THE MacARTHUR ADJUDICATIVE COMPETENCE STUDY(1)
May 2004 Update of the Executive Summary
Clinical norms for the The MacArthur Competence Assessment Tool - Criminal Adjudication (MacCAT-CA) were developed in an NIMH-funded study conducted from 1996-1998. Primary results from that investigation appeared in:
Otto, R. K., Poythress, N. G., Nicholson, R. A., Edens, J. F., Monahan, J., Bonnie, R. J., Hoge, S. K., & Eisenberg, M.. Psychometric properties of the MacArthur Competence Assessment Tool - Criminal Adjudication (MacCAT-CA). Psychological Assessment, 1998, 10, 435-443.
Edens, J.F., Poythress, N.G., Otto, R.K. & Nicholson, R.A.. Effects of state organizational structure and forensic examiner training on pre-trial competence assessments. Journal of Behavioral Health Services & Research, 1999, 26,140-150.
A comprehensive report of both the original MacArthur studies and the NIMH study has been published in book form:
Poythress, N., Monahan, J., Bonnie, R., Otto, R.K., & Hoge, S.K. (2002). Adjudicative competence: The MacArthur Studies. New York: Kluwer/Plenum.
The MacCAT-CA is now commercially available for clinical use; it may be obtained from Psychological Assessment Resources (PAR), www.parinc.com
Subsequent research using the MacCAT-CA with adult criminal defendant appears in:
Rogers, R., Grandjean, N., Tillbrook, C. E., Vitacco, M. J., & Sewell, K. W. (2001). Recent interview-based measures of Competency to Stand Trial: A critical review augmented with research data. Behavioral Sciences and the Law, 19, 503-518.
Although the MacCAT-CA was not developed or normed for use with adolescent populations, it has been used as a research measure with adolescents in:
Burnett, Darla Michelle Rutherford. Evaluation of competency to stand trial in a juvenile population. [Dissertation Abstract] Dissertation Abstracts International: Section B: the Sciences & Engineering. Vol 61(2-B), Aug 2000, 1074, US: Univ Microfilms International.
Grisso, T., Steinberg, L., Woolard, J., Cauffman, E., Scott, E., Graham, S., Lexcen, F., Reppucci, N.D., & Schwartz, R. (2003). Juveniles’ competence to stand trial: A comparison of adolescents’ and adults’ capacities as trial defendants. Law and Human Behavior, 27, 333-364.
Warren, J. I., Aaron, J., Ryan E., Chauhan, P., & DuVal, J. (2003). Correlates of adjudicative competence among psychiatrically impaired juveniles. Journal of the American Academy of Psychiatry and the Law, 31, 299-309.
For further work on the competence of juveniles as criminal defendants,
see the Research Network on Adolescent Development and Juvenile Justice,
In 1994, the American Bar Association's Criminal Justice Mental Health Standards noted that "the issue of present mental incompetence, quantitatively speaking, is the single most important issue in the criminal mental health field." The most recent estimates are that between 24,000 and 60,000 forensic evaluations of criminal defendants for "competence to stand trial"(2) are performed every year in the United States. The quality of these evaluations has substantial ramifications: an evaluator's failure to identify an existing impairment could compromise the fairness of the ensuing adjudication, and an evaluator's erroneous finding of incompetence could lead to a suspension of the criminal proceedings and to a period of compulsory confinement and treatment.
Given the importance of assessments of competence to stand trial and the frequency with which courts refer competence questions to mental health professionals, it is not surprising that a voluminous legal and mental health literature has been generated on this topic. Nevertheless, much remains unknown about criminal defendants' "adjudicative competence" -- a more appropriate term than "competence to stand trial," given that approximately 90 percent of all criminal cases in the United States are resolved by means of guilty pleas, rather than at trial -- and a firm empirical basis for the clinical assessment of competence has yet to be established.
The primary obstacle to progress in this area is the absence of structured and standardized research measures for the assessment of abilities related to adjudicative competence. The MacArthur Adjudicative Competence Study, supported by the Research Network on Mental Health and the Law of the John D. and Catherine T. MacArthur Foundation, was designed to develop such 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.
During its initial phase, beginning in 1988, the project did three things. First, it articulated a coherent legal theory of what "competence" means in the context of the social purposes that legal rules for determining competence are meant to further. Second, it built upon the psycholegal assessment strategy pioneered by the MacArthur Treatment Competence Study (see Executive Summary) to design and pilot test a research instrument to measure the capacities identified by the theory as essential to adjudicative competence. Finally, the project conducted the first epidemiological surveys of the prevalence of impairments in decision-making competence among the general population of criminal defendants.
