Magazine article Clinical Psychiatry News

Restoration to Competency: Programs Are Inconsistent

Magazine article Clinical Psychiatry News

Restoration to Competency: Programs Are Inconsistent

Article excerpt

SAN FRANCISCO -- A survey of restoration-to-competency programs around the United States showed that there is great variability in the content of the programs and the training of the staff, Dr. Timothy Michals and Steven Samuel, Ph.D., said at the annual meeting of the American College of Forensic Psychiatry.

Of 400 articles on competency in the research literature, only 6 dealt with specific programs, said Dr. Samuel, a forensic psychologist and psychoanalyst in private practice in Philadelphia, and Dr. Michals, director of the section on forensic psychiatry at Jefferson Medical College in Philadelphia.

The only common denominator in those six programs was didactic group meetings. Five of the six used mock trials, three of the six used competency assessment instruments, and two of the six required that defendants pass a competency test of their own devising.

Dr. Samuel and Dr. Michal also attempted a telephone survey of 27 programs around the country. Only 11 agreed to the telephone interview and only a single program--the one at Norristown (Pa.) State Hospital--permitted them to visit and observe.

In general, a defendant is considered incompetent to stand trial if, by reason of mental illness or defect, he or she does not possess sufficient present ability to consult with a lawyer with a reasonable degree of rational understanding, and lacks a rational as well as factual understanding of the proceedings against him or her, they noted.

The survey produced a number of findings:

* There are essentially three groups of defendants: 78% return to court within 3 months, 20% return within 3-12 months, and 2% take longer than 12 months.

* The two most common reasons people fail to return to trial are mental retardation and severe psychosis.

* No research has determined the exact number of sessions that is best for a given patient.

* No research has determined whether a group or individual focus is the best format.

* No research has determined what kind of patients benefit from what kinds of approaches.

* With few exceptions, clinicians who administer programs do not obtain standardized training. The most significant way that people learn is simply by being assigned to do the training. Some states offer training, generally 2-day workshops, and Dr. Michal and Dr. Samuel question whether this is adequate. The clinicians are not routinely supervised and do not have their work videotaped.

* The clinicians they spoke with said that 90% of the time judges agreed with their assessments about a defendant's competency, and the judges relied solely upon the written report. …

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