Predicting restoration of competence to stand trial: Demographic, clinical, and legal variables

Introduction. Each year, a considerable number of defendants are referred for competency to stand trial evaluation. Of those judged incompetent to stand trial, a majority are regarded as having a significant likelihood of being restored to competency. While a majority of individuals are restored to competency after restoration treatment, others are deemed incompetent to stand trial and non-restorable. For individuals deemed non-restorable, a protracted stay in a forensic-psychiatric hospital or less-restrictive placement is the norm. This often lengthy period of inpatient commitment expends a great amount of staff and monetary resources. Rationale. In order that scarce monetary and staff resources be saved, early identification of individuals likely to be found incompetent and non-restorable is essential. Presently, minimal research has examined predictors of restoration to competence. Methodology. Retrospective chart review was used to collect demographic, clinical, and legal data from a sample of 80 men court-ordered to inpatient competency restoration at a state-funded forensic-psychiatric facility. Univariate and logistic regression analyses were used to evaluate the relations of these variables with final restoration status (i.e., restored to competency or incompetent and non-restorable). Results. Results of univariate analyses indicated that a history of outpatient treatment and performance on the Assessment of Depression Inventory (ADI) Reliability scale differentiated individuals found restored to competence from those found incompetent to stand trial and non-restorable (IST-NR). Patients who had previous outpatient psychological treatment were more likely to be restored to competence than found IST-NR. Patients who did not exhibit elevated ADI reliability scale scores were more often deemed competent than IST-NR. Those who exhibited elevated scores on the scale were more often found IST-NR than restored to competence. Logistic regression analysis indicated that patients without a history of outpatient treatment were more likely found IST-NR than restored to competence. Discussion. Results suggest history of outpatient treatment and reliability of responding to psychological tests are possible discriminators of likelihood of restoration to competence. Limitations of this study include small sample size, lack of power, and homogeneity of the study sample. This study suggests two variables as important for future replication in research. It is further suggested that past research be replicated and extended in an effort to develop a model of predicting those likely to be found IST-NR, which can be used in applied settings