[Neal Conan:] Yesterday, a federal judge ordered a mental evaluation for Jared Loughner to determine whether the suspect in the shootings in Tucson is competent to stand trial. U.S. District Judge Larry Burns ordered Loughner to a Federal Bureau of Prisons facility in Springfield, Missouri. Loughner's defense attorneys argued that an independent expert, not a government-appointed evaluator, should conduct the exam, and that moving Loughner out of Tucson for the assessment could harm him. Mental competency evaluations are common features on TV police procedurals like "Law & Order," but what exactly are they? How are they conducted? What role do they play in the criminal justice system? If you're a mental health professional, does the mental evaluation system work? Give us a call: 800-989-8255. Email: talk@npr.org. And you could join the conversation at our website. That's at npr.org. Click on TALK OF THE NATION. And joining us now is Dr. Eileen Ryan, an associate professor of psychiatry and neurobehavioral sciences at the University of Virginia, medical director of their Institute of Law, Psychiatry and Public Policy. She's on the phone from her office in Charlottesville, and nice to have you on TALK OF THE NATION today.
[Dr. Eileen Ryan:] Hello.
[Neal Conan:] And I guess the first thing we should establish is what this examination is not. It is not to determine whether the person in question was sane at the time of the alleged crime.
[Dr. Eileen Ryan:] That's correct. That's a completely different type of forensic evaluation.
[Neal Conan:] So what are they doing here?
[Dr. Eileen Ryan:] Well, the requirement that a defendant be competent to stand trial dates back to 17th century, and it's rooted in English common law. And in American courts, competency really has its roots in the concept of fairness. So we really want to see if the defendant has the capacity to get a fair trial. And what the competency to stand trial standard is, that's been actually set by the Supreme Court. They held that competence to stand trial is a fundamental is really fundamental to our system of justice. And the way that they defined competency to stand trial is whether the defendant, whether the accused, has sufficient present ability to consult with his or her lawyer with a reasonable degree of rational understanding, and whether he or she has a rational as well as a factual understanding of the proceedings against him or her.
[Neal Conan:] Would could you summarize that by saying participate in their own defense?
[Dr. Eileen Ryan:] Need to be able to understand what's going on, what they're charged with, what the potential penalties are. And they need to be able, yes, to assist their lawyer in their own defense.
[Neal Conan:] And what happens if they are judged not competent to stand trial?
[Dr. Eileen Ryan:] Well, that's a determination that's made by the court. A psychiatrist or a psychologist performing that evaluation is basically opining as to whether that person has the capacity the capacities necessary for competence. If the judge rules that they're not competent to stand trial, then they the question would be, can they be restored to competency? And in the case of severe mental illness, typically that restoration to competence would involve treatment of the psychiatric disorder...
[Neal Conan:] And that could...
[Dr. Eileen Ryan:] ...typically with medication.
[Neal Conan:] And that could take years.
[Dr. Eileen Ryan:] It potentially could, but it often takes less than that.
[Neal Conan:] And you say medication. Could a prisoner be forced to take medication against his or her will?
[Dr. Eileen Ryan:] Well, there have been cases in which that has, you know, that has come up. And, yes. You know, in terms of serving the purpose of justice and bringing someone to trial, yes, someone can be forced to take medication against their will. That's typically after an extremely long process in which the defense attorneys are, you know, bringing motions to the court regarding that issue.
[Neal Conan:] Okay. And there is then the question of location. Why would the judge order Jared Loughner removed to a facility, all the way from Tucson to Springfield, Missouri?
[Dr. Eileen Ryan:] Well, there can be many reasons. I'm not sure what they would be in this particular case. It really would depend on the defendant him or herself, what the case is about, what the ideas are on the part of the defense attorney and the prosecutor. There's nothing inherent in a competency to stand trial evaluation itself that demands that it be one place or the other. But everyone, the court, the defense and the prosecution, you know, really, has an interest in and investment in a very thorough examination. And a thorough examination, you know, needs to be performed under the conditions that are, really, the most likely to produce valid and reliable results. So sometimes, in an inpatient facility, the you can do a more thorough evaluation.
[Neal Conan:] Okay. So that might explain but why might the prosecution be interested in saying this should be a Bureau of Prisons facility in Springfield, Missouri, halfway across the country, and the defense say, wait a minute, we would prefer an independent expert right here in Tucson?
