Evaluations of competence to stand trial are evolving amid a national “competency crisis”

Abstract

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.

Factors contributing to the delayed submission of competence to stand trial reports and the jail-based competency crisis in Washington.

“…The backlog of court-ordered CST evaluations across the United States has been a defining feature of the wider jail-based competency crisis (Callahan & Pinals, 2020; Gowensmith, 2019; Murrie et al, 2023). These backlogs have been the target of lawsuits and policies aimed at decreasing the time between court orders and completed evaluations, with the Trueblood (2014) decision in Washington being perhaps the best-known example.…”

“…Washington is only one of several states facing challenges and litigation related to the timely provision of competence evaluation and restoration services. For example, there have been class action lawsuits in at least 13 states, including California, Texas, and Florida, with many coming under consent decrees and settlement agreements as a result (see Murrie et al, 2023). The overarching issues faced by these states are similar in many ways, including exponential increases in evaluation orders, limited inpatient beds for restoration treatment, insufficient staffing, etc.…”

“…The overarching issues faced by these states are similar in many ways, including exponential increases in evaluation orders, limited inpatient beds for restoration treatment, insufficient staffing, etc. The term “competency crisis” is now used by many to describe this widespread collection of challenges facing communities, jails, hospitals, courts, evaluators, and other stakeholders in mental health and criminal justice systems (Callahan & Pinals, 2020; Gowensmith, 2019; Murrie et al, 2023).…”

A comprehensive update and evaluation of state and federal statutes on competency to stand trial: Dusky, Jackson, Sell, and Olmstead considerations.

“…It has been 63 years since Dusky and while the number of defendants referred for evaluation remains unknown, it is clear that there has been a dramatic increase in court referrals and evaluations over the course of time (see e.g., Callahan & Pinals, 2020;Danzer et al, 2019;Gowensmith, 2019; N. P. Morris et al, 2021;Mossman et al, 2007;Murrie et al, 2023;Owen et al, 2020). As noted by N. P. Morris et al (2021), estimates have ranged from a low of 19,260 (Steadman et al, 1982) to a high of 94,000 (Owen et al, 2020).…”

Problems with the interjurisdictional regulation of psychological practice.

“…The nation's mental health crisis is not limited to treatment services. In what has been dubbed, "a national competency crisis," our nation's demand for competency evaluation services of criminal defendants is outpacing the resources available through state-based forensic mental health systems (Murrie et al, 2023). Also, police departments are facing a recruitment crisis, which has coincided with a perceived relaxation of hiring standards (Inwald & Thompson, 2021) and related concerns about police misconduct (Huff et al, 2018).…”