Postcards from the Id

New Study Bolsters Findings of Forensic Evaluators

This article reviews new research indicating forensic evaluators operate with a high degree of accuracy.  The research used a mathematical model to assess the findings of a group of forensic psychiatists, who offered opinions on 156 cases.  The researchers found the evaluators distinguished competent from incompetent defendants 29 out of 30 times.  From the article:

In an average of 29 out of every 30 cases, the psychiatrists could distinguish competent defendants from incompetent defendants. That’s a level of performance that exceeds standard diagnostic performance in other areas of medicine, such as spotting breast cancer in mammograms or using advanced imaging methods to detect Alzheimer’s disease.

What I also like about this research is the recognition of the difficulties in providing "Yes/No" responses, as psycho-legal issues generally require, when one is dealing with a particularly complicated case.  It is perfectly reasonable for two experts to examine the same data, yet ultimately arrive at different opinions, when the data is complex, scattered, etc.  There is not a single line separating competency versus incompetency to stand trial, or with other psycho-legal issues; there are cases where defendants fall somewhere in the middle.  As the article states:

“These results help us see how courtroom experts can be quite accurate in distinguishing competence from incompetence, but still reach different conclusions,” says Mossman of the study, which was published online in Law and Human Behavior, the journal of the American Psychology-Law Society. “It’s a matter of where experts draw the line on the issue of competence.”

Continues Mossman: “Experts may disagree with each other even though they are very good at making all the right distinctions. You’re apt to get disagreement when you ask experts for a ‘yes’ or ‘no’ answer, as the courts do, on issues that can have gray areas, like competence to stand trial.”

This is not to say there isn't the occasional individual who tends to find in one direction or the other more frequently, for whatever reason.  However, the notion that virtually all evaluators already have their minds made up is nonsense.  In addition, as the methods available to assess defendants continues to improve, it will become increasingly difficult to defend and outlying opinion.  Foresnic evaluations are far more data-driven than in the past, and more scientific in general; as a result, an opinion isn't worth much unless an expert can back it up on the stand.  A thorough evaluation, addressing the pertinent questions, explaining the findings in a way that makes sense to everyone in the courtroom, and being honest pretty much addresses these issues. 

Current Case Highlights The Differences Between Types of Forensic Evaluations

I just read this article, which indicates the judge has found the defendant competent to stand trial.  This case has reached national prominence; the defendant is accused of killing a beloved high school football coach in Iowa.

According to the article, there was no dispute between the various experts on the defendant's diagnosis: everyone agrees he suffers from paranoid schizophrenia.  However, the judge agreed with the prosecution expert that, due to a positive response to treatment with medication, the defendant meets the critieria to proceed.  From the article: 

The judge said Becker's paranoid schizophrenia is "undisputed" but that an increased dosage of an anti-psychotic medication, along with findings of the prosecution's psychiatrist, lead him to believe Becker can understand the trial proceedings.

"The evidence indicates that Mr. Becker has sufficient ability to recall events which will be pertinent to his defense," Carroll wrote in the order. That includes Becker's ability to recall June 24, when Thomas was shot to death in the high school weight room in front of more than 20 students.

"Becker was able to recall and relate those events in a 'precise, chronologic, detailed, coherent manner,'" the judge wrote.

Carroll also agreed with the prosecution psychiatrist's finding that Becker suffers from auditory hallucinations. The judge said that because the hallucinations do not involve the legal system, and because Becker didn't experience hallucinations during the psychiatrist's interview, they likely won't interfere with his ability to assist with his own defense.

The last paragraph is related to a significant point.  As I've noted in previous posts on the subject of competency to stand trial, the issue of competency is a functional analysis.  That is, an evaluator has to assess to what degree an individual is capable of completing certain tasks.  In the case of competency, the presence of a mental health disorder, even a significant one such as Schizophrenia, does not automatically preclude competency to stand trial.  An evaluator must assess the degree to which the symptoms associated with the disorder impact the abilities required to meet the threshold in question.  In this case, it appears as though all individuals agree not only on the diagnosis, but on a symptom that can significantly impair an individual (auditory hallucinations).  However, even with a symptom like this, an assessment must be made as to whether the presence of this individual's symptom experience would impact the criteria for competency.  In this case, it was determined the auditory hallucinations are not associated with a delusional belief system involveing the legal system; therefore, they do not impact the defendant's competency.

