Although the Court thus clarified that its competency standard was not as broad as some courts had thought, the standard is still broad, open-textured, and vague, permitting clinical evaluators substantial latitude in interpreting and applying the test. The clinical instruments available for competency assessment compound the problem. These instruments typically list the many potentially relevant capacities that a defendant may need without prescribing scoring criteria for how these capacities should be rated. Moreover, because clinical evaluators rarely consult with counsel to ascertain the particular skills the defendant will need to have to function effectively in the case, the assessment instruments encourage clinical evaluators to apply a generalized, abstract standard of competency, rather than following a more appropriate contextualized approach to competency assessment.
By simply relying upon clinical judgment based on all the circumstances, these instruments make competency assessment a highly discretionary exercise in clinical judgment. Many clinical evaluators are paternalistically oriented, and without more concrete guidance, tend to classify marginally mentally ill patients as incompetent. The literature documents the tendency of clinical evaluators in the criminal courts to misunderstand the legal issues involved in incompetency, frequently confusing it with legal insanity or with the clinical definition of psychosis.
This discretion is both increased and made more troubling by the fact that appellate courts rarely review and almost never reverse trial court competency determinations, and that trial judges almost always defer to clinical evaluators. Vesting broad and unreviewable decision-making discretion in clinical evaluators tends to obscure the distinction between the clinical and legal components of incompetency in the criminal process, and allows clinicians to regard a competency assessment as largely an exercise in clinical description. The question of who is competent to stand trial, however, is more legal than clinical. Courts and legislatures thus should define the concept of competency with greater precision. Bonnie's efforts to delineate in detail the various components of competency to stand trial are helpful in this connection. Bonnie (1992) suggests that competency is best viewed as containing two related but separable constructs—a foundational concept of competence to assist counsel, and a contextualized concept of decisional competence. Bonnie persuasively argues that while the first should be required, the second should not always be necessary for a defendant to be considered competent. Also useful in this connection are the efforts of Bonnie's coresearchers in the MacArthur Network on Mental Health and the Law to develop detailed assessment instruments and to conduct empirical research on the decision-making abilities of mentally ill defendants (Hoge et at., 1997). The MacArthur group developed the MacSAC-CD (MacArthur Structured Assessment of the Competencies of Criminal Defendants), a structured, standardized psychometric instrument that can be used by clinicians in their assessment of competence and which has been validated for inter-rater reliability and validity.
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