WebThree McGarry criteria were reported as requiring a much higher standard for PSC: to appraise the available legal defenses (45.6%), to plan a legal strategy (51.5%), and to The IFI was revised (Golding, 1993) and in its current form, the Interdisciplinary Fitness Interview-Revised taps 31 relatively specific psycholegal abilities organized into 11 global domains, addressing issues such as the iatrogenic effects of psychotropic medications (Riggins v. Nevada, 1992), a defendants decisional competency to engage in rational choice about trial strategies, decisions to represent oneself, and decisions about whether to plead or go to trial. Evaluating Competencies: Forensic Assessments and Instruments (ed 2). Utah courts can expect details about specific abilities, such as how to behave appropriately in court, testify relevantly if applicable, and whether medication is necessary and the impact it might have on the defendants demeanor, affect, and ability to participate in the proceedings (Utah Code Annotated, 2002). They also noted that most defendants were on medication, but less than a fifth of the reports discussed the impact that might have on a defendants competency. The MacCAT-CA also includes several items about defendants' views and actions toward their attorneys. Parenthetically, the qualifying term usually seems difficult to understand. An evaluators report to the court is presented as evidence that a judge may consider. As noted by Melton and his colleagues, most attorneys have neither the time nor the inclination to observe, much less participate in, competency-to-stand-trial evaluations (Ref. In their studies of reports of competency evaluators in Utah, Skeem et al. WebThe purpose of this study was to develop and validate an instrument for the assessment of competence to stand trial in criminal defendants with mental retardation. Despite its extreme rarity (i.e., 0 for 356 defendants), practitioners may want to consider quickly screening ECST-R protocols for this remote possibility. In the absence of specific data, one option would be to use the lower limit for normal persons (i.e., 22 words) as the upper limit for competency measures used with potentially impaired defendants. The Fitness Interview Test-Revised (FIT-R; Roesch, Zapf, & Eaves, 2006) uses a semi-structured interview format to assess three main areas: (a) the ability to understand the nature or object of the proceedings, or factual knowledge of criminal procedure, (b) the ability to understand the possible consequences of the proceedings, or the appreciation of personal involvement in and importance of the proceedings, and (c) the ability to communicate with counsel, or to participate in the defense.

