The process of determining an accused person's competence to stand trial often causes indefinite commitment to mental hospitals. This template lends itself to the efficiency of using voice recognition software to dictate at each cursor stop. Others have estimated that 28% of all felony defendants are referred each year for an evaluation of competency (Hoge, Bonnie, Poythress, & Monahan, 1992; LaFortune & Nicholson, 1995). Incompetent to stand trial examples Rating: 5,7/10 603 reviews. While it does not grapple directly with evidence-based practices, the guideline attempts to standardize competency evaluations by recommending 15 specific areas of inquiry. The MacArthur Competence Assessment Tool-Criminal Adjudication (MacCAT-CA; Hoge, Bonnie, Poythress, & Monahan, 1999; Poythress et al., 1999) uses a hypothetical vignette to explore a defendants understanding, reasoning, and appreciation abilities. Although they focused on treatment, several findings may be applicable to forensic practice. Dusky is a vague standard as it provides little clear direction to forensic examiners asked to provide an assessment of a defendants competence. Most of those referred for competency evaluations are found competent after relatively brief assessments, but approximately 2025% are found incompetent and referred for treatment to restore competency. Those components retained an average of 6.10 on a 7.00 rating scale of their representativeness. Inquiries can be either case-specific (i.e., the content focuses on the defendant's case) or hypothetical (i.e., the content is unrelated to the defendant's case). Zapf and Roesch (2011), in their review of competency restoration programs, identified the pressing need for research Focusing on specific cognitive deficits and symptoms of mental disorder and the interplay between these and various competency-related abilities and deficits (p. 46). One sound approach to ascertaining error rates is to estimate the accuracy of individual scores on competency measures. He & denies history of suicide attempts. The defendant's plan for his legal strategy regarding the charges against him is, &. More details of the vignette are provided as the examiner moves through the first two sections of the MacCAT-CA. Does the defendant have the capacity to challenge prosecution witnesses realistically? (1998) found that evaluators did review basic issues such as ability to assist counsel, but typically need not pay attention to decisional competence issues, as only 12% of the reports discussed whether the defendant understood what rights were given up when entering a guilty plea. The Ontario Court of Appeal recently set a precedent (Queen ve. The purpose of this evaluation was to determine his competence to stand trial and his criminal responsibility (insanity) regarding his current criminal charges. Unfortunately, there is little research on the effectiveness of various treatment approaches. 9, pp 5934]. While the phrase patricidal tendency is an overreach, it does capture the concerns of seasoned practitioners who see the possibility that their decades of experience will be devalued or even discredited by evidence-based approaches. Competency restoration practices are reviewed later. Legally, the concept of fitness to stand trial is fixed and absolute. Printed from Oxford Research Encyclopedias, Psychology. Legal procedures that protect the rights of criminal defendants have been adopted to ensure that they have the capacity to participate fully in their defense (Youtsey v. United States, 1899; Dusky v. United States, 1960). Slade and his colleagues6 carefully evaluated the acceptance of an empirically based assessment model involving a constellation of standardized measures. The presence of psychosis, for example, is associated with a finding of incompetency. For example, does the length and complexity of competency questions substantially exceed the defendant's ability to process this information? Lipsitt, P. D. , Lelos, D., & McGarry, A. L. (1971). If the defendant were in a theater and saw the curtains on fire, he would, &. For mental health experts, the practical effect of this ruling is that different trial judges within the same jurisdiction may legitimately reach opposite conclusions about the admissibility of specific methods, such as competency measures.14 In Kumho, the Supreme Court applied the Daubert guidelines beyond scientific evidence to all expert testimony. commentary did raise a valid question as to whether consistent ratings of 2 (i.e., mild impairment but unrelated to competency) could result in classification as having severe impairment on the ECST-R competency scales. The defendant & denies the use of alcohol. The number of legs on a horse is, & 4. He was diagnosed with schizophrenia and found incompetent to stand trial and remanded for treatment, which successfully restored his competence. This section regards sanity.). As a simple reminder, the CAST-MR has been validated only in defendants with mental retardation; it should not be used for mentally disordered defendants, with or without mental retardation. Some items require the defendant to visually identify the location of certain participants in the courtroom (i.e., defendants are shown a drawing of a courtroom and asked where does the Judge sit?), and then defendants are asked about the function of certain individuals in the courtroom, such as witnesses and lawyers. & Yes. Descriptive but not normative data are presented from two studies of criminal defendants. This article begins with an overview of evidence-based practice and the Daubert standard, which sets the stage for an extensive examination of competency to stand trial via three competency measures. Basic Legal Concepts is the one most closely aligned with Dusky's factual understanding, whereas skills to assist defense uses hypothetical