Have the courts abdicated their responsibility for determination of competency to stand trial to clinicians? Printed from Oxford Research Encyclopedias, Psychology. 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. In addition, the lack of information about specific prongs is a limiting factor about the CAST-MR classifications. Several subsequent cases have further defined the nature and scope of a competency determination (Drope v. Missouri, 1975; United States v. Duhon, 2000). The defendant's turn to talk during a trial is, &. He & denies that others listen in on his thoughts. In reviewing the ECST-R normative data, we did not find a single case of any of the competency scales where this occurred. 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 S34). In direct contrast, the ECST-R took into account word length in the development of its items. Recall of these events is likely to be helpful in competency cases in which amnesia plays a central role. The events leading to the charges presently against the defendant were, & (Fill in next section, then return here.) The following is the information given by the defendant regarding his medications. Competence has come to refer to all aspects of participation in the legal process, from pretrial through sentencing and later in the appeal process. Each cursor stop is designated by an ampersand (&), which is erased as the user moves to the next cursor stop. For scientific validity to be relevant, it must be sufficiently tied to the facts of the case (Ref. He has & never been treated for alcoholism or substance abuse. Probably because of its original development as a research measure, 16 of the 22 items do not address the defendant's case. study was their follow-up of the court decisions. The CAST-MR provides the broadest appraisal of factual understanding with inquiries about common legal terms and basic information regarding verdicts and sentencing. He &has never been married. Does the defendant have the ability to appraise the likely outcome of the charges against him? The difference between an apple and an orange is &. Likewise, two McCAT-CA scales are also problematic because of their word length: understanding (mean [M] = 45.31 words) and reasoning (M = 39.88 words). The defendant is & physically healthy. Skeem, Golding, Cohn, and Berge (1998) called for more training and monitoring of evaluators. As noted by one reviewer, it would be utterly nave to attempt to equate any test or laboratory findings with an ultimate or penultimate legal opinion. If the defendant is asked on the witness stand &, then he would testify, &. This historical perspective provides an essential insight: the foundation for evidence-based forensic practice was established while the American Academy of Psychiatry and the Law (AAPL) and its counterpart, the American Academy of Forensic Psychologists, were still in their infancies. The case carried through the appeals process and was eventually heard by the U.S. Supreme Court, which held that a trial judge can deny a defendant the right to proceed pro se even if he or she had previously been found competent. Based upon above 2 conclusions, it is my judgment that this defendant presently is & medically competent to stand trial. The Private Practice Committee of AAPL presents a course every two to three years at the annual meeting. Because the reliability of traditional interviews cannot be established, the use of these competency measures addresses the scientific reliability of expert evidence. This practice was challenged in Jackson. Although the CST appears to be a reliable instrument (Nicholson et al., 1988; Randolph, Hicks, & Mason, 1981), concerns have been raised about its high false-positive rate because the majority of defendants screened as incompetent are later found to be competent in subsequent evaluations (Nicholson & Kugler, 1991). The role of the judge is, &. A reliability assessment does not require, although it does permit, explicit identification of a relevant scientific community and an express determination of a particular degree of acceptance within that community [Ref. Five large cities are, &. For example, Nicholson and Kugler (1991) reviewed 30 studies and concluded that defendants with psychotic disorders were more likely to be incompetent. 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). Without providing standardized questions, it provides a nuanced statement that Assessing and documenting a defendant's functioning usually requires asking specific questions that systematically explore competency-related abilities (Ref. Document the information (and warnings) given to the examinee at the beginning of the examination. I explained that I would not be treating the defendant and that I am not his treating physician. We do not capture any email address. The Supreme Court held in Daubert that expert testimony must be relevant to the matter at hand. Unfortunately, there is little research on the effectiveness of various treatment approaches. This lack of . It is set up as a default template. 