Expert Competency Evaluations
In the American legal system, the concept of competency evaluations plays a critical role in ensuring due process and justice. When concerns arise about a defendant’s ability to participate meaningfully in their defense, courts turn to mental health professionals to assess competency to stand trial. These evaluations serve as a crucial bridge between clinical expertise and legal standards.
In this article, we’ll walk through what competency evaluations are, how they’re conducted, and why they matter in legal settings. We’ll also explore when they’re requested, who performs them, and what legal consequences they can have—along with a look at how they differ from general psychological evaluations.
What Is a Competency Evaluation?
Competency evaluations are psychological assessments designed to determine whether an individual can understand legal proceedings and participate in their own defense. While commonly used in criminal court, they’re also applied in civil and family cases when mental capacity is in question.
A foundational case, Dusky v. United States (1960), set the legal standard: a defendant must have “sufficient present ability to consult with their lawyer with a reasonable degree of rational understanding—and a rational as well as factual understanding of the proceedings against them.”
Why Competency Evaluations Matter in Legal Contexts
These evaluations safeguard an individual’s constitutional rights. If a person is found incompetent to stand trial, the legal process is usually paused until treatment or interventions help restore competency.
According to the National Judicial College, around 60,000 competency evaluations are conducted each year in the U.S. (Morris, 2020). This high number reflects the essential role mental health professionals play in ensuring fair trials.
How the Process Works
Competency evaluations are performed by licensed professionals—typically forensic psychologists or psychiatrists—with training in both clinical and legal frameworks. The process is built to ensure that evaluations are valid, unbiased, and legally defensible (Zapf & Roesch, 2009). It usually includes these key steps:
1. Referral by the Court
A judge, defense attorney, or prosecutor raises concerns about a defendant’s mental state and files a motion for a formal evaluation.
2. Record Review
The evaluator reviews police reports, medical history, psychological records, and other relevant documents to build a comprehensive background (Grisso, 2003).
3. Clinical Interview and Testing
Interviews and cognitive tests are used to examine mental capacity and emotional state. Common tools include the WAIS-IV and the TOMM, which can assess memory, effort, and potential malingering (Grisso, 2003; Zapf & Roesch, 2009).
4. Assessment of Legal Understanding
A core focus is whether the defendant understands the charges, courtroom roles, legal rights, and potential consequences. Hypothetical scenarios and structured questions help evaluate this (Hoge et al., 1992).
5. Final Report
The evaluator submits a report to the court summarizing findings and concluding whether the defendant is competent. This includes determining whether any signs of malingering are present (Zapf & Roesch, 2009).
These evaluations often influence not only the legal proceedings but also whether a person is diverted into mental health care or treatment programs. In some cases, the evaluator may testify in court as a neutral expert.
How Competency to Stand Trial Is Assessed
To put it in context, evaluators use a mix of clinical tools, structured interviews, and legal criteria to assess whether someone can stand trial. Among the most widely used instruments are:
- MacArthur Competence Assessment Tool – Criminal Adjudication (MacCAT-CA): This tool assesses understanding, reasoning, and appreciation through short vignettes (Hoge et al., 1992).
- Evaluation of Competency to Stand Trial – Revised (ECST-R): Aligned with Dusky, this semi-structured interview includes built-in checks for malingering (Pirelli, Gottdiener, & Zapf, 2011).
- Fitness Interview Test – Revised (FIT-R): Common in the U.S. and Canada, this tool evaluates practical legal capacities like understanding court roles and making decisions (Grisso, 2003).
Each of these tools helps assess the three main components outlined by the U.S. Supreme Court in Dusky v. United States (1960):
- Factual Understanding – Knowledge of charges, roles, procedures, and consequences.
- Rational Understanding – Ability to apply facts logically and make reasoned decisions.
- Ability to Consult with Counsel – Capacity to communicate with a lawyer and aid in defense (Zapf & Roesch, 2009).
As Pirelli et al. (2011) highlight, evaluators must also account for variable symptoms, the effects of medications, and contextual factors. A strong assessment integrates testing data, behavior observations, and third-party information (Grisso, 2003).
Legal Consequences of Being Declared Incompetent
A finding of incompetence to stand trial doesn’t halt the legal process forever. Typically, the defendant is committed to a secure facility for competency restoration, which may include therapy, education about legal processes, and psychiatric medication.
Restoration is often time-limited—commonly six months to a year—after which reevaluation is required.
If competency isn’t restored, potential outcomes include:
- Dismissal of charges (often in minor or nonviolent cases)
- Civil commitment for individuals who remain a danger
- Charge modification or plea negotiations
In Jackson v. Indiana (1972), the Supreme Court ruled that indefinite confinement without progress toward restoration violates due process.
