Competence to Stand Trial
what is competence
- task-specific and moment-specific
- not defined by diagnosis alone
- presumed competent unless legally determined otherwise
- variable in threshold based on the legal task
Dusky v. U.S
defendant must have "sufficient present ability to consult with lawyer with a reasonable degree of rational understanding" and understanding the proceedings
Model restoration program
- individualized treatment plan
- multi-modal educational experiences
- CST reassessment
- for low IQ defendants: extra educational support
- 90-180 days typical restoration window for adults
- lower success for ID/DD defendants
What does the insanity defense mean
a legal defense where a person is not held criminally responsible due to mental illness at the time of the crime
M'Naghten rule
right from wrong test- did not know the act was wrong due to mental defect
Legal foundations
6th amendment- right to fair trial, including ability to participate in one's defense
14th amendment- due process- ensures fair legal procedures
Drope v. Missouri
Sell v. U.S
adds the ability to 'assist in preparing defense" to the CST definition
involuntary needs to restore CST are allowed under rare, limited circumstances
Caveats and Concerns
- not all mentally ill but cognitively intact defendants benefit from psychoeducation
- legal education in groups may help, but evidence is limited
What are the assumptions about human behavior in Law vs. psychology
law: assumes free will, meaning people are responsible for their actions
mental health: assumes determinism, where behavior is influenced by biological, psychological and social factors
Irresistible impulse test
Durham rule
couldn't control actions due to mental illness
product test- act must be a product of mental disease or defect
CST by numbers
- questioned in 10-15% of public defense cases
- only 50% are formally evaluated
- 60,000 CST evaluations/year
- 9,000 found incompetent to stand trial
Wilson v. U.S
Amnesia does not automatically equal incompetence. Defendant can still be competent if they can follow proceedings and consult with attorney
Restorability
Predicting Unrestorability is hard:
- most MI defendants restored 3-6 months
- only 20-30% of ID/DD restored
- high over prediction
relevant variables: chronic psychosis, long hospital stays, cognitive impairment
What is the conflict with expert witnesses in court
- experts often present conflicting opinions
law allows opinion based on established science but experts conflict due to legal strategies
American law institue
combined M'Naghten + impulse, lacked substantial capacity to know wrong or control actions
Restoration Approaches
Psychotropic Meds: common for MI defendants; sometimes involuntary(see sell)
non-pharmacological:
- education on legal concepts
- mock trials and anxiety reduction
- repetition and visual aids
Slater Method:
- for defendants with ID, includes knowledge + understanding phases
- delivered inpatient/outpatients
- emphasizes familiarity, visuals, repeated practice
Assessment of CST
- understanding charges and courtroom roles
- ability to assist counsel
- decision- making ability
- understanding potential outcomes
Disposition of Unrestorable Defendants
civil commitment if not restorable
control over placement often combines legal and clinical powers
some states have no time limit on post-IST confinement
what is difference between insanity and incompetence to stand trial
insanity: not responsible for the crime due to mental illness at the time of the crime
incompetence to stand trial: unable to understand or participate in the trial process
sever mental illness prevented appreciation of wrongfulness, excludes general mental illness
Juvenile CST
- not all states require juvenile CST
- relevant factors: immaturity, MI, cognitive ability
CST instruments
MacCat-CA(MacArthur)
ECST-R(evaluation of competency to stand trial-revised)
CAST-MR(for intellectual disability; uses simplified language and multiple choice)
System Improvements
ABA recommendations:
- minor charges: release or civil commitment
- serious charges: trial+ NGI commitment procedures if convicted
Jail Based programs:
- potential benefits- cost, availability
-must address roles, medication, malingering evaluations
How is mental illness considered during sentencing
- it can be mitigating factor(reduce punishment)
- evaluations are required in death penalty cases
Guilty but mentally Ill
guilty of crime, mentally ill but not insane- sentenced normally with optional treatment