An analysis of competency to stand trial: an integration of case law and clinical knowledge

Abstract

In the past three decades competency to stand trial has emerged as a central issue in mental health law and forensic psychology. This article combines legal and clinical frameworks for a more integrated understanding of competency to stand trial. The legal framework focuses on Supreme Court decisions beginning with Dusky and reviews several legal theories of competence. The empirical framework is investigated within Grisso's (1986) conceptualization of legal competencies. In addition, the efficacy of specialized forensic assessments is evaluated, including the newly developed MacArthur Structured Assessment of the Competencies of Criminal Defendants (MacSAC‐CD). The article concludes with observations of competency as a construct and their implications for forensic practice. © 1998 John Wiley & Sons, Ltd.

Have the Courts Abdicated Their Responsibility for Determination of Competency to Stand Trial to Clinicians?

“…Regarding the one case of disagreement, the court found the defendant competent while the mental health professional considered him incompetent. Even though previous literature has found agreement above 90% (Cruise & Rogers, 1998;Freckleton, 1996;Hart & Hare, 1992;Reich & Tookey, 1986), this rate of agreement is exceptionally high. Table 2 shows the actual court outcome for each of the individuals considered to be either competent or incompetent by the certified forensic examiners.…”

“…Rates of agreement between mental health professional's evaluations of competence and court determinations have been estimated at or above 90% (Cruise & Rogers, 1998;Freckleton, 1996;Hart & Hare, 1992;Reich & Tookey, 1986). Findings from competency evaluations have a significant influence on the courts, and research has shown that judges highly value expert testimony on the competency issue.…”

“…Early evidence from studies that assessed the validity of mental health professionals' evaluations suggested that clinicians frequently equated diagnoses of psychosis and mental retardation with findings of incompetence (Golding, 1992;Roesch & Golding, 1980). However, more recent research has indicated that the factors most related to clinical findings of incompetence were poor performance on psychological tests that specifically evaluate competence-related skills, psychotic disorders, and severe symptoms of psychopathology (Cruise & Rogers, 1998;Grisso, 1992;Nicholson & Kugler, 1991). Reich and Tookey (1986) determined that the 91% rate of agreement between evaluators' opinions and the courts' determinations was an underestimate because, in some cases, agreement would have been reached, but the competency evaluation process was never completed and was therefore not counted.…”

Fitness to plead and competence to stand trial: a systematic review of the constructs and their application

“…Their weakness may be the limitation in clinical utility that results when the vignette is too far removed from the case in hand. Its internal factorial structure has also been criticised (Cruise & Rogers, 1998). A specific tool has been developed to assist in the assessment of competence in childhood and adolescence, the Juvenile Adjudicative Competence Interview (JACI; Grisso, 2005aGrisso, , 2005b.…”

End of Life Care: Attitudes Toward Autonomy and Legal Instruments

“…Since then, the MacSAC-CD (MacArthur Structured Assessment of the Competencies of Criminal Defendants) has been used to evaluate the capacity of public defendants in criminal trials, and has been well accepted. The MacSAC-CD was designed to evaluate two major dimensions, namely adjudication and decisional competence (Cruise & Rogers, 1998). The authors draw our attention to the limitations of this test when analyzing aspects of malingering attitudes.…”