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Competency To Stand Trial - How To Assess for the Functional Objective: Competence Assessment for Standing Trial for Defendants

Posted Jan 14 2009 7:25pm

I can’t believe how long it’s been since I posted on competency to stand trial. I actually had to go back and look at where I'd left off, which was with a discussion of the R-CAI. As noted in that post, I use the R-CAI quite frequently. It is semi-structured, which allows for covering all of the bases, but provides enough room for a clinician to further expand their assessment of a defendant on specific issues that are unclear.

There are times, however, where I do not begin my formal assessment of competency with the R-CAI. These times generally involve low intellectual functioning. The importance of obtaining an idea of a defendant’s cognitive functioning (to include an IQ score) is not because one can definitely assess a defendant’s competency based on an IQ score (see my post here ), but because it gives the evaluator an idea about how to approach the task of assessing the functional objective.

Here is an example, based on an extreme case. Let’s say a defendant is referred for a competency evaluation. The defendant suffered a severe head injury after his arrest, while out on bond. The injury was severe enough that the defendant now requires nursing care in order to complete activities of daily living (e.g. washing, dressing, etc.), and his cognitive capacity has been similarly impacted. What to do?

First, the evaluator will still want to obtain a history. In addition, medical records will be crucial, including any information regarding prognosis. People suffering head injuries may experience recovery for quite awhile (at least one year, sometimes up to two years), but most of that recovery will occur within the first six months. All of this will be considered in the recommendation to the court regarding restoration, as discussed here.

The main part of the evaluation will be an assessment of the individual’s current level of functioning. The defendant’s various cognitive abilities will be assessed enough to answer the questions of the court. Let us assume, for this example, the individual is assessed to have an IQ, post-injury, of 50. This is very low (more than three standard deviations below the mean, and more than a full standard deviation below 70, which is the numeric value necessary for a diagnosis of mental retardation).

Do we need to complete the R-CAI in order to assess this defendant for competency to stand trial? No. Remember, there are two prongs regarding competency - understanding court proceedings, and having the ability to aid one’s defense. In this case, asking five to ten basic questions, and documenting the defendant’s current inability to answer these questions, will be enough. An evaluation of someone with an IQ this low will likely go something like this:

* What is the job of a judge? - “To help me.”

* What have you been charged with? - “I hurt someone.”

* Is this crime a misdemeanor or felony? - “I don’t know.”

* If the judge asks someone “How do you plead,” what kind of answers can someone give? - “I don’t know.”

* What does a plea bargain mean? - “I don’t know”

And so on. One will get the impression this individual cannot answer many questions related to either of the prongs, and will not be able to easily learn them, either. The main question before the court, in this case, is one of restoration, not current competency. In general, all sides will recognize this, unless there is a suspicion of malingering (which does occur).

However, in most cases, the issue will not be so clear-cut. As stated in previous posts, a serious mental health problem (to include mental retardation) is necessary but not sufficient in order to be found incompetent. Individuals with mental retardation are certainly capable of being competent to stand trial, assuming the level of impairment is not too severe (i.e. an individual with profound or severe mental retardation will not be restorable).

Another issue in assessing for competency is that the evaluator needs to remember the defendant must have both a factual and rational understanding of competency. Therefore, it is not enough to simply determine the defendant can provide rote answers due to rehearsal (or prior court experience!). They have to understand these concepts to a reasonable degree.  This is where the CAST-MR comes in, as a nice assessment device that will allow for an assessment of factual understanding, along with normative data that allows for comparisons to various groups.  In Part II of this post, I will discuss the specifics of the CAST-MR.

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