There are about 25,000 competence to stand trial evaluations (CST) performed each year. In Dade County these evaluations are carried out by psychologists and psychiatrists broadly using the Dusky standard. We are to examine the defendant taking into account following seven factors: 1. Appreciation of the charges against the defendant. 2. Appreciation of the range and nature of the possible penalties. 3. Understanding of the adversarial nature of the legal process. 4. The capacity to disclose to attorney facts pertinent to the proceedings. 5. Ability to manifest appropriate courtroom behavior. 6. Capacity to testify relevantly. 7. Any other factors deemed relevant.

The most frequently used assessments include a mental status exam and some form of psychological testing such as the Minnesota Multi phasic Inventory, the Symptomatic Checklist-90-R, or the Mac Arthur Competency Assessment Tool. Since professional and financial resources are scarce in Dade county, we all try to do our best within a narrow time frame. This presents even more difficulty than first imagined because of the ever increasing complexity of the task. Previously, mental health professionals usually base their evaluations on the notion that mental illness or psychosis to an assessment of incompetency.

Recent findings by Nestor, Daggett, Haycock, and Price in Law and Human Behavior Volume 23 1999 calls into question our present form of assessment. They indicate that a different set of psychological measures are also extremely important in this evaluation, mainly cognitive tests. They examined retrospectively 309 patients over an 8 year period. From this sample they identified 181 patients who had undergone CST evaluations. They compared neurological test scores on those recommended as competent versus those recommended as incompetent. Salient variables were indexes of intelligence, memory, attention, and concentration. The most predictive of these tests were those of memory, particularly verbal memory. There were no differences on standardized tests of academic skills or executive functions.