[Dr. Eileen Ryan:] Well, I don't know why in this particular case. You know, typically, attorneys have their reasons for wanting particular evaluations done in by certain people in certain places. One thing may be that there may be the perception that a certain type of evaluation may be done by, for example, psychiatrists or psychologists employed by the government.
[Neal Conan:] Mm-hmm.
[Dr. Eileen Ryan:] And so given the fact that we have an adversarial system, there may be a desire to, you know, obtain an expert that, for example, the defense may know does a very thorough evaluation versus an expert that the defense does not know. Same thing can be true of the prosecutors.
[Neal Conan:] For sure. Everybody prefers their own, I guess.
[Dr. Eileen Ryan:] Right.
[Neal Conan:] And in such an evaluation, obviously every one is different, but typically, what kinds of questions are asked?
[Dr. Eileen Ryan:] Well, you're really doing a thorough evaluation that is looking at first of all, a forensic evaluation is different from a clinical evaluation in that there isn't confidentiality. And so the defendant needs to know that. There isn't a doctor-patient relationship. You're looking at relevant background information, and you're looking at information and presenting that information in a way that would be relevant to competency. So you don't want information, for example, in a report that is going to, in any way, bear on the alleged offense. So you're looking at family history, personal history, educational history, particularly if one of the areas that's being looked at in the competency evaluation is some sort of cognitive deficit, for example, mental retardation. You're looking at relationship history, medical history can be very important, drug and alcohol history, and then, of course, psychiatric history.
[Neal Conan:] Mm-hmm.
[Dr. Eileen Ryan:] You're also doing any relevant evaluations, examinations that need to be done, including psychological testing if that is indicated. If there isn't an indication for specific psychological tests, there's no reason to do them. A mental status examination, which is really kind of the psychiatric equivalent of a physical examination, in which you're examining the defendant's thought processes, thought content, really trying to understand if there is evidence of a severe mental illness, for example, psychosis.
[Neal Conan:] Mm-hmm.
[Dr. Eileen Ryan:] And then you're asking questions that are specific to that competency standard that I mentioned before. You know, you want to ask questions that would get to whether the defendant understands and appreciates the charges, whether they understand the trial process, whether they've got the capacity to work with their attorneys around preparing a defense.
[Neal Conan:] Mm-hmm.
[Dr. Eileen Ryan:] For example, someone who is psychotic and paranoid may feel like his or her defense attorney is in some sort of a conspiracy with the judge and with the prosecution. That would obviously impair the person's ability to work with their attorney. So you're looking at those kinds of questions.
[Neal Conan:] Let's get a caller in on the conversation. We're talking with Dr. Eileen Ryan about the competency, the mental competency exam process. And we'll start with Nicholas, Nicholas with us from Sacramento.
[Nicholas:] Yeah. How you doing today, Neal?
[Neal Conan:] I'm good. Thanks.
[Nicholas:] Yeah, my question actually is that your guest has made a comment that if a person is, you know, is found that at the time maybe they're not completely mentally sound, that they can be sometimes induced to take medication, and as a result, bring somewhat be brought back to competency. But how does that actually hold up as far as when the crime is committed, they obviously weren't of sound mind? So to re-induce some kind of a state of consciousness, I don't understand I guess I'm having a problem with, if they weren't competent at the time, but yet if drugs are going to make them aware of the situation, does that really change their mental state at the time of the crime?
[Dr. Eileen Ryan:] Well, that's a great question. And it doesn't, because those are two different evaluations. The competency to stand trial is very much a here-and-now assessment. So really, someone needs to be competent to stand trial in order to go forward. So in order for someone to, for example, to progress to the point where they are asserting an insanity defense, for example, which is mental state at that time of the alleged offense, they need to be competent in order to present that defense. So you can be competent to stand trial. And you can be competent to stand trial without medications, without you can have a competency to stand trial evaluation and be found by the judge competent to stand trial without ever being forced to take any medications but still assert an insanity defense, because that would really be pertaining to the way you were at the time that the alleged crime was committed.
[Neal Conan:] Nicholas, thanks very much.
[Nicholas:] Thank you very much.
[Neal Conan:] We're talking about the mental competency examination. You're listening to TALK OF THE NATION from NPR News. And let's see if we can go next to this is... this is Glen, Glen with us from Columbus, Ohio.