What this case may also highlight is the difference between various types of evaluations: in this case, competency to stand trial versus sanity at the time of the offense.  Often people will confuse the two, or believe there is no differnce: "How can he be competent now when he was so crazy then?  it's the same thing!"  No, it isn't, and this case seems to prove why in at least one way: medication.  An individual who engages in behaviors while experiencing the symptoms of a significant mental health problem may be taken into custody, where they then receive treatment, including medication.  If the individual responds to the treatment, they may present as a whole lot better than how they looked before their arrest.  It is certainly possible to be found competent to stand trial, but insane at the time of the offense, or vice versa.  I am certainly interested in seeing how this case plays out from this perspective, as more information is made known.

Raising The Issue of Competency To Stand Trial

I’ve discussed this issue before, but since so much of my work involves assessing defendant’s competency to stand trial, I read a lot about various aspects of this issue.  I find it helpful to review even the basics, as having additional work experience often provides an opportunity to consider something I have already learned in a new light.

In this case, I’ve been reading parts of a new book on Competency Evaluations, Evaluation of Competence to Stand Trial, by Patricia Zapf and Ronald Roesch.  A well-written, detailed book, I’ve read a few sections to either refresh my memory on certain issues, or look for additional information.  In this case, I came across a brief section of book pertaining to raising the issue of the competency of a defendant.

This is pretty well-established law, according to everything I’ve read on the subject: the issue of competency must be raised by any officer of Court (that is, the judge, prosecution, or defense) if there is a bona fide doubt as to the defendant’s competence.  According to Zapf and Roesch, this standard was established by the Supreme Court in 1966, during the case of Pate vs. Robinson.  I’ve also heard of cases where the initiation of the question regarding competency has originated from pre-trial services staff (such as a pre-trial officer gathering background information), and in one case I heard about, it was a Spanish interpreter who informed the judge that the defendant was speaking Spanish, but wasn’t making any sense.

  The book notes (as have other books, and also what I’ve personally observed) that the threshold for establishing a bona fide doubt is low: virtually all courts will order an evaluation if the issue is raised.  The legal system wants a fair, accurate trial for the defendant, and judges do not want cases turned over on appeal.  According to Zapf and Roesch, the case Drope vs. Missouri (1975) noted three issues related to a defendant’s competency; if even one of these observations are made, it may be sufficient to warrant an evaluation:

1) a defendant’s irrational behavior

2) a defendant’s demeanor at trial

3) any prior medical opinion on competence to stand trial

In addition, it should be noted that these issues may warrant an evaluation at any point during the legal process.  That is, a defendant may be competent at the start of a trial; should his presentation or functioning change during the course of the trial, the necessity of an evaluation remains. 

Personally, I’ve observed that there is, in general, a fairly low threshold for referring a defendant for a competency evaluation, at least within the federal system.  I’ve had individuals sent for a evaluation who have no mental health or legal history, but presented as tearful during an appearance in court, and acknowledged they were depressed.  I’m not offering judgment either way in this respect; it is a judge’s decision whether an individual warrants an evaluation.  I also understand (and appreciate) that legal professionals generally acknowledge that the mental health knowledge involved with respect to issues related to competency, responsibility, etc. are beyond their training.  Requesting for an evaluation is often simply an acknowledgment that there is an issue present; while it may not be severe, non-mental health clinicians are not always aware of this.  As a simple example, some diagnoses sound pretty significant, even though they are not necessarily all that severe, or relevant to the issue of competency.   Of course, we still doa full evaluation of an individual’s competency to stand trial, but when a defendant is relatively healthy mental health-wise, there is generally less to assess than with a defendant who presents with multiple issues and a lengthy treatment history.

The only other observation I’ll note at this time is that I’ve come across a few questions from time to time about the high number of people found competent to stand trial, when compared to individual’s found incompetent.  The data suggests that approximately 70-80% of defendant’s evaluated for competency are, in fact, found competent.  Only 20-30% are found incompetent.  This is primarily due to two factors: 1) the threshold for referring an individual for an evaluation is low; and 2) The threshold for being competent is low.  That is, lots of people meet the criteria to warrant an evaluation.  Conversely, not much is legally required to be found competent.  Most individuals are found competent because they are competent, even when they have some sort of mental health issue.  It takes a fair degree of impairment to be found incompetent.  I’ve gone into all of this before, so help yourself to previous postings on this subject!

