Forensic e-mental health is an area of psychology that is relatively underdeveloped considering technological advancements and the many mental health needs of justice-involved individuals. It includes the procurement, storage, sharing, and provision of forensic mental health information and services via electronic means and is associated with improved accessibility, efficiency, cost-savings, and safety. During the COVID-19 pandemic, clinics, hospitals, jails, prisons, and the courts rapidly adopted these modalities for service continuity out of necessity, rather than choice. In the absence of formal guidelines, practitioners, researchers, and policymakers were left searching for answers: what forensic e-mental health technologies are available, what was their research evidence, and what could the future hold? A "primer" covering the many aspects of technology-assisted forensic practice and research was overdue. To address this knowledge gap, we reviewed the e-mental health research base encompassing forensic evaluations and interventions. Considering stakeholders' needs, cost, and feasibility, we prioritized key topics that should rise to the top of the forensic e-mental health research agenda: the psychometric properties of forensic e-mental health assessments, impact of video recording evaluations, how to assess and treat diverse populations, restoration of competence to proceed, continuum of care, minimizing treatment attrition, and decreasing substance use. We report how to plan for and overcome logistical hurdles when implementing forensic e-mental health policy, utilize technology for training and education, and harness digitized data across the forensic realm. In conclusion, we find that there is ample opportunity for leveraging technology to improve forensic mental health practice, research, and policy.

We examined 2,260 forensic assessments in which the evaluator opined that the defendant was incompetent to stand trial. In approximately one half of these evaluations (52%), the evaluator concluded that the defendant was likely to be restored to competency in the foreseeable future. This opinion was reached more frequently with defendants who were female, under the age of 60, suffering from an affective or psychotic disorder with previous psychiatric hospitalizations, and who were noncompliant with psychiatric medication at the time of the offense. Similarly, defendants were viewed as more likely to be restored to competency if the evaluation had been requested by the defense, the defendant was seen as not impaired on the capacity to understand legal proceedings element of the Dusky v. United States standard, the evaluator had a terminal degree of EdD and the defendant's psychological, medical, and/or criminal records had not been obtained and considered as part of the forensic assessment. Using chi-square automated interaction detector analyses (CHAID; Kass, 1980), we found that psychiatric diagnosis was the most powerful variable in classifying opinions concerning the restorability of incompetent defendants. Defendants diagnosed with an affective or psychotic disorder were more likely to receive an opinion of likely/probable restoration than those defendants diagnosed with pervasive developmental, organic, substance-use, personality, or other disorders. These data suggest that the clinical condition of the defendant lies appropriately at the center of this process of predictive opinion formulation. The results also indicate that referral biases and/or crime-specific motivations for finding offenders restorable, often suggested as possible contaminants to this process, are not statistically significant in our large sample of forensic referrals.

Joint evaluations of competency to stand trial (CST) and mental state at the time of the offense (MSO) are common practice and implicitly assumed to be unrelated to evaluators' psycholegal opinions. To investigate this assumption, the authors used a sample of 5,731 forensic evaluations conducted over a 17-year span to determine (a) the prevalence of joint versus CST-only and MSO-only evaluations; (b) their association with evaluators' opinions regarding defendants' competency and/or sanity; and (c) whether referral source, defendant-specific and evaluation characteristics, and psycholegal criteria interact with joint versus referral-specific evaluations in determining evaluators' opinions. Results indicate that a joint evaluation structure occurred in 54% of the evaluations. Opinions of incompetency were significantly more likely in CST-only relative to joint evaluations. Conversely, opinions of insanity were significantly more likely in joint relative to MSO-only evaluations. Within the joint evaluations, competent and sane was the most frequent opinion. In CST-only evaluations, opinions of incompetency were associated with defendants' medication noncompliance at the time of the offense, being charged with a nonviolent offense, and the evaluator receiving defendants' criminal records. These variables were not associated with an incompetency opinion in joint evaluations. In joint evaluations, the absence of prior conviction was related to an opinion of incompetency; this was not the case for CST-only evaluations. The predictors of insanity did not interact with evaluation structure. These findings suggest that the evaluation structure is more important than commonly assumed for forensic practice and may help to inform the clinical practices of evaluators.

Competency to stand trial evaluations are conducted by forensic mental health professionals to opine whether defendants possess the mental abilities to understand, appreciate, and reason in regard to their court proceedings. The majority of research on competency to stand trial evaluations has focused on males, with research on female defendants being relatively underexplored. Even less is known of diverse female samples referred for competency evaluation. In the current study, we sought to examine whether characteristics associated with competency among predominantly male samples translate to a racially, ethnically, and culturally diverse group of female defendants (N = 288, 85% non-White). Chi-square analyses revealed significant relationships between findings of incompetence and defendants' diagnosis of a psychotic disorder, active psychotic symptoms, medication noncompliance, nonparticipation in the evaluation, and nonfelony charges. Logistic regression analysis indicated that defendants who experienced active psychotic symptoms, did not participate in their evaluations, and were not compliant with their medication were most likely to be found incompetent. Notably, neither minority status nor age was a significant characteristic in predicting incompetence. These findings in particular differ from much of the literature and highlight the need to examine competency within a cross-cultural framework, as characteristics associated with competency opinions do not necessarily translate across demographic groups.