Observations from the world of Vermont Forensic Psychiatry

Tuesday, April 6, 2010

Juvenile Competency

The additional considerations (age, maturity, mental illness, developmental disability, mental retardation, etc) used in assessing the competence of juveniles does provide a more comprehensive understanding of the individuals. Those criteria are a separate aspect of the assessment and, while those considerations may be part of the underlying reasoning in the examiner's opinion, that opinion is ultimately driven by the 'Dusky' standard. How the added elements might be applied or used by the court is unclear.

Involuntary Medication in Orders of Non-Hospitalization

Patients involuntarily committed to psychiatric hospitals are commonly discharged on orders of non-hospitalization. During the hospitalization, the medication regimens are often in transition such as when cross tapering from one medication to another or when switching from oral to injectable medication. These transitions are frequently not completed by the time of discharge. Once in the community, the psychiatrists are reluctant to alter the regimen that was in force at the time of discharge potentially leaving the patients with an excessive medicine burden.

Monday, April 5, 2010

Competency and the Antisocial Personality

In determining competency to stand trial, a defendant's failure to cooperate based on an Antisocial Personality Disorder would usually be considered a voluntary choice by the defendant. As such, it would not lead to an opinion that the defendant is incompetent. The defendant's choice to not work collaboratively with his or her attorney and/or to be disruptive in court may become problematic for advancing the case. Such a defendant may not be suitable for self representation and certain limitations on the defendant's conduct may be necessary.