[Glen:] Yes. I have two points. First one's regarding juveniles. We get into some sticky issues with this where a juvenile is at risk of punishment as an adult, but of course, they don't get any of the rights and responsibilities of an adult. And if they're found innocent, they go back to being children again. Is there any kind of evaluation to determine that a person who's 16 is actually of the sound mind of an adult when they committed a crime, or is it just a dilemma of the prosecutor? And I had a second point.
[Neal Conan:] And obviously, this does not apply to Jared Loughner, who is 23. But anyway, go ahead, Eileen Ryan.
[Glen:] Right.
[Dr. Eileen Ryan:] Well, that's a very complicated issue and it really it sort of varies from state to state. In many states, most states, juveniles, depending on their age and the legislation in various states, can be tried as adults. Some states, that's 16. For some states it's 14. And if you are tried as an adult, then you are able to have the same possible defenses...
[Neal Conan:] But that determination of being tried as an adult, that's a determination by the prosecutor, not by any examination by anybody.
[Dr. Eileen Ryan:] Well, whether or not one is tried as an adult, whether one is bound over to adult court, that's a determination that can be made by -depending on the state again it can be made by legislature. I mean, there are certain states in which for certain crimes such as murder, the prosecutor doesn't make that decision. You're automatically tried as an adult if you're a certain age. Now, when that happens and in states regardless of whether you're tried as an adult or whether you remain in juvenile court, you can obtain a competency to stand trial evaluation.
[Neal Conan:] And...
[Dr. Eileen Ryan:] So there's competency to stand trial evaluations that are done on juveniles who are staying in the juvenile system, and then there are competency to stand trial evaluations of juveniles in the adult system.
[Neal Conan:] And...
[Dr. Eileen Ryan:] So regardless of where you are, you have to be competent to stand trial to proceed.
[Neal Conan:] And let's go next to Tim. And Tim is with us from Hyde Park in Utah.
[Tim:] Yes.
[Neal Conan:] Go ahead, please.
[Tim:] You hear me okay?
[Neal Conan:] Yeah.
[Dr. Eileen Ryan:] Yeah.
[Tim:] My brother was recently convicted of the kidnapping of Elizabeth Smart. And he was repeatedly found incompetent to stand trial in the state court and spent a lot of time in a hospital because of a delusional psychosis. Well, finally the federal court, when they charged him on that, they hired a guy named Welner from out of New York, paid him $500,000, and he finally declared my brother competent to stand trial. But my brother was not willing to actually talk to most of these people. So they did the competency off of statements of family members, statements of, you know, the, you know, young woman who was kidnapped and so forth.
[Neal Conan:] And...
[Tim:] And finally, that's the way they kidnapped I mean, they finally convicted him based on that. But we...
[Neal Conan:] And I don't mean to cut you off, but we're running out of time. And I wanted to give Eileen Ryan a chance to respond.
[Tim:] Oh.
[Neal Conan:] And she may not be familiar with this particular case, but that procedure in general.
[Tim:] Yeah, we kept...
[Neal Conan:] Yeah, let's let Dr. Ryan...
[Tim:] OK.
[Dr. Eileen Ryan:] Well, you know, again, these are very much individualized cases, and competency really is contextual. And one of the things that's very important is that it's got to be the evaluator is looking at many things. Again, I'm not commenting on that particular case or the case of this man's brother. But one of the things that all forensic evaluators are assessing is whether someone is incapable of working with his or her attendee...
[Neal Conan:] But if the person refuses to cooperate with the examiner, then you could go to other...
[Dr. Eileen Ryan:] Exactly. It's unwillingness versus incapacity.
[Neal Conan:] Yeah. Okay. Tim, I'm sorry we ran out of time. That's an interesting question. Tim joined us on the line from Hyde Park in Utah. And, Dr. Ryan, thank you very much for your time today.
[Dr. Eileen Ryan:] Sure.
[Neal Conan:] Dr. Eileen Ryan, associate professor of psychiatry and neurobehavioral sciences at the University of Virginia, with us on the line from her office in Charlottesville. Tomorrow, legendary comedian Carol Burnett joins us to take your calls. Be there for that. This is TALK OF THE NATION, from NPR News. I'm Neal Conan, in Washington.