Autistic Murder Suspect Likely Not Competent For Trial

According to this article, an autistic teen-ager from Ohio, accused of beating his mother to death, is likely not competent to stand trial.  The article indicates that both the prosecution and defense agree on this point at this time, with the judge set to make a decision next week.  From the article:

The attorneys said they accepted a mental health evaluation of Sky Walker, 18, that concluded he is unable to help in his defense. 

Portage County Common Pleas Judge John Enlow said he probably would rule next week on whether Walker, who did not attend Friday's hearing, will stand trial and, if not, whether to send him to a treatment facility. The judge said he expects to keep the evaluation under court seal and not release it publicly.

The article only offers a brief description of autism as a “developmental disorder that limits social interaction and communication skills, usually starting before age 3.”

Also from the article:

The defense had argued that Walker cannot carry on a conversation and would be unable to assist in his defense. He was disruptive at his first court appearance and was kept in a restraint chair and had a mask to keep him from spitting at deputies.

He was found in the home with his mother’s blood all over his feet, a trail of blood from his mother’s body leading police to his location (in the basement).  The other pertinent information appears to be that his mother called in to his school to inform them he wouldn’t be coming in, due to “a meltdown.”

The article’s brief description of Autism does not do justice to just how debilitating Autism can be.  When severe, individuals with this disorder can have major deficits in social, communicative, and behavioral functioning.  Individuals with Autism usually (but not always) are mentally retarded, and can have extremely poor frustration tolerance due to their difficulty with communication.  A larger individual with severe autism can be quite a handful, to say the least.  From a competency perspective, a significant case of autism could certainly impair not only an individual’s ability to assist their attorney, but also their rational understanding of court proceedings.  This might be due to associated cognitive deficits, but socially they may not grasp the nature and purpose of many aspects of court proceedings.  In addition, you may also find an inability to assist on one’s defense due to behavioral problems, as was identified in the article.

Given this is a pervasive developmental disorder with no “cure,” (though lots of dedicated families and treatment providers work extremely hard to improve the deficits of those afflicted), it is not likely that an individual found incompetent to stand trial due to autism would be restorable in the near future.  Of course, I’m speaking in generalities, I am not familiar with the specifics in this case.  For more information about autism, check out here and here.

Defense Challenges Statements Based on Mental Health Diagnosis

Caught this article, which examines the argument by a defense attorney that his client’s statements to police should not be admitted due to his Bipolar diagnosis.  The prosecution is arguing that the defendant’s presentation at the time of his statements was within normal limits; therefore, his mental health condition is not a factor.  From the article:

Kevin Porter's statement and admission to police should be blocked from being introduced into evidence because of those mental health problems, lawyer John Tardif said during a hearing to suppress evidence.

And:

Porter, who is being held on $250,000 bail, is bipolar and on several medications to treat that condition, Tardif said.

He told Judge Lloyd Macdonald that Porter's mental condition and the fact he had not taken his medication for hours prior to being questioned by police were evidence Porter could not legally volunteer to make a statement.

Prosecutor Marian Ryan argued that Porter acted in a manner typical of someone trying to deflect blame and was also extremely detailed in describing the events of that day.

This gets to the issue of competency to waive Miranda rights, one of several different types of competency.  While I don’t know much about the specifics of this case, a couple of thoughts do come to mind:

1) Most mental health issues ought to be considered on a continuum, rather than either/or, in terms of their impact on functioning.  The presence of a particular disorder, such as Bipolar I Disorder, is a necessary but not sufficient condition for a lack of competency.  Until such a level of functioning is established, the diagnosis alone, generally speaking, is only one step in the process of determining whether the defendant was competent at that time.  What is truly unfortunate is that this vagueness is not limited to lay people - plenty of records I’ve received over the years will have the generic “Bipolar” listed as a diagnosis, which becomes problematic when sorting out what symptoms the person has actually experienced.

2) It is often extremely frustrating when partial diagnoses such as “Bipolar” are thrown around.  There are multiple diagnostic issues related to Bipolar-type disorders, which address many areas, including severity.  As a primary example, Bipolar I Disorder is often a significantly debilitating disorder when untreated; Bipolar II Disorder, in contrast, might disrupt functioning to some degree, but would generally not impair an individual’s competency.

