Psycholegal Abilities and Restoration of Competence to Stand Trial

Abstract

Criminal defendants adjudicated incompetent to stand trial are typically hospitalized for competence restoration in state institutions. Prolonged restoration hospitalizations involve civil rights concerns and increasing financial costs, and there remains interest in determining which individuals are likely to be successfully restored. We retrospectively reviewed hospital records of 455 male defendants admitted to a forensic treatment center for competence restoration in an effort to determine whether psychiatric diagnoses, demographic factors, or psycholegal abilities were predictive of successful or failed restoration. At varying stages of restoration efforts, psychotic disorder, mental retardation, and previous state hospitalization predicted unsuccessful restoration, while substance use and personality disorders were predictive of successful restoration. Psycholegal abilities were predictive of successful restoration and appeared to form a continuum, with basic behavior and outlook, factual legal understanding, and rational attorney assistance factors demonstrating progressively increased importance in successful restoration.

Offense Characteristics of Incompetent to Stand Trial Defendants Charged With Violent Offenses

“…This decline may be less pronounced among those with mental illness. Consistent with the results of the current study, mean ages often exceed 30 years among samples of individuals found not guilty by reason of insanity (NGRI; e.g., Heilbrun, Heilbrun, & Griffin, ; Skipworth, Brinded, Chaplow, & Frampton, ) and pretrial defendants evaluated for competency to stand trial (e.g., Morris & DeYoung, ; Rice & Jennings, ). Of course, the IST defendant sample included only adult perpetrators, which may account for some of the difference between their ages and that reported in the BJS survey.…”

Mental health symptoms predict competency to stand trial and competency restoration success

“…Overall, our findings are consistent with extant research finding specific symptoms, associated with psychotic and neuropsychological disorders, related to both IST and non‐restoration (Advokat et al ., ; Colwell & Gianesini, ; Morris & DeYoung, ; Morris & Parker, ; Mossman, ). Although studies have typically evaluated IST and restoration independently, our results suggest many of the same variables are associated with both initial IST finding and ultimate restoration outcome.…”

“…In terms of the predictive power of mental health symptoms and demographic variables, an intellectual disability diagnosis predicted both IST and non‐restoration. This finding is consistent with previous research (Advokat et al ., ; Colwell & Gianesini, ; Cooper & Zapf, ; Gay et al ., ; Hubbard et al ., ; Morris & DeYoung, ; Morris & Parker, ; Mossman, ; Pirelli et al ., ; Sakdalan & Egan, ). Although associated with IST and non‐restoration, the number of neuropsychological symptoms was not predictive of competency outcomes.…”

“…Incompetent to stand trial (IST) defendants make up the largest group of legally committed individuals in United States (US) state psychiatric hospitals. Mental health professionals annually conduct approximately 60,000 competency to stand trial (CST) evaluations in the United States alone, placing a huge burden on state mental health systems (Bonnie & Grisso, ; Morris & DeYoung, ). Of these evaluations, approximately 30% of the evaluated defendants are adjudicated incompetent to proceed and subsequently court‐ordered to a state psychiatric hospital for restoration (Melton, Petrila, Poythress, & Slobogin, ).…”

Patient Characteristics and Outcomes Related to Successful Outpatient Competency Restoration

“…Those who were deemed not restorable also had lower global assessment of functioning (GAF) scores and longer lengths of stay than those who were restored to competency. Morris and DeYoung () examined information from 455 individuals committed to inpatient competency restoration. After 3 months of hospitalization, they found that individuals who had been diagnosed with a psychotic disorder, mental retardation, or comorbid mental retardation and another mental illness were less likely to have regained competency, whereas those individuals with personality disorder or substance‐use diagnoses were more likely to have regained competency.…”