AAPL Practice Guideline for the Forensic Psychiatric Evaluation of Competence to Stand Trial: an American legal perspective.

The AAPL Practice Guideline for the Forensic Psychiatric Evaluation of Competence to Stand Trial provides a rich discussion of the legal standards and procedures for evaluating and determining a criminal defendant's trial competence and for restoring to competence defendants found to be incompetent. The document includes an up-to-date discussion of the applicable case law, examines ethics considerations for forensic examiners, addresses cultural issues, and offers practical templates for interviewing defendants and preparing reports. Although its focus is on trial competence in adult criminal court, the document also attends to competency considerations for minors facing delinquency proceedings in juvenile court. Comprehensive and incisive, if not optimally organized and tabulated, the Guideline will serve as the standard reference for psychiatrists asked to provide trial competence assessments in criminal and juvenile court cases.

Enhancing the Value of Expert Assistance in Pro Se Competence Determinations.

Forensic mental health practitioners are comfortable assessing criminal defendants' competence to stand trial. They have a long history of making such assessments and a large body of research and scholarship to guide them. In recent years, however, the courts have drawn a distinction between general trial competence (i.e., competence while represented by counsel) and competence to proceed pro se (i.e., competence without counsel). The seminal case on point is Indiana v. Edwards (554 U.S. 164 (2008)). In Edwards, the Court found that general trial competence may provide an inadequate measure of pro se competence. Recognizing the profession's need for direction in making the more particularized assessment called for in pro se cases, White and Gutheil offer a new "Model for Assessing Defendant Competence to Self-Represent." Neatly tied to the elements of pro se competence, discussed in Edwards, and envisioning a fresh new role for experts, consistent with the Court's reasoning, the model provides a valuable resource for forensic practitioners.

Sexual offender commitment in the United States: legislative and policy concerns.

Fifteen states and the District of Columbia have laws for the special civil commitment of convicted sexual offenders who are about to be released from penal confinement and do not meet criteria for ordinary psychiatric civil commitment. As of summer 2002, nearly 2500 sexual offenders were hospitalized pursuant to one of these laws. An American Psychiatric Association task force declared that "sexual predator commitment laws establish a non-medical definition of what purports to be a clinical condition without regard for scientific and clinical knowledge," and thus "distort the traditional meaning of civil commitment, misallocate psychiatric facilities and resources, and constitute an abuse of psychiatry." It remains unclear how legislatures in states with these laws will respond to the U.S. Supreme Court's 2002 decision in Kansas v. Crane indicating that, absent a finding that an offender has "serious difficulty controlling behavior" (not an explicit commitment criterion in any state), commitment is invalid.

DSM-5 and substance use disorders: clinicolegal implications.

Presumed distinctions between substance dependence and substance abuse have been at the heart of the development and utilization of substance-based diversion from criminal prosecution to treatment for the past several decades, including its use in drug courts. These distinctions have been promulgated by organized psychiatry since the publication of the Diagnostic and Statistical Manual of Mental Disorders, Third Edition (DSM-III) in 1980. With the release of DSM-5 and the replacement of abuse and dependence categories with a single use disorder construct, the legal grounds for diversion in many states now stand at odds with organized psychiatry and its adoption of recent science. This article reviews the scientific basis for the DSM's new classification scheme, the dilemmas posed for states with statutes that rely on the abuse/dependence distinction, and potential remedies for legislatures wishing to keep pace with evolving research and clinical practice.