As previously noted, a rating of 4 shows substantially impaired competency by itself, whereas a rating of 3 shows deficient competency but does not, by itself, show substantially impaired competency. Obviously, the group of hospitalized legally incompetent defendants should theoretically evidence clinically significant impairment, given their combined psychiatric and legal status. Evidence-based practice for evaluation of competency to stand trial cannot be considered without first providing a clinical context and legal framework. Others have estimated that 28% of all felony defendants are referred each year for an evaluation of competency (Hoge, Bonnie, Poythress, & Monahan, 1992; LaFortune & Nicholson, 1995). The competency screening test was administered to 43 men who had been referred to a state hospital for determination of competency to stand trial. current status and future directions, in Taking Psychology and Law Into the Twenty-First Century. 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 is & able to concentrate. 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. 9, p 592). His appetite is & good. 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. With NIMH support, Lipsitt and his colleagues35 developed in 1971 the first standardized competency measure, the Competency Screening Test (CST). I explained that I would not be treating the defendant and that I am not his treating physician. Gutheil and Bursztajn48 wisely counsel that forensic practitioners avoid even the appearance of ipse dixitism with respect to unsubstantiated opinions. 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). Beyond this critically important discussion, the relevance of a measure must also consider its appropriateness for the intended population (i.e., impaired defendants). Defendants with serious mental disorders or mental retardation are likely to have substantial deficits in capacity to process information. 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). He & denies history of suicide attempts. The Jackson decision led to revisions in state statutes that provided alternatives to commitment and limited the length of commitment (Roesch & Golding, 1980). Although not a perfect match, this last scale is most closely aligned with factual understanding. For example, if the defendant adequately describes the role of a defense attorney, he or she would receive a score of 2. Their field reliability study reviewed evaluators in over 200 cases, with each case requiring three independent evaluations by Hawaii law. It is one of the many educational programs1 and publications that establish the standards for forensic psychiatry reports. & Yes. 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. If any officer of the court (defense, prosecution, or judge) has reason to believe there is a bona fide doubt as to a defendants competence, the issue must be raised in court, and failure to provide a defendant with a hearing to determine competency when there is sufficient evidence that competency may be an issue is a violation of the defendants sixth amendment right to a fair trial (Pate v. Robinson, 1966). The process of determining an accused person's competence to stand trial often causes indefinite commitment to mental hospitals. Helpful reports give the court unambiguous conclusions with which it can either agree or disagree. Discuss the examiner's reasoning in reaching his or her conclusions. Competency to Stand Trial Evaluation Tests and Screening Instruments The difference between an apple and an orange is &. Mossman (2007) gives an example of a line of research that addresses this issue. 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. The minimum sentence he faces is, &. Limit sections to 10 paragraphs or fewer. Competence Assessment for Standing Trial for defendants with Mental Retardation (CAST-MR) assesses the competence of defendants with intellectual deficits (Everington & Luckasson, 1992). 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 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. Researchers sometimes overestimate the ability of their standardized measures to evaluate complex clinical constructs. List the examiner's unambiguous answers to the questions to be answered in the report (second listed item). Occasionally, a court may request that both evaluations take place at the same time (Chauhan, Warren, Kois, & Wellbeloved-Stone, 2015). 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. The use of medication raises the question of whether an incompetent defendant can refuse to consent to being medicated. & He denies any history of significant illness such as & cancer, & heart disease, & diabetes, or & epilepsy. Board Certified in General Psychiatry and Forensic Psychiatry. 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. 43 legal criteria defining competency to stand trial historically, criminal competency has been defined The defendant's behavior in today's examination was & calm and cooperative. An example is the cursor stop that details the findings that support a conclusion of incompetence to stand trial. The next section addresses the admissibility of expert evidence in light of the Daubert9 standard. It is set up as a default template. Objections by practitioners to using the assessment model have included concerns about its cost (35%), usefulness (38%), duplicated effort (23%), and duration (10%). Some variability was due to clinician discipline (psychologists, psychiatrists, and social workers conducted the evaluations), which Murrie et al. Does the defendant have an appreciation of the range and nature of the possible penalties he faces? 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. There is no explicit prohibition forbidding the offering of an ultimate opinion and, in many ways, a well-written report should make the evaluators opinion obvious even if it is not directly stated. Self-serving & motivation. 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. If not based on disciplines, what accounts for this polarization? al. Parts that need no modification can be skipped. 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 defendant does have criminal charges pending against him. In direct contrast, the ECST-R took into account word length in the development of its items. 