Assessing competency to stand trial: a case study of technology diffusion in four states.

During the 1970's, in the wake of major court decisions affirming the due process rights of criminal defendants suspected of incompetency to stand trial, state criminal justice and forensic mental health systems instigated changes both in the organization of systems through which alleged incompetents were processed and in the specific format and objectives of the competency examination itself. The early part of this period (1970-74) coincided with the latter phases of a project sponsored by the National Institute of Mental Health to develop reliable instruments that would translate the essentially legal criteria for competency into terms capable of being assessed by the mental health professionals now charged with competency evaluations in most states. l The hope was that these instruments, properly used, would provide a more reliable and consistent basis for competency determination than the unelaborated legal criteria by themselves. Dr. A. Louis McGarry, director of the NIMH project and the man whose name is most frequendy associated with the instruments, developed them at the Harvard Laboratory for Community Psychiatry and employed them for a time, with some success, at Bridgewater and Boston State Hospitals in Massachusetts. As other states showed interest, Dr. McGarry also made visits to demonstrate the instruments or to give depositions concerning aspects of the competency determination process. This paper reports the findings of a project designed to explore the factors influencing four states to use or not use the results of the NIMH-supported research directed by Dr. McGarry. The states are Tennessee, Ohio, North Carolina, and West Virginia. Since the instruments came on the scene at a time of general ferment in the area of psychiatric diversion from the criminal justice system, and since their adoption or non-adoption (and the modes thereoO are heavily influenced by the structure of state forensic service systems and their relationship to criminal justice systems, it was not possible to study the use of the instruments, or the states' encounter with McGarry's work, in isolation. Instead the project sought to explore these issues in the context of on-going developments in forensic service organization in each state. As will be documented later on, these developments, as much as the