1) for a more thorough introduction. Criteria for competency to stand trial: A checklist for . I offer these four points to make reports clear and easy to read: Limit paragraphs to 10 sentences or fewer. A template is offered for quick preparation of such reports. 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. The ECST-R uses the following classification: 60 to 69 T, moderate impairment, usually associated with competent defendants; 70 to 79 T, severe impairment, which can reflect competent or incompetent defendants; 80 to 89 T, extreme impairment, usually associated with incompetent defendants; and 90 to 110 T, very extreme impairment, almost always associated with incompetent defendants. By entering Ctrl + j, the cursor goes to the next cursor stop for text modification, eliminating the time otherwise used to move the cursor manually to the next text modification spot. Berman et al. As found by Aarons et al.,7,8 we suspect there is some professional arrogance arising from views that practitioners are superior to researchers and their standardized methods. The defendant is & free of psychosis, depression, mania, and confusion. The use of psychotropic medication has been shown to be effective in restoring competence, as evidenced by the high rate of restoration noted. For example, the three competency measures differ in the extent to which they have been evaluated for pretrial defendants with mental retardation. Evaluators may use psychological tests on occasion when it is thought to be helpful in identifying clinical constructs such as intelligence, psychopathology, or academic achievement. Then the dictation goes directly into the template at the right spot. The CAST-MR comprises 50 verbally administered questions that assess basic legal concepts, skills to assist defense, and understanding of case events. We will consider the scale classifications (interpretations) in the subsequent paragraphs. As summarized in Table 1, two scales of the CAST-MR appear to meet this guideline, with understanding case events being particularly straightforward. (Erase from here for sanity report. Each defendant is asked about the nature of the charges that he or she is facing, how the defendant would assist his or her lawyer, the nature of his or her relationship with the lawyer, and the consequences of a guilty verdict. The shift to other settings has been driven in part by research showing that opinions about a defendants competence can be made after a relatively brief assessment (see Zapf & Roesch, 2009). A major strength of the three competency measures is the excellent data on their reliability and errors in measurement. Psychiatrists view fitness as a homeostatic functional capacity. With NIMH support, Lipsitt and his colleagues35 developed in 1971 the first standardized competency measure, the Competency Screening Test (CST). This observation is a likely explanation for the differences in cut scores between the two measures. The process of determining an accused person's competence to stand trial often causes indefinite commitment to mental hospitals. Mental Health and Legal Implications of Access to the Outdoors during Incarceration, Victim Intoxication and Capacity to Consent in Sexual Assault Statutes across the United States, Preserving Immunity for Reporters of Medical Child Abuse, by The American Academy of Psychiatry and the Law, Appendix: Forensic Psychiatry Report Template, American Academy of Psychiatry and the Law. The following are the answers given by the defendant today to the questions I asked him in a standard mental status examination. The opening paragraph of this article noted the professional schisms between traditional practice and the growing movement toward evidence-based practice. Issues such as intellectual and developmental disabilities or cognitive deficits resulting from fetal alcohol spectrum disorder or other organic causes should be considered when appropriate in evaluations of competence (Cochrane, Grisso, & Frederick, 2001; Everington & Dunn, 1995; McLachlan, Roesch, Viljoen, & Douglas, 2014; Zapf, Roesch, & Pirelli, 2013). The attorney on the other side of the defendant's case is called, &. Today is, &. Abstract. The contextual nature of competence means that the necessary level of psycholegal abilities may vary depending on the nature of the legal proceedings expected of a defendant. The focus of the ECST-R inquiries is not on the decision itself but rather on the reasoning underlying the decision. 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. 