Competence Restoration Amid a Widespread “Competency Crisis”

Gowensmith, Neil; Murrie, Daniel C.

doi:10.1007/978-3-031-13733-4_8

Cited by 6 publications

(9 citation statements)

References 39 publications

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“…More detailed information about competency rates in this sample is provided by Murrie, Gardner, and Torres (2022). However, the overall rate of incompetence in this sample is broadly consistent with the trend of increasing incompetence rates across the United States in recent years (Gowensmith & Murrie, 2022; Murrie, Gardner, & Torres, 2022).…”

Section: Methodssupporting

confidence: 61%

Reporting potentially irrelevant information—Defendant race/ethnicity, criminal history, and substance use—in competence to stand trial reports: A statewide study.

Gardner¹,

Murrie²,

Guarnera³

et al. 2023

Psychology, Public Policy, and Law

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Professional guidelines consistently advise evaluators to include only relevant information, and exclude irrelevant information, when crafting forensic mental health reports. However, such guidance is more general than specific, and many forensic reports include background information that is not directly relevant to the psycholegal question. In this study, we considered three types of defendant information for which the competency literature provides no clear guidance for inclusion or exclusion: defendant criminal history, substance use history, and race and/or ethnicity. We examined the frequency with which evaluators report these types of information in a statewide sample of Virginia court-ordered competence reports (N = 1,126). We sought to assess common reporting practices, determine whether such practices varied among evaluators, and identify potential explanations for differing reporting practices. Results revealed no consensus among evaluators regarding what types of information should be routinely included in competence reports. Reports were slightly more likely to include substance use information (57.6% of reports) and criminal history information (57.5%) than race/ethnicity information (52.0%). However, there was significant variability in reporting practices among evaluators, especially regarding the inclusion of defendant race/ethnicity (68.6% of variability explained by evaluator differences). Overall, many reporting practices appeared to be best explained by evaluator habit or convention, rather than relevance, although alternative explanations are discussed. Findings highlight the need for more definitive guidance on the topic and future research exploring the potential impact of reports that include irrelevant (and potentially prejudicial) information.

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Section: Methodssupporting

confidence: 61%

Reporting potentially irrelevant information—Defendant race/ethnicity, criminal history, and substance use—in competence to stand trial reports: A statewide study.

Gardner¹,

Murrie²,

Guarnera³

et al. 2023

Psychology, Public Policy, and Law

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“…Given more orders for competence restoration and fewer inpatient psychiatric hospital beds, the proportion of forensic (vs. civil) patients in state psychiatric hospitals has increased dramatically in recent years (Callahan & Pinals, 2020; Fitch, 2014; Gowensmith et al., 2016; Gowensmith & Murrie, 2022). For example, the U.S. inpatient IST population increased more than 70% between 1999 and 2014, even amidst the overall decrease in inpatient hospital capacity (Wik et al., 2020).…”

Section: Historical Reliance On Inpatient Restorationmentioning

confidence: 99%

“…Even assuming optimal evaluator training and reliability, this movement toward more expansive competence evaluations—that is, competence evaluations that require opinions on additional issues such as triage and placement—will require careful study and monitoring from our field. The field of competence restoration has received remarkably little empirical research or analysis relative to its substantial role in the public mental health system (Gowensmith & Murrie, 2022; Heilbrun et al., 2019; Pirelli & Zapf, 2020). Thus competence restoration “business as usual” has been fraught with a variety of systemic problems and intertwined with the broad phenomena known as the “criminalization of mental illness” (Callahan & Pinals, 2020; Dvoskin et al., 2020; Fuller et al., 2017).…”

Section: Emerging Practice and Future Directionsmentioning

confidence: 99%

“…Beyond offering placement recommendations, another example of new evaluator requirements involves triaging or offering opinions on the urgency of inpatient restoration treatment. Colorado developed a triage-style procedure to replace the usual "first come, first served" inpatient admission strategy, with the goal of expediting treatment for defendants with the most dire treatment needs (Center for Legal Advocacy v Barnes, 2019;Gowensmith & Murrie, 2022).…”

Section: Triage Recommendations In Competence Evaluationsmentioning

confidence: 99%

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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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“…However, union-organizing attempts are on the rise in the health care industry, with recent successful resident-organizing drives at Stanford, the University of Southern California, and the University of Vermont . Since January 2022, the National Labor Relations Board has received 153 petitions for representation to initiate the unionization process in the health care industry overall, but only 3 include attending physicians .…”

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confidence: 99%