3) The diagnosis of “Bipolar” is fast becoming a diagnosis assigned to people who have engaged in impulsive behavior, often reckless or short-sighted, and based on an environmental trigger which escalated a particular emotion.  Generally speaking, this is not Bipolar.  This doesn’t mean that people with Bipolar disorder cannot be impulsive as well; the problem is that individuals with certain personality characteristics (often with the additional influence of alcohol or drugs), will typically engage in unhealthy behaviors whenever their emotions shift.  This is not a Bipolar Disorder.  A Bipolar Disorder is a mood disorder, which means that is experienced as a longer term, qualitative shift in emotion that lasts almost all day, every day, for the duration of the disturbance.  Full mania is debilitating, in that it often results in significant incapacitation and incredibly reckless behavior based on psychotic belief systems that develop as the mood elevates to extreme levels.  As an example of mood versus affect (or short-term emotional state), a Major Depressive Mood episode must last a minimum of two weeks to be considered “depression.”  A full manic episode must last a minimum of one week (often much longer when untreated), and represent a significant shift in functioning.  Someone who acts out whenever something happens that changes how they feel in the moment may be impulsive, but this is not manic.  Hopefully, the DSM-V will address this diagnostic trend, but I’m not optimistic; I fear the next round make actually make the issue worse. 

Anyway, back to this case.  The real issues in front of the judge are: 1) does the individual have a diagnosis that meets the state’s criteria for the minimum mental health issue that must be present; 2) Was the diagnosis, if present, active at the time of the statements; 3) if the symptoms were active, then to what degree were they active, and did they impair the individual’s understanding of his rights, and how making statements might impact his legal standing.  Transcripts will certainly be important (how and what the defendant said during those sessions can go a long way towards determining whether he was experiencing any mania during the time frame in question).  Even better would be a video recording of the interview, which is more and more common as a result of these types of issues being raised.  Also of import would be the defendant’s actions prior to, and following, his statements.

Motion Denied to Dismiss Charges Against Elizabeth Smart’s Alleged Kidnapper

First, I can’t believe almost six years have passed since Elizabeth Smart was found. It seems like yesterday the news came out that she had turned up very much alive, after most people had given up hope. What is also amazing is how long the case against her two alleged kidnappers, Brian David Mitchell and Wanda Barzee, has dragged on. In both cases, it has been the issue of competency to stand trial that has slowed the proceedings.

According to this article, Mitchell has been found incompetent due to a diagnosis of Delusional Disorder, a psychotic disorder that is relatively rare, and can be difficult to treat. Interestingly, the judge on the case has previously ruled against forcibly medicating Mitchell for the purpose of restoration to competency, though that is an option. I won’t comment on the decision, since I am not familiar with the details. Suffice to say, however, recovery from that particular mental health disorder without medication is unlikely. There is no guarantee medication will work, but without medication, the chances are even worse. I have read some legal briefs arguing therapy can be just as effective as medication in addressing the symptoms of a delusional disorder - my experience with this issue would suggest that if he has been in the hospital since 2003 and has not improved without medication, then anti-psychotic medication would be the only other reasonable option. Ultimately, it is the judge’s call. I do wonder, though, why the judge agreed to forcibly medicate Barzee and not Mitchell. I’ll have to dig around online a bit...

I also find this indefinite state of affairs interesting. There is often a provision associated with competency that states competency must be restored within a reasonable time frame, or at least expected to be restored, or else the criminal changes must be dropped. Different states do have different standards, however, and I am guessing Utah can simply keep the charges against someone indefinitely, or at least until the judge decides otherwise. The article mentions federal prosecutors are examining how to prosecute Mitchell - this may be an effort to get a federal judge to medicate Mitchell, but again, I don’t know any details - this is simply hypothetical.

In any event, Mr. Mitchell is being held in a state mental hospital, and it appears he will remain there for the time being. I’ll try to do a bit of research on the previous decisions, and I’ll post if I find anything interesting, or if anything new pops up.

Flagstaff Murder Case Resolved

According to this article, a plea agreement has been reached in the case against the nine-year old Flagstaff, Arizona boy charged with murdering his father and another man.  Apparently, the boy will plead to one count of negligent homicide.  The article isn't written very clearly, but it looks as if the boy will be spared juvenile detention, and instead will receive periodic evaluations.

While there are many facets to the case, my primary interest in it was the angle of competency to stand trial.  There was to be a hearing on February 27 to address the issue; I am presuming the issue is now moot, given the plea arrangement.  However, I'm still a bit stumped - if the defense attorney was worried about the boy's competency to stand trial, is he not worried about the boy's ability to make an informed judgment regarding the plea bargain?  A rational understanding of the plea bargain process is a significant aspect of competency to stand trial, and I'm surprised the competency hearing wasn't held prior to allowing the plea bargain to go through.  Regardless, it's not my call, I'll just point out the loophole in logic...

