Transcript 2012-WRAMTA-Competence-presentation

Developing Court Competence Through Music
March 24, 2012
WRAMTA Regional Conference
Salt Lake City, UT
Mary E. Alvarado, MT-BC
Yu-Chuan Chen, MT
Atascadero State Hospital
Atascadero State Hospital – A Quick Look
• Current Population +/- 1000
• All Adult Male Forensic
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Mentally Disordered Offenders
Not Guilty by Reason of Insanity
Referrals from CDCR
Incompetent to Stand Trial
Incompetence to Stand Trial
• Most countries don’t have competency
to stand trial laws
• U.S. states have fairly consistent laws
from state to state
• Theory is that it is improper to try
someone in abstentia
• Mental illness could constitute “mental
abstentia”
Incompetence to Stand Trial
• Law distinguishes those who have free choice
to be present versus those who do not
(mentally ill)
• Competency to stand trial standard two
pronged
• Rational understanding of charges and procedures
• Ability to rationally assist attorney in presenting
defense
Incompetent to Stand Trial
• Dusky v US:
• Defendant must have a “present ability to consult with
his lawyer with a reasonable degree of rational
understanding” and “factual and rational
understanding of the proceedings”
Jackson v Indiana:
• Placed time limits on length of confinement as
incompetent to stand trial
• Reasonable period to determine there is substantial
probability of regaining competency in foreseeable
future
Incompetent to Stand Trial
• Sell v. U.S. 2003
• Involuntary forced medications is balance between
government interests and individual rights
• Non-dangerous defendants can be forced
medicated only under certain conditions
• Treatment is medically appropriate
• Side effects won’t undermine fairness of trial
• Less intrusive methods unlikely to work
Who Decides Incompetence???
• Court officer (DA, PD, judge) can raise
doubt
• Judge determines “official doubt” based
on substantial evidence
• Court appoints 2-3 evaluators
• Speedy trial clock stops
• Bail revoked, if on OR and taken into
custody
Who Decides Incompetence?
• Hearing held after receipt of reports
• Jury trial if either side requests
• Hearings can only occur in Superior
Court
Competency Program in ASH
Admission Unit
• From 1st day to two months or so
• Goal: Become competent to stand trial by
attaining mental stability, familiarity with the
treatment program at ASH and participation in the
competency tests
Treatment Unit
• Currently ASH has 2 treatment units.
• Goal: Essentially the same as on admissions
however treatment units also clarify diagnoses,
refine medication regimens and enhance
resources as necessary to assist with attaining
competency.
Competency Tests
• R-CAI (Revised-Competency Assessment
Instrument) or other instruments as indicated
by the needs of the patient
• Mock Trial
• Clinical Staffing
• Forensic Staffing
• Outcome: 1) Competent to stand trial,
2)Malingering, and 3) Non restorable to
competency
The Clinical Picture
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Mentally Ill
• Upon admission typically
psychotic, unstable
• Poor self care
• Possibly aggressive
• Responds well to medication
• Once in stabilization mode is
willing to participate in
treatment to attain competency
• May have behavioral
issues/delusions that will impact
upon competency
• May have learning or cognitive
deficits that slow progress
towards competency
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Malingering
• Upon admission appears non
psychotic, easily able to make
needs known
• Often excellent self care
• Becomes the “king pin” on the
unit
• Shows no response to
medication or atypical response
• Unwilling to comply with testing
and treatment
• Often has multiple physical
concerns needing staff
attention
• Can be aggressive if needs are
not met to satisfaction or as a
means of intimidation
2011 Statistics
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Total IST admitted to ASH – 268
Total returned to court (all reasons) – 381
Average length of stay – 139 days
Total passing all tests – 356 (average 126
days)
• Discharged with Malingering Dx – 19
• Discharged as “non restorable” – 21
• 7 completed the 3 year statute
Competency Treatment Groups
Trial Competency
• Has demonstrated ability to
concentrate for extended
period
• Goal: To improve
knowledge of court
information
Competency through
Activities
• Typically more challenged
patient with poor ability to
concentrate and needs
repetitive information
• Goal: To improve
knowledge of court
information
• Additional Treatment as
Indicated
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Medication Education
Substance Abuse
Depression Management
Neuro/Cognitive Services
Compulsory Education
Anger Management
Leisure & Recreation
Social Skills
Medical/Physical
Music Therapy at ASH
• Currently 18 Music Therapists and 1 intern
• Groups provided both in a centralized music
center and throughout the hospital
• Groups range from insight oriented lyric
analysis to emotive improvisation to social
expression and just good old bands. (which
provide all of the above!)
Developing Court
Competence Through Music
• All Functioning Levels
• Goals:
• Address ambivalence about returning to court
• Identify problematic behaviors contributing to
barriers to competency
• Provide “safe space” emotional expression for
feelings related to being arrested, charged and
committed for treatment
• Reinforce court information
• Increase attention span
Characters of the Court
Improvisation
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Judge
District Attorney
Public Defender
Bailiff
Defendant
Witness
Jury Member
Friend
Family Member
Court Reporter
• Objectives:
• Reinforce knowledge
of key roles in the
court room
• Warm up and ground
the group
• Encourage focus and
attention
• Interpret non verbal
communication
Court Scenario Process
• Objectives
• Non verbal expression of feelings related to
returning to court
• Clarification of concerns related to IST issues
• Pre problem solving of potential situations IST
patients could encounter upon return to court
• Resolution of ambivalence for those attempting to
avoid return to court due to fears of long sentence,
“injustice of the system”, etc.
Court Scenario Chant
• “The Court is the place that needs your
face”
• ….so get there
Structured Songwriting
• Objectives:
• Expression of concerns about being found
Incompetent to Stand Trial
• Group Identity/Group Cohesion as a
distinct population at ASH
• Instillation of hope during a time of great
uncertainty
• Humor
Developing Court Cooperation
Through Music
Mary Alvarado: [email protected]
Yu-Chuan Chen: [email protected]