What is the legal standard for competency to stand trial?

The standard comes from Dusky v. United States (1960), in which the U.S. Supreme Court held that a defendant is competent to stand trial if they have '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.' This standard has two prongs: (1) the ability to assist counsel, and (2) the ability to understand the proceedings. The standard is functional and present-focused — it asks whether the defendant can do these things now, not whether they have a mental illness or whether they could do them in the past. A defendant may have a serious mental illness and still be competent if the illness does not impair these specific functional abilities.

What happens if a defendant is found incompetent to stand trial?

If the court finds a defendant incompetent based on the evaluation and hearing, the defendant is typically committed to a competency restoration program — usually at a state psychiatric facility or, increasingly, through outpatient or jail-based restoration programs. Restoration treatment typically focuses on psychoeducation about the legal process, psychiatric medication to manage symptoms that impair competency-related abilities, and coaching on how to work with defense counsel. Under Jackson v. Indiana (1972), a defendant cannot be held indefinitely solely for restoration — the commitment must bear a reasonable relationship to the purpose of restoration. If a defendant cannot be restored to competency within a reasonable period, the charges may be dismissed, civil commitment may be pursued, or alternative dispositions may be sought.

Can a psychologist determine that a defendant is malingering incompetence?

Yes, and this is a critical component of competency evaluations. Research suggests that a meaningful percentage of defendants referred for competency evaluations exaggerate or fabricate symptoms of mental illness to avoid trial. The evaluator should use multiple methods to assess response validity: structured instruments like the SIRS-2 (Structured Interview of Reported Symptoms), the TOMM (Test of Memory Malingering), or the M-FAST (Miller Forensic Assessment of Symptoms Test); validity scales embedded in psychological tests like the MMPI-3; behavioral observation for inconsistencies between reported symptoms and observed behavior; and collateral records review for consistency of symptom presentation over time. The evaluator should never use a single indicator to determine malingering — the conclusion must be based on convergent evidence from multiple sources.

What is the difference between competency to stand trial and insanity?

These are fundamentally different legal questions. Competency to stand trial is a present-focused assessment: can the defendant understand the proceedings and assist counsel right now? It determines whether the trial can proceed. Insanity (or Not Guilty by Reason of Insanity) is a retrospective assessment: at the time of the alleged offense, did the defendant's mental illness prevent them from knowing the nature of their act or knowing that it was wrong (under the M'Naghten standard) or from conforming their conduct to the law (under the ALI/MPC standard)? A defendant can be competent to stand trial but may have been insane at the time of the offense, or vice versa. A single evaluation should address only the question that was referred — do not conflate the two.

Who can request a competency evaluation?

A competency evaluation can be requested by the defense attorney, the prosecutor, or the judge. In most jurisdictions, either party can raise the issue of competency at any point during the proceedings if there is a bona fide doubt about the defendant's ability to understand the proceedings or assist counsel. The court then orders the evaluation. Once ordered, the evaluation is typically conducted by a psychologist or psychiatrist approved by the court or employed by the court's forensic services division.

Competency to Stand Trial Evaluation Report

Forensic & Legal|14 min read|Updated 2026-03-20|Clinically reviewed

What Is a Competency to Stand Trial Evaluation?

A competency to stand trial (CST) evaluation is a forensic psychological assessment that addresses whether a criminal defendant possesses the mental capacity to participate meaningfully in their own defense. The legal standard, established by the U.S. Supreme Court in Dusky v. United States (1960), requires that the defendant have (1) a sufficient present ability to consult with their attorney with a reasonable degree of rational understanding, and (2) a rational as well as factual understanding of the proceedings against them.

The competency evaluation report translates clinical findings into a psycholegal opinion that assists the court — it does not determine the legal outcome. The judge makes the ultimate competency determination. The evaluator's role is to assess the defendant's relevant functional abilities, identify any mental disease or defect that may impair those abilities, and communicate the findings in a manner that is clear, well-supported, and responsive to the legal standard.

Competency evaluations are among the most frequently requested forensic assessments in the criminal justice system. They require specialized training in forensic psychology, familiarity with the Dusky standard and its progeny, competence in assessing psychopathology and malingering, and the ability to connect clinical findings to legally relevant functional abilities.

