The Utility of an Admission Screening Procedure for Patients Committed to a State Hospital as Incompetent to Stand Trial

Competence to stand trial is the most requested forensic evaluation in the United States, with a minimum of 60,000 assessments conducted per year. In the U.S., once found incompetent, restoration typically is provided by the mental health system, generally via an inpatient admission. There has been a nationwide surge in referrals for competence to stand trial evaluations, with a corresponding increase in defendants court-ordered for restoration. When jurisdictions require inpatient treatment for this restoration process, defendants often wait in jail for a hospital bed. As more states face litigation because of these waiting times, strategies to improve the efficiency of systems charged with restoration is imperative. Our study examined the utility of an admission screening process to achieve this goal. Eight hundred and thirty seven patients were admitted as incompetent to stand trial during the study period, 486 of whom had adequate data for analysis. Our results indicated that this screening process was useful in identifying individuals who may need a comprehensive assessment of feigning. Our data confirm that the assessment of response style is a critical component of a forensic evaluation. If this assessment is not performed pretrial, there is benefit to conducting the assessment on admission for restoration.