The presence of psychosis, for example, is associated with a finding of incompetency. Perlin cited the case of Colin Ferguson, who was accused of murdering six people and injuring 19 others on the Long Island Rail Road. 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. Its error rate focuses specifically on the accuracy of measurement, which is affected by reliability and validity. This is because a competency evaluation focuses on a defendants present mental state and its relationship to the ability to proceed with his or her case, whereas a criminal responsibility assessment requires a retrospective evaluation of past mental states. 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. Beyond this critically important discussion, the relevance of a measure must also consider its appropriateness for the intended population (i.e., impaired defendants). While it does not grapple directly with evidence-based practices, the guideline attempts to standardize competency evaluations by recommending 15 specific areas of inquiry. To be sure, the presence of a severe mental disorder such as a psychosis is an important first step in the evaluation of competence (Rosenfeld & Wall, 1998). The original version included 17 items but a revised version, referred to as the GCCT-Mississippi State Hospital Revision (GCCT-MSH), has four additional items (Wildman, White, & Brandenburg, 1990). Manual for Competence Assessment for Standing Trial for Defendants with Mental Retardation: CAST-MR. Review of the Evaluation of Competency to Stand Trial-Revised. 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. McGarry Criteria. 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. What about the gross incongruencies criticism of the ECST-R of Melton and his colleagues32? 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. study was their follow-up of the court decisions. mcgarry criteria competency stand trial. 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. In this regard, the ECST-R is distinguished from the other two competency measures by its highly reliable scales that screen for feigned incompetency. 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. 
Borrowing from Slade et al.6: are these measures useful, nonduplicative, and time-efficient? Mental Illness. While the bulk of the article addresses research findings, the next two paragraphs outline the equally important topic of professional attitudes. 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. Rogers Criminal Responsibility Assessment Scales (R-CRAS) and Test Manual. 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. 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. 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). The instrument was created by an Next, we examine these measures in light of error and classification rates. Evaluation of Competency to Stand Trial-Revised (ECST-R) and Professional Manual. Because many defendants are found incompetent due to a psychosis, psychotropic medication is the most frequent type of treatment. The CAST-MR test manual provides little guidance for making classification of competent and incompetent defendants with mental retardation. 
WebCompetence to stand trial: the legally determined capacity of a criminal defendant to proceed with criminaladjudication.Jurisdictionalstatutesand case law set out the This article has provided an overview of forensic assessment instruments that have been developed to guide this process. Although the Court did not indicate how a reasonable period of time should be defined or progress toward regaining competency could be assessed, the decision made clear that if these two conditions were not met, the defendant would have to be released unless civil commitment was an appropriate alternative. 1. The Daubert guidelines ask that experts address the error rates associated with their methods. Suicide by Cop and Civil Liability for Police, Polygenic Risk Score Effect on Violent Behavior in Schizophrenia, Effects of Online Distance Learning on Violence Risk Knowledge and Competencies, by The American Academy of Psychiatry and the Law, http://libproxy.library.unt.edu:2055/ehost/detail?vid=3&hid=102&sid=bdf72205-c12f-4c62-aa8f-e6eedlalb8e2%40sessionmgr110&bdata=JnNpdGU9ZWhvc3QtbG12ZSZzY29wZT1zaXR1#db=loh&AN=16093149, Competency Measures and Evidence-Based Practices, American Academy of Psychiatry and the Law. He was diagnosed with schizophrenia and found incompetent to stand trial and remanded for treatment, which successfully restored his competence. 2 2019] RE-EVALUATING COMPETENCE TO STAND TRIAL 159 and suffer the same inability to participate in their trials. Off. Skeem and Golding (1998) suggest a three-step procedure for establishing a link between psychopathology and impairment of legal abilities: one might (a) carefully consider the nature and content of the defendants primary symptoms, (b) consider how these symptoms might relate conceptually to the defendants specific psycholegal impairments, then (c) assess, as directly as possible, whether there actually is a relationship between the symptom and the CST impairment (p. 364). As evidence of their growing importance, an American Psychiatric Association Task Force undertook a multiyear analysis of psychiatric measures resulting in a comprehensive textbook.47 Beyond these general trends, specific contributions to competency measures have been multidisciplinary from the early efforts in the 1970s. They found 51% of defendants with a diagnosis of psychosis to be incompetent, compared to only 10% without this diagnosis. 