When You Need It

When a court orders a competency evaluation based on a motion by defense counsel, the prosecution, or the judge's own observation
When a defendant exhibits signs of significant mental illness, intellectual disability, or cognitive impairment during court proceedings
When defense counsel reports inability to communicate with or obtain rational assistance from the client
When a defendant's behavior in court suggests potential incompetence (disruptive behavior, inability to follow proceedings, delusional statements)
When a defendant has a known history of psychiatric hospitalization, psychotic disorder, or significant cognitive impairment
When a previously incompetent defendant has undergone restoration treatment and a re-evaluation is ordered to determine whether competency has been restored

Key Components

Referral Information

Document the referring court, the judge's name, the case number, the charges, the date of the court order, the specific referral question, and the name of defense counsel and the prosecutor.

Notification and Consent

Document that the defendant was informed of the purpose of the evaluation (to assess competency, not to provide treatment), the non-confidential nature of the evaluation (the report goes to the court and is available to both parties), the limits of the evaluator-examinee relationship, the voluntary nature of participation (the defendant may decline to participate, though this will be noted in the report), and that anything disclosed may appear in the report.

Sources of Information

List all sources: clinical interview dates and durations, psychological tests administered, records reviewed (arrest reports, prior psychiatric records, jail medical records, prior forensic evaluations), and collateral contacts (defense attorney, jail staff, family members if appropriate).

Relevant History

Present the defendant's psychiatric history, substance use history, educational background, intellectual and cognitive functioning history, prior competency evaluations and outcomes, and relevant medical history. This section establishes whether there is a mental disease or defect that could impair competency-related abilities.

Current Mental Status and Clinical Presentation

Document a thorough mental status examination: appearance, behavior, speech, mood and affect, thought process and content, perceptual disturbances, orientation, attention and concentration, memory, insight, and judgment. This is the clinical foundation for your psycholegal opinion.

Psychological Testing

Report results of competency-specific instruments (e.g., MacCAT-CA, ECST-R), cognitive or intellectual testing if indicated (WAIS-V, cognitive screening), personality and psychopathology measures (MMPI-3, PAI), and response validity measures (SIRS-2, TOMM, M-FAST). Address the validity of the testing results.

Assessment of Competency-Related Abilities

This is the core of the report. Assess each functional ability under the Dusky standard:

Factual Understanding of Proceedings:

Understanding of the charges and their seriousness
Understanding of possible penalties
Understanding of the roles of courtroom personnel (judge, prosecutor, defense attorney, jury, witnesses)
Understanding of the plea options and their consequences
Understanding of basic trial procedures

Rational Understanding of Proceedings:

Ability to appreciate the personal relevance of the proceedings ("this is happening to me")
Ability to appreciate the adversarial nature of the proceedings
Rational (non-delusional) understanding of the evidence, potential outcomes, and legal strategy
Ability to make rational decisions about legal options when presented with relevant information

Ability to Assist Counsel:

Ability to communicate relevant information to the attorney
Ability to maintain a coherent narrative of events
Ability to respond relevantly to attorney questions
Ability to follow attorney advice and participate in legal strategy
Ability to maintain appropriate courtroom behavior
Ability to testify relevantly if needed

Response Validity Assessment

Address whether the defendant is providing a credible presentation of symptoms and functional deficits. Integrate data from validity testing, behavioral observation, and collateral records.

Psycholegal Opinion

State your opinion clearly: in your professional opinion, does the defendant meet or fail to meet the Dusky standard? Connect the clinical findings to the specific functional deficits, if any. If the defendant is opined to be incompetent, address the likely cause (mental illness, intellectual disability, cognitive impairment), whether the condition is amenable to restoration, and recommended restoration interventions.

Competency Evaluation — Summary and Opinion Section

Defendant: James R. Whitfield | DOB: 08/14/1989 | Age: 36 Case No.: 2026-CR-00891 | Charges: Aggravated Assault (2 counts), Criminal Threatening Evaluator: [Name], Psy.D., Licensed Psychologist, Board Certified in Forensic Psychology Date of Report: 03/20/2026 | Evaluation Dates: 02/28/2026, 03/07/2026, 03/14/2026

Summary of Clinical Findings:

Mr. Whitfield is a 36-year-old male with a well-documented psychiatric history of Schizoaffective Disorder, Bipolar Type, with multiple psychiatric hospitalizations (2016, 2019, 2021, 2023). He was evaluated over three sessions totaling 6.5 hours at the county detention center. Review of records included 487 pages of psychiatric records from State Hospital, jail medical records, two prior competency evaluation reports (2019, 2023 — found incompetent both times, subsequently restored), arrest report, and police body camera transcript.

