Okay, in terms of general considerations when evaluating for competency, we’ve discussed various aspects of reliability and validity. Now for a few other observations before we start covering specific assessment instruments.
First, an evaluation ought to have a plan, including a method of being thorough without wasting time doing too much. As stated in previous posts, lots of collateral data are helpful in doing a thorough evaluation, including collateral contacts with other people privy to the defendant (including attorneys, family members, other staff, etc.), prior treatment/mental health records, school records, etc. It helps very much to be organized in a way that allows you to gather these materials and make these contacts as efficiently as possible. In my case, I am very lucky, because defendants are transported to my facility for the evaluation. I am alerted to their pending arrival in advance, which allows me time to send out requests for information from the attorneys, and to even speak to them ahead of time, if necessary. Once the defendant arrives, part of my initial session, conducted at the time of the arrival, is to inquire about treatment records, and get releases of information signed right then and there, in order to provide the records departments ample time to send me the relevant documents. I also review with the defendant the nature and purpose of the evaluation, issues of confidentiality, etc., immediately upon arrival, and provide information sheets, so that the defendant can speak with family members, their attorney, etc. about any issue with which they are uncomfortable.
Again, the idea is efficiency. I gather history from the defendant, including educational history, family/childhood history, work history, etc., but only what is necessary to get a good overview, as well as to look for red flags. For example, if a guy says he dropped out in the ninth grade, I want to know why. Was it conduct related, or due to significant difficulties with the school work? Important question to answer, as it pertains to competency.
However, we don’t want to sacrifice comprehensiveness for efficiency. You can’t simply screen for mental status, and then determine competency. Do what you’ve got to do, but don’t utilize the “shotgun” approach. You know, throw everything you’ve got at the guy, in every direction. That’s a waste of time. In addition, many of these guys will fatigue, so if you are doing hours and hours of interviewing and testing, you’re results might be impacted by the overkill.
Generally, in addition to a general interview, where I get an overview of all the important aspects of a defendant’s life (as well as follow-up in specific, relevant areas, as mentioned above), I also utilize two tests, in addition to my competency-specific assessment instrument. I utilize a cognitive screening in order to get a quick yet efficient look at the person’s general cognitive ability, and I give a personality inventory, as long as the person’s reading ability is sufficiently high enough to satisfactorily answer the questions. However, I adapt this based on the case. If a guy comes for an evaluation and has a college degree, the cognitive screening may be perfectly adequate. However, if he was referred because he suffered a serious head injury six months ago, I will not only use a full IQ test instead of a screen, but I will likely examine other areas of cognitive functioning as well - memory, executive functioning, etc. If a guy denied any mental health issues whatsoever, I will definitely give a personality inventory, but I will not assess for malingering. If on the other hand, the defendant is claiming every symptoms under the sun, and has never seen a mental health clinician before in his life, I will definitely screening for malingering.
Basically, you start with a plan, but you allow the information you gather to shape and individualize the evaluation as you need to. If a guy appears bright, but does poorly on an IQ test, you will want to explore why. But you don’t give 15 different tests simply because you have 15 tests to give. You tailor the evaluation to suit the needs of the particular defendant. This includes assessing the specific abilities of competency to stand trial. The next few posts will cover some of the competency-specific instruments next.