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. Utah Code Annotated 77-15-1 et seq. 8, issues 24) and the American Journal of Public Health (vol. This article has provided an overview of forensic assessment instruments that have been developed to guide this process. We believe that failures of both researchers and practitioners are to blame. 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. Professional Manual for the MacArthur Competence Assessment Tool-Criminal Adjudication (MacCAT-CA). We will consider the scale classifications (interpretations) in the subsequent paragraphs. A comprehensive review of the Daubert decision is far beyond the scope of this article, given the hundreds of scholarly works in the psychological, medical, and legal literatures. The vignette describes a bar fight between two men, Fred and Reggie, that results in an aggravated assault charge against Fred. For instance, what would be the similarities in MacCAT-CA's aggravated assault between friends and delusionally motivated crimes? Enter multiple addresses on separate lines or separate them with commas. The difference between a bush and a tree is &. Psychiatrists view fitness as a homeostatic functional capacity. Page 6 In her second evaluation, Susan E. Rushing, M.D., J.D., a forensic psychiatrist, found For two scales (FAC and RAC), such ratings would show only moderate impairment, which is typically associated with competent defendants. 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). 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). Additionally, in the case of a particular scientific technique, the court ordinarily should consider the known or potential rate of error. Many patients are . He has & never been treated for alcoholism or substance abuse. One sound approach to ascertaining error rates is to estimate the accuracy of individual scores on competency measures. Clinically significant impairment was designated as deficits at and above 1.5 SD. The present series of studies were designed for two purposes: (a) to provide evidence for the validity . 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. He & denies feeling worthless. judication," "competence to stand trial," and "fitness to stand trial" are used interchangeably throughout the Guideline. This section regards sanity.). The defendant is & familiar with plea bargaining. Competence for execution is an infrequently raised competence issue, and the reader is referred to Zapf (2016) for a review and discussion. There was considerable variation in opinions about incompetency, as the rates of incompetency determinations ranged from 0% to 62%. My examination of him began at & pm and ended at & pm. 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. Conservative estimates suggest there are 60,000 competency cases per year, with rates of incompetency often falling in the 20- to 30-percent range.32 When extrapolated from the number of actively psychotic and mentally disordered inmates,33 the potential number of competency evaluations could easily be twice this estimate. His answer can be quoted or paraphrased. 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. 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. Grisso39 provides a thorough review of the CAST-MR and the MacCAT-CA. 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. 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 CAST-MR also has a specific scale for considering the defendant's memory of the offense and subsequent arrest. Confusion of Competency with Criminal Responsibility In past decades, competency to stand trial was often confused by legal and . 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. 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. The vast majority of defendants are competent to understand the charges against them, appreciate the legal consequences, make decisions about how to proceed with their cases, and able to communicate rationally with their attorneys. Psychiatric Services in Jails and Prisons (ed 2). & Yes. Psychological Evaluations for the Courts (ed 3). The defendant lives & alone. As well, assessments of juveniles are increasingly becoming more common, but the issues of concern focus more on developmental factors like maturity (Ryba, Cooper, & Zapf, 2008) rather than mental illness (see Kruh & Grisso, 2009; Roesch & Viljoen, 2016; Warren et al., 2009). The following is the information given the by defendant regarding his family history. The items are scored on a 3-point scale with a score of 2 indicating full understanding of the item. The reason that games have rules is &. The Jackson decision raises the issue of whether it is possible to predict which incompetent defendants are unlikely to be restored. There is no standard report format, but a number of sources provide guidelines that forensic evaluators can reference (Otto, DeMier, & Boccaccini, 2014; Zapf & Roesch, 2009). In contrast, Guidelines 2 and 4 were relatively easy to grasp. 2324). The Private Practice Committee of AAPL presents a course every two to three years at the annual meeting. 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. 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. 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. The CST process is done among the criminal justice victims to assure that they are fit and competent to stand criminal trials and respond sufficiently to charges leveled against them. The following are my thoughts regarding this case. 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. 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). Beyond complex content, we suspect there is some professional arrogance arising from the use of sophisticated research designs and psychometric rigor. The ECST-R has excellent normative data based on 200 competency referrals and 128 jail detainees. The majority who scored low on the test were indefinitely committed, while . Paris1 ably documents the evolution of psychiatric practice from idiosyncratic clinical inferences and basic research studies to systematic investigations of evidence-based practice. If more than one cursor stop is left in its default state, then the Ctrl key can be held down while the j key is tapped repeatedly. The charges against him are, &. This amendment states that all people are guaranteed a fair trial. The ECST-R manual provides extensive data on the accuracy of its measurements. Cognitive deficits should also be a focus of an evaluation. He has & 3 children. Perlin cited the case of Colin Ferguson, who was accused of murdering six people and injuring 19 others on the Long Island Rail Road. Furthermore, evaluators in the past rarely took into account the specific demands of a defendant's case. &. Structured Interview of Reported Symptoms (SIRS) and Professional Manual. The role of the jury is, &. With regard to symptoms of mania, the defendant & denies feeling extremely happy for no reason (inappropriate euphoria). Some resistance is encountered from the either-or fallacy wherein practitioners erroneously assume that they must choose between their own individualized methods and psychometrically validated measures. 