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

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.     

Competency to stand trial evaluations: A state-wide review of court-ordered reports

Competence to stand trial (CST) evaluations are a critical part of certain criminal proceedings, and competence-related evaluation and treatment are an increasing part of public mental health services. Whereas more research describes the defendants undergoing competence evaluations, less research has examined the actual reports detailing those competence evaluations. This study reviewed 3,644 court-ordered CST evaluation reports submitted by 126 evaluators in Virginia since Virginia initiated an oversight system allowing for comprehensive review. The base rate of incompetence opinions was 38.8%, but these rates varied significantly across evaluation type (initial versus post-restoration efforts) and evaluators (ranging from 9.1% to 76.8% incompetence rate). Results suggest generally strong compliance with state statutes guiding CST evaluations, but also highlight marked variability in forensic conclusions and reveal a few areas in which some reports fell short of statutory requirements and practice guidelines.     

Five-year research update (1986-1990): Evaluations for competence to stand trial

This article reviews and evaluates publications during 1986–1990 with relevance for assessments of competence to stand trial. The review focuses specifically on articles that provide new concepts or data supported by research or case studies. The studies are reviewed under the following headings; (a) the systemic context of competence to stand trial (CST) evaluations, (b) conceptual definitions of competence and models for CST assessment, (c) research on CST assessment methods, (d) characteristics of incompetent defendants, (e) interpretation of CST evaluation data, (f) issues in CST assessment of special populations, and (g) treatment to restore competence. Suggestions are offered for further research to advance the quality of clinical evaluations for competence to stand trial.     

Involuntary competence

This article addresses whether the state has the right to medicate involuntarily a defendant who is incompetent either to plead guilty or to stand trial for the purpose of restoring legal competence. It first presents the constitutional background concerning incompetence and the right of prisoners generally to refuse psychotropic medication. Then the article examines the individual and state interests that must be considered to decide specifically whether the state may involuntarily medicate a criminal defendant solely for the purpose of restoring competence. Although the individual interests are strong, the article contends that the state does have a right to medicate involuntarily defendants charged with most crimes to restore trial competence, and that adequate remedies are available to ensure that medicated defendants receive a fair trial.     

Can defendants with mental retardation successfully fake their performance on a test of competence to stand trial?

The purpose of this study was to determine whether criminal defendants with mental retardation can feign poor performance on a test of competence to stand trial. Four groups of adjudicated criminal defendants were given a test of competence to stand trial. In the experimental condition, defendants with mental retardation (MR) and mentally typical defendants (non-MR) were given instructions to fake their performance on the test. In the control, MR defendants and non-MR defendants took the test under standard conditions. The results indicated that both the MR and non-MR fakers scored significantly lower than the MR and non-MR controls. There was no significant difference in the scores of the MR and non-MR fakers. The results suggest that defendants with mental retardation may be able to successfully fake their performance in certain circumstances. Implications of these findings are discussed.     

Pre-adjudicative and adjudicative competence in juveniles and young adults

There are several different types of legal competence, such as competence to waive Miranda rights, competence to confess, and competence to stand trial. Although it can be surmised that many of the underlying factors that influence the different legal competencies are similar, little research has been conducted to empirically test this hypothesis. In the present study, juveniles' and young adults' understanding and appreciation of their Miranda rights and their ability to stand trial were measured. Age, suggestibility, average grades in school, and frequency of previous police involvement were also examined as possible factors that influence both types of legal knowledge. Results indicated that Miranda competence and adjudicative competence are indeed strongly related, especially for juveniles. Also, age and suggestibility were found to predict Miranda competence, whereas suggestibility and average school grades predicted competence to stand trial. Patterns of findings often diverged for juveniles and young adults. Implications for legal policy are discussed.     

Competency to stand trial: Legal and clinical issues

A fundamental principle of criminal law is the right of defendants to a fair trial. Courts have long recognized that an essential component of this fairness doctrine is the ability, or competency, of defendants to participate in their defense. Mental health professionals have been extensively involved in assisting the courts in the evaluation of competency to stand trial. Three aspects of competency to stand trial in criminal cases are reviewed: the legal criteria defining competency to stand trial, the clinical assessment of competency, and the treatment of defendants found incompetent to stand trial.     

