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A new research instrument, the MacArthur Structured Assessment of Competencies of Criminal Defendants (MacSAC-CD), was administered to three groups of women defendants: those adjudicated incompetent and committed to forensic hospitals for treatment (n = 38), jail inmates receiving mental health treatment (n = 18) who had not been adjudicated incompetent, and randomly selected jail inmates (n = 50). Measures of the competence-related abilities of understanding and reasoning were found to have satisfactory indices of internal consistency (coefficient alpha), and all measures correlated in the expected direction with measures of global psychopathology, psychoticism, and verbal cognitive functioning. Between-group mean scores were all in the expected direction and were statistically significant for four of seven measures. No differences in MacSAC-CD performance were found in comparisons of male and female defendants who had been adjudicated incompetent, nor were differences found in the performance of male and female jail inmates.

A set of measures assessing competence-related abilities was administered to three groups of criminal defendants: a group committed for restoration of competence, a group identified by jail personnel as mentally ill but not incompetent, and a group without identified mental disorder. Data from this study were used to test key assumptions bearing on the legal criteria for adjudicative competence. The data show that among defendants able to understand the nature and purpose of the criminal proceedings, a significant proportion have an impaired ability to appreciate their situations as criminal defendants or to communicate relevant information to counsel; among defendants able to understand the proceedings and to assist counsel, a significant proportion have impaired decision-making abilities; and among defendants able to understand the nature and consequences of decisions to plead guilty or waive a jury, a significant proportion have impaired abilities to appreciate the significance of these decisions or to rationally manipulate information pertinent to making them. These findings highlight the importance of disaggregating the components of adjudicative competence.

Half a decade ago, the Zinermon court announced the need for clinicians to evaluate the competence of people with mental illness to consent to voluntary hospital admission, but the court did not specify the test of capacity that mental health professionals should use. As has occurred in other areas dealing with legal competence, there is a need for the field to develop standardized assessment procedures for evaluating capacity to consent to voluntary hospitalization. Both theoretical and practical considerations suggest that these procedures should be modeled after what S. K. Hoge has termed a "weak" model of consent. This and other studies of the ability of mentally ill persons to understand disclosed information suggest that their level of understanding may be assessed optimally with measures that utilize recognition rather than recall response elicitation formats.

The legal construct of competence to stand trial, or "adjudicative competence," is based on the premise that some mentally disordered defendants have impaired abilities when compared with most defendants and that adjudication should be barred if these competence-related abilities are significantly impaired. Where the line is drawn between sufficient and insufficient abilities has important consequences: as a result of being adjudicated incompetent, defendants may be detained and treated involuntarily and their trials will be delayed. However, no studies have systematically compared the capacities of relevant groups of defendants. In this study, 84 criminal defendants--42 of whom were hospitalized as incompetent and 42 of whom were regarded as unquestionably competent--were administered three instruments measuring capacity to understand legally relevant information. Incompetent defendants performed more poorly on all measures of understanding. Twenty-eight incompetent defendants were administered the measures a second time, after restoration to competence. Restored defendants improved their performance on all measures of understanding and their performance was similar to that of normal, competent defendants.