Opinion formation in evaluating the adjudicative competence and restorability of criminal defendants: a review of 8,000 evaluations

Abstract

Evaluations of competence to stand trial (CST) are the most common type of criminal forensic evaluation conducted, and courts tend to defer to clinician opinions regarding a defendant's competence. Thus, it is important to study the ways in which clinicians arrive at opinions regarding adjudicative competence and the data they consider in forming their opinions. We reviewed 8,416 evaluations conducted by forensic evaluators in Virginia over a 12 year period, and examined (a) the clinical, demographic, and criminal characteristics of a defendant as related to opinions regarding competence, predicted restorability, and impairment on "prongs" of the Dusky standard, (b) process and outcome differences in evaluations conducted by psychiatrists versus psychologists and inpatient versus outpatient evaluators, and (c) the consistency of incompetence base rates over a 10 year period. Overall, clinicians opined that 19% of defendants were incompetent and considered 23% of these unlikely to be restored to competence. Not surprisingly, psychotic and organic/intellectual disorders were most strongly associated with findings of incompetence. However, there were some notable differences between evaluations by psychologists versus psychiatrists and between evaluations conducted in inpatient versus outpatient settings.

The Role of Cognitive Assessment in Determining Fitness to Stand Trial

“…This was an unexpected result and the opposite of that found in a recent U.S. study (Warren et al, 2006). It may be that psychologists in the present study were involved in cases primarily concerning cognitive abilities including intellectual disability that may be more contentious.…”

The Role of Psychologists in the South Australian Fitness to Stand Trial Process

“…Given that the Warren et al, 2006 report suggests that psychologists are far more involved in reporting on mental fitness in the United States than this study found occurs in South Australia, it is worth further consideration of the differences which may lead to the apparent underutilization of psychologists in the process in South Australia. To be registered as a psychologist in the United States requires the practitioner to hold a doctorallevel qualification À something that is not required in Australia.…”

“…The first two cases (R v. Stevens; R v. Kola) bear on the issue of the use of psychological tests, the next case (R v. Millar No 2) illustrates judgments which included both complimentary and critical comment regarding the evidence of expert witnesses and the last case (R v. Bober) shows the care given to the fitness to plead concept by the court. The use of neuropsychological and other fitness tests has long been a controversial area with regard to fitness to stand trial in Australia and overseas (Heilbrun, 1992) although evidence suggests that forensic assessments are made largely on the basis of clinical skills without support from psychometric tools (Warren et al, 2006;Winick, 1995). Specific tests for mental unfitness for trial are not generally used in South Australia due to the lack of availability of appropriate Australian standardized instruments.…”

“…Forensic professionals who are asked to provide expert advice to the court do not make a decision regarding the fitness of a defendant, but rather offer an opinion to the court, which the court can then use to guide its decision-making (Large, Nielssen, & Elliott, 2009;Warren et al, 2006). Even though there is no necessity for the court to defer to the expert witnesses who provide opinions of mental fitness to the court (as fitness is a legal rather than clinical decision), courts usually agree with these experts at a rate estimated to be above 90% (Jager, 2000;Warren et al, 2006;Zapf, Hubbard, Cooper, Wheeles, & Ronan, 2004).…”

Brain lesions and their implications in criminal responsibility

“…However, between 60 and 77% of all defendants found not guilty by reason of insanity are diagnosed with a psychosis, and at least 10% of these individuals have a diagnosis of neurologically based psychosis (Cochrane, Grisso, & Frederick, 2001;Warren et al, 2006). This suggests that, while neuroimaging evidence might currently pose unfair bias in some criminal trials, the evidence is certainly relevant to many cases and should not be excluded wholesale.…”