The role of competency to stand trial in mental health courts

Concerns have been raised in the literature about the competency to stand trial and competency to make treatment decisions of defendants referred to mental health courts. However, there is little information reported about the evaluation and prevalence of incompetence, characteristics of incompetent mental health court defendants, and disposition of mentally ill defendants too disturbed to be diverted from the criminal justice system through mental health courts. This study reports on the 85 potential mental health court defendants referred for trial competency evaluations during the first three years of operation of the Akron Ohio Mental Health Court. Of the 80 defendants who could be located for evaluation, 77.5% were found incompetent, and 53% of the incompetent defendants were not restored to competence even after an average of 49 days of treatment in a state psychiatric hospital. The implications of these findings in terms of the diversion potential of mental health courts for the severely mentally ill are discussed.     

The detection of malingering in criminal forensic groups: MMPI validity scales

Despite the value of the MMPI to the forensic assessment of malingering (exaggeration) of psychopathology, few studies have assessed the accuracy of the MMPI validity scales in criminal forensic populations. We administered the MMPI to 35 insanity defendants undergoing evaluation for fitness to stand trial and/or sanity at the time of the crime, who stood to benefit from being assessed as psychologically disturbed, and 39 subjects previously found not guilty by reason of insanity (NGRI), who did not stand to gain from such an assessment, Insanity defendants showed significantly more malingering than NGRI subjects, p less than .05. Racial differences did not affect the data. These findings support the efficacy of MMPI validity scales in assessing malingering within criminal forensic groups, and support the generalizability of the scales across race.     

The Detection of Malingering in Criminal Forensic Groups: MMPI Validity Scales

Despite the value of the MMPI to the forensic assessment of malingering (exaggeration) of psychopathology, few studies have assessed the accuracy of the MMPI validity scales in criminal forensic populations. We administered the MMPI to 35 insanity defendants undergoing evaluation for fitness to stand trial and/or sanity at the time of the crime, who stood to benefit from being assessed as psychologically disturbed, and 39 subjects previously found not guilty by reason of insanity (NGRI), who did not stand to gain from such an assessment. Insanity defendants showed significantly more malingering than NGRI subjects, p < .05. Racial differences did not affect the data. These findings support the efficacy of MMPI validity scales in assessing malingering within criminal forensic groups, and support the generalizability of the scales across race.     

The victimful-victimless crime distinction,and seven universal demographic correlates of victimful criminal behavior

A distinction is drawn between crimes that victimize fellow social group members (victimful crimes) and ones that do not (victimless crimes). With this victimizing distinction and crime seriousness in mind, studies are reviewed which have correlated various demographic variables with criminal behavior. Results revealed that there are at least seven demographic variables that universally correlate with serious victimful criminal behavior. The nature of these universal correlates are as follows: (1) Persons who come from families in which parents are no longer living together are more likely to engage in serious victimful crimes that persons from maritally intact families. (2) Persons who come from families with large numbers of siblings commit more serious victimful crimes than those from small families. (3) Blacks have higher serious victimful crime rates than whites, and whites in turn have higher rates than persons of Oriental racial ancestry. (4) Using a variety of indices, individuals of low social status exhibit higher probabilities of serious victimful crimes than individuals of middle and high social status. (5) Persons reared in urban areas commit more serious victimful crimes than those reared in suburban, and especially rural areas. (6) Serious victimful criminal behavior is most likely during the second and third decades of life. (7) Males are more likely to commit serious victimful crimes than females. While none of these universal correlates of victimful criminal behavior denote direct causal influences, theories are needed which predict the essential nature of their relationships to serious criminal behavior and to one another.     

Women accused of sexual offenses

Few studies exist on female sexual offenders or women accused of sexual offenses. In some instances, conclusions from existing studies conflict. In an effort to better understand the phenomenon of sexual abuse by females, we gathered data on all women charged with a sexual offense referred to our facility (William S. Hall Psychiatric Institute in Columbia, South Carolina) for a criminal responsibility/competence to stand trial evaluation from 1987 to 1997. Alleged sexual offenses included criminal sexual conduct one, two, and three and performing a lewd act upon a minor. Fifteen women were referred. This study examines characteristics of the accused women and their victims. Patterns of the alleged offenses and outcome of forensic evaluation are also examined. We found women accused of committing sexual offenses to have a high likelihood of past sexual and physical victimization as well as ongoing physical victimization. Borderline intellectual function and mental retardation were common and women acted frequently with co-defendants. The victims knew the perpetrator in every instance.     

