Predicting restorability of incompetent criminal defendants.

Full Abstract

U.S. courts frequently require forensic examiners to offer opinions concerning the likelihood that criminal defendants found incompetent to stand trial can have their competence "restored" through treatment. Yet no jurisdiction has established legal guidelines for testimony concerning restorability, and several authors have suggested that mental health professionals cannot accurately predict whether treatment to restore competence will succeed. This study asked whether reliable information that is consistently available at the time of examination might support empirically grounded opinions about the likelihood of restoration. Using records from all 351 inpatient pretrial defendants who underwent competence restoration at a state psychiatric hospital from 1995 through 1999, I evaluated whether several types of information that are reliable and that could consistently be made available to forensic examiners--including evaluees' demographic characteristics, diagnoses, symptom patterns, criminal charges, number of prior public sector hospitalizations, and cumulative prior length of stay (LOS)--would predict outcome of restoration efforts. I modeled the probability of successful restoration using logistic regression equations, and evaluated the equations' predictive accuracy using k-fold cross-validation and receiver operating characteristic (ROC) analysis. Lower probability of restoration was associated with having a misdemeanor charge, longer cumulative LOS, older age, and diagnoses of mental retardation, schizophrenia, and schizoaffective disorder. Although the overall rate of successful restoration for felony defendants was 75 percent, logistic equations allowed selection of subgroups with high predicted probabilities of restoration (>90%) and low probabilities of restoration (<35%). In cross-validation simulations, predictive equations had ROC areas of 0.727 for all defendants, and 0.735 for felony defendants. These findings provide scientific support for testimony that two types of incompetent evaluees have well-below-average probabilities of being restored:
chronically psychotic defendants with histories of lengthy inpatient hospitalizations and defendants whose incompetence stems from irremediable cognitive disorders (such as mental retardation). Nonetheless, courts may still deem low probabilities of success to be "substantial" enough to warrant attempts at restoration.

Learn Faster Today Improve your study skills

Author information

Author/s: Mossman, Douglas (D);

Affiliation: Division of Forensic Psychiatry, Wright State University Boonshoft School of Medicine, Dayton, OH, USA. douglas.mossman(-atsign-)wright.edu

Journal and publication information

Publication Type: Journal Article

Journal: The journal of the American Academy of Psychiatry and the Law (J Am Acad Psychiatry Law), published in United States. (Language: eng)

Reference: 2007-; vol 35 (issue 1) : pp 34-43

Dates: Created 2007/03/28; Completed 2007/07/16;

PMID: 17389343, status: MEDLINE (last retrieval date: 12/26/2008)

Sourced from the National Library of Medicine. Abstract text and other information may be subject to copyright.

Comments and Corrections

CommentIn: J Am Acad Psychiatry Law. 2007;35(1):44-6. (PMID: 17389344)

External Links for this article (including full text providers, if available):

Click Electronic Full-text Provider Links to see options for finding the electronic full text links to this article. Note there may be a subscription or fee required for access to the full text. See our FAQ for information on finding FREE full text articles.

This article may also be located in paper journal collections available in many libraries. Use the Journal and Publication Information above to find the full article.

MeSH headings (categories)

This article was linked to the MESH Headings shown below.

Adolescent
Adult
Aged
Combined Modality Therapy
Crime - legislation & jurisprudence
Criminal Psychology - legislation & jurisprudence
Female
Hospitals, Psychiatric
Humans
Insanity Defense
Length of Stay - legislation & jurisprudence
Male
Mental Competency - legislation & jurisprudence

Mental Competency - legislation & jurisprudence
Mental Disorders - diagnosis; psychology; therapy
Mental Retardation - diagnosis; therapy
Middle Aged
Ohio
Outcome Assessment (Health Care) - legislation & jurisprudence
Patient Readmission
Probability
Prognosis
Psychotherapy, Group - legislation & jurisprudence
Psychotic Disorders - diagnosis; therapy
Psychotropic Drugs - therapeutic use
Schizophrenia - diagnosis; therapy

Associated Chemicals: Psychotropic Drugs (0)

These are the highest related articles currently in the database:

See 100+ related articles.