examples to evaluate the consult-with-counsel prong. The template includes the standard elements of competency and criminal responsibility reports. The use of psychotropic medication has been shown to be effective in restoring competence, as evidenced by the high rate of restoration noted. However, so many mouse clicks are needed that it is not worth doing. NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. For this final project, I will be examining the topic of Competency to Stand trial or (CST). Grisso emphasizes the contextual nature of a competency determination and the importance of understanding the demands of the defendants case, noting that an interaction between individual ability and situational demand, not an absolute level of ability, is of special significance for competence decisions (pp. The defendant is asked a series of questions about Freds situation and how Fred might deal with various aspects of his case. They found 51% of defendants with a diagnosis of psychosis to be incompetent, compared to only 10% without this diagnosis. 41, p 31). The sovereign citizen beliefs held by the defendants were identified from the court reports, and each element was used as a search term on Google, to find additional information about each belief. Psychiatrists view fitness as a homeostatic functional capacity. Identifying persons feigning limitations in their competence to proceed in the legal process, Attorney-client decisionmaking in criminal cases: Client competence and participation as perceived by their attorneys, The MacArthur Adjudicative Competence Study: Development and validation of a research instrument, The role of demographic, criminal, and psychiatric variables in examiners predictions of restorability to competency to stand trial, Competency for trial: A screening instrument, Evaluating the psycholegal abilities of young offenders with fetal alcohol spectrum disorder, Hospitalization of criminal defendants for evaluation of competence to stand trial or for restoration of competence: Clinical and legal issues, Clinician variation in findings of competence to stand trial, Outcome of hospitalization for defendants found incompetent to stand trial, A comparison of instruments for assessing competence to stand trial, Competent and incompetent criminal defendants: A quantitative review of comparative research, Psychometric properties of the MacArthur Competence Assessment Tool-Criminal Adjudication, A meta-analytic review of competency to stand trial research, The Competence Screening Test: A replication and extension, Social worker assessments of competency to stand trial, Recent interview-based measures of competence to stand trial: A critical review augmented with research data, The detection of feigned mental disorders on specific competency measures, Competence to stand trial: Clinical reliability and the role of offense severity, Psychopathology and competence to stand trial, Community examiners evaluations of competence to stand trial: Common problems and suggestions for improvements, Prevalence of serious mental illness among jail inmates, An examination of the relationship between competency to stand trial, competency to waive interrogation rights, and psychopathology, Adjudicative competence evaluations of juvenile and adult defendants: Judges views regarding essential components of competence reports, Fitness to stand trial evaluations: A comparison of referred and non-referred defendants, Diagnosis, current psychiatric symptoms, and the ability to stand trial, An evaluation of malingering screens with competency to stand trial patients: A known-groups comparison, Factors influencing 2,260 opinions of defendants restorability to adjudicative competency, Developing a forensic service delivery system for juveniles adjudicated incompetent to stand trial, The Georgia Court Competency Test: The baserate problem. Parenthetically, the qualifying term usually seems difficult to understand. What about the gross incongruencies criticism of the ECST-R of Melton and his colleagues32? 7031 Koll Center Pkwy, Pleasanton, CA 94566. It is my judgment that this defendant presently & has the ability to understand the proceedings against him. He is & able to carry on a normal conversation. The CST has 22 item stems that ask defendants to complete sentences. The other sentences that the defendant might get include, &. This section regards competence.). He & denies loss of interest in his usual activities, including his self care. While competency to stand trial is the most commonly used term, competency in the criminal trial process encompasses all stages of participation in the legal process, including pretrial, trial, sentencing, and appeals. This lack of . The ECST-R is composed of both competency and feigning scales. He & denies the use of street drugs. I offer these four points to make reports clear and easy to read: Limit paragraphs to 10 sentences or fewer. I do give you my consent to release this report to any appropriate party. McGarry, 1965; Roesch & Golding, 1980). Occasionally, a court may request that both evaluations take place at the same time (Chauhan, Warren, Kois, & Wellbeloved-Stone, 2015). Each evaluates the defendant's understanding of the courtroom personnel and their respective roles at trial. The defendant lives & alone. If someone said to the defendant that the grass is always greener on the other side of the fence, that person would be trying to say, &. The competency screening test was administered to 43 men who had been referred to a state hospital for determination of competency to stand trial. The defendant demonstrates during today's examination that his motivation is & self-serving and not self-defeating. Criminal trial competency is raised substantially more often than other pretrial forensic assessment issues such as criminal responsibility. In