health professional’s report. Although the determina-
tion of a defendant’s competency status is a legal deci-
sion, research has shown that the courts typically
concur with the opinion of mental health profession-
als. In fact, some research has indicated rates of agree-
ment between the court and the evaluator to be greater
than 95%.
Defendants who are found competent by the court
will proceed with their case, whereas those who are
found incompetent will, in most instances, be ordered
by the court to undergo treatment for the purpose of
restoration of competency. Treatment for restoring a
defendant’s competency to stand trial most often
occurs on an inpatient basis, although some states
have moved toward a “least-restrictive” alternative,
which allows for the possibility of outpatient treat-
ment. Generally, most defendants are restored to com-
petency within a 1-year period. Once restored, the
defendant resumes with his or her legal proceedings.
Those defendants who cannot be restored to compe-
tency will generally have their charges dismissed or
nolle processed.
Until the 1970s, incompetent defendants were
often committed to lengthy periods of confinement in
state maximum-security units, even though they were
neither tried nor convicted of a crime. In 1972, the
U.S. Supreme Court in the case of Jackson v. Indiana
decided that incompetent individuals could not be
held for “more than a reasonable period of time nec-
essary to determine whether there is a substantial
probability” that they will regain competency in the
foreseeable future (p. 738). The Court, however, did
not give any indication as to what might be considered
a “reasonable” period of time. As a result of the
Jacksondecision, many states amended their statutes
to include either language similar to Jacksonor spe-
cific timelines for determining whether someone
might be restored to competency.
With respect to the issue of medication, the U.S.
Supreme Court in a series of decisions has indicated
that a defendant may be forcibly medicated to restore
competency under certain conditions, including an
“overriding justification and a determination of medical
appropriateness” (Riggins v. Nevada, 1992); its being
essential to the safety of the defendant or the safety of
others (Riggins v. Nevada, 1992; Washington v. Harper,
1990); or a finding that the medication is likely to
restore competency and will not result in side effects
that might affect a defendant’s ability to assist counsel
and alternative and less intrusive methods are notavailable (Sell v. United States, 2003). Thus, for the
purpose of restoring competency, it seems that the right
of a defendant to refuse medication is significantly lim-
ited. In this instance, it appears that the government’s
interest in trying a competent defendant carries more
weight than a defendant’s right to refuse medication.CCoommppeetteennccyy EEvvaalluuaattiioonn
At its most basic, the evaluation of a defendant’s
competency to stand trial involves an assessment of
the psycholegal abilities required of the defendant (as
per the relevant legal statutes of the jurisdiction), an
assessment of the current mental status of the defen-
dant, and a determination of whether a linkage exists
between any psycholegal deficits that may be evident
and any mental disease or defect that may exist. Thus,
a mental disease or defect serves as a prerequisite for
a determination of incompetency, and any deficits in
the relevant psycholegal abilities must be linked to
this mental disease or defect. In addition, the evalua-
tion of these components must occur within the spe-
cific context of the defendant’s particular case. That
is, the complexities of the particular case must be con-
sidered as well as, and in conjunction with, the spe-
cific abilities of the particular defendant.
Numerous forensic assessment instruments have
been developed to aid in the evaluation of competency
to stand trial. A full review of these instruments is
beyond the scope of this entry, but the interested
reader is referred to the cross-references listed below
for more information. The instruments that have been
developed range from simple checklists with little to
no empirical support to detailed measures that have
been developed and investigated with the highest level
of scientific rigor. Some tools, such as the Fitness
Interview Test–Revised, can be used either as a screen
to help systematically identify individuals in need of
further evaluation or as a means of structuring a more
detailed competency evaluation. Others, such as the
MacArthur Competence Assessment Tool–Criminal
Adjudication or the Evaluation of Competence to
Stand Trial–Revised, provide for a detailed assess-
ment of competency-related abilities, to be used in
conjunction with additional assessment with respect
to the defendant’s particular case. In addition, other
instruments have been developed for use with specific
populations of defendants, such as the Competence
Assessment for Standing Trial for Defendants With
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