The other issue, from the public's standpoint, will be a lack of answers.  Apparently, the case is sealed, with a gag order, meaning no one will be allowed to talk about what they know.  So, it is doubtful that relevant details will come out pertaining to competency, or anything else, for some time.  There is another hearing on March 5th, maybe some news will become available then.  If not, there will likely be a slow trickle for a bit, and then nothing, as this case fades and others become more salient. 

Nine Year Old Flagstaff Suspect Offered Plea Deal

Of course, the details are lacking, but this article suggests prosecutors have crafted an offer to the defense regarding the murder charges against the nine-year old accused of shooting his father and another man. Based on the comments of the defense attorney, it appears possible the boy would not serve any further jail time, even in a juvenile facility. This is at odds with the wishes of family members of the other victim; however, the prosecutors will have to make their decisions on the basis of what they think is the most appropriate direction to head in, when considering all of the available facts.

In terms of forensic psychology, the article mentions the prior finding of incompetency to stand trial based on the evaluation of the defense’s expert; the findings of the prosecution’s experts appears to remain on the docket, scheduled for February 27. This is the aspect of the case that most interests me, from a professional standpoint. In fact, I don’t know that any plea agreement can be accepted at this point, until it is determined whether the boy is competent to make that decision. It may be the prosecution feels good about the chances the boy will be found competent; however, that is simply speculation on my part.

As more news comes in, I’ll continue to provide updates.

Man Found Competent to Stand Trial - Schizotypal Personality Disorder Discussed

Here’s an article summarizing the finding that a man accused of killing his wife is competent to stand trial. Opposing experts testified before the judge, with the defense expert stating the defendant’s diagnosis, Schizotypal Personality Disorder (in addition to either Narcissistic Personality Disorder or narcissistic features) was impairing his ability to aid in his defense. The prosecutor’s expert, in contrast, stated the defendant is capable of both understanding the proceedings, and aiding in his defense; he is simply choosing not to do so. In a previous post, I discussed the standards with respect to competency to stand trial here, if any readers are more interested.

More interestingly, I find the effort to argue an individual to be incompetent to stand trial on the basis of a personality disorder to be interesting, simply because personality disorders are generally not considered to be a “severe mental disease or defect,” often a requirement for a finding of incompetence. However, if there is going to be a personality disorder that one might make an argument on, Schizotypal PD is certainly one of the better personality disorders to go with.

According to the DSM-IV-TR, personality traits are enduring patterns of perceiving, relating to, and thinking about the environment and oneself that are exhibited in a wide range of social and personal contexts. Only when personality traits are inflexible and maladaptive and cause significant functional impairment or subjective distress do they constitute Personality Disorders. The essential feature of a Personality Disorder is an enduring pattern of inner experience and behavior that deviates markedly from the expectations of the individual's culture and is manifested in at least two of the following areas: cognition, affectivity, interpersonal functioning, or impulse control. This enduring pattern is inflexible and pervasive across a broad range of personal and social situations and leads to clinically significant distress or impairment in social, occupational, or other important areas of functioning. The pattern is stable and of long duration, and its onset can be traced back at least to adolescence or early adulthood.

More specifically, Schizotypal Personality Disorder is considered to be a pervasive pattern of social and interpersonal deficits marked by acute discomfort with, and reduced capacity for, close relationships. In addition, there is a presence of cognitive or perceptual distortions and eccentricities of behavior. These patterns are usually first observed by early childhood, and are present in a variety of contexts.

More casually, many consider Schizotypal PD to be “mild schizophrenia,” in that they have difficulty in relationships, odd/eccentric behavior, and peculiar beliefs about others and the world. They tend to interpret events and statements in a different manner than the typical person, and often have associated depression and/or anxiety due to their difficulty of “fitting in.” However, they generally do not exhibit symptoms that rise to the level of psychosis (i.e. a “break with reality”). Wracking my brain for examples in pop culture, I think Johnny Depp’s character in Benny and Joon might qualify, though it’s been a long time since I’ve seen that film, and he may have been schizophrenic. Another possible example would be Robert De Niro’s Travis Bickle in Taxi Driver, prior to his decompensation. He definitely had severe suspiciousness (if not paranoia), but their was an odd interpersonal style as well; for example, his complete inability to understand that taking a woman to a porn film on a first date may not be the best way to make a good first impression.

