EDUCATING AND RESTORING ADJUDICATED YOUTH

Educating and Restoring Adjudicated Youth in the Public School

EDUCATING AND RESTORING ADJUDICATED YOUTH IN THE PUBLIC SCHOOL

Sample Article

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Introduction

Evaluations of competency to stand trial are the most common source of referrals to forensic mental health practitioners. While the clear majority of those examined are viewed as competent to proceed, those found incompetent to stand trial (IST) may be subjected to treatment and training to enable them to proceed to trial, typically referred to as competency restoration. These individuals constitute the largest group referred for mental health treatment under the auspices of the criminal justice system, with several thousand persons hospitalized in the United States at any given time. Despite the significant variability in treatment and education efforts, as many as 9 in 10 persons originally found unfit are eventually adjudicated competent and proceed to disposition of the charges against them. There is a dearth of systematic research on the methods used to accomplish this result. Restoration efforts typically require no more than 4 months, and an increasing number of jurisdictions allow for outpatient treatment and training to minimize pretrial deprivation of liberty. Medication is often a key component of treatment for defendants with psychiatric illness. Prognosis is more guarded for restoration of cognitively impaired defendants.

Some commentators have questioned the propriety of the competency restoration programs provided by mental health practitioners. An alternative view holds that enabling impaired defendants to develop or regain the ability to participate in the resolution of their legal predicaments is ethically justified. This entry summarizes the legal and ethical context of competency restoration efforts, the presenting problems that are typically the focus of treatment, treatment methods and programs, and the outcomes of restoration efforts. (Seligman, 1975)

Competency restoration is often implemented on an individualized basis, though some inpatient centers offer highly structured programs. The most common model combines these elements and involves individual treatment of any underlying mental illness combined with group education and practice modules and individual coaching. There is consistent evidence that defendants referred for non-restoration-specific, general psychiatric hospital care are significantly less likely to regain competency than those receiving care in a formal restoration program, either inpatient or community based.

Defendants referred for restoration can be broadly divided into those with primarily Axis I disorders and those with mainly cognitive limitations. In practice, many incompetent defendants exhibit multiple diagnoses, particularly involving personality disorders and substance abuse. While the latter factors are rarely priorities for immediate treatment, they may complicate restoration efforts. Given the overrepresentation of linguistic and cultural minorities among the defendant population, acculturation issues and language barriers can also be significant complicating factors. Individualized treatment planning is required to manage these varied needs.

Defendants with a major mental illness are typically treated with the implicit assumption that but for their psychiatric symptoms, they would be competent. Schizophrenic-spectrum illnesses are most commonly a focus of treatment—and less frequently, mood disorders. Symptoms including delusions, hallucinations, disorganized thought or behavior, and agitation often impair defendants' understanding of their ...