Psychological Evaluations for the Courts (ed 3). He & denies feeling the need for only 23 hours of sleep per night (manic sleep pattern). The MacCAT-CA was not originally developed as a measure of competency to stand trial. The report template is designed to expedite the process of creating reports. There are many ways to take notes during a forensic examination. 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. In one attempt to identify a criterion, Golding, Roesch, and Schreiber (1984) used a panel of experts, referred to as a blue ribbon panel, to serve as an independent criterion. Reference Manual on Scientific Evidence (ed 2). Since then, a psycholegal concept known as Competency to Stand Trial (CST) was introduced. In reviewing the ECST-R normative data, we did not find a single case of any of the competency scales where this occurred. 1) for a more thorough introduction. The MacCAT-CA has excellent normative data for 446 jail detainees, 249 of whom were receiving mental health services. We do not capture any email address. In the small dialogue box, click the small blue square. study was their follow-up of the court decisions. In their study, they asked two experts to make judgments about competency based on a review of records, reports from hospital evaluators, and evaluations using the Interdisciplinary Fitness Interview (IFI). This survey of forensic mental health experts studied potential PSC criteria. In this regard, the ECST-R is distinguished from the other two competency measures by its highly reliable scales that screen for feigned incompetency. Only the parts that require changes need be modified. The Supreme Court later held in Drope v. Missouri (1975) that evidence of a defendants irrational behavior, his demeanor at trial, and any prior medical opinion on competence to stand trial are all relevant in determining whether further inquiry is required, but that even one of these factors standing alone may, in some circumstances, be sufficient (p. 180). The defendant demonstrates during today's examination that his motivation is & self-serving and not self-defeating. The Competency Screening Test (CST) was constructed by McGarry et. Now, anytime Ctrl + j is typed on the keyboard, the cursor will go to the next ampersand and erase it. It explicitly rejected the test established in Frye v. United States,10 which relied solely on general acceptance. Items are scored based on the ability of the individual to relate information about his or her case in an accurate and understandable manner. 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. One limitation of the ECST-R is that its cut scores have not been validated for defendants with IQs of less than 60. Does the defendant have the capacity to testify relevantly? Furthermore, evaluators in the past rarely took into account the specific demands of a defendant's case. & Yes. The following are my conclusions regarding this defendant, to a reasonable degree of medical certainty, based upon the above history and findings. The role of the jury is, &. The defendant's plan for his legal strategy regarding the charges against him is, &. 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). Indiana Code 35-36-3-1 states that a defendant is incompetent to stand trial if the defendant lacks the ability to understand the proceedings and assist in the preparation of a defense. The term competence to stand trial is perhaps misleading because only a small percentage of criminal cases actually go to trial. Competence has come to refer to all aspects of participation in the legal process, from pretrial through sentencing and later in the appeal process. The following is the information given by the defendant regarding his medications. The ECST-R has excellent normative data based on 200 competency referrals and 128 jail detainees. 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. More details of the vignette are provided as the examiner moves through the first two sections of the MacCAT-CA. 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. Researchers and scholars have critically evaluated whether general psychological tests meet the Daubert guidelines for admissibility. 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. The user can create a personalized template for court-appointed cases, a different one for private cases, and so forth. Cognitive deficits should also be a focus of an evaluation. He & denies seeing things that are not there. (1998) found that evaluators did review basic issues such as ability to assist counsel, but typically need not pay attention to decisional competence issues, as only 12% of the reports discussed whether the defendant understood what rights were given up when entering a guilty plea. Objections by practitioners to using the assessment model have included concerns about its cost (35%), usefulness (38%), duplicated effort (23%), and duration (10%). Agreement about more specific psycholegal abilities is likely not as high. They found that for the 17 cases seen by the blue-ribbon panelists, they agreed with the IFI panelists 88% of the time, with the hospital staff 82% of the time, and with the courts 88% of the time, and they concluded that on the basis of these data it would be hard to argue for one criterion definition over another (p. 331). At this point the defendant appears to be psychiatrically & normal. One of the first cases to consider the question of the range of competencies was Godinez v. Moran (1993), in which the U.S. Supreme Court held that the standard for various types of competency (i.e., competency to plead guilty, to waive counsel, or to stand trial) should be considered the same. 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). The . Evaluation of Competency to Stand Trial-Revised (ECST-R) and Professional Manual. 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). It is offered as a public domain document, which means that everyone is free to copy it, modify it, and use it in any way. 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 defendant did sign a consent allowing me to examine him, release my findings to & you, and record the examination. Competency to stand trial is a concept of jurisprudence allowing the postponement of . 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 following is the information given by the defendant regarding his employment history. Competence Assessment for Standing Trial for defendants with Mental Retardation (CAST-MR) assesses the competence of defendants with intellectual deficits (Everington & Luckasson, 1992). 