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. The foregoing discussion focused on the congruence between competency measures and the Dusky standard. Could each forensic psychiatrist or psychologist develop his or her own specific questions and systematic examination of competency? Understanding case events asks for detailed recall (e.g., date and witnesses) of the alleged crime and the current criminal charges. As mentioned earlier, this template streamlines the mechanics of writing reports. Brown v. State 1960 The criteria for determining competency to stand trial in Georgia was handed down by the Georgia Supreme Court in Brown v. State (1960) two months before Dusky ruling. There are many ways to take notes during a forensic examination. There was considerable variation in opinions about incompetency, as the rates of incompetency determinations ranged from 0% to 62%. What is the level of the defendant's unmanageable behavior? The number of legs on a horse is, & 4. The method makes use of currently available computer technology. An interesting addition to the Gowensmith et al. &. Later, at my desk, I correct typographical errors and rephrase my entries as necessary, either by typing or dictating. Competency to participate fully in the defense of his or her criminal case is an essential right of a defendant to ensure a fair trial. Obviously, case-specific data are likely to meet the Daubert guideline of being sufficiently tied to the facts of the case. In contrast, hypothetical data must be examined closely to determine its relevance or fit to a particular defendant's case. However, the mere presence of either of these conditions is not sufficient, as a functional approach to assessing competency dictates that the mental illness or cognitive deficit must be shown to affect the defendants specific legal competencies. Borrowing from Slade et al.6: are these measures useful, nonduplicative, and time-efficient? Less intrusive forms of treatment include legal rights education, deficit-focused remediation programs, and standard hospital treatment programs (Bertman et al., 2003). Competency to Stand Trial Evaluation Tests and Screening Instruments Next, we examine these measures in light of error and classification rates. In fact, this approach is embraced by the AAPL Task Force in its summary statement about competency measures: Instead, psychiatrists should interpret results of testing in light of all other data obtained from clinical interviews and collateral sources (Ref. 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). The defendant & denies feeling depressed at this point. This section regards competence.). He & denies feeling the need for only 23 hours of sleep per night (manic sleep pattern). He & denies any history of suicidal thoughts. 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). Validity of evaluators conclusions about competence is more difficult to assess, as there is no gold standard against which to compare evaluator opinions (Zapf & Roesch, 2009). Lessons from Slade et al. Template for Quickly Creating Forensic Psychiatry Reports, Journal of the American Academy of Psychiatry and the Law Online. Established practitioners sometimes are slighted by evidence-based researchers, who now feel entitled to criticize and rectify clinical authorities perhaps motivated by an iconoclastic or even patricidal tendency (Ref. Field reliability of competence to stand trial opinions: How often do evaluators agree, and what do judges decide when evaluators disagree? recognized in the trial process. Moreover, the objectivity of evidence-based researchers has been called into question because they are motivated by payment and publication to produce noteworthy results.4 The acceptance of evidence-based methods within the psychiatric community is clearly influenced by both concerns regarding research design and polarized professional attitudes. The following is the information given by the defendant regarding his psychiatric history. In Indiana v. Edwards (2008) the U.S. Supreme Court held that a higher standard may be required for pro se competence (PSC) than for competence to stand trial (CST), but provided little guidance for the trial court judge. The two most salient objections to evidence-based practice were that clinical experience is better than standardized methods and that practitioners know better than researchers. Other cursor stops require modification. The role of the defendant's attorney is, &. This question is for testing whether or not you are a human visitor and to prevent automated spam submissions. The pleadings available to the defendant include, &. If the judge sustains an objection, that means, &. Their field reliability study reviewed evaluators in over 200 cases, with each case requiring three independent evaluations by Hawaii law. For our purposes, we selectively review articles that provide key insights in Daubert and examine several examples of how Daubert has been applied to standardized measures and legal standards. The Supreme Court held that medication could be forced but only in rare, limited circumstances in which it is found that medication is substantially likely to render the defendant competent to stand trial and substantially unlikely to have side effects that will interfere significantly with the defendants ability to assist counsel in conducting a defense. The Court also noted that it must be shown that less intrusive treatments are unlikely to restore competence. This and other research (Hubbard & Zapf, 2003; Morris & Parker, 2008) suggests that it may be difficult to predict who will be restored, but this research is unlikely to affect court practice since most incompetent defendants are restored with treatment, so judges may decide to order treatment for a limited period even for those in a low success group. . Therefore, the following analysis examines the construct validity of competency measures in light of their specific applications to defendant categories. 