What Does "Not Fit to Stand Trial" Mean?

One of the basic tenets of the criminal justice system is that before a person can be held accountable for their alleged criminal behavior, the person must be competent to stand trial. Therefore, competency to stand trial (CST) is a legal construct. The law requires that a defendant have sufficient present ability to consult with their attorney with a rational degree of understanding and factual comprehension of the proceedings brought against them. This is not the mental state of the defendant at the time of the alleged crime, but rather the defendant’s state of mind at the time of the criminal proceeding.

Why competency matters

Competency has two important purposes: reducing the risk of erroneous convictions and protecting defendants’ autonomy in their decision-making. For example, an incompetent defendant might understand the facts of the charges against them and the nature and purpose of the criminal proceedings. However, they may be unable to understand different defenses such as a plea bargain. Defendants play a role in formulating the best defense in conjunction with their attorney. Court decisions must be made knowingly, intelligently, and voluntarily.

Changes to mental status

If a defendant’s mental status changes at any point in the litigation, competency can be questioned at that time, not only at the beginning of the legal proceedings. When that happens, the judge will usually appoint experts to examine the defendant, determine their mental condition, and report their findings to the court. At times, a defendant’s fitness for trial is controversial and several experts may be involved. Each expert will give their opinion to the court through testimony. Based on all the data that is presented, a judge will issue their decision as to the defendant’s fitness for trial.

An individual who has been found not competent to stand trial by the court is not set free. They can be sent to a psychiatric facility and treated until they are restored to competency. If subsequent restoration to competency is not a possibility because the defendant is so psychiatrically ill, they may be legally committed to a psychiatric hospital for a lengthy period of time.

CST evaluations

The evaluations of CST are findings given to the court through expert testimony. It is important to take proper measures to protect against self-incrimination. During a CST evaluation, the mental health professional should disclose to the defendant the nature of the evaluation, why the evaluator has been retained, the lack of doctor-patient confidentiality, that the evaluator may be called to give testimony in court, and the right of the defendant not to answer questions. Finally, it should be noted why the evaluation was ordered.

The evaluation should determine whether the defendant has a mental disorder or mental defect. This may or may not include a DSM-V diagnosis. The forensic examiner will be tasked with identifying impairments related to competency. The last issue of the CST evaluation addresses the defendant’s need for treatment, prognostic information, and an opinion addressing restoration to competence.

The case of Jared Loughner

One recent example of CST is the case of Jared Loughner, who killed 6 people and wounded 14 others in Tucson, Arizona on January 8, 2011. The Loughner case is a stark example of a person deteriorating into mental illness, but who was ultimately found fit to stand trial.

Loughner may have been suffering from prodromal signs of schizophrenia, which escalated around the time of his withdrawal from high school. He began using hallucinogens and dabbled with other drugs. He began to obsessively exercise to enter the Army. However, at his recruitment interview, he sabotaged his chances by telling the recruiter he smoked marijuana excessively.

Loughner's behavior became increasingly erratic after the Army failure. Friends reported he often spoke in random strings of words best described as psychotic word salad. He had run-ins with police and lost several menial jobs due to his inability to follow instructions. His mental status continued to deteriorate when he entered college. Campus police discovered a video shot by Loughner, in which he stated that the college was illegal according to the United States Constitution. He described his school as "one of the biggest scams in America."

The college suspended Loughner and sent a letter to his parents. The college told Loughner that if he wanted to return, he needed to resolve his code of conduct violations and obtain a mental health clearance. On October 4, Loughner and his parents met with campus administrators and Loughner indicated he would withdraw from the college. During Loughner's time at the school, a classmate said she worried about his bizarre behavior. One of his teachers claimed a similar suspicion after the Tucson shooting. He never submitted to a mental health evaluation and did not return to the college.

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Several college classmates recalled an incident in which Loughner, during a class discussion, had mocked and laughed hysterically in class disruptively. Loughner's behavior frightened fellow students. While in a math class one of the professors noted his odd thinking as Loughner “denied math.” As Loughner began to get more ill his odd behaviors escalated.

At this trial, the evaluators’ reports concluded that Loughner was unable to rationally understand what was happening to him and he was not able to assist his lawyers in his own defense. He apparently thought that his lawyers were engaged in a conspiracy against him and spat on his lawyers, threw chairs at them, was screaming in the courtroom at the judge. He was then found too mentally ill to stand trial. He was taken to a nearby psychiatric hospital.

If Loughner refused to take the medications, the government could try to force the issue. One way would be to show that an unmedicated Loughner is a safety risk to himself or other inmates. The Supreme Court has also allowed the government to medicate incompetent defendants against their will if four things are shown: a compelling reason for medicating, a good chance the drugs will work, proof that the drugs are necessary, and a lack of other options.

What is important to remember is that persons with mental illness are no more likely to commit a violent crime than anyone else. In fact, they tend to be victimized at a greater rate. All people are entitled to the defense in their best interest.

In the end, Loughner was prescribed medication, restored to competence, and then stood trial. He was sentenced to serve seven consecutive life terms plus 140 years in prison without parole.