Hospitalization of criminal defendants for evaluation of competence to stand trial or for restoration of competence: clinical and legal issues

Abstract

The clinical and legal literature abounds with articles dealing with competence to stand trial; while most agree that criminal defendants must be capable of defending themselves before the state can bring them to trial, a number of articles are quite critical of the procedures by which these concepts are operationalized, some even going so far as to suggest abolishing the requirement for competence altogether. One of the major problems leading to the criticisms is the unnecessary loss of liberty involved. Although the length of incarceration has decreased significantly since the 1970s, the majority of states still permit, or require, hospitalization for evaluation of competence, and even more so for treatment to restore competence. The author reviews case law and presents data from his survey of current state statutes and responses from state forensic mental health program directors, to demonstrate the rarity of outpatient treatment to restore competence. He argues that outpatient treatment for defendants who do not require hospitalization on clinical or public safety grounds should be available, on both clinical and legal grounds, and provides recommendations for establishing such programs in the community.

Ten Year Research Update (2001–2010): Evaluations for Competence to Stand Trial (Adjudicative Competence)

“…Noffsinger () identified specific elements recommended for inclusion in a competency training program, using Ohio's Northcoast Behavioral Healthcare System program as a model. Miller () examined the practice of hospitalizing defendants for AC assessment and/or restoration treatment. He concluded that outpatient restoration treatment is rare, noting that more than one‐third of U.S. states, by statute, do not permit such treatment.…”

Patient Characteristics and Outcomes Related to Successful Outpatient Competency Restoration

“…The large number of defendants in need of such treatment has led to a significant strain on resources and a log‐jammed forensic system (Wortzel et al, ). Despite an apparent need for outpatient competency restoration treatment, research on such programs remains scarce, and most states seem to be reluctant to utilize them (Gowensmith et al, ; Miller, ). Our goal was to provide a description of one program that has been successfully implemented and to examine the factors related to competency restoration in the civilly committed forensic outpatients it has served.…”

“…In 2003, Miller reported that 32 states permitted outpatient restoration, but only 14 states reported actually utilizing outpatient restoration programs. Further, the forensic mental health program directors in only three of those states reported that more than 5% of all restorations were done on an outpatient basis (Miller, ). More recent reports indicate that 35 states (plus the District of Columbia) now permit outpatient restoration, but only 16 have functioning formal programs (Gowensmith, Frost, Speelman, & Therson, ; Johnson & Candilis, ).…”

Feigning in adjudicative competence evaluations

“…Given the decrease in the number of psychiatric beds over the past three decades, the use of a hospital bed for competency evaluation may result in denying treatment to a genuinely mentally ill patient. Fourth, inpatient assessment may result in an unnecessary deprivation of liberty for the defendant, especially if he would be granted bond but for the evaluation (Miller, 2003).…”