With the post-Gault trend toward the criminalization of the juvenile court, the demand for risk prediction assessment scales took on newfound importance. The past several decades of research have underscored the limitations of these scales. To address these limitations, and to shift the focus from current and future risk to least restrictive management strategies and effective treatment, we have developed and implemented a new assessment protocol that relies on risk relevant dynamic factors to inform and individualize treatment interventions as a vehicle for reducing recidivism and promoting healthy development among juveniles with sex offenses—without focusing solely on risk prediction. This Treatment Needs and Progress Scale (TNPS) is currently being pilot tested in five states. This article reviews the methodological problems of the extant risk assessment scales, discusses the development of the TNPS and how this protocol seeks to address many of these problems, including shifting the outcome target from reoffense to mitigation of risk factors through treatment and healthy growth and adjustment. We conclude with discussing how the TNPS may improve decision making regarding the management of juveniles with sex offenses, inform public policy and law, and facilitate healthier outcomes.
A core principle of modern-day law is that all defendants maintain the right to a fair trial. A defendant must be able to factually and rationally understand and participate in a court process, the ability to do so deems the defendant competent. Competency is relevant through all stages of the criminal justice process from arrest through sentencing. This article describes research and scholarship related to competency to stand trial. Competency to stand trial is a doctrine of jurisprudence that requires criminal proceedings to be postponed if a defendant is unable to meaningfully participate in his or her defense on account of a mental disease or defect. The US law regarding trial competency was established in the 1960 US Supreme Court Case Dusky v. United States (cited under Origins of Competency to Stand Trial and Key Legal Cases), and currently all states use some variant of the Dusky standard, with the exact definition varying by jurisdiction. Competency evaluations are essential to ensure the protection of a defendant’s due process rights guaranteed by the US Constitution. Approximately sixty thousand defendants are evaluated for trial competency annually, making this the most common forensic issue evaluated. Ultimately, an individual’s competency is a legal issue and does not have a distinct or easily identifiable psychological correlate. However, judges’ rulings closely follow mental health professionals’ recommendations most of the time, highlighting the importance of forensic mental health evaluators understanding the reason for the referral, the concerns surrounding competency, and the specific demands of the case. Issues of competency may be raised at any point during the proceedings, and if a bona fide doubt exists regarding competency, the issue must be formally considered: thus requiring a forensic evaluation. A defendant’s competency is assessed based on his or her present ability to understand court proceedings, make educated legal decisions, conduct oneself in a manner appropriate for court, and contribute to the development and execution of one’s legal defense. Forensic evaluators are tasked with describing the degree of congruence or incongruence between the relevant jurisdictional competency standard and the defendant’s current abilities. To complete this task, forensic evaluators must maintain a combination of advanced clinical skills coupled with knowledge about the legal system, competency standards, and the proper interpretation of the data collected for the evaluation.
Beginning in the 1960s, a steady decline in the number of inpatient psychiatric beds has occurred across the United States, primarily as a result of stricter civil commitment criteria and a societal movement toward deinstitutionalization. Concomitant with this decrease in psychiatric beds has been a steady increase in the number of mentally ill individuals who are arrested and processed through the criminal justice system as defendants. One consequence of this has been an explosion in the number of defendants referred for evaluations of their present mental state—adjudicative competence—and subsequently found incompetent and ordered to complete a period of competency restoration. This has resulted in forensic mental health systems that are overwhelmed by the demand for services and that are unable to meet the needs of these defendants in a timely manner. In many states, lawsuits have been brought by defendants who have had their liberties restricted as a result of lengthy confinements in jail awaiting forensic services. The stress on state-wide forensic systems has become so widespread that this has reached the level of a near-national crisis. Many states and national organizations are currently attempting to study these issues and develop creative strategies for relieving this overburdening of forensic mental health systems nationwide. The purpose of this article is to review the current state of the research on competence to stand trial and to highlight those issues that might be relevant to the issue of criminalization of individuals with mental illness in the United States.
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