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. An investigation of the construct of competence: A comparison of the FIT, the MacCAT-CA, and the MacCAT-T, Future directions in the restoration of competence to stand trial, Personality Assessment in Clinical Psychology, Psychological Assessment of Older Persons. The minimum sentence he faces is, &. Among the broad array of criticisms, researchers have been singled out as motivated by personal and professional gain.5 An alternative view is that traditionalists are equally motivated to avert criticisms of their current clinical practices by researchers. Although not a perfect match, this last scale is most closely aligned with factual understanding. The Supreme Court later held in Drope v. Missouri (1975) that evidence of a defendants irrational behavior, his demeanor at trial, and any prior medical opinion on competence to stand trial are all relevant in determining whether further inquiry is required, but that even one of these factors standing alone may, in some circumstances, be sufficient (p. 180). The importance of competency evaluations was recently underscored by the 2007 publication of the AAPL Practice Guideline.37 This guideline provides a thorough introduction to the legal framework and conceptual basis for conducting these evaluations. The figures reveal that this is not supported, revealing a flaw in the test. The decision about competency is ultimately one that rests in the hands of the presiding judge. The difference between a bush and a tree is &. He was subsequently charged with attempted murder, battery with a deadly weapon, criminal recklessness, and theft. On a five-point scale, the ratings were somewhat variable, with Skills to Assist in Defense reaching an average score of only 3.03 regarding the appropriateness of its content (Ref. Sixty-eight (22.7%) forensic evaluators replied. Calculated as the standard error of measurement (SEM), each competency measure produces small SEMs, indicating a high level of accuracy (Table 2). The shape of the (round) clock on the wall is, & round. He was allowed to represent himself, and his behavior during the trial led Perlin to comment that the Godinez decision resulted in a trial in which dignity, a prerequisite for a fair trial, was not preserved. Utah Code Annotated 77-15-1 et seq. The MacCAT-CA uses a hypothetical assault to evaluate the defendant's ability to distinguish relevant and irrelevant information and consider choices related to matters such as plea bargaining. If the defendant is found guilty, the maximum sentence he faces is, &. The cursor will then be ready for text to be typed, dictated, or deleted at the spot where the ampersand was. Most competency items are scored on five-point ratings: 0, not observed; 1, questionable clinical significance; 2, mild impairment unrelated to competency; 3, moderate impairment that will affect but not by itself impair competency; and 4, severe impairment that substantially impairs competency. Both the report template and the service agreement template are available from the author in Microsoft Word document format. Stated in Daubert terms, the error rate is five percent or smaller. 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. While the McGarry criteria help to structure CST evaluations, both individual McGarry criteria determinations and ultimate restoration opinions rested largely in evaluators' subjective ratings of defendants' abilities. The vignette describes a bar fight between two men, Fred and Reggie, that results in an aggravated assault charge against Fred. Most competency evaluations are typically done by psychologists or psychiatrists, but social workers are also qualified in some states to conduct these evaluations (Jenkins v. United States, 1962; Roesch, 2015). If someone said, don't cry over spilled milk, that would mean, &. 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 distance from & to & is &. 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. Agreement about more specific psycholegal abilities is likely not as high. Competence can even arise in death penalty cases in which the competence to proceed with appeals or to be executed is questioned (Cunningham, 2013). The patricidal tendency of researchers to diminish the contributions of seasoned practitioners may play a relevant role. Does the defendant have the ability to plan a legal strategy? I explained that the usual doctor-patient confidentiality does not exist in this examination. 