In practical terms, an incompetence ruling may delay a case significantly and result in longer psychiatric confinement than a potential jail sentence (Pirelli et al., 2011).
Competency vs. General Psychological Evaluations
Here’s a quick breakdown of how competency evaluations differ from general psychological assessments:
| Feature | Competency Evaluations | General Psychological Evaluations |
|---|---|---|
| Purpose | Assesses legal ability to proceed with trial | Diagnoses mental illness or recommends treatment |
| Requested by | Court or attorneys | Client, family, or healthcare provider |
| Legal Standard | Dusky v. U.S. (1960) | DSM-5 and clinical criteria |
| Outcome | Legal report, may include testimony | Clinical summary, private use |
| Confidentiality | Shared with court | Protected by client-therapist privilege |
While both rely on psychological tools, competency evaluations are focused on functionality in legal settings—not diagnosis. Tools like the ECST-R or MacCAT-CA are common, while general psychological evaluations use broader batteries like the MMPI-2 or Beck Depression Inventory (Hoge et al., 1992).
The Role of Forensic Mental Health Professionals
Professionals conducting competency evaluations serve a specific legal function. They are not treating clinicians but neutral experts for the court. This distinction must be clearly explained to the person being evaluated (Zapf & Roesch, 2009).
Their responsibilities include:
- Remaining objective: Avoiding therapeutic bias and basing conclusions on validated tools and behavior.
- Clarifying limits of confidentiality: As per the American Psychological Association’s forensic guidelines (APA, 2013).
- Testifying in court: Many evaluations lead to courtroom testimony and cross-examination.
- Recommending treatment: If a defendant is found incompetent, evaluators may suggest restoration programs or facilities.
Their work can determine whether a case proceeds, is delayed, or is dismissed—so their reports are reviewed closely by all parties (Grisso, 2003).
When and Why Courts Request These Evaluations
Judges may order competency evaluations when:
- A defendant shows signs of serious mental illness
- There is incoherent or bizarre behavior in court
- The defendant cannot understand basic legal concepts
- There’s refusal to cooperate with counsel
These evaluations are also used in civil matters involving guardianship or medical decision-making.
Who Can Conduct Competency Evaluations?
Qualified evaluators must:
- Be licensed mental health professionals
- Have training in forensic psychology
- Understand state and federal competency laws
- Use validated instruments and remain neutral
At Sessions Health, we work with board-certified forensic psychologists who bring years of experience in civil and criminal contexts.
Real-World Scenarios
1. Violent Felonies
A Texas case from 2021 involved a defendant who disrupted court with incoherent statements and couldn’t identify his lawyer. He was found incompetent and sent for treatment.
2. Mental Illness Defense
Defendants who plan to use an insanity defense typically need a competency evaluation first to ensure they can understand trial proceedings.
3. Developmental or Cognitive Disabilities
People with intellectual disabilities or traumatic brain injuries are often evaluated for competency. Research shows that those with IQs below 70 are frequently referred for this type of evaluation (Morris & DeYoung, 2020).
4. Elderly Defendants
As dementia and Alzheimer’s become more common, courts increasingly order evaluations for older adults showing cognitive decline.
5. Strange Courtroom Behavior
Paranoid claims, silence, or religious delusions (e.g., “I am a divine messenger”) can all be red flags, like in a Florida arson case where active psychosis was diagnosed.
Key Challenges and Ethical Concerns
- Faking illness (Malingering): Some defendants may intentionally feign mental illness to avoid trial or delay proceedings. This poses a significant challenge for forensic evaluators, who must distinguish between genuine psychiatric symptoms and fabricated or exaggerated claims. To address this, evaluators rely on validated tools such as the Test of Memory Malingering (TOMM) or the Structured Interview of Reported Symptoms (SIRS), as well as behavioral inconsistencies and collateral information from records or third parties.
- Extended hospitalization: A major ethical concern is that individuals found incompetent to stand trial can end up spending months or even years in psychiatric facilities, sometimes far exceeding the potential sentence they would have faced if convicted. This raises serious questions about proportionality and justice. According to the Treatment Advocacy Center (2017), this overreliance on institutionalization not only delays legal resolution but can also expose defendants to prolonged involuntary treatment and isolation—especially in under-resourced systems where restoration services are limited or slow.
A Human Approach to Legal Mental Health
When mental health and the law intersect, it’s not just about legal standards—it’s about treating people with dignity and clarity.
If you or someone you care about is navigating the legal system and mental health concerns, Sessions Health is here to help—with clarity, compassion, and clinical excellence.
Led by Dr. Mel Corpus, a licensed clinical psychologist and founder of Sessions Health, we provide trauma-informed, culturally sensitive, and legally sound competency to stand trial evaluations nationwide.
Because at Sessions Health, we believe fairness in court begins with understanding the person behind the case.