Current Mental Status: Mr. Whitfield presented as a disheveled male who appeared older than his stated age. He was cooperative but intermittently distracted by internal stimuli. Speech was tangential with loose associations, requiring frequent redirection. He reported auditory hallucinations ("voices telling me the judge works for them") that he endorsed as ongoing for approximately four months since he stopped taking his prescribed olanzapine. Mood was described as "wired" and affect was labile, ranging from irritable to grandiose within a single interview. He endorsed the belief that the arresting officers were "agents of a shadow government" and that his arrest was orchestrated to "silence" him. Thought content was notable for persecutory and grandiose delusions. He was oriented to person and place but was uncertain of the date. Attention and concentration were impaired; he was unable to complete serial 7s and lost track of questions mid-sentence on multiple occasions.

Psychological Testing: The MMPI-3 validity scales indicated a valid, non-feigned profile with significant elevations on Thought Dysfunction (THD, T=85), Ideas of Persecution (RC6, T=92), and Aberrant Experiences (RC8, T=88), consistent with an active psychotic process. The ECST-R yielded a Competency score in the impaired range, with particular deficits in Rational Understanding and Consult with Counsel scales. The M-FAST score of 3 was below the malingering screening cutoff of 6, and the SIRS-2 classifications were in the Genuine range across all primary scales, supporting the conclusion that Mr. Whitfield's symptom presentation is credible and not feigned.

Assessment of Competency-Related Abilities:

Factual Understanding: Mr. Whitfield was able to identify his charges as "assault" but was unable to articulate the possible penalties beyond stating, "they want to lock me up forever." He identified the judge as "the person in charge" and the prosecutor as "the one against me" but described his own defense attorney as "possibly compromised" and "maybe working with them." He identified the plea options as "guilty and not guilty" but was unable to explain the consequences of each or describe what a plea bargain is. His factual understanding is partially impaired.

Rational Understanding: Mr. Whitfield's rational understanding is significantly impaired by active persecutory delusions. He believes his arrest and prosecution are part of a conspiracy rather than a response to his alleged criminal behavior. He stated, "This isn't a real case — this is a setup." He was unable to engage in rational discussion of the evidence against him, instead incorporating witness statements into his delusional system ("they were paid to say that"). He denied that the proceedings could result in a meaningful consequence because "the truth will come out and they'll have to release me."

Ability to Assist Counsel: Mr. Whitfield's ability to assist his attorney is significantly impaired. Defense attorney Maria Santos reported (collateral contact, 03/05/2026) that Mr. Whitfield has refused to discuss case strategy because he believes she is "part of the system working against him." During the evaluation, Mr. Whitfield was unable to provide a coherent, linear account of the events leading to his arrest, instead incorporating delusional material. His tangential thought process and distractibility by auditory hallucinations prevent him from sustaining a goal-directed conversation about legal matters for more than 2-3 minutes. He stated he would refuse to follow his attorney's advice because "she doesn't understand what's really going on."

Opinion:

It is my professional opinion, to a reasonable degree of psychological certainty, that Mr. Whitfield does not currently meet the standard for competency to stand trial as defined by Dusky v. United States (1960). Specifically, Mr. Whitfield's active Schizoaffective Disorder — manifesting in persecutory delusions, auditory hallucinations, tangential thought process, and impaired concentration — substantially impairs both his rational understanding of the proceedings and his ability to assist defense counsel.

Mr. Whitfield's impairment is attributable to an active psychotic episode in the context of medication non-adherence (olanzapine discontinued approximately four months ago). His two prior episodes of incompetence (2019, 2023) were both successfully restored following reinstatement of antipsychotic medication and psychoeducation. It is my opinion that Mr. Whitfield's competency is restorable within a reasonable period, likely 90 to 120 days, contingent upon reinstatement and stabilization on antipsychotic medication and participation in a structured competency restoration program.

Recommendations:

Commitment to an inpatient competency restoration program at [State Forensic Hospital]
Psychiatric medication evaluation and reinstatement of antipsychotic treatment
Structured competency restoration education once psychiatric stabilization is achieved
Re-evaluation of competency upon completion of the restoration program

This is a sample for educational purposes only — not real patient data.

How to Write It Step by Step

Step 1: Review the court order and charges. Understand the specific charges, their severity, and the complexity of the upcoming legal proceedings. A defendant facing a simple misdemeanor may need less sophisticated legal understanding than one facing a multi-count felony with complex legal issues.