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. It is my judgment that this defendant presently & has the ability to understand the proceedings against him. Citing Federal Rule of Evidence 702, it requires a valid scientific connection to the pertinent inquiry as a precondition to admissibility (Ref. The next section addresses the admissibility of expert evidence in light of the Daubert9 standard. Indeed, some evaluators may choose to use multiple FAIs for the same evaluation, as each type of FAI provides slightly different perspectives and information about a defendants competence. Five large cities are, &. He is & able to put his thoughts into words. 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. He is & able to carry on a normal conversation. 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. In contrast, questions for the assist defense scale include preliminary information that increases the average length to 46.9 words. 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 use of psychotropic medication has been shown to be effective in restoring competence, as evidenced by the high rate of restoration noted. They seem to stem mostly from apparent confusion over the meaning of an ECST-R rating of 3. If the defendant were in a theater and saw the curtains on fire, he would, &. The reason that games have rules is &. Indeed, the term itself is misleading because few defendants actually go to trial, as the vast majority of cases are resolved through plea bargaining. Each of these three sections provides clinicians with specific questions that tap into different areas involved in competency. Early evaluators were employed typically in 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. With NIMH support, Lipsitt and his colleagues35 developed in 1971 the first standardized competency measure, the Competency Screening Test (CST). Parenthetically, the qualifying term usually seems difficult to understand. The present series of studies were designed for two purposes: (a) to provide evidence for the validity . 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 the legal profession. (A normal person can repeat 7 digits forward and 4 digits backward.) While the McGarry criteria help to structure CST evaluations, both individual McGarry criteria determinations and ultimate restoration opinions rested largely in evaluators' subjective ratings of defendants' abilities. This section will provide a brief overview of possible FAIs that clinicians can use when evaluating competency. 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. 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. While the bulk of the article addresses research findings, the next two paragraphs outline the equally important topic of professional attitudes. The issue reached the U.S. Supreme Court in the case of Sell v. United States (2003). An evaluators report to the court is presented as evidence that a judge may consider. A macro command must be programmed so that the computer will respond to the Ctrl + j command. Specific factual aspects of cases must also be considered. The minimum sentence he faces is, &. 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. It is important though, for evaluators to keep in mind that many defendants with such a diagnosis are considered to be competent. Competency to stand trial is an extremely complex issue, and practice has required that the psychiatrist play a major role in its determination. Skeem, Golding, Cohn, and Berge (1998) called for more training and monitoring of evaluators. Extrapolated models go beyond the legal criteria delineated by the Dusky standard to provide inferences about what might be or should be included in . 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. Restoration was again successful, and he was allowed to proceed with adjudication. If a witness is testifying against a defendant, and the defendant sees that the witness is lying, the defendant should, &. The link was not copied. 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. 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. Most of those referred for competency evaluations are found competent after relatively brief assessments, but approximately 2025% are found incompetent and referred for treatment to restore competency. Rather, the majority of cases are resolved through plea bargaining. Each item is rated on a 3-point scale ranging from no impairment to definite or serious impairment. Based on her work, we should anticipate that more scientific guidelines will generate greater discrepancies among trial courts. The sovereign citizen beliefs held by the defendants were identified from the court reports, and each element was used as a search term on Google, to find additional information about each belief. His list was based largely on criteria cited in law related to adults' competency to stand trial, widely-used criteria developed by mental health professionals for adult competency cases (e.g., McGarry, Lipsitt & Lelos, 1977), and Stein's own experiences with youths in juvenile court proceedings. Substantiation should embrace an array of relevant sources by knowledgeable experts. The authors argue that an adequate competency assessment should take into account the defendant's ability to consider his available pleas rationally. This observation is a likely explanation for the differences in cut scores between the two measures. 2. Grisso39 provides a thorough review of the CAST-MR and the MacCAT-CA. The difference between an apple and an orange is &. It is a support to him and not an area of conflict. Especially useful for court reports and subsequent testimony is the 95 percent confidence interval. & Yes. If the defendant is found guilty, the sentence he is most likely to get is, &. 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. The competency screening test was administered to 43 men who had been referred to a state hospital for determination of competency to stand trial. He & denies making big plans that are unrealistic (grandiosity). Beyond this critically important discussion, the relevance of a measure must also consider its appropriateness for the intended population (i.e., impaired defendants). Have the courts abdicated their responsibility for determination of competency to stand trial to clinicians? This place is, &. If the text is deleted, it is highlighted and deleted or is deleted by holding down the delete key. In direct contrast, the ECST-R took into account word length in the development of its items. 9, p 591). Consistent with the American Academy of Psychiatry and the Law Practice Guideline, it recommends the integration of competency interview findings with other sources of data in rendering evidence-based competency determinations. can clearly be applied to forensic practice regarding important determinants for the acceptance of evidence-based practice. 