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. 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. The ECST-R was developed specifically for the purpose of evaluating the Dusky prongs. 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 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. Specific factual aspects of cases must also be considered. The CAST-MR also has a specific scale for considering the defendant's memory of the offense and subsequent arrest. The lower limit for unimpaired persons is 22.38 words. Could each forensic psychiatrist or psychologist develop his or her own specific questions and systematic examination of competency? 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). Competency restoration practices are reviewed later. The vignette describes a bar fight between two men, Fred and Reggie, that results in an aggravated assault charge against Fred. 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). 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). WebState 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 WebThe issue of a defendants competency to stand trial is usually raised by a written motion suggesting that the defendant is incompetent to stand trial. The term competence to stand trial is perhaps misleading because only a small percentage of criminal cases actually go to trial. 11 Other defendants who suffer from physical disabilities,12 such as deafness13 or cancer,14 can also face hurdles when demonstrating their incapacity to Berman et al. Unlike other forensic concerns, competency to stand trial has been the vanguard of evidence-based practice, championed for decades by prominent forensic psychiatrists and psychologists. Therefore, it assesses rational abilities but does not consider the actual defendant-attorney relationship or the ability to communicate rationally. Slade and his colleagues6 carefully evaluated the acceptance of an empirically based assessment model involving a constellation of standardized measures. WebThe Competence to Stand Trial Assessment Instrument, often called the Competency Assessment Instrument (CAI), was developed in 1973 as a companion instrument to the In Joiner, the Court specified that the trial judge would be the arbiter of scientific admissibility and could be overruled based only on the abuse-of-discretion standard. The original IFI comprised three major sections assessing legal issues, psychopathological issues, and an overall evaluation of competency. The use of medication raises the question of whether an incompetent defendant can refuse to consent to being medicated. The MacCAT-CA also includes several items about defendants' views and actions toward their attorneys. However, the limited research has produced mixed results. Printed from Oxford Research Encyclopedias, Psychology. The MacCAT-CA has excellent normative data for 446 jail detainees, 249 of whom were receiving mental health services. Thank you for your interest in recommending The Journal of the American Academy of Psychiatry and the Law site. Restoration was again successful, and he was allowed to proceed with adjudication. In his seminal work, Robey34 proposed in 1965 a standardized checklist for operationalizing competency to stand trial. We will consider the scale classifications (interpretations) in the subsequent paragraphs. 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. Each evaluates the defendant's understanding of the courtroom personnel and their respective roles at trial. Competence issues also arise in noncriminal settings such as immigration removal proceedings (Filone & King, 2015), but that is beyond the scope of this article. Competence Assessment for Standing Trial for defendants with Mental Retardation (CAST-MR) assesses the competence of defendants with intellectual deficits (Everington & Luckasson, 1992). If they do not have the capacity in any of these areas, they may be found incompetent to proceed and the judicial proceedings are suspended until they are treated and competency is restored. 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. 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. We must tackle directly the professional objections to evidence-based practice. Almost all incompetent defendants are returned to court within a year, with only a small percentage found to be unresponsive to treatment and thus not restorable. They were compared with 283 incompetent defendants in a competence restoration program. 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). 23 Sovereign Citizen Beliefs Common Law Courts Webtence to stand trial. Neither the CAST-MR nor MacCAT-CA assesses defendants' knowledge of their own criminal charges and the severity of these charges. Before the Court of Appeals, defendant argued that the trial court ignored the liberal standard that Rule 702 Despite its extreme rarity (i.e., 0 for 356 defendants), practitioners may want to consider quickly screening ECST-R protocols for this remote possibility. 