Patient Characteristics and Outcomes Related to Successful Outpatient Competency Restoration

Abstract

Criminal defendants have a fundamental right to a fair and speedy trial. However, individuals found incompetent to stand trial are unable to move forward in the adjudication process and are often mired in protracted legal proceedings. If competency restoration is statutorily permissible and can be conducted in the outpatient setting, we propose that it should be considered based on burgeoning empirical data. We present data from an outpatient forensic clinic in which individuals are conditionally released to receive competency restoration in the community. Results indicated that three variables, including being single/never married, having comorbid intellectual disability and mental illness, and having one's conditional release revoked, were negatively related to successful restoration. The final model explained approximately one-third of the variance in restorability and correctly classified 75% of cases. Results demonstrate that individuals can be safely released to the community and successfully restored to competency in the outpatient setting. Utilizing outpatient competency restoration would not only reduce strain on inpatient facilities, but would also reduce the cost of treatment. Copyright © 2017 John Wiley & Sons, Ltd.

Jackson-based restorability to competence to stand trial: Critical analysis and recommendations.

“…Certain similar factors were associated with unrestorability in a subsequent study of 71 individuals hospitalized for competence restoration (Colwell & Gianesini, 2011), including (a) prior hospitalizations, incarcerations, and episodes of incompetence; (b) less serious charges; (c) more frequent diagnoses of psychotic and cognitive disorders; (d) higher medication dosages; and (e) lower global functioning. The co-occurrence of intellectual disability and mental illness was also associated with adjudicated unrestorability in an additional study involving 80 defendants admitted for competency restoration services, 37 of whom (46.3%) were ultimately restored, with an average length of stay of 249.65 days ( SD = 174.07; Mikolajewski et al, 2017). Additionally, lower intellectual functioning was associated with a greater likelihood of unrestorability in juveniles ( N = 58), of whom, 40 (69%) were restored to competency, with an average length of stay of 94 days ( SD = 39.9) (Chien et al, 2016).…”

Characteristics and outcomes for defendants charged with misdemeanors referred for court-ordered competency evaluations.

“…Mental Health Courts have been shown to reduce recidivism rates not only for individuals who have completed the program, but also individuals who have only partially participated (Hiday & Ray, 2010). Relevant to the present study, evaluations of CST are also located in the third intercept, with several states providing outpatient competency restoration programs that have favorable results (Gowensmith et al, 2016; Mikolajewski et al, 2017). Further, some states, including Florida and New York, have eliminated competence restoration treatment for less serious offenses altogether (Gowensmith, 2019).…”

Guidelines for determining restorability of competency to stand trial and recommendations for involuntary treatment

“…Further, having an intellectual disability may in and of itself render a defendant incompetent. Indeed, research has found defendants with intellectual and cognitive disorders may never attain competency (e.g., [32,33]). Therefore, effective treatment of a comorbid psychotic illness, while beneficial to the patient, will not resolve the cognitive deficits that lead to a defendant's incompetence.…”