the small dialogue box, click the small blue square. Skeem and Golding (1998) argue that if the report educates the court about all relevant clinical factors, as well as how they are connected to the legal criteria, an opinion about the ultimate issue may simply be redundant. When that spot is completed, then Ctrl + j moves the cursor to the next cursor stop where dictation is entered. Both the public and the professional community view the participation of mental health professionals in the criminal justice system with some misgiving. The ECST-R focuses on both courtroom proceedings and defendants' understanding of their own criminal charges. It was followed in 1973 by the Competency Assessment Instrument (CAI), developed and validated by McGarry and his team36 at Harvard Medical School's Laboratory of Community Psychiatry. If more than one cursor stop is left in its default state, then the Ctrl key can be held down while the j key is tapped repeatedly. Based upon above 2 conclusions, it is my judgment that this defendant presently is & medically competent to stand trial. They found that for the 17 cases seen by the blue-ribbon panelists, they agreed with the IFI panelists 88% of the time, with the hospital staff 82% of the time, and with the courts 88% of the time, and they concluded that on the basis of these data it would be hard to argue for one criterion definition over another (p. 331). While the bulk of the article addresses research findings, the next two paragraphs outline the equally important topic of professional attitudes. It describes relevance as a matter of fit; scientific validity is not sufficient unless it fits the specific matter under consideration by the trial court. 37, p S43). The Evaluation of Competency to Stand Trial-Revised (ECST-R; Rogers, Tillbrook, & Sewell, 2004) presents a clinical interview with both semi-structured and structured components. The psychiatric medications the defendant presently takes are &. As part of this substantiation, reliable and standardized information from competency measures should not be routinely ignored by forensic practitioners. It is also a consideration if a defendant chooses to represent him or herself. The defendant & denies feeling depressed at this point. If the text is left in its default form, then nothing further is done at that cursor stop. The CAST-MR is composed of three competency scales: Basic Legal Concepts (25 multiple-choice questions), Skills to Assist Defense (15 multiple-choice questions), and Understanding Case Events (10 open-ended questions). Early evaluators were employed typically in The report template is designed to expedite the process of creating reports. But note that an almost equal number of defendants with a diagnosis of psychosis are considered to be competent, making it clear that psychosis alone is not sufficient by itself to find a defendant incompetent. As summarized in Table 1, two scales of the CAST-MR appear to meet this guideline, with understanding case events being particularly straightforward. The ECST-R demonstrates high internal consistency, with alpha coefficients for the competency scales ranging from .83.89 and alpha coefficients for the feigning scales ranging from .63.87. Simply put, how are these classifications established and what is their relevance to the Dusky standard? The feigning scales were developed by using two primary detection strategies: rare symptoms and symptom severity. Parts that need no modification can be skipped. Additions can be inserted anywhere. If, during his trial, the judge overrules an objection, that means, &. &. judication," "competence to stand trial," and "fitness to stand trial" are used interchangeably throughout the Guideline. At the beginning of my examination of the defendant, I explained the purpose of the examination, and that my findings would not be confidential. It is my judgment that this defendant presently & has the ability to assist in the preparation of his defense regarding the criminal action against him. Citing Federal Rule of Evidence 702, it requires a valid scientific connection to the pertinent inquiry as a precondition to admissibility (Ref. The items are scored on a 3-point scale with a score of 2 indicating full understanding of the item. Regardless of their professional background, it is essential that professionals conducting competency evaluations obtain training in the requisite knowledge and skills to do so, including familiarity with relevant state statutes and case law (Zapf & Roesch, 2009). The MacCAT-CA was not originally developed as a measure of competency to stand trial. Many legal scholars and researchers criticized the Godinez decision, arguing, particularly with respect to competency to represent oneself, that this requires a higher level of competency (Melton, Petrila, Poythress, & Slobogin, 2007; Perlin, 1996). Readers can independently evaluate the following analyses of competency measures in light of this disclosure. While cautioning that the CAST-MR is only one part of the competence assessment, we note that the mean total score for the defendants with mental retardation was 25.6 for incompetence versus 37.0 for competence. What is the quality of the anticipated manner in which the defendant will relate to his attorney? He & denies any other involvements in the legal system. The MacCAT-CA also includes several items about defendants' views and actions toward their attorneys. Bonnie noted that prohibiting incompetent defendants from proceeding with trial is essential to preserve the dignity of the judicial process, the reliability or accuracy of the courts verdict, and the autonomy of defendants to make key decisions about their case. An interesting question is whether involuntary medication would also prove effective in restoring competence. Its error rate focuses specifically on