mcgarry criteria competency stand trial

Lipsitt, P. D. , Lelos, D., & McGarry, A. L. (1971). 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. Each item is rated on a 3-point scale ranging from no impairment to definite or serious impairment. The Jackson decision raises the issue of whether it is possible to predict which incompetent defendants are unlikely to be restored. The opening paragraph of this article noted the professional schisms between traditional practice and the growing movement toward evidence-based practice. Obviously, the group of hospitalized legally incompetent defendants should theoretically evidence clinically significant impairment, given their combined psychiatric and legal status. In addition, data were available for comparison purposes for 71 feigners as classified by simulation research or results on the SIRS.29 Cut scores were developed on the basis of linear T scores, which facilitates their interpretation.

Thank you for your interest in recommending The Journal of the American Academy of Psychiatry and the Law site. 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. The magistrate observed that Hall exhibited organized, rational, sequential, and coherent thought processes and, based on his observation and the psychologist's report and testimony, recommended that Hall be found competent to stand trial. 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. 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. 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. The next section addresses the admissibility of expert evidence in light of the Daubert9 standard. Although the newest measure, the ECST-R is the only one of these competency measures to be reviewed by the well-respected Mental Measurements Yearbook.45,46 By combining these sources, practitioners will become knowledgeable regarding the strengths and limitations of competency measures. Especially useful for court reports and subsequent testimony is the 95 percent confidence interval. Psychiatric Services in Jails and Prisons (ed 2). Citing Federal Rule of Evidence 702, it requires a valid scientific connection to the pertinent inquiry as a precondition to admissibility (Ref. 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. A recent study of defendants found incompetent in the federal court system (Cochrane, Herbel, Reardon, & Lloyd, 2013) found that 79% of 132 involuntarily medicated defendants were successfully restored to competence, with an average treatment period of less than five months. Several subsequent cases have further defined the nature and scope of a competency determination (Drope v. Missouri, 1975; United States v. Duhon, 2000). 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. If incompetency is indicated, evaluators in Utah are also asked to specify treatment and whether the defendant can provide informed consent to treatment. The MacCAT-CA is composed of 22 items that are organized into three scales: understanding (8 items), reasoning (8 items), and appreciation (6 items). It is also a consideration if a defendant chooses to represent him or herself. Fundamental justice requires that criminal defendants should be able to Fundamentals of Forensic Practice: Mental Health and Criminal Law. of Docs., U.S. Govt. With professional experience and expertise, practitioners can make informed decisions in selecting the appropriate competency measure to evaluate specific competency-related situations. Competency to stand trial is a concept of jurisprudence allowing the postponement of criminal proceedings for those defendants who are considered Despite these important contributions to competency assessments, the caution of the AAPL Task Force is well founded; conclusions should not be based only on this source but should reflect a careful integration of multiple sources of data. 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. Rogers Criminal Responsibility Assessment Scales (R-CRAS) and Test Manual. 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. 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. Web(1) (a) The legislature establishes a performance target of seven days or fewer to extend an offer of admission to a defendant in pretrial custody for inpatient competency evaluation or inpatient competency restoration services, when access to 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. 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). 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. Unfortunately, there is little research on the effectiveness of various treatment approaches. The original IFI collected data from defendants interviewed by a two-person team, composed of a lawyer and either a psychologist or a social worker, and found high agreement about their final opinions of competency (Golding et al., 1984). 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. Practitioners sometimes exaggerate the limitations of standardized measures while possibly overvaluing their own expertise. 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. 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. Although considered to be factual understanding,40 this scale also requires rational abilities in deciding on the alternatives. Incompetent defendants with intellectual deficits fare more poorly in restoration programs. WebTHE CST WAS CONSTRUCTED BY MCGARRY AND OTHERS AS AN OBJECTIVE, PRELIMINARY SCREENING INSTRUMENT. An important consideration in establishing error rates is whether bogus (e.g., malingered) presentations will be mistaken for genuine incompetency. He was subsequently charged with attempted murder, battery with a deadly weapon, criminal recklessness, and theft. The MacCAT-CA has the most problems of competency measures in establishing accurate classifications. With respect to the preference of judges regarding report content, one study found that juvenile and criminal court judges from seven states stated they wanted ultimate opinions about competence and legal deficits more so than descriptions of causal explanations for psycholegal deficits (Viljoen, Wingrove, & Ryba, 2008). This article will review laws and practices related to competency to stand trial in adult criminal populations. Rather, the MacCAT-CA asks the examinee to consider a hypothetical case about two men (Fred and Reggie) and their involvement in a serious, almost deadly, assault following an altercation while playing pool. 41, p 31). 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. Charles Sell was a dentist who was charged with fraud and attempted murder. 5, p 327). 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. We will consider the scale classifications (interpretations) in the subsequent paragraphs. Within the context of family law, Kelly and Ramsey27 provide a masterful analysis of validity as it applies to psycholegal constructs and measures, along with a detailed list of specific benchmarks. We believe that failures of both researchers and practitioners are to blame. The majority who scored 95, suppl. 