A longitudinal description of incompetent to stand trial admissions to a state hospital

McDermott, Barbara E.; Warburton, Katherine; Auletta-Young, Chloe

doi:10.1017/s1092852919001342

Cited by 3 publications

(3 citation statements)

References 50 publications

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“…The reason that so many arrestees are ultimately referred for a competence evaluation is an important research trajectory to pursue. Researchers examining data from 2009 to 2016 found that the percentage of incompetent defendants admitted for inpatient restoration with more than 15 prior arrests grew from 17.7% to 46.4% (McDermott et al, 2020). At the same time, the study’s population was significantly less likely to have a history of inpatient psychiatric hospitalization as time passed (from 76.1% to 47.2%).…”

Section: Discussionmentioning

confidence: 99%

Court-reported competence to proceed data across the United States.

Kois,

Potts,

Cox

et al. 2024

Law and Human Behavior

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Objective: Competence to proceed (CTP) is a constitutional protection intended to facilitate fairness and dignity of court proceedings. Researchers have estimated that between 60,000 and 94,000 defendants are evaluated for CTP each year. Yet no research has systematically identified the number of evaluations conducted each year, despite their critical role and many profound implications. We used large-scale, systematic data collection to address this knowledge gap. Hypotheses: Given the siloed nature of the judicial and forensic mental health systems, we anticipated incomplete data and that the number of evaluations would far exceed previous estimates. Method: In September 2019, we used public information requests to solicit CTP evaluation order data from the judiciaries of 50 U.S. states, the District of Columbia, and the Federal Bureau of Prisons. We accepted evaluation proxies, such as evaluations ordered or evaluations filed, from the 2018/2019 calendar/fiscal year. We used Uniform Crime Reporting data to estimate a nationwide evaluation-to-arrest ratio and annual evaluation volume. Results: Twenty-five states provided data. We deemed data from 18 states acceptable while acknowledging that data likely underrepresented actual evaluation volume. By extrapolating data from these 18 states, we estimated a conservative national evaluation-to-arrest ratio of 0.015 (95% confidence interval [−0.007, 0.037]), which suggested that 15 evaluations are conducted per 1,000 arrests each year. Consequently, it seems likely that at least 140,000 evaluations are ordered each year nationwide, with several hundred people referred for evaluations each day. Conclusions: Annual CTP evaluation volume likely far exceeds previous estimates. Transparent data are difficult, if not impossible, to obtain. As a result, researchers, legal and forensic mental health professionals, and policymakers lack the ability to implement informed, constitutionally protected CTP practices. Key implications, research directions, and detailed data infrastructure recommendations are provided.

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Section: Discussionmentioning

confidence: 99%

Court-reported competence to proceed data across the United States.

Kois,

Potts,

Cox

et al. 2024

Law and Human Behavior

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“…As state hospitals must prioritize forensic patients for competence restoration, they face a vicious cycle in which there are fewer available beds for civil patients, who then may remain untreated until their psychiatric crises lead to involvement with the criminal legal system. As a result, “civil” patients may become “forensic” patients, thereby creating further demand for forensic services and further stress on hospitals to prioritize forensic services over traditional civil psychiatric treatment (McDermott et al., 2020).…”

Section: Historical Reliance On Inpatient Restorationmentioning

confidence: 99%

Evaluations of competence to stand trial are evolving amid a national “competency crisis”

Murrie

Gowensmith

Kois

et al. 2023

Behavioral Sci & The Law

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Across the United States, court orders for competence to stand trial (CST) evaluations and competence restoration services have been increasing much more rapidly than states can provide these services, prompting what has been called a national "competency crisis." The challenge in providing timely competence restoration services has, in several jurisdictions, prompted a change in competence evaluations. Evaluators are more often required to address broader clinical issues-such as recommending placement or addressing the urgency of hospitalization-rather than addressing only CST. This marks an evolving practice in forensic evaluation, which moves evaluators beyond the very narrow forensic question of competence and into more traditionally clinical recommendations. We describe several state examples of changing practice in order to highlight the initial barriers, and potential benefits, to addressing additional clinical issues in competence evaluations, amid a national competence crisis.

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“…Over the past 2 decades, the number of defendants found incompetent to stand trial (IST) and committed to state hospitals for restoration has increased substantially in the U.S. (Wik et al, 2020). Consistent with this trend, between the fiscal years 2013/ 2014 and 2015/2016, the California Department of State Hospitals (DSH) saw a doubling of IST referrals and the numbers continue to rise (McDermott et al, 2020). Multiple explanations have been provided for these observed increases, one of which is an increased recognition of mental disorders by the court (Sewell, 2016).…”

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confidence: 99%

Persistent, poor quality competency to stand trial reports: Does training matter?

Hill¹,

Homsy²,

Woofter

et al. 2022

Psychological Services

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Consistent with nationwide trends, the number of defendants judicially ordered to the California Department of State Hospitals (DSH) for competency restoration has nearly doubled in recent years. Previous research has shown that the majority of the time, judicial rulings on competency reflect forensic evaluators' opinions. Thus, the quality of competency to stand trial (CST) reports is critical. We examined 388 CST reports from defendants who were ultimately found incompetent to stand trial and admitted to a state hospital for restoration in 2012-2013. We evaluated the reports for adherence to both professional guidelines and current literature on the appropriate conduct of CST evaluations. Consistent with previous studies, our results showed that the reports evidenced overall poor quality and evaluators were largely unable to accurately describe the nature of the mental illness or explain how clinical factors (i.e., diagnoses or symptoms) impacted CST abilities. Notably, we found that experts board certified in psychiatry or psychology produced reports of higher quality. These findings demonstrate the continued poor quality of CST reports and highlight the importance of training. As in previous similar studies, we recommend mandatory training for experts conducting CST evaluations. Impact StatementOur study demonstrates that competency to stand trial reports overall evidence continued poor quality. However, training clearly improves the quality and thoroughness of these reports. Specialized education and training for clinicians conducting these evaluations is recommended.

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A longitudinal description of incompetent to stand trial admissions to a state hospital

Cited by 3 publications

References 50 publications

Court-reported competence to proceed data across the United States.

Court-reported competence to proceed data across the United States.

Evaluations of competence to stand trial are evolving amid a national “competency crisis”

Persistent, poor quality competency to stand trial reports: Does training matter?

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