Development and validation of a typology of criminal defendants admitted for inpatient competency restoration: A latent class analysis.

Aaron J. Kivisto, Megan L. Porter Staats, Robert Connell

Research output: Contribution to journalArticlepeer-review

Abstract

Objective: To develop a typology of criminal defendants found incompetent to stand trial using data-driven classification techniques and validate it against forensically relevant outcomes. Hypotheses: We hypothesized that discrete groups of defendants determined to be incompetent exist that can be identified in the structure of observed clinical, demographic, and criminological data. We also expected that class membership would be differentially associated with competency restoration. Method: We coded hospital records for 492 consecutive male criminal defendants committed to a secure hospital for competency restoration between 2013 and 2017 (mean [M] age = 38.7 years, standard deviation [SD] = 14.2; 61.0% White, 34.2% Black, 2.6% Hispanic, 2.2% “Other”). Clinical, demographic, and criminological data were analyzed using latent class analysis. Validation analyses modeled competency restoration outcomes as a function of class membership. Results: An 8-class solution best fit the data and included 3 discrete classes of patients with psychotic disorders (Class 2, n = 74; Class 3, n = 78; Class 6, n = 68), as well as classes characterized by intellectual limitations without comorbid psychosis (Class 4, n = 54), comorbid psychosis and intellectual limitations (Class 1, n = 41), mood disorders (Class 5, n = 80), older adults with neurocognitive disorders (Class 8, n = 59), and chronic instability (Class 7, n = 38). The restoration rate in the overall sample was 87.8%, and Classes 1–7 showed restoration rates similar to the overall sample, ranging from 82.9% to 100%. The restoration rate of Class 8 was 66.1%, and this was the only class to show significantly lower odds (odds ratio [OR] = 0.181, 95% confidence interval [CI: 0.093, 0.353], p <.001) and hazards (hazard ratio [HR] = 0.511, 95% CI [0.361, 0.724], p <.001) of restoration. Conclusion: Older adults with neurocognitive disorders admitted for competency restoration are at increased risk of failed restoration. (PsycInfo Database Record (c) 2021 APA, all rights reserved) <strong xmlns:lang="en">Public Significance Statement—The accurate identification of the small minority of criminal defendants found incompetent to stand trial who are unlikely to be restored is essential to ensuring that these defendants are afforded their constitutional protections against indefinite commitment. This study developed a typology of defendants admitted for inpatient competency restoration using data-driven classification techniques and found that one discrete class, comprising older adults with neurocognitive disorders, was at a substantially increased risk of failed restoration. Forensic evaluators and judges should recognize the decreased probability of restoration in this group to ensure that alternative dispositions are considered when appropriate. (PsycInfo Database Record (c) 2021 APA, all rights reserved)

Original languageEnglish (US)
Pages (from-to)449-460
Number of pages12
JournalLaw and Human Behavior
Volume44
Issue number6
DOIs
StatePublished - Dec 2020
Externally publishedYes

Keywords

  • competency restoration
  • forensic typology
  • Jackson v. Indiana
  • predicting restoration

ASJC Scopus subject areas

  • Arts and Humanities (miscellaneous)
  • Psychology(all)
  • Psychiatry and Mental health
  • Law

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