Following these activities, the full-scale adjudicative competence study was conducted with 366 adult male defendants and 106 adult female defendants recruited from Florida and Virginia. These included several groups: randomly-selected pre-trial jail detainees; defendants who were currently receiving mental health services in jail; and defendants recently admitted to state forensic hospitals for restoration of competence.
o A defendant may need several different capacities to be competent to proceed with criminal adjudication -- the capacities to make choices, to understand information, to think rationally about alternative courses of action, and to appreciate one's situation as a criminal defendant. It is not sufficient to assess only one capacity to evaluate adjudicative competence: a defendant with mental disorder may not have an impairment on the assessed capacity, even though other capacities required for adjudicative competence are impaired.
o A person whose competence is impaired for one legal purpose (e.g., accepting or refusing treatment) does not necessarily lack competence for other legal purposes (e.g., adjudicating his or her criminal case). Conversely, a person who is competent for one legal purpose may have impairments in competence for other legal purposes.
o While no clinical diagnosis by itself indicates incompetence, competence-related impairments regarding criminal adjudication are strongly associated with symptoms of severe mental disorder, and particularly with a diagnosis of schizophrenia. However, many defendants with severe mental disorder are nonetheless competent to proceed with adjudication.
o When defendants hospitalized for restoration of competence were re-tested with our instruments, significant improvement in decision making abilities was observed for those defendants who were treated and referred back to court as having been restored to competence.
o Whether defendants are seen as legally competent or incompetent for their cases to proceed to adjudication will depend on which legal tests for adjudicative competence are adopted in a particular adjudication. Empirical information is now available to inform judges and legislators as they set these standards.
After the study described above had been successfully concluded, the project set about developing a brief (30 minute), user-friendly, "clinical" version of its lengthy research instrument. Standard statistical item-reduction techniques, as well as consideration of legal face-validity, were employed. The 22-item clinical instrument that resulted -- the MacArthur Competence Assessment Tool - Criminal Adjudication (MacCAT-CA) -- was field-tested on a sample of 107 criminal defendants in a jail and in a forensic hospital in Virginia and found to possess psychometric integrity. In 1996, a grant was awarded by the National Institute of Mental Health to Drs. Norman Poythress and Robert Nicholson to conduct an eight-state study of the MacCAT-CA, with over 700 hospitalized and jailed defendants as subjects.
The MacCAT-CA is now available for clinical use. It can be obtained from Psychological Assessment Resources, P.O. Box 998, Odessa, FL (http://www.parinc.com).
Research on the adjudicative competence of juvenile offenders, conducted
by the MacArthur Program on Adolescent Development and Juvenile Justice,
is in progress (for a description, see the website:
Bonnie, R. (1992). The competence of criminal defendants: A theoretical reformulation. Behavioral Sciences and the Law, 10, 291-316.
Bonnie, R., Poythress, N., Hoge, S., and Monahan, J. (1996). Decision-making in criminal defense: An empirical study of insanity pleas and the impact of doubted client competence. Journal of Criminal Law and Criminology, 87, 48-62.
Bonnie, R., Hoge, S., Monahan, J., Poythress, N., Eisenberg, M., and Feucht-Haviar, T. (1997). The MacArthur Adjudicative Competence Study: A comparison of criteria for assessing the competence of criminal defendants. Journal of the American Academy of Psychiatry and the Law, 25, 1-11.
Edens, J.F., Poythress, N.G., Otto, R.K. & Nicholson, R.A. (1999). Effects of state organizational structure and forensic examiner training on pre-trial competence assessments. Journal of Behavioral Health Services & Research, 26, 140-150.
Hoge, S., Bonnie, R., Poythress, N., and Monahan, J. (1992). Attorney-client decision making in criminal cases: Client competence and participation as perceived by their attorneys. Behavioral Sciences and the Law, 10, 385-406.
Hoge, S., Poythress, N., Bonnie, R., Eisenberg, M., Monahan, J., Feucht-Haviar, T., and Oberlander, L. (1996). Mentally ill and non-mentally ill defendants' abilities to understand information relevant to adjudication: A preliminary study. Bulletin of the American Academy of Psychiatry and the Law, 24, 187-198.
Hoge, S., Poythress, N., Bonnie, R., Monahan, J., Eisenberg, M., and Feucht-Haviar (1997). The MacArthur Adjudicative Competence Study: Development and validation of a research instrument. Law and Human Behavior, 21, 141-179.
Hoge, S., Poythress, N., Bonnie, R., Monahan, J., Eisenberg, M., and Feucht-Haviar. (1997). The MacArthur Adjudicative Competence Study : Diagnosis, psychopathology, and adjudicative competence-related abilities. Behavioral Sciences and the Law, 15, 329-345.
Otto, R., Poythress, N., Nicholson, R., Edens, J., Monahan, J., Bonnie, R., Hoge, S., and Eisenberg, M. (1998). Psychometric properties of the MacArthur Competence Assessment Tool-Criminal Adjudication (MacCAT-CA). Psychological Assessment, 10, 435-443.
Poythress, N., Bonnie, R., Hoge, S., Monahan, J., and Oberlander, L. (1994). Client abilities to assist counsel and make decisions in criminal cases: Findings from three studies. Law and Human Behavior, 18, 437-452.
Poythress, N., Hoge, S., Bonnie, R., Monahan, J., Eisenberg, M., and Feucht-Haviar,
T. (1998). The competence-related abilities of women criminal defendants.
Journal of the American Academy of Psychiatry and the Law, 26, 215-222.
2. The legal standard for "competence to stand trial" has not changed since the United States Supreme Court enunciated it in 1960: "The test will be whether [the defendant] has sufficient present ability to consult with his lawyer with a reasonable degree of rational understanding, and whether he has a rational as well as a factual understanding of the proceedings against him" (Dusky v. Unites States, 362 U.S. 402). Competence focuses on the defendant's "present ability" to proceed to adjudication, and is to be distinguished from retrospective inquiries regarding criminal responsibility (such as the insanity defense) which focus on the defendant's mental state at the time of the offense.