A comparison of self‐report of criminal involvement and official arrest records

Self‐reports of arrests and official arrest records were compared for 250 male and 80 female participants in the ongoing Hyperactivity Follow‐Up Study of Young Adults at University of California at Berkeley. For males, kappa coefficients indicated good statistical agreement between arrest records and self‐report measures for 7 of the 12 types of crimes. Statistical agreement, however, may not be the most meaningful yardstick to judge concordance. Additional analyses reveal that for almost all of the crimes examined, one third or more of those with an arrest record for the crime failed to reveal this information on the self‐report measure. Arrests for both some high‐frequency, less serious crimes and some low‐frequency, more serious crimes were not revealed in the subjects’ self‐reports. An examination of the unique information gained from self‐reports found that the subjects most often reported committing public disorder crimes for which they were not caught (over 30%) and were least likely to self‐report crimes against people (less than 10%). Furthermore, subjects with more convictions were more likely to accurately self‐report their criminal involvement. Since both self‐report and official records each contribute unique information and reflect different sources of error, it is proposed that a combination of both types of records is the most inclusive indicator of criminal activity in adulthood. Aggr. Behav. 27:44–54, 2001. © 2001 Wiley‐Liss, Inc.     

The Impact of Race,Racial Attitude,and Gender on Reactions to the Criminal Trial of O. J. Simpson1

Opinions about the criminal trial of O. J. Simpson, as well as general racial attitude, were assessed in different samples of African Americans and Whites in three studies: during jury selection (Study 1), after closing arguments (Study 2), and after the jury verdict was reached (Study 3). We assessed the effects of respondent race, gender, and general racial attitude on case opinion factors and guilt judgments at each point in time. Race was strongly related to case opinions and guilt judgments in all three studies. Racial attitude related significantly to guilt judgments only in Study 1 for Blacks and in Study 3 for Whites. Guilt judgments of Whites were more strongly predicted by the case opinion factors than were those of African Americans. General racial attitudes and opinions about the criminal justice system were more positive for Blacks in Studies 2 and 3, while they did not differ across studies for Whites. A hindsight bias was found for Whites but not for African Americans. Race had a more powerful impact than did gender. Across-study comparison suggested that very few respondents changed their views appreciably over the year-long trial.     

Factors associated with experts' opinions regarding criminal responsibility in The Netherlands

In many jurisdictions, offenders need to have freely chosen to commit their crimes in order to be punishable. A mental defect or disorder may be a reason for diminished or total absence of criminal responsibility and may remove culpability. This study aims to provide an empirically based understanding of the factors on which experts base their judgements concerning criminal responsibility. Clinical, demographic and crime related variables, as well as MMPI-2 profiles, were collected from final reports concerning defendants of serious crime submitted to the observation clinic of the Dutch Ministry of Justice for a criminal responsibility assessment. Criminal responsibility was expressed along a five-point scale corresponding to the Dutch legal practice. Results showed that several variables contributed independently to experts' opinions regarding criminal responsibility: diagnosis (Axis I and II), cultural background, type of weapon used in committing the crime, and whether the defendant committed the crime alone or with others. In contract to jurisdictions involving a sane/insane dichotomy, the Dutch five-point scale of criminal responsibility revealed that Axis II personality disorders turned out to be mostly associated with a diminished responsibility. MMPI-2 scores also turned out to have a small contribution to experts' opinions on criminal responsibility, independently of mere diagnostic variables. These results suggest that experts base their judgements not only on the presence or absence of mental disorders, but also on cultural and crime related characteristics, as well as dimensional information about the defendant's personality and symptomatology.     

