Mental Competence for Immigration Proceedings “It seems that this is one of those areas everybody knows is important but nobody knows too much about.” Henry Dlugacz, J.D., M.S.W. Author of Competence in the Law: From Legal Theory to Clinical Application, 2009
Mental Competence in Criminal Courts “The issue of present mental incompetence, quantitatively speaking, is the single most important issue in the criminal mental health field.” 24,000 and 60,000 forensic evaluations/ year American Bar Association's Criminal Justice Mental Health Standards, 1994
Objectives Explore competency standards applied to other settings Identify tools and techniques for assessment of competency Discuss special issues of mental retardation, malingering and identifying examiners
Overview General principles of competency Criminal competency assessments Other competencies Special problems and populations
Competency is a Practical Matter Functional Specific to context
Competency is on a Sliding Scale Complexity of case Amount of assistance available What is this defendant/ respondent facing? – Evidence – Stakes
Threats to Competency Cognitive Impairment Psychosis Other psychiatric impairment
Threats to Competency Cognitive Impairment – Low IQ – Dementia – Head injury – Drug use
Threats to Competency Psychosis – Grandiose delusions “I am the Messiah and man’s rules have no power over me.” – Paranoia “You are trying to kill me so I must remain silent.” “Everyone in the courtroom is an imposter.” – Other bizarre beliefs that interfere with understanding nature of proceedings
Threats to Competency Psychosis: Hallucinations – Hearing voices that command or distract
Threats to Competency Disorganized thoughts and speech
Threats to Competency Mood – Depression: nihilism, wish for punishment – Mania: overconfidence, rapid speech, poor attention
Competency Can Be Created or Restored (sometimes) Classes Video
Restoration of Competency Typically: treatment with medications in a hospital setting – Some outpatient restoration programs Short shelf life
Unrestorable Not all mentally ill people respond adequately to treatment Jackson v. Indiana: there must be a prospect of restoration within a reasonable time Most states: possible civil commitment
Assessment of Competency Records Collateral information Interview
Criminal Competency: Dusky Standard “Sufficient present ability to consult with his lawyer with a reasonable degree of rational understanding” and “a rational as well as factual understanding of the proceedings against him.”
Variations: Nevada “Incompetent” means that the person does not have the present ability to: (a) Understand the nature of the criminal charges against him; (b) Understand the nature and purpose of the court proceedings; or (c) Aid and assist his counsel in the defense at any time during the proceedings with a reasonable degree of rational understanding.
Variations: Utah Code The experts shall consider... and address, in addition to any other factors determined to be relevant... : (a) the defendant's present capacity to: (i) comprehend and appreciate the charges or allegations against him; (ii) disclose to counsel pertinent facts, events, and states of mind; (iii) comprehend and appreciate the range and nature of possible penalties, if applicable, that may be imposed in the proceedings against him;
Variations: Utah Code (iv) engage in reasoned choice of legal strategies and options; (v) understand the adversary nature of the proceedings against him; (vi) manifest appropriate courtroom behavior; and (vii) testify relevantly, if applicable; (b) the impact of the mental disorder, or mental retardation, if any, on the nature and quality of the defendant's relationship with counsel;
Variations: Utah Code (c) if psychoactive medication is currently being administered: (i) whether the medication is necessary to maintain the defendant's competency; and (ii) the effect of the medication, if any, on the defendant's demeanor and affect and ability to participate in the proceedings.
Competency to Self Represent: Indiana v. Edwards, 2008 A higher standard for self-representation when proceeding in criminal trial No guidance as to what that higher standard is Contrast Godinez
Process in Criminal Cases Questions about Criminal defendant’s competence Referral/ screen; proceedings on hold Assessment and report Incompetent: court ordered treatment in forensic hospital Court hearing Restored: back to court
MacArthur Adjudicative Competence Study Recognized the absence of structured and standardized research measures for the assessment of abilities Developed measures and to use them to provide information to clinicians and policy makers to help them address questions about the adjudicative competence of criminal defendants.
Tools Tests of knowledge Structured interviews – Fitness Interview Test (FIT), 70 questions – Evaluation of Competency to Stand Trial (ECST-R) Problem solving abilities – MacArthur Competence Assessment Tool (MacCAT-CA) 22 items IQ tests not routine Always need interview with case specific questions
Why Standardized Tools? Systematically assess relevant issues Decrease subjectivity and bias Allow for normative comparisons Allow for testing of reliability
What are we assessing? Practical knowledge Beliefs Behaviors Decision making
Interview: Practical Knowledge Do you know what your legal problems are? What are the possible outcomes? What are your options? Who are the people in the courtroom? Who can help you?