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. I offer these four points to make reports clear and easy to read: Limit paragraphs to 10 sentences or fewer. The MacCAT-CA also includes several items about defendants' views and actions toward their attorneys. 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 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. Basic Legal Concepts is the one most closely aligned with Dusky's factual understanding, whereas skills to assist defense uses hypothetical examples to evaluate the consult-with-counsel prong. criteria in competency to stand trial assessments should be relevant to the defendant's situation and to the legal definition of competency. The remainder of this article assumes that practitioners will integrate case-specific (clinical interview and collateral information) with nomothetic (standardized results) data. Our informal observations suggest that forensic psychiatrists and psychologists are divided with respect to their use of competency measures. In addition, the lack of information about specific prongs is a limiting factor about the CAST-MR classifications. 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 purpose of this evaluation was to determine his competence to stand trial and his criminal responsibility (insanity) regarding his current criminal charges. 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). Their similarity is &. 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. Does the defendant have the capacity to testify relevantly? The standards for a helpful forensic psychiatry report are as follows: List the questions to be answered in the report. Slade and his colleagues6 carefully evaluated the acceptance of an empirically based assessment model involving a constellation of standardized measures. Forensic practitioners should decide which is most relevant to a particular competency evaluation. The pleadings available to the defendant include, &. Manual for Competence Assessment for Standing Trial for Defendants with Mental Retardation: CAST-MR. Review of the Evaluation of Competency to Stand Trial-Revised. Practitioners should be familiar with the Dusky standard and relevant appellate cases. This information may help with the consult-with-counsel prong. Indeed, the term itself is misleading because few defendants actually go to trial, as the vast majority of cases are resolved through plea bargaining. &. It argues that no valuable information, be it clinical acumen or standardized data, should be systematically ignored. But note that an almost equal number of defendants with a diagnosis of psychosis are considered to be competent, making it clear that psychosis alone is not sufficient by itself to find a defendant incompetent. The feigning scales were developed by using two primary detection strategies: rare symptoms and symptom severity. As summarized in Table 1, two scales of the CAST-MR appear to meet this guideline, with understanding case events being particularly straightforward. The CAST-MR comprises 50 verbally administered questions that assess basic legal concepts, skills to assist defense, and understanding of case events. However, the limited research has produced mixed results. 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. 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. The defendant demonstrates during today's examination that his motivation is & self-serving and not self-defeating. Competence can even arise in death penalty cases in which the competence to proceed with appeals or to be executed is questioned (Cunningham, 2013). 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. 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). The . The template includes the standard elements of competency and criminal responsibility reports. Finally, general acceptance can yet have a bearing on the inquiry. Mild impairment was designated as the narrow band of deficits falling between 1 and 1.5 SD. 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). & Yes. Aarons et al.7,8 have gone a step further in studying how professional attitudes toward evidence-based practice are reflected in effective interventions. 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). Melton and his colleagues were the first to raise the concern of whether competency measures appear to permit gross incongruencies between item ratings and scale interpretations (Ref. 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. & Low. Does the defendant manifest self-serving motivation or self-defeating motivation? 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. 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. 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. This practice was challenged in Jackson. A major strength of the three competency measures is the excellent data on their reliability and errors in measurement. 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). Several points should be emphasized: 1. With regard to symptoms of psychosis, the defendant & denies hearing things that are not there. In reviewing the ECST-R normative data, we did not find a single case of any of the competency scales where this occurred. When that spot is completed, then Ctrl + j moves the cursor to the next cursor stop where dictation is entered. The CST has 22 item stems that ask defendants to complete sentences. 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. 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. 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). 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). 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).
Chicago High School Edition Tracks, Articles M
Chicago High School Edition Tracks, Articles M