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). Although considered to be factual understanding,40 this scale also requires rational abilities in deciding on the alternatives. Duration of Commitment . The Competency Assessment Instrument (CAI; McGarry & Curran, 1973) was one of the early competency measures, used in the late 1960s. It is important though, for evaluators to keep in mind that many defendants with such a diagnosis are considered to be competent. State laws typically do not specify what should be contained in a report, although the Utah statute is a clear exception. Be that as it may, two criteria stand out as being relevant for a determina tion of competency to stand trial: the presence of psychosis and/or the 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). Regarding the MCMI-III, Rogers and his colleagues22 questioned the admissibility of any measure when the error rate substantially exceeded its accuracy. Less intrusive forms of treatment include legal rights education, deficit-focused remediation programs, and standard hospital treatment programs (Bertman et al., 2003). The specific issue there was whether the standard for competency to stand trial and competency to represent oneself should be the same. in English. 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). Applied mostly to treatment and treatment outcomes, evidence-based practice is an attempt to evaluate treatment efficacies systematically via randomized control trials and meta-analyses.2,3 These efforts to revolutionize mental health practices are not without critics,4,5 who raise problems with research design (e.g., weak outcome measures, diagnostic validity, comorbidity, and subsyndromal cases). Bonnie and Grisso (2000) estimated some 60,000 annual evaluations, a figure that was a substantial increase over prior estimates (Hoge et al., 1997). 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). Clinically, the movement toward empirically based assessments has created important advances, some limitations, and substantial resistance. For normal (unimpaired) persons, the capacity to process information is generally limited to the magic number of 7 2 concepts.43 For language, individuals use verbal chunking consisting of 6 to 12 syllables per concept.44 Using the MacCAT-CA as a benchmark with 1.34 syllables per word, the midpoint for unimpaired persons would be: 7 concepts 9 syllables 1.34 syllables per word = 47.01 words. It emphasizes the ability of the defendant to cooperate with his counsel, while not acquiescing to others (e.g., police or prosecutors). As reported in Table 2, expert ratings of defendants that exceed the cut scores by three or more points have at least a 95 percent likelihood of being accurate. 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. One strength of the ECST-R is that it both prompts and educates defendants with insufficient responses on factual understanding. PDF. State v. Dean Garfoot Both criteria measure certain areas of knowledge and mental ability that are useful in a court setting. Overall, these two studies suggest that while agreement between evaluators is generally high, there are a substantial number of cases in which evaluators disagree (18% in Utah and 29% in Hawaii). Lessons from Slade et al. The MacCAT-CA also assesses courtroom personnel and then uses a hypothetical case to evaluate criminal charges related to assault and matters such as plea bargaining. Recall of these events is likely to be helpful in competency cases in which amnesia plays a central role. The MacCAT-CA was not originally developed as a measure of competency to stand trial. More details of the vignette are provided as the examiner moves through the first two sections of the MacCAT-CA. An interesting addition to the Gowensmith et al. The majority who scored Cognitive deficits should also be a focus of an evaluation. Because the law has provided only vague criteria, incompetency to stand trial has tended to be equated with mental illness by both psychiatrists and members of Competency to stand trial is a concept of jurisprudence allowing the postponement of criminal proceedings for those defendants who are considered 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. (2012) provide one of the few studies of evaluators in routine practice of conducting competency evaluations. 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 MacCAT-CA has the most problems of competency measures in establishing accurate classifications. It argues that no valuable information, be it clinical acumen or standardized data, should be systematically ignored. Individual items for the competency scales were developed and pilot tested. For scientific validity to be relevant, it must be sufficiently tied to the facts of the case (Ref. 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. Each item is rated on a 3-point scale ranging from no impairment to definite or serious impairment. With NIMH support, Lipsitt and his colleagues35 developed in 1971 the first standardized competency measure, the Competency Screening Test (CST). These normative data were used for clinical interpretation of information from the jail detainees to establish three categories. 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