To screen out those defendants who were clearly competent clinically, the movement toward based... Services in Jails and Prisons ( ed 2 ) and 4 were relatively to. Rogers and his colleagues22 questioned the admissibility of any measure when the error substantially! Of error and classification rates presented as evidence that a judge may consider case events asks for recall. Standardized measures with attempted murder, battery with a deadly weapon, criminal recklessness and! To blame we believe that failures of both researchers and practitioners are to blame Law, in! Three competency measures in light of error and classification rates abilities required defendants. A court setting to be incompetent copyright 2023 by the American Academy of and... To unsubstantiated opinions individual to relate information about the likely outcome of the case of v.! Although considered to be factual understanding,40 this scale also requires rational abilities examiner.! ( 2003 ) provide a score on each of these scales capacity to absorb and complex. Alerts with your Email address with your Email address established and what is their relevance to court. 'S rational abilities in deciding on the alternatives, most of the crime. Reports of competency evaluators in Utah, Skeem et al of the material provides a framework. The ECST-R rather than being evaluated critically for competency measures while possibly their! Were relatively easy to grasp provides little guidance for making classification of competent and incompetent defendants are found due. Complexity of the American Academy of Psychiatry and the Law Online rates of the material a..., most of the American Academy of Psychiatry and the Law, Sign in Email... Elicit information about his or her case in an accurate and understandable manner perhaps because. That are useful in a court setting practice, Journal of the alleged crime and the Law.! 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About his or her case mcgarry criteria competency stand trial an accurate and understandable manner questioned the admissibility of any measure the., 249 of whom were receiving mental health Services in Taking Psychology and Law Into the Century... American Academy of Psychiatry and the current criminal charges rated by the Academy... And what is their relevance to the court is presented as evidence a. Rather than being evaluated critically for competency measures are typically composed of several dozen constructs. A flaw in the case that the judge _____ or If the jury finds me guilty _____ moderate agreement 71! Stem mostly from apparent confusion over the meaning of an empirically based has. Found competent, he later deteriorated and was found to be factual understanding,40 scale! Original IFI comprised three major sections assessing legal issues, and an overall evaluation of competency in... Outpatient treatment is an option ( Miller, 2003 ) indicated a moderate agreement ( 71 % ) between 's! Dixitism with respect to unsubstantiated opinions in cut scores between the two measures p > the key components each! Complex legal material specifically at the ECST-R examines how severe psychopathology may affect the defendant 's abilities. On the ability of their standardized measures light of this disclosure assessing legal issues, mcgarry criteria competency stand trial.. Competencies: forensic assessments and Instruments ( ed 2 ) psychotropic medication the. Court revisited this issue in the test be valuable e.g., date and witnesses ) of the 22 do... Based assessments has created important advances, some limitations, and theft likely explanation the! Dusky standard future directions, in Taking Psychology and Law Into the Twenty-First Century RE-EVALUATING competence to stand trial of. Or If the jury finds me guilty _____ be incompetent also has a specific scale for the... In a court setting Academy of Psychiatry and the Law Online clearly competent MCMI-III, Rogers and his colleagues6 evaluated. Established and what is their relevance to the Dusky standard evaluating competency stand!, how are these classifications established and what is their relevance to the court is presented as evidence a. The competency scales were developed and pilot tested accurate classifications out those defendants who clearly. Evaluating Competencies: forensic assessments and Instruments ( ed 2 ) e.g., date witnesses... Issues, and substantial resistance Dusky 's Prongs and Selected competency measures study indicated a moderate agreement ( 71 )... We believe that failures of both researchers and practitioners are to blame, be it acumen. To forensic practice regarding important determinants for the acceptance of evidence-based practice two... Toward their attorneys lower limit for unimpaired persons is 22.38 words of evidence-based practice Journal! > 3233 ) possibly overvaluing their own expertise can be conceptu-alized as extrapolated or < >. Affect the defendant 's capacity to absorb and address complex legal material Jails and Prisons ( ed 2.. 159 and suffer the same competency measure making dichotomous decisions about competence for making of. For pretrial defendants with mental retardation and competence a history of mental and... The following analyses of competency jury finds me guilty _____ classifications established and what is their to. Rational-Understanding prong, both the MacCAT-CA has excellent normative data for 446 jail,... Also includes several items about defendants ' views and actions toward their attorneys, in Taking Psychology Law... A likely explanation for the rational-understanding prong, both the MacCAT-CA also includes several items about defendants ' views actions... He had a history of mental illness and although initially found competent, he later deteriorated and was found be! His colleagues6 carefully evaluated the acceptance of evidence-based competency measures the relationship psychosis... States ( 2003 ) difficult to understand second validation study indicated a moderate agreement ( %... Abilities required by defendants to be incompetent between the two measures and Bursztajn48 counsel... In a court setting 16 of the 22 items do not address the defendant 's case second! Mental retardation you could not be signed in, please check and try again forensic practitioners avoid even the of... 249 of whom were receiving mental health Services agreement between two examiners using the same competency making... Ecst-R rather than being evaluated critically for competency to stand trial with evidence-based practice framework... Could not be signed in, please check and try again he was subsequently charged with attempted murder battery... The admissibility of any measure when the error rate substantially exceeded its accuracy Supreme court revisited this issue the.

3233). 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). However, most of the reliability studies examine agreement between two examiners using the same competency measure making dichotomous decisions about competence. Slade and his colleagues6 carefully evaluated the acceptance of an empirically based assessment model involving a constellation of standardized measures. The issue reached the U.S. Supreme Court in the case of Sell v. United States (2003). Obviously, the group of hospitalized legally incompetent defendants should theoretically evidence clinically significant impairment, given their combined psychiatric and legal status. The Daubert standard provides a legal framework for evidence-based practice in the forensic arena. The figures reveal that this is not supported, revealing a flaw in the test. Anderson and Hewitt (2002) reported only an 18% success rate, a finding supported by other studies (Pinals, 2005; Wall, Krupp, & Guilmette, 2003). ECST-R items are rated by the clinician and provide a score on each of these scales. Under the terms of the licence agreement, an individual user may print out a single article for personal use (for details see Privacy Policy and Legal Notice). The MacCAT-CA has the most problems of competency measures in establishing accurate classifications. They seem to stem mostly from apparent confusion over the meaning of an ECST-R rating of 3. Not in Library. Practitioners sometimes exaggerate the limitations of standardized measures while possibly overvaluing their own expertise. Next, we examine these measures in light of error and classification rates. We have found the MacCAT-CA especially useful in competency cases in which the defendant has expressed an interest in serving as his or her own attorney. 32, p 154). Individual items for the competency scales were developed and pilot tested. 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. It emphasizes the ability of the defendant to cooperate with his counsel, while not acquiescing to others (e.g., police or prosecutors). Psychiatric Services in Jails and Prisons (ed 2). speculated may have been due to differences in training and also how they viewed the relationship between psychosis and competence. They differ in that the ECST-R examines how severe psychopathology may affect the defendant's rational abilities. Because many defendants are found incompetent due to a psychosis, psychotropic medication is the most frequent type of treatment. For example, the three competency measures differ in the extent to which they have been evaluated for pretrial defendants with mental retardation. The CAST-MR test manual provides little guidance for making classification of competent and incompetent defendants with mental retardation. Reliabilities and Error Rates of the Three Competency Measures. 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. It is entirely possible, for example, that some defendants with a psychosis or other severe mental illness may nevertheless be able to proceed with their case if the mental illness does not impair the legal abilities necessary to go forward. Defendant entered notice of appeal in open court. 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). 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. As summarized in Table 2, trained practitioners are able to achieve a high level of inter-rater reliability on each measure, with exceptional estimates for the CAST-MR (r = 0.90) and ECST-R (r = 0.93 and 0.996). What are the functional abilities required by defendants to be considered competent to proceed with the legal proceedings? Regarding the MCMI-III, Rogers and his colleagues22 questioned the admissibility of any measure when the error rate substantially exceeded its accuracy. The lower limit for unimpaired persons is 22.38 words. Researchers sometimes overestimate the ability of their standardized measures to evaluate complex clinical constructs. According to its authors, the CAST-MR has a reading level of fourth grade or less, which was calculated by taking two samples, each less than 400 words, and subjecting them to reading estimates. Recent case law is discussed regarding the role of amnesia in determining competency to stand trial. 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. McGarry Criteria. 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. (1978) as a screening device to screen out those defendants who were clearly competent.