the accuracy of measurement, which is affected by reliability and validity. (1973) to be an objective, preliminary screening instrument to identify individuals who may be legally incompetent. A comprehensive review of the Daubert decision is far beyond the scope of this article, given the hundreds of scholarly works in the psychological, medical, and legal literatures. These items are scored on the basis of the reasons that the defendant provides for his or her judgment and whether they are plausible or implausible (i.e., grounded in reality or based on delusional beliefs). This amendment states that all people are guaranteed a fair trial. Whereas Guideline 1 is more theoretical, Guideline 3 is solidly methodological. With regard to symptoms of mania, the defendant & denies feeling extremely happy for no reason (inappropriate euphoria). The examination was videotaped. Treatment staff reported that his condition precluded his understanding the nature of charges against him and participating in his defense, and stated that there was no treatment that could help Jackson learn minimal communication skills. The attorney is & a pubic defender. The defendant & denies lack of energy. 9, p 591). & Yes. Forensic practitioners should supplement the previous analysis with careful reviews from other researchers and scholars. Evaluating Competencies: Forensic Assessments and Instruments (ed 2). Furthermore, evaluators in the past rarely took into account the specific demands of a defendant's case. One of the first to examine an education-focused approach, Siegel and Elwork (1990) found that incompetent defendants randomly assigned to an educational program that provided information on the legal process as well as problem-solving training showed significantly greater improvement on competency assessment instrument scores compared to a control group. 41, p 19). The ECST-R also asks defendants to consider how they might make important decisions about their cases, such as plea bargaining. As mentioned earlier, this template streamlines the mechanics of writing reports. The MacCAT-CA has the most problems of competency measures in establishing accurate classifications. This section will provide a brief overview of possible FAIs that clinicians can use when evaluating competency. He examined a sample of incompetent defendants in a restoration program and found that a number of factors were associated with a low probability of restoration, including a longstanding psychotic disorder, a diagnosis of mental retardation, and older age. They differ in that the ECST-R examines how severe psychopathology may affect the defendant's rational abilities. Stated in Daubert terms, the error rate is five percent or smaller. Although considered to be factual understanding,40 this scale also requires rational abilities in deciding on the alternatives. The FIT-R has been shown to have high inter-rater reliability and validity in studies comparing ratings by psychologists, psychiatrists, nurses, and psychology graduate students, and comparison of judgments based on the FIT-R with institutional-based evaluations of competency (Viljoen, Roesch, & Zapf, 2002a; Zapf, Roesch, & Viljoen, 2001), and high agreement with other competency measures such as the MacCAT-CA (Zapf & Roesch, 2001) and correlations with related constructs such as intelligence and psychosis (Viljoen, Roesch, & Zapf, 2002b; Viljoen, Zapf, & Roesch, 2003). They seem to stem mostly from apparent confusion over the meaning of an ECST-R rating of 3. While serving as gatekeepers, trial judges are to consider the following guidelines under Daubert: Ordinarily, a key question to be answered in determining whether a theory or technique is scientific knowledge that will assist the trier of fact will be whether it can be (and has been) tested. Does the defendant have an appreciation of the range and nature of the possible penalties he faces? The CAST-MR is administered as an interview, although examinees are given a copy of the items to facilitate comprehension. The authors administered the Competency Screening Test, a device for determining competency, to 43 men who had been referred to a state hospital for determination of competency to stand trial. For assessments, the use of reliable and valid measures is the most direct and empirically defensible method of achieving this standardization. It argues that no valuable information, be it clinical acumen or standardized data, should be systematically ignored. Golding and Roesch (1988) defined the open-textured, context-dependent nature of the construct of competency to stand trial: Mere presence of severe disturbance (a psychopathological criterion) is only a threshold issueit must be further demonstrated that such severe disturbance in this defendant, facing these charges, in light of existing evidence, anticipating the substantial effort of a particular attorney with a relationship of known characteristics, results in the defendant being unable to rationally assist the attorney or to comprehend the nature of the proceedings and their likely outcome. Does the defendant understand the procedures of the court? Warren, Chauhan, Kois, Dibble, and Knighton (2013) found a similar rate in a study of restoration of incompetent juveniles (see also McGaha, Otto, McClaren, & Petrila, 2001). The template provides the whole report, for both competency and criminal responsibility, with both the dictated and inserted paragraphs already in place. Abstract. His memory is & good. The remainder of this article assumes that practitioners will integrate case-specific (clinical interview and collateral information) with nomothetic (standardized results) data. Document the information (and warnings) given to the examinee at the beginning of the examination. The specific issue there was whether the standard for competency to stand trial and competency to represent oneself should be the same. Helpful reports give the court unambiguous conclusions with which it can either agree or disagree. This information may help with the consult-with-counsel prong. The role of the judge is, &. & Yes. Of mostly historical interest, first-generation measures have limited data on their psychometric properties, a lack of normative data, and poor correspondence to the relevant legal standard.38 Although reviews of these measures are readily available,39 this article focuses more selectively on three published competency measures. It is offered as a public domain document, which means that everyone is free to copy it, modify it, and use it in any way. Using the Daubert guidelines as a framework, we examined each competency measure regarding its relevance to the Dusky standard and its error and classification rates. 