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). Once a competency evaluation is ordered, the evaluation itself can take place in a range of settings, including jails, forensic facilities, or if a defendant is released on bail, in an outpatient setting. Competency to Stand Trial & Mental Illness (Dhew Publications; Adm 74-103) April 1975, Jason Aronson. Although classifications based on the ECST-R evidence a high concordance with legal outcome (88.9%), classifications by ECST-R scales are based on construct validity and the use of normative data. Clinically, the movement toward empirically based assessments has created important advances, some limitations, and substantial resistance. WebOf the three, only the discrete abilities model evidenced a good fit, indicating that competency to stand trial should consider separately each defendants factual Additionally, in the case of a particular scientific technique, the court ordinarily should consider the known or potential rate of error. Print. 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). Forensic practitioners should decide which is most relevant to a particular competency evaluation. It explicitly rejected the test established in Frye v. United States,10 which relied solely on general acceptance. Because the reliability of traditional interviews cannot be established, the use of these competency measures addresses the scientific reliability of expert evidence. Regarding the MCMI-III, Rogers and his colleagues22 questioned the admissibility of any measure when the error rate substantially exceeded its accuracy. WebThe Competence to Stand Trial Assessment Instrument, often called the Competency Assessment Instrument (CAI), was developed in 1973 as a companion instrument to the For example, the three competency measures differ in the extent to which they have been evaluated for pretrial defendants with mental retardation. Individual items for the competency scales were developed and pilot tested. 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. Evaluating Competencies: Forensic Assessments and Instruments (ed 2). The items are scored on a 3-point scale with a score of 2 indicating full understanding of the item. However, efforts in this direction have not been successful. Gatowski and her colleagues,17 in a national study of 400 state trial court judges, found that most judges (i.e., ranging from 88% to 93%) believed that the individual Daubert guidelines were useful in deciding the admissibility of scientific evidence. 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. 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 ECST-R focuses on the nature of the defendant-attorney relationship; through open-ended questions, it examines the quality of that relationship and the defendant's ability to identify and resolve disagreements in relationship to the trial. Clinically significant impairment was designated as deficits at and above 1.5 SD. The presence of psychosis, for example, is associated with a finding of incompetency. Webnecessary criteria for competency to stand trial for more than four decades (Grisso, 2003). An interesting addition to the Gowensmith et al. Murrie and Zelle (2015) reviewed the literature and identified five essential capacities: (1) a factual understanding of the legal proceedings, (2) an appreciation of how the factual understanding can be applied to his or her case, (3) an ability to make reasonable and logical decisions, (4) an ability to assist and communicate with counsel, and (5) an ability to make decisions about issues such as whether to accept a plea agreement, proceed with trial, testify, and the many other decisions faced by defendants in criminal cases. With reference to forensic concerns, can the concept be empirically tested and does the research have the potential to disprove the conclusion? Substantiation should embrace an array of relevant sources by knowledgeable experts. 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). Been an inpatient for 60 consecutive days in preceding 12 months. The ECST-R was developed specifically for the purpose of evaluating the Dusky prongs. 1) for a more thorough introduction. An interesting feature of the MacCAT-CA is that that an education component is built into the measure. The CAST-MR provides the broadest appraisal of factual understanding with inquiries about common legal terms and basic information regarding verdicts and sentencing. The U.S. Supreme Court held that defendants committed solely on the basis of incompetency cannot be held more than the reasonable period of time necessary to determine whether there is a substantial probability that he will attain that capacity in the foreseeable future (p. 738). 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. Recent case law is discussed regarding the role of amnesia in determining competency to stand trial. The competency measures are markedly divergent in their assessment of Dusky's consult-with-counsel prong. Preliminary Steps The assessment template includes a list of documents that the evaluator should obtain or consider 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). The CAST-MR comprises 50 verbally administered questions that assess basic legal concepts, skills to assist defense, and understanding of case events. THREE EXPERIMENTS WERE Descriptive but not normative data are presented from two studies of criminal defendants. 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. For scientific validity to be relevant, it must be sufficiently tied to the facts of the case (Ref. Gutheil and Bursztajn48 wisely counsel that forensic practitioners avoid even the appearance of ipse dixitism with respect to unsubstantiated opinions. 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. The Jackson decision led to revisions in state statutes that provided alternatives to commitment and limited the length of commitment (Roesch & Golding, 1980). Research on report content suggests that many reports do not contain the details called for in Utah, as evaluators often fail to relate specific abilities and deficits to the particular case (Heilbrun & Collins, 1995). Reliabilities and Error Rates of the Three Competency Measures. The duration of confinement varied from state to state, with some states providing maximum time limits (e.g., 18 months) while others tied treatment length to a proportion of the length of sentence that would have been given if the defendant had been convicted. Finally, general acceptance can yet have a bearing on the inquiry. They differ in that the ECST-R examines how severe psychopathology may affect the defendant's rational abilities. A number of instruments have been developed that may assist the examiner in evaluating the possibility of malingering (see Miller, 1995; Rogers, Bagby, & Dickens, 1992), including one designed specifically for feigning competence-related abilities (Guenther & Otto, 2010). 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. 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). This provides an assessment of a defendants capacity to understand and acquire and process new information. An interesting finding was that agreement dropped to 61% in reevaluations of defendants undergoing restoration after being found incompetent. 9, p 591). In their studies of reports of competency evaluators in Utah, Skeem et al. However, consistent with the functional approach to competency assessments, the scale scores are not summed to total one final score for the ECST-R, and no cut-offs are used to determine whether a defendant is competent or incompetent.

