By: Andrea Cipriano, MAFP

When the mental state of a defendant is brought into question during criminal proceedings, it’s important to understand what it means for the trial ahead.

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When Milton Richard Dusky was arrested in 1958, no one could imagine that years later, his criminal case would be brought before the Supreme Court to argue for the rights of defendants for decades to come.

As Dusky faced a jury of his peers for a kidnapping charge, it took only two hours for them to come back and say he was guilty. His court-appointed team of defense attorneys felt that it was a grave injustice, considering even though he was cognitively aware of basic things like who he was and where he was, Dusky had difficulty understanding the trial.

Two years later, the U.S. Supreme Court agreed that he wasn’t in the right state of mind for the trial, and the Court rewrote the legal rules regarding competency to stand trial.

What is competency to stand trial?

Competency to stand trial (CST) is a measurement of legal philosophy that assesses a defendant’s mental or physical condition to determine whether or not they are able to participate in their defense and face a trial. 

The question of a defendant’s competency can be raised at any time, and since every criminal defendant has the legal right to fully comprehend why they’re being charged and what’s legally happening to them, all proceedings are halted until the matter is concluded.  

It’s important to note that the question of someone’s competency is different from the legal consideration of insanity.

The main difference is that competency only refers to their cognitive abilities at the time of their defense — not their psychological state at the time of the crime, as is the case with considering insanity. A judge determines competency before a trial begins, whereas a jury determines insanity at the end of trial with the verdict.

A defendant may be able to offer evidence of insanity at the time of the crime, but still be competent and able to stand trial.

Three ‘Dusky’ Prongs of Competency

A defendant is considered mentally competent to stand trial as long as they can adequately meet the requirements of the three prongs of competency — otherwise known as the Dusky Prongs after the U.S. Supreme Court establishment,

A defendant must be able to: 

Prong 1

Factually understand the criminal process and the proceedings against them

This is relatively simple. Either the defendant knows the facts or they don’t. For example, are they able to identify who the Judge is? Do they know who their defense attorney is? These are facts.

Prong 2

Rationally understand the criminal process and the proceedings against them.

This is much more nuanced, and hasn’t been fully legally defined. To that end, there’s a general acceptance that a defendant must be able to reason with logic regarding the criminal process and proceedings. 

For example, if the defendant truly believes the Judge is conspiring with the government to put them in prison, that would be irrational. Or, even taken a step further, if a person has deluded thoughts that the prosecutor is an alien or the jury members are zombies, these would be irrational.

Prong 3

Rational ability to consult with counsel.

A defendant must be able to work with their defense lawyer to help with the case. While this in no way means they need to become a part of the legal team to help them win a case, it does imply that the defendant must communicate and work with their team.

How is competency evaluated? 

Once the issue of competency is raised, a judge either orders in-patient treatment at a mental hospital or a treatment facility, or out-patient treatment. They’re also ordered to undergo an evaluation.

Treatment will look different for each person, but it often includes some level of medication and supervision for a few days.

For an evaluation, a forensic psychologist will be brought in to assess for components of competency. Today, clinicians often use the Evaluation of Competency to Stand Trial-Revised (ECST-R) framework. 

The ECST-R is a semistructured interview that is designed to assess the defendant’s ability against the three Dusky prongs. In addition, the ECST-R includes a specific screen for feigned incompetence — meaning the test will be able to identify if the defendant is faking their mental condition to get out of facing a trial. 

Not all competency-related abilities will be captured by the ECST-R — or by any other competency measure, so it’s important for a forensic psychologist to be supplemented with case-specific details in order to make a full determination. 

Faking mental illness — better known as malingering in the correctional system, happens more often then you’d think. One study from 2007 found that roughly 21 percent of defendants faked a mental disorder to defect or avoid prosecution. 

What happens if you’re deemed incompetent?

If a judge finds a defendant incompetent to stand trial (IST) based on the forensic psychologist’s evaluation, the criminal proceeding is halted and the defendant continues to receive treatment until they are deemed competent. 