9, pp 5934]. Berman et al. The defendant's turn to talk during a trial is, &. 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. 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. The ampersand macro command is easily set up with these steps: In the Press new shortcut key dialogue box, type Ctrl + j (hold Control key while typing j), In the Find What box, tap the ampersand (shift + 7). Inter-rater reliability for the ECST-R scales ranged from .911.00 (Rogers, Grandjean, Tillbrook, Vitacco, & Sewell, 2001; Rogers, Tillbrook, & Sewell, 2004). He & denies the use of street drugs. Murrie, Boccaccini, Zapf, Warren, and Henderson (2008) took a different approach to studying evaluator reliability by examining whether some evaluators find defendants incompetent more often than other evaluators. 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). 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). He & denies any other involvements in the legal system. 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. Lessons from Slade et al. 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. For example, after asking the examinee if he has criminal charges against him, I type his answer at the ampersand. Psychiatric Services in Jails and Prisons (ed 2). & Yes. For competency determinations, the Supreme Court in Dusky established the three prongs for which the fit or congruence of scientific evidence must be considered. 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). If the text is left in its default form, then nothing further is done at that cursor stop. The standards for a helpful forensic psychiatry report are as follows: List the questions to be answered in the report. Practitioners sometimes exaggerate the limitations of standardized measures while possibly overvaluing their own expertise. The lower limit for unimpaired persons is 22.38 words. An interesting feature of the MacCAT-CA is that that an education component is built into the measure. However, efforts in this direction have not been successful. The specific issue there was whether the standard for competency to stand trial and competency to represent oneself should be the same. 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. He & denies feeling worthless. The colors of the American flag are, & red, white and blue. They found 51% of defendants with a diagnosis of psychosis to be incompetent, compared to only 10% without this diagnosis. 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. The Competence to Stand Trial Assessment Instrument, often called the Competency Assessment Instrument (CAI), was developed in 1973 as a companion instrument to the Competency Screening Test (CST) and sought to standardize as well as quantify the criteria for competence to stand trial. Readers may wish to refer to the Federal Judicial Center16 and special issues of Psychology, Public Policy, and Law (vol. Additionally, in the case of a particular scientific technique, the court ordinarily should consider the known or potential rate of error. Criteria for competency to stand trial: A checklist for . The vignette describes a bar fight between two men, Fred and Reggie, that results in an aggravated assault charge against Fred. This template lends itself to the efficiency of using voice recognition software to dictate at each cursor stop. There was considerable variation in opinions about incompetency, as the rates of incompetency determinations ranged from 0% to 62%. He had no schooling after that. Next, we examine these measures in light of error and classification rates. The Appendix illustrates a template for a written report on competency to stand trial and criminal responsibility. 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). It was followed in 1973 by the Competency Assessment Instrument (CAI), developed and validated by McGarry and his team36 at Harvard Medical School's Laboratory of Community Psychiatry. 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). Helpful reports give the court unambiguous conclusions with which it can either agree or disagree. The MacCAT-CA has the most problems of competency measures in establishing accurate classifications. He & denies that the television watches him. this arti- cle focuses on three aspects of criminal competency: (a) the legal criteria defining competency to stand trial, (b) the clinical assessment of competency, and (c) the treat- ment of defendants found incompetent to stand trial. Court outcome is an imperfect criterion as studies show that judges routinely accept the recommendations or opinions of evaluators, with agreement rates of over 90% (Cox & Zapf, 2004; Zapf, Hubbard, Cooper, Wheeles, & Ronan, 2004). 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. If the defendant were walking down the street, and found a letter lying next to a mailbox, he would, &. 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. He & denies loss of interest in his usual activities, including his self care. We believe that failures of both researchers and practitioners are to blame. The template's word processing format allows all parts of it to be modified or deleted. The attorney is & a pubic defender. & He denies any history of significant illness such as & cancer, & heart disease, & diabetes, or & epilepsy. 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. (The McGarry criteria are taken from McGarry Al, Curan WJ, Lipsett PH, et al: Competency to Stand Trial and Mental Illness. Defendants with serious mental disorders or mental retardation are likely to have substantial deficits in capacity to process information. 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. The template includes the standard elements of competency and criminal responsibility reports. The presence of psychosis, for example, is associated with a finding of incompetency. However, most of the reliability studies examine agreement between two examiners using the same competency measure making dichotomous decisions about competence. It is important, however, that mental health professionals are able to reliably and validly inform the court about the competency of defendants whose competence has been questioned by their lawyers, the prosecution, or the court. As used in the section, mental disease or defect means a severely abnormal mental condition that grossly and demonstrably impairs a person's perception, but the term does not include an abnormality manifested only by repeated unlawful or antisocial conduct. Abstract. 37, p S34). He & denies that others listen in on his thoughts. Courts require competency before defendants stand trial in order to preserve due processthat is, to make sure the proceedings are fair. 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