Houston Journal of Health Law and Policy, Vol. 4, No. 2, 2004


This Article considers the legal standards for the determination of competency to stand trial, and whether those standards are understood and applied by psychiatrists and psychologists in the forensic evaluations they perform and in the judgments they make–judgments that are routinely accepted by trial courts as their own judgments. The Article traces the historical development of the competency construct and the development of two competency standards. One standard, used today in eight states that contain 25% of the population of the United States, requires that the defendant be able to assist counsel in the conduct of a defense “in a rational manner.” The second, adopted by the Supreme Court in Dusky v. United States, 362 U.S. 402 (1960) as the Court’s interpretation of the federal competency statute, requires that the defendant have an ability to consult with counsel with a reasonable degree of “rational understanding.” The “rational manner” standard seemingly focuses on the defendant’s behavior; the “rational understanding” standard seemingly focuses on the defendant’s thinking. The Article reports on a survey we conducted of 273 forensic psychiatrists and psychologists who were asked to read two case study vignettes and assess the competency of each criminal defendant using the “rational manner” standard, the “rational understanding” standard, and the federal statutory standard that merely requires that the defendant be able to “assist properly” in his or her defense. In one vignette, the defendant’s thinking was irrational but his behavior was rational. In the other, the defendant’s thinking was rational, but her behavior was irrational. In responding to both vignettes, more than three-fourths of all respondents either found the defendant competent under all three standards or incompetent under all three standards. Surprisingly, in answering the first vignette, the respondents divided almost equally in deciding whether the defendant was competent. The Article analyzes the results of the study and concludes with specific proposals to improve competency to stand trial assessments. Fairness to the defendant requires that the competency standard be clearly defined and applied by those who assess and determine competency.


Civil Rights and Discrimination | Constitutional Law | Courts | Health Law and Policy | Jurisprudence | Law | Law and Psychology | Medical Jurisprudence | Public Law and Legal Theory

Date of this Version

September 2004