Competent and incompetent criminal defendants: a quantitative review of comparative research

Thirty studies comparing competent and incompetent criminal defendants (N = 8,170) were quantitatively reviewed to identify variables associated with judgments about defendants' competency to stand trial. Effect sizes reflecting the magnitude of the relationship between competency status and defendant characteristics were derived and averaged across studies. The characteristics most strongly related to incompetency were (a) poor performance on psychological tests or interviews specifically designed to assess defendants' legally relevant functional abilities, (b) a psychotic diagnosis, and (c) psychiatric symptoms reflective of severe psychopathology. To a lesser degree, traditional psychological tests, previous psychiatric hospitalization, previous legal involvement, marital resources, and demographic characteristics were also related to competency status. Although these results are generally consistent with the legal standard for competency to stand trial, some of the correlates of competency may reflect potential biases in the decision-making process. Limitations of existing research and directions for future inquiry are discussed.     

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

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.     

Patterns of drug use and criminal activities among latino arrestees in California: Treatment and policy implications

This study examined the patterns of drug use and criminal activities among Latino arrestees. The findings indicate that while the prevalence of drug use at time of arrest, and in the prior 12 months were significantly lower for Latinos compared to Whites and Blacks, drug use still is of concern for this ethnic group. Almost 50% of Latinos reported drug use in the last year, and more importantly, they were more likely to report using dangerous drugs such as cocaine, heroin, and PCP than any other ethnic group. These findings are even more alarming considering that, for the most part, Latino drug users were treatment-naive, and that less than half perceived a need for drug treatment. Regarding criminal activities, Latinos were less likely to have a history of prior arrests and to have been arrested in the year prior to the interview than any other ethnic group. Interestingly, those immigrants who have resided in the U.S. for less than 1 year were significantly more likely to have been charged with drug-related crimes. U.S. born Latinos were more likely to have been arrested for property crimes, while Central American immigrants were more likely than any other Latino group to have been arrested for violent and domestic violence crimes. Treatment and policy implications of these findings are discussed.     

The competency of criminal defendants to refuse,for delusional reasons,a viable insanity defense recommended by counsel

This article addresses the issues of whether mentally ill defendants charged with serious crimes who refuse to plead a viable and counsel-recommended insanity defense for delusional reasons (but who are otherwise competent to stand trial) should be considered to be competent, or incompetent, to stand trial; whether such defendants should be allowed to represent themselves with a delusional defense; and whether an insanity defense may properly be imposed upon such defendants. Based on an analysis of relevant Supreme Court decisions and other relevant cases, it is concluded that such defendants should not be allowed to go forward with a delusional defense (at least until reasonable efforts to treat the defendants' delusions are made). It is also argued, however, that unless an insanity defense would be viable (as well as recommended by counsel) delusional defendants who are otherwise competent to stand trial should be permitted to go forward, and represent themselves, with the defense of their choosing.     

Psychopathy in Italian female murderers

Over the years, the number of homicides in Italy has progressively decreased, ultimately becoming one of the lowest rates in Europe (357 = 0.7 per 100,000 inhabitants in 2017, according to ISTAT 1 ISTAT: Italian Institute of Statistics.
). The number of homicides committed by women was about 9% of the total number of homicides during our study period. The percentage has increased in recent years because the total number of homicides has decreased without a proportionate decrease in the number of female homicides. Indeed, murder is an unusual type of crime for a woman and is often associated with a mental disorder, so when a woman committed a homicide, a psychiatric assessment was often performed. A forensic psychiatry expert was assigned to investigate the offender's psychopathology and mental state at the time of the offense. The root causes of the crime remained unexplained, however, due to the lack of a psychiatric precedent to justify this kind of assessment. The role of psychopathy in homicide has seldom been studied in female offenders, even though psychopathy has an important role in violent crimes. The investigators examined, clinically and historically, a sample of women who committed murder with different levels of criminal responsibility (female homicide offenders found not guilty by reason of insanity, having partial criminal responsibility, and convicted as criminally responsible and sentenced to prison) to identify the prevalence of the psychopathic dimension and its possible role in this sample. Prevalence and degree of psychopathic traits were examined in these female offenders using the Psychopathy Checklist‐Revised. This study showed that females who had committed homicide were likely to suffer from mental illness; most of the homicidal acts were committed impulsively; and most female homicides occurred within the family, especially among women who were psychotic, but less so if they were psychopathic. Psychopathy tended to co‐occur more with personality disorders than with psychotic psychopathology. Psychopathy was more evident among female homicide offenders who had been abused or traumatized. Psychopathic women who killed had high factor F1 scores and low antisocial component of factor F2.