Assessing Competency: A Closer Look at the MacCAT-CA and Its Applications in Court

For over forty years, the United States Supreme Court has helped establish key criteria in Dusky vs the United States (1960). These criteria, commonly called the Dusky criteria, provide the standard for determining an individual’s competency to stand trial. According to these criteria, the defendant must fulfil two main conditions-

1. Factual Understanding—The defendant should be able to understand clearly and rationally the legal proceedings, including the charges against them, the role of the court, and the possible outcome of the trial.
2. Ability to communicate with counsel—The defendant must be able to rationally communicate and consult with their lawyer. They need to understand the legal advice given and actively participate in their defence.

These criteria are required to ensure that the defendant has the cognitive ability to comprehend the legal and trial process. This also ensures that the defendant has the mental capacity to assist in their own defence. Most states in the USA have incorporated the Dusky criteria into their law and require mental health professionals to evaluate their defendants’ competency to stand trial. Earlier estimates suggest that over 20,000 competency-to-stand trial assessments were conducted annually in the United States. More recent data suggests that this number has increased to more than 60,000. This highlights the importance of these evaluations and the significant role that they play in the mental health and criminal justice system.

Various instruments have been created to help the experts assess the individuals’ competency to stand trial. These instruments vary in their purpose, scope, design, and the extent of the empirical observation and validation. They include various checklists, sentence-completion questionnaires, and structured interviews that help the examiner evaluate the Dusky criteria.

Some of the commonly used instruments include the Competence to Stand Trial Assessment Instrument, the Georgia Court Competency test-Mississippi State Hospital revision, the Interdisciplinary Fitness Interview (IFI), and the Fitness Interview Test (FIT). Each of these initial assessment techniques has been widely used and reviewed. These measures made valuable contributions to the assessment of competence to Stand Trial, but they also faced criticism for various reasons. These critiques included their psychometric limitations, their failure to address important domains related to the Dusky criteria, such as rational decision-making, and their limited practical utility. These issues led to the revision of the existing measures and led to the development of IFI-R and FIT-R. It also led to the creation of new competence assessment tools that would overcome these limitations and incorporate more standardized administration and scoring methods. Thus, two notable competence assessments were produced- the MacArthur Competence Assessment Tool-Criminal Adjudication (MacCAT-CA) and the Evaluation of Competency to Stand Trial-Revised (ECST-R). These instruments aim to address the shortcomings of the previous assessments and offer more robust and comprehensive assessments. Thus, they also enhance the reliability and validity of the competence evaluations in the criminal justice system.

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The MacArthur Competence Assessment Tool-Criminal Adjudication (MacCAT-CA)-

The MacCAT-CA was developed over the years and was studied extensively between 1996-1998. This tool consists of 22 items that are structured into three different sections to meet the Dusky criteria. The assessment starts with a standardized procedure where the examiner presents a vignette to the defendant describing a hypothetical offence involving an aggravated assault in a pool hall. This scenario provides the context for the first 16 items. These items are helpful in assessing the defendant’s understanding and reasoning. For the remaining six items, the defendants are required to make a comparative judgment about their own cases and also explain their reasoning to the examiner. These reasons are evaluated by the examiner, and the defendant is scored using a three-point scale, with scores of 0, 1, and 2. This vignette format and objectively scored questions are used to measure three different competence-related abilities-

1. Understanding
2. Reasoning
3. Appreciation

The first section assesses the ability of the defendant to understand general information about the legal justice system and the adjudication process. This section contains items with two parts and assesses the defendants’ existing knowledge of the legal system. If the responses of the defendant are inadequate, the examiner gives an informative narrative explaining the legal system, following which the defendant is asked to paraphrase the information they just heard. This is an important step because it measures the defendants’ ability to learn, retain, and apply new information. The goal of this section is not only to assess the existing knowledge but also to check their capacity to grasp new knowledge, legal concepts, and procedures when explained to them.

The second section focuses on assessing the ability of the defendant to understand the legal relevance of information. This section also assesses their capacity to think rationally and critically about the particular decision that the defendant is going to face throughout a criminal proceeding. This section comprises eight items, out of which five items require the defendant to differentiate between more or less factual information that is legally relevant. The remaining three items prompt the defendant to engage in more rational decision-making by reasoning through hypothetical scenarios such as plea bargaining.

The final section aims to assess the defendants’ understanding of the meaning and implications of their own legal circumstances. This section contains six items that investigate the defendants’ beliefs and perceptions about their roles as defendants. Unlike the previous responses, the scoring for the responses for this section is based on their plausibility, for example, whether the responses are grounded in reality or are influenced by delusional beliefs.

The validation studies of MacCAT-CA involve three different groups of criminal defendants, including those without any mental health concerns, those receiving mental health treatment, and those who were adjudicated incompetent due to mental illness. This underscores the robustness of the instrument and its applicability in various contexts of the legal justice system. The findings from different studies support the reliability and validity of the scale. These studies also emphasize the value of the MacCAT-CA in ensuring fair and effective assessments of competence to stand trial in the Criminal Justice System.

References-

1. https://www.parinc.com/Products/Pkey/221
2. https://paa.com.au/product/maccat-ca/
3. Pinals DA, Tillbrook CE, Mumley DL. Practical application of the MacArthur competence assessment tool-criminal adjudication (MacCAT-CA) in a public sector forensic setting. J Am Acad Psychiatry Law. 2006;34(2):179-88. PMID: 16844797.