Commentary: No rational reasons for changing competency-to-stand-trial standard

Law Professor Grant Morris and his psychiatrist colleagues have delved into the nuances of competency to stand trial statutes. Through their exploration via a survey of forensic psychiatrists and psychologists, they have effectively raised concerns about the assessment of competency to stand trial. They subsequently offer recommendations from their data. Rethinking their work from methodologic, clinical, and legal perspectives highlights some shortcomings in the design of their survey and subsequent analysis of the data to support their recommendations as well as other findings they assert flow from their information regarding the competency assessment by forensic clinicians. The authors’ survey of forensic psychiatrists and psychologists revolved around three different legal definitions of competency to stand trial. Survey participants were asked to assess the competence of two defendants presented in case vignettes, by using three different competency standards: (A) the “rational understanding” standard based on Dusky v. U.S.; (B) the “rational manner” standard; and (C) the “assist properly” standard. The authors viewed standard A as a cognitive test and standard B as a behavioral test. Presumably, they would have also categorized standard C as a behavioral test. Based on their findings, the authors recommended: (1) eliminating the “rational manner” standard currently in use in eight states; (2) calling on legislatures and appellate courts to refine the “rational understanding” standard promulgated by Dusky; and (3) calling on judges, attorneys, and forensic clinicians to understand and accept their roles in the process of the assessment and determination of competence. While the authors’ survey data on competence to stand trial can, on the surface, appear compelling because of the volume of data obtained, there are significant limitations to their findings, including some possibly questionable assumptions. There may be some confusion on the part of the authors in categorizing the Dusky “rational understanding” standard as purely a cognitive test. The Dusky standard can be conceptualized as having both cognitive and volitional (i.e., behavioral) components, with the former component involving the capacity to comprehend relevant legal concepts and procedures and the latter component involving the capacity to utilize information appropriately in one’s own defense and to function effectively in the legal environment. Although this realization may not necessarily alter the authors’ recommendations, their rationale for elimination of the “rational manner” standard appears less vibrant, as all three standards can be conceptualized as having at least some behavioral component. The authors made no visible attempt to validate their survey questions by a pretest. They assumed that what they had intended should be clear to the survey takers. This deficiency becomes an important matter when considering their outcomes. Also, the order effect (see Ref. 4, p 256) may have influenced the results, as each subject was asked to evaluate the competency of the vignette’s defendant in a certain Dr. Leong is Staff Psychiatrist, Program for Forensic Evaluations in Corrections and the Community, Center for Forensic Services, Western State Hospital, Tacoma, WA; and Clinical Professor of Psychiatry, School of Medicine, University of Washington, Seattle, WA. The views expressed in this paper are those of the author and do not necessarily represent the views of the Washington Department of Social and Health Services or the University of Washington. Address correspondence to: Gregory B. Leong, MD, Center for Forensic Services, Western State Hospital, 9601 Steilacoom Blvd, SW, Tacoma, WA 98498-7213. E-mail: leonggb@dshs.wa.gov