Anyone who has worked in a forensic field or mental health field in general is aware that we can see clients who struggle to comprehend the world around them. This can be especially difficult in legal situations when individuals with mental health concerns are asked to be accountable for their alleged actions and assist in their defense. Competency to stand trial, or capacity to proceed as it is known in North Carolina, applies to all phases of a criminal case and guarantees an individual must be able to understand the nature and object of the proceedings, understand their situation in reference to the proceedings, and assist their defense in a rational and reasonable manner. On the federal level, this requires a rational and factual understanding of the proceedings against them, as well as the ability to consult with their lawyer with a reasonable degree of rational understanding. Individuals must have a mental disease or defect to be considered incompetent to stand trial and the burden of proof in these situations falls on the defense.

But what goes into an evaluation of competency or capacity? To obtain an accurate picture of the client’s mental health, the psychologist will look to several sources of information, thus a strong evaluation would include several components. A clinical interview allows the evaluator to observe the client’s speech, thinking, and other behaviors. Ideally, an evaluator would be provided with the client’s medical history to review all relevant records, as well as witnesses to the client’s behavior in their daily functioning to speak with, to help determine the difference in presentation across domains. With adolescents, the Juvenile Adjudicative Competence Interview (JACI) can be used. The JACI is currently the only structured competence interview designed for use with juveniles. It provides a structured set of questions to help assess the youth’s Understanding, Appreciation, and Reasoning. The JACI provides interview questions for 12 content areas carefully selected in accordance with long-standing definitions of the abilities associated with the legal standard for competence to stand trial, using wording structured to be more understandable to juveniles. Areas include: nature and seriousness of the offense, nature and purpose of the juvenile court trial, possible pleas, guilt and punishment/penalties, role of the prosecutor, role of the juvenile defense lawyer, role of the probation officer, role of the juvenile court judge, assisting the defense attorney, plea bargains/ agreements, reasoning and decision making, and participating at juvenile court hearing.

Competency to stand trial evaluations should also include specific competency testing, the most widely used of which include the MacArthur Structured Assessment of the Competencies of Criminal Defendants (MacCAT-CA) and the Evaluation of Competency to Stand Trial-Revised (ECST-R). The MacCAT-CA is a competence-to-proceed measure that provides simple judicially-based scenarios to the examinee and then asks his understanding of the scenario. If the examinee does not respond correctly, he is given the correct answers and then asked to convey understanding. An examinee’s competence is assessed within three distinct domains: Understanding, Reasoning, and Appreciation. The MacCAT-CA is comprised of 22 items designed to test an individual’s understanding, reasoning, and appreciation. It relies primarily on hypothetical cases of two men and has examinees answer questions regarding those cases. It has been normed on 446 jail detainees, 249 of whom were receiving mental health services and compared to 283 incompetent defendants in a restoration program. The ECST-R tests an individual’s ability to consult with counsel, their factual understanding of the courtroom proceedings, and their rational understanding of the courtroom proceedings. It also contains a measure of feigning, which it assesses through atypical presentation. It was normed off of 200 competency referrals and 128 jail detainees, in addition to 71 feigners as classified on another measure of feigning. While the MacCAT-CA was initially created for and validated with an adult population, since no current tests exist for use specifically assessing competence in juveniles, research has explored the MacCAT-CA use with adolescents (Grisso et al. 2003; Viljoen et al. 2009). The 2003 study, which involved over 900 youth, found its administration was feasible with adolescents. The 2009 study found that five of the 22 items are statistically significantly more difficult for adolescents than adults. Despite this age-related bias on these items, Viljoen et al. (2009) concluded the MacCAT-CA “scale scores do not appear to systematically underestimate or overestimate adolescents’ legal capacities” and ultimately recommend its use in conjunction with other assessments (such as the JACI) in assessing the legal capacities of adolescents.

In addition to measures of competency, measures of cognitive and psychological constructs, such as the Wechsler Adult Intelligence Scale (WAIS-IV) and Minnesota Multiphasic Personality Inventory (MMPI-2), have been commonly used in competency evaluations. If specific concerns regarding intelligence or diagnosis of a mental health disorder are raised in interactions with your client, it is important to share these concerns with an evaluator.

There are a number of benefits to a competency evaluation. In evaluations where an individual is found not competent, they may be able to receive needed treatment they could otherwise not obtain. An evaluation may generate evidence in support of a mental health defense, mitigating factors at sentencing, or have a positive impact on plea discussions. There are also some potential drawbacks to consider. Proceedings may result in disclosure of information damaging to the defendant, and involuntary commitment for competency restoration can lead to a longer confinement period than a conviction for certain charges. There is also the concern of stigma surrounding mental health and an individual being found incompetent. All of these factors should be weighed when considering a capacity evaluation. Overall, these evaluations can provide valuable information to assist attorneys in understanding their client and formulating their defense.


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