Because of the 2003 landmark Supreme Court ruling in Sell v. United States, a defendant in this circumstance could be involuntarily medicated solely for the purpose of restoration.

For most cases, research shows that nearly all defendants are restored to competency within 90 — 120 days.

In the high profile case of ‘doomsday cult mom’ Lori Vallow Daybell who was facing murder charges for the deaths of her two children, Vallow’s competency was questioned in 2021 after spending some time in jail awaiting trial.

She was deemed IST, and spent nine months in a mental health facility receiving treatment before being restored. Later that same year, her mental health was called into question again, but the Court determined she was fit to proceed with trial. She was ultimately found guilty.

Another high profile case is that of Alexander Kinyua, a Maryland college student who confessed to law enforcement in 2012 that he killed his roommate with an ax, and ate his heart and brain. Kinyua, who was 22 at the time of the murder, was deemed incompetent because he had delusional thoughts about what the judge’s role was in the proceedings, and didn’t believe he was impartial.

Kinyua returned to the maximum-security psychiatric hospital, where he’ll likely remain for the rest of his life.

What happens if someone cannot be restored to competency?

It’s possible someone’s mental status never improves and they’re never able to be restored to competency. If that’s the case, the individual remains in custody in a mental health institute.

This seems to be the case for serial killer Ryan Sharpe.

Sharpe has been indicted in Louisiana for a string of shootings at places of worship in the summer of 2017. He ultimately called the police and identified himself as the shooter, telling investigators that he killed people to “fill government issued hunting tags.”

Many of his motives for the attacks are linked to delusions he’s suffered with. To that end, Sharpe has pleaded not guilty by reason of insanity, though doctors have concluded he was sane at the time of the offense.

Despite multiple evaluations and hearings since his arrest, Sharpe has never been deemed competent to assist his attorney in his defense. Experts in 2020 believe it’s possible he’ll never face trial again, after his last trial returned a split verdict.

Infamous Competency Case: Dusky v. United States (1960)

When Milton Richard Dusky was arrested in 1958, he was a 33-year-old man from Kansas with no criminal history and a prior diagnosis of Schizophrenia. He suffered from psychosis — with delusions, intense hallucinations, and morbid preoccupations — as well as depression and alcoholism. When he was younger, he was discharged from the Navy because of a psychoneurosis. 

While being treated for his psychiatric needs in a Veteran Affairs hospital in March of 1958, his wife left him for his brother. Because of this, something in Dusky snapped.

The night before the offense he was arrested for, Dusky was in a vulnerable state of mind.

He was thrown out of his room by his landlady, and was sleeping in his car. He drank two pints of vodka, and consumed a fair amount of unknown “tranquilisers.” 

The following day, on August 19, 1958, Dusky drove two boys who were friends with his son to visit a girl. They never made it to her place because on the way, the two boys saw a second girl that the pair knew. They pulled over, and picked up the 15-year-old girl. Without pre-planning the offense, Dusky and the boys abducted the girl, driving across state lines to Missouri, where the two adolescent boys raped her.

Dusky attempted to rape her, but he was impotent.

After his arrest, he was evaluated by a doctor who said he was “oriented to time, place and person” so he was deemed stable enough to proceed to trial.

His court appointed attorney, however, said that Dusky’s severe mental illness was enough that he couldn’t understand the proceedings against him, or adequately assist in his defense.

Dusky was tried, found guilty in two hours, and sentenced to 45 years for his kidnapping crimes.

However, after successful appeals and review by the Supreme Court of the United States, the Court concluded that mental competency to stand trial must include if the accused has the ability to consult with their lawyer, and have a “reasonable degree of rational understanding” of the proceedings against them. 

Love this post? Meet the Author.

Andrea Cipriano is the Digital Content Specialist at Uncovered, where she writes for the twice-weekly true crime newsletter, The Citizen Detective. Andrea graduated with a Master of Arts in Forensic Psychology from John Jay College of Criminal Justice, where she focused on researching and peeling back the criminal mind. Andrea believes that it’s never too late for justice.

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