The present study is a meta-analysis of competency to stand trial research. One meta-analysis was previously conducted in this area, but the large number of empirical studies that have been conducted since and the introduction of new instruments and revision of old instruments warranted updating and expanding upon the previously conducted study via contemporary meta-analytic methods. We metaanalyzed 68 studies published between 1967 and 2008 that compared competent and incompetent defendants on a number of demographic, psychiatric, and criminological variables. Categorical and continuous variables commonly investigated in competency research were coded and aggregated to generate cumulative effect sizes in the form of odds ratios and Cohen's d statistics, and moderation was tested via meta-F and meta-regression analyses. The most robust findings were that defendants diagnosed with a Psychotic Disorder were approximately eight times more likely to be found incompetent than defendants without a Psychotic Disorder diagnosis and the likelihood of being found incompetent was approximately double for unemployed defendants as compared to employed defendants. The likelihood of being found incompetent was also double for defendants with a previous psychiatric hospitalization compared to those without a hospitalization history. Comparative data on 12 competency assessment instruments and three traditional instruments were also explored and the effect sizes associated with the competency measures were substantially larger (i.e., approximately one Cohen's d-point) than those for the traditional measures. Limitations of the primary research and the previ-This article was published Online First January 17, 2011.

Exposure to irrelevant contextual information prompts confirmation-biased judgments of forensic science evidence . Nevertheless, some forensic examiners appear to believe that blind testing is unnecessary. To assess forensic examiners' beliefs about the scope and nature of cognitive bias, we surveyed 403 experienced examiners from 21 countries. Overall, examiners regarded their judgments as nearly infallible and showed only a limited understanding and appreciation of cognitive bias. Most examiners believed they are immune to bias or can reduce bias through mere willpower, and fewer than half supported blind testing. Furthermore, many examiners showed a bias blind spot (Pronin, Lin, & Ross, 2002), acknowledging bias in other domains but not their own, and in other examiners but not themselves. These findings underscore the necessity of procedural reforms that blind forensic examiners to potentially biasing information, as is commonplace in other branches of science.

Clinicians possess significant discretion in competency to stand trial assessment. Therefore, it is paramount to explore the contribution of individual variables to ensure that the decision-making process is devoid of bias and solely relates to the legal criterion. To test for the possibility of bias in clinical decision-making, we examined the predictive efficiency of clinical, criminological, and sociodemographic variables in a sample of 468 criminal defendants referred for competency evaluations. Only clinical diagnostic variables and employment status were significant predictors. This finding supports the idea that examiner decisions of competency appear to be unbiased and relate primarily to a defendant's functional ability.

Decision-making of mental health professionals is influenced by irrelevant information (e.g., Murrie, Boccaccini, Guarnera, & Rufino, 2013). However, the extent to which mental health evaluators acknowledge the existence of bias, recognize it, and understand the need to guard against it, is unknown. To formally assess beliefs about the scope and nature of cognitive bias, we surveyed 1,099 mental health professionals who conduct forensic evaluations for the courts or other tribunals (and compared these results with a companion survey of 403 forensic examiners, reported in Kukucka, Kassin, Zapf, & Dror, 2017). Most evaluators expressed concern over cognitive bias but held an incorrect view that mere willpower can reduce bias. Evidence was also found for a bias blind spot (Pronin, Lin, & Ross, 2002), with more evaluators acknowledging bias in their peers’ judgments than in their own. Evaluators who had received training about bias were more likely to acknowledge cognitive bias as a cause for concern, whereas evaluators with more experience were less likely to acknowledge cognitive bias as a cause for concern in forensic evaluation as well as in their own judgments. Training efforts should highlight the bias blind spot and the fallibility of introspection or conscious effort as a means of reducing bias. In addition, policies and procedural guidance should be developed in regard to best cognitive practices in forensic evaluations.

The agreement rate between mental health professionals' opinions and court determinations of competency to stand trial is typically above 90%. Scant research has been conducted regarding competency judgment discrepancies between forensic examiners and the court.This study investigated (a) the concordance rate between mental health professionals' opinions regarding competency and the courts' determinations of competency for 328 defendants referred for competency evaluation in Alabama, and (b) the quality of the reports in terms of whether or not they contained specific content as set out in Alabama statute. It was found that in all but one case the court accepted the mental health professionals' recommendations. Additionally, the reports were found to be lacking in specific information required by the courts. Further investigation of this high concordance rate has revealed a tendency on the part of judges to regard forensic examiners as the expert and to prefer that the examiner make the determination of competency rather than leave it to the court to make a legal determination. The pitfalls of this approach are discussed, and implications for the practice of mental health professionals in this area are delineated.