95, suppl. List the examiner's unambiguous answers to the questions to be answered in the report (second listed item). If a defendant received a rating of less than a 2, the examiner provides the answer and then asks the defendant to repeat the provided answer in his or her own words. It is my judgment that this defendant was & able to appreciate the wrongfulness of his conduct at the time of the offense. Although not a perfect match, this last scale is most closely aligned with factual understanding. In this article, the relationship between refusing an insanity plea and competency to stand trial will be explored in the context of defendants who lack insight into their mental illness. Each defendant's competence to stand trial was assessed in a semistructured interview format based on the McGarry criteria. Unlike the MacCAT-CA, which restricts its normative data to presumably competent participants, the ECST-R includes both competent and incompetent defendants in its normative group, thereby mirroring the entire population that it is intended to evaluate. Obviously, the group of hospitalized legally incompetent defendants should theoretically evidence clinically significant impairment, given their combined psychiatric and legal status. There is no explicit prohibition forbidding the offering of an ultimate opinion and, in many ways, a well-written report should make the evaluators opinion obvious even if it is not directly stated. This is not the case for most defendants who are actually incompetent and hospitalized (see Ref 40, Tables 46): the understanding scale: 33.2 percent clinically significant impairment, 15.9 percent mild impairment, and 50.9 percent minimal or no impairment; the reasoning scale: 41.3 percent clinically significant impairment, 13.8 percent mild impairment, and 44.9 percent minimal or no impairment; and the appreciation scale: 44.5 percent clinically significant impairment, 9.2 percent mild impairment, and 39.2 percent minimal or no impairment. Sixty-eight (22.7%) forensic evaluators replied. The following is the information given by the defendant regarding his employment history. The Court reaffirmed the flexibility in applying the Daubert guidelines, which may or may not be relevant in determining the reliability of the expert testimony in a particular case. With NIMH support, Lipsitt and his colleagues35 developed in 1971 the first standardized competency measure, the Competency Screening Test (CST). As used in the section, mental disease or defect means a severely abnormal mental condition that grossly and demonstrably impairs a person's perception, but the term does not include an abnormality manifested only by repeated unlawful or antisocial conduct. Based on her work, we should anticipate that more scientific guidelines will generate greater discrepancies among trial courts. Two measures are intended for general competency evaluations: the MacArthur Competence Assessment Tool-Criminal Adjudication (MacCAT-CA)40 and the ECST-R.30 The third measure, the Competence Assessment for Standing Trial for Defendants with Mental Retardation (CAST-MR),41 concentrates on defendants with mental retardation. Competence can even arise in death penalty cases in which the competence to proceed with appeals or to be executed is questioned (Cunningham, 2013). He & denies spending a lot of money for things he doesn't really need (manic spending). This place is, &. The standardized results, while only one component of competency evaluations, achieve four major objectives by systematizing the evaluation of key points, reducing the subjectivity in recording competency-related information, providing normative comparisons, and demonstrating the inter-rater reliability of observations and findings. It is important, however, that mental health professionals are able to reliably and validly inform the court about the competency of defendants whose competence has been questioned by their lawyers, the prosecution, or the court. Competency to stand trial is especially important to evidence-based forensic practice because of its prevalence; it represents the most common pretrial focal point within the criminal domain of forensic psychiatry. Unfortunately, this approach was unsuccessful for the appreciation scale; the authors simply assigned cut scores to the three categories, based on their own hypotheses regarding delusional thinking. Moves the cursor to the next two paragraphs outline the equally important topic of competency to stand is. Method of achieving this standardization we should anticipate that more scientific guidelines will generate greater discrepancies among trial.! Process of determining an accused person & # x27 ; s competence to stand trial rating... Incompetent to stand trial is fixed and absolute is raised substantially more often than other pretrial assessment! Freds situation and how Fred might deal with various aspects of his conduct the. 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