trial, The Competency Screening Test and a revised version of The Georgia Court Competency Test. in a sample of 140 defendants admitted to the forensic unit of a state hospital for court-ordered pretrial evaluation. Scores on the tests were used to predict staff decisions about competency. Correlates of scores on the two tests also were examined. The tests were highly correlated with one another and with the decisions of forensic examiners. Although neither of these instruments should provide the sole basis for competency decisions, both may be useful components of a comprehensive program of competency evaluation.Portions of this paper were presented at the annual convention of the American Psychological Association, Washington, D.C., August, 1986.     

精神病人受审能力评定标准的制订

目的制订符合中国刑事法律体系的精神病违法者受审能力评定标准。方法根据自己的法医精神病学实践,结合国外已有的标准和中国刑事法律,研究者首先创建了称为“受审能力评定表”的评定工具,然后在实践中运用该工具;最后通过诊断性实验,对该工具的信度、效度及实用性进行了检验。结果该工具的分半信度和同质性信度分别为0.9366和0.9213,工具评定与专家评定的一致性为0.704,除了敏感性为0.6097,其他所有的诊断性指标均大于0.80。结论受审能力评定表具有较好的实用性。     

Criminal offense, psychiatric diagnosis, and psycholegal opinion: an analysis of 894 pretrial referrals

This article presents the results of a study of 894 criminal defendants referred by Virginia courts for evaluation of competency to stand trial or criminal responsibility. All evaluations were conducted on an outpatient basis by mental health professionals who had received specialized training in forensic evaluation. Findings as to the referral questions posed, the criminal offenses charged, and the clinical diagnoses and psycholegal opinions offered by the evaluators are described. Statistical analyses demonstrate significant relationships between both diagnosis and criminal charge and the psycholegal opinion rendered.     

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.     

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.     

Evaluation of competency to stand trial in defendants who do not want to be defended against the crimes charged

Implicit but significant assumptions made in the criminal justice system include beliefs that criminals do not commit crimes to be tried and convicted and that, once arrested, defendants' primary motives are to avoid or minimize the legal consequences of the charges they face. When those assumptions are not correct, clinicians and legal decision makers are faced with difficult tasks. The authors present three cases of defendants who were not primarily concerned with defending themselves against the charges they faced, but rather with using the criminal justice procedures to further personal goals, and discuss the problems involved for forensic evaluators and courts.     

Recidivism among drug offenders: A survival analysis of the effects of offender characteristics,type of offense,and two types of intervention

The determinants of recidivism are increasingly becoming the focus of public concern. This study explores the relative effect of type of intervention, offender characteristics, and type of incident offense on time to a petition to revoke probation and time to a probation revocation. Our analysis of intervention effects includes both parametric and nonparametric estimation procedures. Estimating five distributional forms of survival and a proportional hazard model for each measure of recidivism, the analysis indicates no difference in the effect of a program of drug monitoring and treatment, compared to drug monitoring only, for either of the two measures of recidivism. In addition, findings indicate that younger offenders and African American offenders have a shorter time to a petition to revoke probation. We also found a reduced time to failure for a probation revocation for African American offenders and offenders with a prior arrest record. Our findings offer empirical support for a reconsideration of the type of intervention effective in deterring offenders while on probation.     

Patterns in burglary: An empirical examination of offense and offender characteristics

Key cluster analysis was used to examine the various characteristics of both burglars and burglaries to determine the existence and extent of any relationship between the offender and the incident. The data were gathered from six law enforcement agencies in California.Although some patterns were suggestive of a relationship between race, method of entry, and economic level of the burglarized location, no strong patterns could be found.     

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.