The Five Objectives of Competency Evaluations: #2 - Causal Explanations for Deficits in Competency Abilities
Posted Oct 03 2008 12:52pm
Okay, so in the last post on this subject (objective #1, amazingly), we discussed objective #1, which is to provide a functional description of the defendant’s specific abilities, as they relate to being competent. The next objective in a evaluation is to provide the “why.” That is, provide all relevant information that may indicate the cause of the deficits in the abilities that were observed and documented. So, first we discuss the deficits, then we try to provide a causal explanation for said deficits. The examiner will provide a rationale, laying out the most reasonable explanation for the deficits that were observed, but also identifying other possible explanations as well.
Laying out the causal explanation is important clinically, obviously (the type of treatment required will depend on the type of cause), but it is also important in terms of the legal purpose of the evaluation (especially considering we are only officially concerned with the competency of the defendant, not the ancillary issues). This is because certain types of causes of deficits are consistent with the definition of competency, while others effectively rule out the possibility of being found incompetent. Remember, many jurisdictions (including U.S. Federal Court) have as part of the definition of incompetence “a severe mental disease or defect...”. Given this, the causal explanation will either meet the criteria of “severe mental disease or defect,” or it won’t. It may be a severe mental disorder, or a mental disorder that is not considered severe. Other possibilities include ignorance of the law and legal processes, situational states (i.e. fatigue), or malingering (the intentional feigning or exaggeration of mental health symptoms).
Of these four areas, only the mental disorders will generally constitute a legal reason to determine a defendant is incompetent. The others are almost never found to be legitimate bases for finding a defendant incompetent. If someone is experiencing a situational state that is interfering with competency, the situational state simply needs to be addressed, possibly followed by a re-examination, but not a full referral for restoration to competency. The same applies to lack of knowledge. If a defendant is ignorant simply because of a lack of exposure to the legal process, this can be addressed by basic education (which is actually often completed during the evaluation process itself). Malingering is usually an effort by an individual to attempt to gain some personal benefit through feigning or exaggerating a mental health problem. Obviously, if a defendant is found to be malingering, they will not be afforded the status of incompetent (in fact, attempting to malinger can be seen as a demonstration that an individual has an awareness of their current legal situation, reinforcing the idea they are competent!).
To sum up, this objective requires the evaluator to obtain information in these three areas, and provide said information to the Court:
1) Document the nature of any mental health symptoms currently being experienced by the defendant
2) Document the presence or absence of any of the other possibilities (situational states, ignorance of the law, and/or malingering)
3) Provide the best explanation possible regarding the relationships between the four conditions, and any observed deficits in functional abilities
A couple of other points regarding this. A common question asked is, “Okay, so what is a ‘severe mental disease or defect?” Beats me (just kidding). In reality, this isn’t specifically defined. There is no list that says, “Schizophrenia - Yes, Depression - No.” However, there are a few general rules when considering this standard. First, psychotic symptoms, to include hallucinations, delusions, grossly disorganized thinking, etc., are generally considered to rise to the level of severe symptoms in terms of competence. Other examples would include, but are not limited to, various neurological impairments, amnestic disorders, and mental retardation. These aren’t the only ones, however, depending on how the evaluation presents the impairment and its impact on the defendant’s functional abilities (for example, a case of severe depression might rise to the level of “severe mental disease or defect,” depending on the specific symptoms and level of impairment, especially if psychotic features are also present). Personality disorders, on the other hand, are virtually never recognized as a severe mental disorder. Other disorders that would typically not rise to that level would include things like ADHD, mild depression, most anxiety disorders, adjustment disorders, etc.
One must all consider the fact that cases aren’t always cut and dried, in terms of the deficits being from only one of the four areas noted above. For example, a defendant may have Antisocial Personality Disorder, be malingering (via exaggeration of deficits and symptoms), and have a mental health disorder. The job of the evaluator is to weed out the true amount of deficits in functional abilities, what symptoms are legit, and then present, as best as one can, which facets of the defendant’s presentation are responsible for what. As you can imagine, in these cases both the evaluation, as well as the written report, can be quite long!
The evaluator also wants to establish the connection between the observed mental health disorder (or other causal factors), and the documented functional deficits. For example, “How does the defendant’s delusions of persecution impair his functional ability to aid his attorney in his defense?” Maybe, as an example, his delusion has incorporated his attorney into the belief system, and the defendant now believes his attorney is part of the conspiracy to kill him. These types of connections need to be laid out, and in a way that makes sense, and is clear (not a lot of psychological jargon). This effort is aided by a detailed understanding of the various mental health disorders, as well as symptoms. Understanding not only what symptoms make up each diagnosis, but understanding how symptoms impact people, what effect they have on functioning, etc. Whenever people ask me about working in forensic psychology, I always recommend they develop really good diagnostic skills, with a detailed understanding of symptoms. Become familiar with the DSM-IV (the diagnostic “Bible” for mental health practitioners), and refer to it constantly. This helps tremendously in explaining how a mental health issues impair the relevant areas of competency.