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Consistent with nationwide trends, the number of defendants judicially ordered to the California Department of State Hospitals (DSH) for competency restoration has nearly doubled in recent years. Previous research has shown that the majority of the time, judicial rulings on competency reflect forensic evaluators’ opinions. Thus, the quality of competency to stand trial (CST) reports is critical. We examined 388 CST reports from defendants who were ultimately found incompetent to stand trial and admitted to a state hospital for restoration in 2012–2013. We evaluated the reports for adherence to both professional guidelines and current literature on the appropriate conduct of CST evaluations. Consistent with previous studies, our results showed that the reports evidenced overall poor quality and evaluators were largely unable to accurately describe the nature of the mental illness or explain how clinical factors (i.e., diagnoses or symptoms) impacted CST abilities. Notably, we found that experts board certified in psychiatry or psychology produced reports of higher quality. These findings demonstrate the continued poor quality of CST reports and highlight the importance of training. As in previous similar studies, we recommend mandatory training for experts conducting CST evaluations.

Our study demonstrates that competency to stand trial reports overall evidence continued poor quality. However, training clearly improves the quality and thoroughness of these reports. Specialized education and training for clinicians conducting these evaluations is recommended.

Over the past 2 decades, the number of defendants found incompetent to stand trial (IST) and committed to state hospitals for restoration has increased substantially in the U.S. (Wik et al., 2020). Consistent with this trend, between the fiscal years 2013/2014 and 2015/2016, the California Department of State Hospitals (DSH) saw a doubling of IST referrals and the numbers continue to rise (McDermott et al., 2020). Multiple explanations have been provided for these observed increases, one of which is an increased recognition of mental disorders by the court (Sewell, 2016). Generally, concerns about competency are raised by the defense attorney, who identifies a possible mental health issue. If the judge determines that this concern is valid, a...