Because of small sample sizes and large variability, they provide the following caution: only a gross estimate can be made of the degree to which CAST-MR total scores discriminate between groups found to be competent versus those found to be incompetent (Ref. The term competence to stand trial is perhaps misleading because only a small percentage of criminal cases actually go to trial. They drew on samples of 60 evaluators in Virginia and Alabama who had performed a minimum of 20 court-ordered evaluations, with a combined total of over 7,000 evaluations. We revisit these objections later in the context of evidence-based competency measures. 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.

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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). 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). Welch15 extensively describes Daubert's legacy of confusion in allowing trial judges to apply any or all of the Daubert guidelines when admitting expert testimony. 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.

He was diagnosed with schizophrenia and found incompetent to stand trial and remanded for treatment, which successfully restored his competence. 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. Fundamental justice requires that criminal defendants should be able to understand the charges against them, appreciate the nature and range of penalties, and communicate with their attorney. For example, Nicholson and Kugler (1991) reviewed 30 studies and concluded that defendants with psychotic disorders were more likely to be incompetent. Off. WebEven a person who meets civil commitment criteria may be considered competent to stand trial, although there does appear to be a strong relationship between incompetence and commitability. 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. Fitness to stand trial (equivalent to competency to stand trial) requires that defendants have a basic understanding of the purpose of the trial and the trial procedures. 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 Supreme Court held in Daubert that expert testimony must be relevant to the matter at hand. 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. Occasionally, a court may request that both evaluations take place at the same time (Chauhan, Warren, Kois, & Wellbeloved-Stone, 2015). Grisso (2003) defined functional abilities as that which an individual can do or accomplish, as well as to the knowledge, understanding, or beliefs that may be necessary for the accomplishment (pp. 8, issues 24) and the American Journal of Public Health (vol. Enter multiple addresses on separate lines or separate them with commas.

Similar to other studies showing high concordance between evaluator recommendations and court decisions, judges agreed with the majority opinion in 92.5% of the initial evaluations, but this dropped to 77.4% in subsequent evaluations. The competency issue is raised when an officer of the court (defense, prosecution, or judge) has reason to believe there is a bona fide doubt as to a defendants competence. The focus of the ECST-R inquiries is not on the decision itself but rather on the reasoning underlying the decision. Standards For Determining Competency And For Conducting A Hearing.