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. The following is the information given by the defendant regarding his employment history. & Yes. The term competence to stand trial is perhaps misleading because only a small percentage of criminal cases actually go to trial. The ECST-R has excellent normative data based on 200 competency referrals and 128 jail detainees. This survey of forensic mental health experts studied potential PSC criteria. The other sentences that the defendant might get include, &. Evaluating Competencies: Forensic Assessments and Instruments (ed 2). An evaluators report to the court is presented as evidence that a judge may consider. The MacCAT-CA was not originally developed as a measure of competency to stand trial. He was represented by counsel and convicted of the attempted murder and battery charges. 5, p 327). & Yes. The issue reached the U.S. Supreme Court in the case of Sell v. United States (2003). The Interdisciplinary Fitness Interview (IFI) was designed to assess both the legal and psychopathological aspects of competency (Golding et al., 1984), ideally involving interviews conducted by a psychologist and a lawyer team. The Supreme Court revisited this issue in the case of Indiana v. Edwards (2008). The defendant Ahmad Edwards attempted to steal a pair of shoes from a department store in Indiana, and when security officers tried to apprehend him, he fired shots at them. The difference between a bird and an airplane is &. Practitioners sometimes exaggerate the limitations of standardized measures while possibly overvaluing their own expertise. Competency to stand trial is a long-established legal principle in the U.S. criminal justice system that ensures that a criminal defendants right to a fair trial is protected. Individual items for the competency scales were developed and pilot tested. 34,35 and the Evaluation of Competency to Stand Trial-Revised (ECST-R), 36 would be helpful in quantifying individuals . His memory is & good. 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. After I enter his answer at that cursor stop, I type Ctrl + j, and so forth. Limited research suggests that it can be a reliable and valid instrument used primarily as a guide for clinicians to focus on competence-related abilities (Nicholson & Kugler, 1991; Roesch & Golding, 1980). Their similarity is &. A semi-structured interview gathers information to score 13 items related to legal issues, such as appraisal of available legal defenses, quality of relating to attorney, capacity to disclose pertinent facts, and capacity to testify relevantly. Items are scored on a 5-point scale, ranging from total incapacity to no incapacity. The CAI manual contains clinical examples of levels of incapacity, as well as suggested interview questions. He is & able to put his thoughts into words. Daubert and two subsequent Supreme Court cases (General Electric Co. v. Joiner12 and Kumho Tire Co. v. Carmichael13) are referred to as the Daubert trilogy. Incompetent defendants with intellectual deficits fare more poorly in restoration programs. also found improved scores on competency measures for incompetent defendants in legal rights education and deficit-focused remediation programs, but questioned whether the results were due to the greater individualized attention paid to the experimental group rather than the specific content of the programs. (2002). One of the first cases to consider the question of the range of competencies was Godinez v. Moran (1993), in which the U.S. Supreme Court held that the standard for various types of competency (i.e., competency to plead guilty, to waive counsel, or to stand trial) should be considered the same. The CAST-MR also has a specific scale for considering the defendant's memory of the offense and subsequent arrest. The practice has evolved to assess first if a defendant has a psycholegal ability incapacity and if so, whether the defendants mental status (mental illness or intellectual deficit) is causally connected to that incapacity. 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. He has & 3 children. Competency to stand trial is a concept of jurisprudence allowing the postponement of . Prior to my examination of him, I reviewed the several documents & you sent. The CAST-MR is an outgrowth of a doctoral dissertation. The notion that defendants must be capable of assisting in their defense and participating in the legal process can be traced to at least the 14 century, when Common Law courts refused to proceed against defendants considered to be incompetent as a result of mental disorder or mental defect (Poythress, Bonnie, Monahan, Otto, & Hoge, 2002). I find the most efficient way is to type my notes directly into the template on a laptop computer. The ECST-R is composed of both competency and feigning scales. The ECST-R was developed specifically for the purpose of evaluating the Dusky prongs. With reference to forensic concerns, can the concept be empirically tested and does the research have the potential to disprove the conclusion? Minimal or no impairment had assessed deficits that fell within 1 standard deviation (SD) of the presumably competent detainees. The AAPL Private Practice Committee produced a similar public domain document in 1997.
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mcgarry criteria competency stand trial