In the context of competency issues, I think any personality disorder is a tough sell for a cause of incompetency, even Schizotypal PD. While the DSM-IV description sounds severe (and often the poor judgment exhibited by individuals with personality disorders is quite severe), there is no underlying disconnect with reality - individuals with personality disorders are aware of their actions, and the potential consequences. Generally speaking, personality disorders are not even raised as a possible diagnositc reason for competency - they are simply not considered to meet the criteria of “severe mental disease or defect,” in the legal sense of that phrase.

What can happen, however, is that the difficulties in functioning as a result of an individual’s personality issues can become so significant that other issues also appear. The other possibility is that the symptom presentation that meets critieria for the personality disorder eventually manifests into a more severe mental health problem over time.  In the example of Taxi Driver above, Travis Bickle’s personality traits lead to a series of increasingly poor decisions and interpretations, that be the end of the film he has developed a significant psychotic disorder. Or, in another way of interpreting it, the Schizotypal PD was a prodromal presentation of a more severe psychotic diorder.  Enough information is not contained in the article to be able to say whether that has occurred in this particular case, though I think that would have been argued by the defense if that were in fact the case. Once again, the threshold for a finding of competence is very low - it takes a truly significant degree of impairment to be found incompetent. In the case of personality disorders, their lack of cooperation with the trial process, no matter how stupid (to be blunt), is a decision made with a sufficient knowledge of the consequences.

The other interesting comment from the article (to me) was this statement:

In such cases a person is often considered odd or bizarre and does interact well with others.
Obolsky said Pender was also extremely narcissistic and boasted of dating 3,000 women. He also does not respect boundaries and cannot prioritize information to determine what is important, Obolsky said.

"He can't process what he's told. It just doesn't register," he said.

It also can't be faked, Obolsky noted. "It's an actual unhinging of the mind."

This is simply an incredibly odd statement to make; anything can be faked. Some disorders are easier to fake than others, and some people are better than others at faking. However, if a person reads the relevant information, and particularly if they receive coaching, some people are actually not bad at it. It is usually caught, but the idea that someone “can’t fake” certain diagnoses sounds strange to me. I wonder if there is something lost in the translation here, such as the defense attorney stating that the defendant was not faking, based on observations, etc. I simply can’t imagine anyone saying a mental health diagnosis can’t be faked.

Anyway, I thought this blurb would provide a good opportunity to discuss competency and how it works in the real world. I’ll continue to seek out other examples and offer observations as they become available.

Flagstaff Murder Trial: "Holding Pattern"

Another quick update on the murder trial in Flagstaff, where a nine-year old boy is charged with two counts.  First, the issue of competency has yet to be resolved, and it appears the judge is unwilling to rule on other matters until this issue is addressed.  This has frustrated the prosecution, who has motions pending before the judge, and the defense, as these various delays prevent a resolution to the case (and keep the boy in a detention center).

Another interesting tidbit from this article is that, as information continues to slowly trickle out,  it is apparent much of the legal wrangling stems from a very simple, yet extremely complex, question: "What do you do with an eight-year old kid (he has since turned nine) who is capable of what appears to be first degree murder?"  There are hard-liners on both sides: those who blame everyone but the child; others who'd have hung him already.  I'd argue there are several compelling issues that require consideration: 1) the boy probably isn't competent in a manner consistent with an adult; 2) flip-side is that most nine-year olds aren't, yet virtually no eight-year olds will engage in anything approaching this sort of behavior, so; 3) what combination of treatment, detention, etc. will maximize the chances this kid gets the helps he needs, while also appreciating; 4) two people are dead. 

I've mentioned this before, but I'll say it again: there's no need to boil down complex issues into one item of consideration.  This case has multiple facets, and there isn't much precedent to go on, particularly if this child has exhibited psychopathic traits - any treatment for that will be intensive, long=term, and will pretty much hope to limit how psychopathis he becomes (individuals with significant psychopathy generally aren't going to grow up to be upstanding citizens, no matter what we do).  Alternatively, if the child's behavior was more truama-driven, there's likely more hope for significant intervention.  Currently, we don't know, but hopefully the competency evaluations, even given their limited scope, will provide the court some direction re: this kid's mental health issues.  Ultimately, this article makes it sonds as if all sides are considering all of the various issues in front of them, if not in the exact same proportions...