Interview: Beliefs and Behaviors Delusions – Any special rights or qualities? – Is there anyone trying to harm you? Can this person tolerate the courtroom? Is there evidence of distractibility that could interfere with participation?
Decision Making Case based options and scenarios – Confronting witnesses – Problem solving with attorney Implications – What do you give up when you plead guilty? – What do you risk when you go to trial?
33 What Should a Report Include? Warning of limits of confidentiality Description of abilities relevant to competency in question Opinion tied to statutory language Clinical recommendations if requested What the court specifies (Hawaii) Guideline info: www.umassmed.edu/forensictraining/reports/
Contrast: Testimonial Capacity 5 Basic Skills 1.Hear/ see 2.Recall what you saw/ heard 3.Describe what you saw/ heard 4.Understand the difference: truth vs lie 5.Understand moral weight of an oath Relevance to asylum applicants who testify to fear of persecution.
Special Problems and Populations Mental Retardation/ Developmental Disabilities Malingering Role Conflict
MR (DD) and Malingering Even low IQ (less than 60) can be competent – MR diagnoses typically define MR as IQ 70 or below plus other deficits Tools developed for MR criminal defendants (CAST-MR) – 50 questions, most are multiple choice, 4 th grade level
Malingering Feigned or exaggerated symptoms with clear gain Tools to assess – Extended observation (inpatient) – SIRS (not validated in non-US populations) Structured Interview of Reported Symptoms – TOMM – response style Test of Malingered Memory
Who Should Assess Competency Mental health professionals – Psychologists – Psychiatrists – Forensic training – Forensic board certification Legal professionals Other
States Vary on Who Assesses Competency Hawaii: – 3 MD and PhD examiners from a panel – Inpatient and outpatient assessments – Contracted individually through district court – Training and certification – Specific format set forth by court
States Vary on Who Assesses Competency Nevada: – Felonies: 2 exams (3 with a tie) by MDs or PhDs contracted with the Nevada Dept of Mental Health and Developmental Disabilities – Misdemeanors evaluated by MSWs – Restoration evaluations by treating doctors – Training and certification required
Role Conflict Who should complete the competency assessment? Avoid dual roles to protect – Objectivity – Duty to patient/ court – Confidentiality
Immigration Cases Jaadan v. Gonzales, 6 th Circuit Court, 2006 Mute, signs of mental illness during hearings Competency hearing to determine need for attorney or guardian is unrepresented Mental incompetence does not preclude deportation
Immigration Cases Nee Hao Wong v. INS, 9 th Circuit Court, 1977 Deportation proceedings may continue against aliens determined to be incompetent Mental incompetence does not preclude deportation
Summary Principles of competence Dusky standard, Indiana v Edwards Limited immigration cases (Review of more cases, Mimi Tsankov) Opportunity to establish standards for both represented and unrepresented participants in immigration courts
References Competency Hearings for Aliens During Deportation Hearings, J. Am Acad. Psych. Law, 35(4),2007 Mental Competence in the Context of Immigration Proceedings, J Immigrant Health, 6(1), 2004 (Asylum applicant competency) Incompetent respondents in removal proceedings, Mimi Tsankov, Immigration Law Advisor April, 2009 http://www.usdoj.gov/eoir/vll/ILA- Newsleter/ILA%202009/vol3no4.pdf http://www.usdoj.gov/eoir/vll/ILA- Newsleter/ILA%202009/vol3no4.pdf American Academy of Psychiatry and the Law Guidelines on Evaluation of Competency to Stand Trial http://www.jaapl.org/cgi/reprint/35/Supplement_4/S3
References Indiana v Edwards http://www.law.uh.edu/healthlaw/perspectives/2008/ %28AK%29%20Edwards.pdf http://www.law.uh.edu/healthlaw/perspectives/2008/ %28AK%29%20Edwards.pdf McArthur Foundation: http://www.macarthur.virginia.edu/adjudicate.html http://www.macarthur.virginia.edu/adjudicate.html Overview of competency assessment for judges: http://www.unl.edu/ap-ls/student/CST%20assess.pdf