Encyclopedia of Psychology and Law

video-recorded demonstrations, role-playing, written

exercises, and handouts. Group format training offers

the advantage of not only efficient service delivery but

also social learning of appropriate behavior for a

courtroom setting and the opportunity to assess each

defendant’s response to the increased stimulation of a

small group setting.

Some commentators have expressed concern that

mentally retarded individuals may appear to benefit

from educational efforts while still lacking a more

nuanced understanding of the charges and proceedings

against them. This view holds that while even very lim-

ited individuals can be taught to repeat basic facts, they

may yet lack the understanding and reasoning required

to be a meaningful participant in the adjudication

process. Practitioners should avoid “teaching to the

test” used to measure progress. Alternative forms of

assessment, such as open-ended questions and role-

play may help differentiate those defendants who have

learned basic facts from those who can apply that infor-

mation in a meaningful way to the case at hand.

Restoration Success Versus Failure

The clear majority of those referred for restoration are

ultimately adjudicated competent, with some centers

reporting success rates of 80% to 90%. Success appears

most likely for individuals with functional psychiatric

illnesses that are responsive to medication treatment.

Not surprisingly, individuals who show clinically sig-

nificant improvement in general psychopathology are

more likely to be perceived as restored to competency.

There is no consensus about the factors that are predic-

tive of restorability in primarily mentally ill defendants,

and attempts to derive predictions from clinical sam-

ples have failed to generalize adequately given the rar-

ity of nonrestorability. Half or more than half the

individuals with mental retardation or acquired cogni-

tive deficits are not restored, consistent with the

intractable nature of these disorders.

It is well settled that defendants must be competent

at each stage of adjudication, from arraignment through

imposition of sentence. “Recidivism,” which consists

of a decline in functioning that warrants a return for

additional restoration treatment before either trial or

sentencing, is of concern in a minority of cases. These

may involve the defendant’s refusal of medication after

discharge from a treatment program. Anecdotal evi-

dence suggests that other causes include medication

being unavailable in a jail or during transportation to

court, defendants being subjected to other conditions of

confinement that undermine their prior progress, or

substance abuse while on bail that results in an exacer-

bation of symptoms. It is generally assumed that a

renewal of appropriate treatment will again result in

restoration or competency.

Few state statutes provide specific time limits for

commitment to either inpatient or outpatient restora-

tion treatment. Federal law provides for a 4-month

inpatient commitment, with possible extensions for

cause, while some states tie duration of treatment to

the potential maximum sentence for the underlying

charges. Many jurisdictions set no limit. With or with-

out formal limits, the typical successful restoration

occurs in 2 to 6 months. While circumstances may

warrant more extended efforts in some cases, the like-

lihood of success beyond 3 to 4 months appears

diminished.

The minority of individuals who are persistently

incompetent may be subjected to civil or “quasi-crim-

inal” commitment in lieu of further criminal proceed-

ings. While in some jurisdictions the procedures are

identical to those in the regular civil commitment

statute, in the majority of states and in federal courts,

special commitment procedures apply, though these

must provide due process protections similar in kind

to those in the regular commitment statute. Some of

these are narrowly drawn to focus on danger to others

or property and frequently lack provisions for com-

mitment based on danger to self or “grave disability.”

The possibility of long-term commitment may dis-

courage malingering about incompetency, particularly

in jurisdictions where charges could be reinstated

when the former defendant “recovers” sufficiently to

warrant consideration for release.

Edward E. Landis

See also Capacity to Consent to Treatment; Civil

Commitment; Competency to Stand Trial

Further Readings

Anderson, S. D., & Hewitt, J. (2002). The effect of

competency restoration training on defendants with

mental retardation found not competent to proceed.Law

and Human Behavior, 26(3), 343–351.

Bertman, L. J., Thompson, J. W., Waters, W. F.,

Estupanian-Kane, L., Martin, J. A., & Russell, L.

(2003). Effect of an individualized treatment

program on restoration of competency to

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