Factors Related to Repeat Forensic Hospital Admissions for Restoration of Competency to Stand Trial

ABSTRACT

In Drope v. Missouri (1975), the Supreme Court expanded the standard for competency outlined in Dusky v. United States (1960) requiring that judges be attuned to changes in defendants’ presentations throughout court proceedings, including following competency restoration. As such, concerns about competency to stand trial must be raised even for those defendants previously found competent or who underwent restoration treatment. This can result in multiple hospitalizations for defendants undergoing restoration, which can impact defendants’ abilities to resolve their legal cases, and has financial implications for hospitals. The literature offers little information on factors that may differentiate defendants requiring multiple hospitalizations for competency restoration from those restored following a single hospitalization. The current exploratory study sought to identify factors (i.e., diagnosis, severity of pending charges, level of intellectual functioning, chronicity of mental illness, modality of prescribed medication, and treatment compliance) that would differentiate those defendants requiring a single versus two or more admissions for restoration of competency. This retrospective study utilized psychological testing, hospital records, and demographic data for 465 English-speaking pretrial defendants, 123 (26.5%) of whom underwent more than one period of restoration, admitted for treatment over a period of 9 years in New York State. Overall, immigrant status, absence of suspected feigning according to psychological testing and evaluator opinion, and being prescribed no medications or oral medications at the time of discharge from the initial hospitalization were significant predictors of readmissions. By identifying and addressing these factors during initial hospitalizations, evaluators and treatment teams may effectively decrease the rate of readmissions.

KEYWORDS:

• Competency to stand trial
• readmission
• restoration
• feigning

Disclosure statement

No potential conflict of interest was reported by the authors.

Notes

1 Significance of analyses did not change when excluding individuals suspected of feigning by evaluator opinion alone.