Step 2: Review all available records before the interview. Obtain psychiatric records, prior forensic evaluations, jail medical records, arrest reports, and any other relevant documentation. This allows you to assess consistency of symptom presentation and to identify areas requiring focused inquiry.

Step 3: Provide notification and document it. Before beginning the clinical interview, inform the defendant of the evaluation's purpose, the non-confidential nature of the interaction, and the limits of the evaluator's role. Document the notification and the defendant's apparent understanding of it.

Step 4: Conduct a thorough clinical interview. Assess psychiatric history, current symptoms, mental status, and relevant background. Then systematically assess each competency-related functional ability under the Dusky standard using structured inquiry.

Step 5: Administer psychological testing. Select instruments that are relevant to the referral question: a competency-specific tool (MacCAT-CA or ECST-R), response validity measures (SIRS-2, M-FAST, TOMM), and measures of psychopathology and cognitive functioning as indicated.

Step 6: Obtain collateral information. Contact the defense attorney regarding their observations of the defendant's functional abilities. Review jail medical records for observations of behavior and medication compliance. Contact family members if relevant and appropriate.

Step 7: Integrate findings and formulate your opinion. The opinion must connect clinical findings to legally relevant functional abilities. It is not enough to say the defendant has schizophrenia — you must explain how the symptoms of schizophrenia impair specific competency-related abilities. If the defendant is competent despite having a mental illness, explain why the illness does not impair the relevant functions.

Step 8: Address restorability if opining incompetence. If you conclude the defendant is not competent, the court will want to know whether competency can be restored, how, and in what time frame. Base this opinion on the nature of the impairing condition, the defendant's treatment history, and prior restoration outcomes.

Common Mistakes

Equating mental illness with incompetence. A diagnosis of schizophrenia, bipolar disorder, or intellectual disability does not automatically render a defendant incompetent. Many defendants with serious mental illness are competent to stand trial. The question is whether the specific symptoms impair the specific functional abilities required by Dusky.
Failing to assess malingering. Not every defendant who appears psychiatrically impaired is genuinely symptomatic. Failure to assess response validity leaves your report vulnerable to challenge and may result in a miscarriage of justice.
Using conclusory language without functional analysis. Writing "the defendant is incompetent due to schizophrenia" without explaining which functional abilities are impaired and how is insufficient. Describe the specific deficits and connect them to the clinical presentation.
Addressing the ultimate legal issue without qualification. While evaluators typically offer an opinion on competency, it is important to frame this as a professional opinion to assist the court, not as a legal determination. The judge decides competency — you provide the psychological data.
Including information about the alleged offense that is not relevant to competency. A competency evaluation is not a criminal responsibility (insanity) evaluation. Avoid detailed analysis of the defendant's mental state at the time of the offense unless it is directly relevant to a competency-related question.

Ethical Considerations

Competency evaluations require strict adherence to the forensic role and its ethical obligations, which differ substantially from clinical practice.

The defendant is not your client. The referral source is the court. Your obligation is to provide accurate, objective data to assist the court's determination. You are not an advocate for the defendant, nor are you an agent of the prosecution.
Informed consent in a coercive context. Defendants in custody are in an inherently coercive environment. While participation in a competency evaluation is typically not legally compelled (a defendant may refuse to participate), the evaluation will proceed regardless — your report will note the refusal and describe any observations you were able to make. Be transparent about this reality during notification.
Limits of confidentiality. Nothing the defendant tells you is confidential. The report goes to the court, the defense, and the prosecution. Make this explicitly clear during the notification and document it.
Scope of the evaluation. Confine your evaluation and report to the referral question. Do not offer opinions on criminal responsibility, sentencing, or treatment needs unless these are specifically requested by the court order. Expanding beyond the referral question risks providing information that could be used in ways you did not intend and that the defendant was not notified about.
Cultural and linguistic considerations. If the defendant has limited English proficiency, the evaluation must be conducted through a qualified interpreter or by a bilingual evaluator. A defendant who appears to lack factual understanding of proceedings may simply have a language barrier rather than a cognitive or psychiatric impairment. Cultural factors in symptom expression must also be considered.
Avoiding bias. The nature of the charges, the defendant's criminal history, or the circumstances of the alleged offense may evoke strong emotional reactions. The evaluator must monitor and manage personal biases and ensure that the competency opinion is based on the psychological data, not on feelings about the case or the defendant.