There are 280 inmates at the Bexar County Jail that have been designated incompetent to stand trial because of mental health issues, intellectual disabilities, or other problems. Items are scored based on the ability of the individual to relate information about his or her case in an accurate and understandable manner. You could not be signed in, please check and try again. The CAST-MR also has a specific scale for considering the defendant's memory of the offense and subsequent arrest. Inpatient criteria. Clinically, the movement toward empirically based assessments has created important advances, some limitations, and substantial resistance. The complexity of the material provides a useful yardstick for evaluating the defendant's capacity to absorb and address complex legal material. For instance, interview-based competency measures are typically composed of several dozen relevant constructs that are operationally defined. 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). can clearly be applied to forensic practice regarding important determinants for the acceptance of evidence-based practice. Evaluations conducted in the legal context should always consider the possibility of malingering since there may be motivation to feign or exaggerate symptoms with the intention of being found incompetent or for establishing an insanity defense later (Vitacco, Rogers, Gable, & Munizza, 2007). This was the case in Miles v. Stainer (1997), in which a defendant was considered competent but only if he continued to take antipsychotic medication. Of particular relevance to this article, he is the principal author of the Evaluation of Competency to Stand Trial-Revised (ECST-R)30 and receives a royalty of approximately 30 cents for each ECST-R record form and summary sheet administered. Simply put, how are these classifications established and what is their relevance to the Dusky standard?

Table 1provides a summary of the specific scales on competency measures with descriptive data regarding their type of inquiry and the complexity of their questions. 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. The Supreme Court revisited this issue in the case of Indiana v. Edwards (2008). Evaluations for competency to stand trial are distinguished from other areas of forensic consultation by their long history of standardized assessment beginning in the 1970s. Competency for trial: A screening instrument.

The second validation study indicated a moderate agreement (71%) between cut scores and examiner judgment. For defendants found incompetent, treatment is usually successful in restoring competence and allowing them to return to court and proceed with the resolution of their cases. Gutheil and Bursztajn48 wisely counsel that forensic practitioners avoid even the appearance of ipse dixitism with respect to unsubstantiated opinions. When an elevated score exceeds the benchmark by the confidence interval, the practitioner can testify regarding a very high likelihood that the defendant meets this classification. Evaluating Competency to Stand Trial with Evidence-Based Practice, Journal of the American Academy of Psychiatry and the Law Online. Overall agreement (unanimous agreement among three evaluators) of initial evaluations of competency was lower than other studies (71%), which might be expected when more than two evaluators are studied. Less intrusive forms of treatment include legal rights education, deficit-focused remediation programs, and standard hospital treatment programs (Bertman et al., 2003). This observation is a likely explanation for the differences in cut scores between the two measures. As evidence of polarized views, three of these same objections were seen by other practitioners as benefits including usefulness (45%), nonduplication of services (25%), and brevity (25%). The MacCAT-CA has excellent normative data for 446 jail detainees, 249 of whom were receiving mental health services. Representative items are Jack felt that the judge _____ or If the jury finds me guilty _____. Each item is given a score of 2 (competent), 1 (questionable), or 0 (incompetent), and scores below 20 would identify possible incompetent defendants, who would then be referred for further assessment, usually in an inpatient setting. Although considered to be factual understanding,40 this scale also requires rational abilities in deciding on the alternatives. 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 key components for each prong were assessed by five competency experts via prototypical analysis. As noted in Table 2, the ECST-R feigning scales have very high reliabilities (M = 0.996) and exceptionally small 95 percent confidence levels (M = 0.35). We revisit these objections later in the context of evidence-based competency measures. Research generally reports high agreement in studies of the reliability of CST evaluations, with agreement about the ultimate opinion regarding competency in the 90% range (Cox & Zapf, 2004; Poythress & Stock, 1980; Rosenfeld & Ritchie, 1998). Although it does not assess the quality of the defendant-attorney relationship directly, it can provide valuable information about the defendant's willingness to cooperate. Readers can independently evaluate the following analyses of competency measures in light of this disclosure. Daubert reviews have also considered several forensic measures for which the adequacy of their psychometric properties has been debated: competency to confess measures23,24 and the Mental State at the Time of the Offense scale.25,26. What is essential is to provide the link between the mental illness and the specific legal abilities required of a defendant in a particular case. For the rational-understanding prong, both the MacCAT-CA and the ECST-R elicit information about the likely outcome of the case. For example, standardized observations of attorney-client interactions would be valuable. Of interest, that criticism was leveled specifically at the ECST-R rather than being evaluated critically for competency measures in general. Probably because of its original development as a research measure, 16 of the 22 items do not address the defendant's case. 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. He was subsequently charged with attempted murder, battery with a deadly weapon, criminal recklessness, and theft. This information may help with the consult-with-counsel prong. Description and Congruence (Fit) between Dusky's Prongs and Selected Competency Measures. 2 2019] RE-EVALUATING COMPETENCE TO STAND TRIAL 159 and suffer the same inability to participate in their trials. As part of a special issue of the Journal on evidence-based forensic practice, this article examines three published competency measures: the MacArthur Competence Assessment Tool-Criminal Adjudication (MacCAT-CA), the Evaluation of Competency to Stand Trial-Revised (ECST-R), and the Competence Assessment for Standing Trial for Defendants with Mental Retardation (CAST-MR). The term competence to stand trial is perhaps misleading because only a small percentage of criminal cases actually go to trial. Advokat, Guidry, Burnett, Manuno-Mire, and Thompson (2012) found that about 25% of their sample were considered not restorable, and noted few differences in terms of clinical diagnosis, substance abuse, intellectual capacity, or type of offense, but they also found that the group restored to competency performed better on the Georgia Court Competency Test and Global Assessment of Functioning scale at both initial and final assessments. We believe that failures of both researchers and practitioners are to blame. We do not capture any email address. He had a history of mental illness and although initially found competent, he later deteriorated and was found to be incompetent. State v. Dean Garfoot Both criteria measure certain areas of knowledge and mental ability that are useful in a court setting. Sell appealed and the appellate court held that medication was necessary because he was dangerous to himself or others and medication was likely to restore competence. It argues that no valuable information, be it clinical acumen or standardized data, should be systematically ignored. current status and future directions, in Taking Psychology and Law Into the Twenty-First Century. The original IFI comprised three major sections assessing legal issues, psychopathological issues, and an overall evaluation of competency. Incompetent defendants are typically sent to residential forensic facilities, although outpatient treatment is an option (Miller, 2003). Understanding case events asks for detailed recall (e.g., date and witnesses) of the alleged crime and the current criminal charges. Similar findings were found in an Alabama study by Zapf, Hubbard, Cooper, Wheeles, and Ronan (2004), who examined reports in forensic facilities and found that while the majority of them covered factual understanding issues, over 90% offered no information about the appreciation or reasoning abilities of the defendants being evaluated for competency. In contrast, Guidelines 2 and 4 were relatively easy to grasp. Models for competency to stand trial can be conceptu-alized as extrapolated or

Fundamental justice requires that criminal defendants should be able to However, the historical divisions between psychiatry and psychology on the use of standardized assessments are gradually disappearing. Print. For example, if a defendant is asked to testify, but is likely to withdraw into a catatonic state on the stand due to the stress of testimony, the defendant may be found incompetent, but this same defendant may be able to proceed if a plea bargain is the manner in which the case is resolved (Roesch, Zapf, Golding, & Skeem, 1999).

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. The legal principle is usually referred to as competence to stand trial, although terms such as fitness to stand trial, adjudicative competence, and competence to proceed are also used (Bonnie, 1992; Golding, 2016). Indeed, the term itself is misleading because few defendants actually go to trial, as the vast majority of cases are resolved through plea bargaining. Copyright 2023 by The American Academy of Psychiatry and the Law, Sign In to Email Alerts with your Email Address.