The Competency Assessment of Edward Wilson- Elizabeth Hall

The Competency Assessment of Edward Wilson
Often the role of the forensic psychologist involves assessing, restoring, and determining mental functioning levels to decide whether an offender is mentally fit to stand trial.  According to Greene, Heibrun, Fortune, & Nietzel, (2006) a person is fit to stand trial only if they can understand the proceedings taking place during the trial, and, can also confer with their counsel with relative rational understanding. 
In cases of mental diseases such as schizophrenia, patients often stop taking their prescribed antipsychotic medication and commit crimes. We will explore one such case in detail, and entail what procedures forensic psychologists use to complete a competency assessment.  This includes, defining schizophrenia and its symptoms, what additional background information I will need to complete the assessment, what other people I need to interview about the case, if Mr. Wilson meets competency criteria to stand trial, what questions I used to determine this, and his propensity for any further violent actions (Greene et al, 2006). 
Eastern State Hospital Behavioral Health Client Case File
Client: Wilson, Edward            DOB: 8/15/1979     Client CIS ID# ES10854
Address: 3543 Sunnyvale Lane                                Client SSN: 401-85-7530
City: Lexington   State: KY   Zip: 40517                    Health Insurance Co: Anthem
Phone (859) 849-5298      E-mail docplocky405@yahoo.com  Health Plan: Access
Case Type: Competency Assessment for Trial         Initial Patient Screening Date: 2/12/2004
Background Provided By Previous Facility
Medical History: Mild mental retardation I.Q. range, history of Mental Health treatments beginning in 1996 with his hospitalization for self-inflicted gunshot wound to mouth.  Institutionalized again in 1998, after incident with mom and sister because he became enraged, and tried to choke her, all the while shouting at his mother, “she should have been destroyed years ago”.  During this hospitalization, he presented with hallucinations and delusions, which resulted in a diagnosis of paranoid schizophrenia.  After this diagnosis, he was treated with the antipsychotic medicine Clozaril®), which stabilized his symptoms and Edward, was released.
Criminal Case Information:  2/4/2006, Officers are dispatched to the residence of John and Jane Wilson to investigate a shooting at the residence.  Two bodies are evident at the scene, a man and a woman, John and Jane, her with her head in his lap.  It was obvious that Jane had been murdered in the car’s right front passenger seat and dragged to her current position.  Witnesses on the scene were there to visit, and found bodies.  The client was also there as well, and as indicated in the police report met the witnesses outside, and told them to call an ambulance as “something had happened there” and told to leave.  The client was consequently arrested, and charged with two counts of first-degree homicide.                        Figure 1
What is Schizophrenia?
Schizophrenia is an unending brutal immobilizing mental disease and appears in the latter teenage years or early twenties for males and later in women, usually in the twenties and thirties (Spearing, 2002).  The symptoms of the disease are not only hard to function with but downright alarming.  People who suffer from this disease suffer from hallucinations, which are disruptions in sensory perception causing patients to see visual items that do not exist.  Schacter, (2009) defines the disease as “a disorder characterized by the profound disruption of basic psychological processes; a distorted perception of reality; altered or blunted emotion; and disturbances in thought, motivation, and behavior”.  Their behavior may be categorized as catatonic, grossly disorganized, and they may have disorganized speech.  They also suffer from delusions which are false beliefs which are often extravagant and peculiar and negative symptoms which are described as “emotional and social withdrawal”, indifference, and lack of speech (Schacter, 2006).
There are five different types of schizophrenia states Schacter (2006).  Paranoid, catatonic, disorganized, and undifferentiated are what they are called.  The last is known as residual schizophrenia. Edward Wilson has been diagnosed with paranoid schizophrenia, which gets its name from the symptoms. The client suffers from hallucinations and delusions that make them think that someone is out to get them.  The DSM-IV-TR notes that a diagnosis can be made, when two or more of the symptoms mentioned earlier present themselves emerging during an uninterrupted session of 1 month and symptoms of the disease are persisting on and off over a period of six months (Schacter, 2006).

Additional Background Information Needed
  On February 12, 2004, Edward Wilson was ordered to Eastern State Hospital by Judge Anne Morken for mental competency screening and restoration services in relation to his pending legal case.  This was determined after he met with his public defender, and the lawyer requested competency screenings to determine if Mr. Wilson was in fact competent enough to stand trial after only ten minutes of consultation.  He is facing two counts of first-degree murder in relation to the deaths of both his mother and father.  Upon initial intake, the information shown in Figure 1 above was all information provided by the jail with client arrival.
 According to the Northern Arizona Regional Behavioral Health Authority (Narbha), (2008),   I need more information than I have been given in this small example of the history of Edward Wilson just to begin services.  During the initial intake process, staff had him fill out the Behavioral Health and Medical History Questionnaire, as it is important to rule out any medical condition that could be causing the symptoms and to get family history (Greene et al, 2006).  They also inquired about any special needs he may have, such as mobility, hearing, and visual impairment assistance, childcare assistance, and if necessary an interpreter.  Another thing collected at intake would be key contacts such as legal guardian, grandparents, family friends, and any school, probation officer, or any other agency involved with the client (Narbha, 2008).
Other Information Needed on Wilson  
After assessing the information on the Behavioral Health and Medical History Questionnaire, and information provided at intake I sent Mr. Wilson to see our staff MD, Dr. Mitihrumgehen.  This is because in our initial interview, Edward admitted to several factors relevant to his competency and environment.  The first thing admitted was the fact that he was not taking his medicine at the time of the crime, because it was causing him to sleep too much and causing his lips to smack involuntarily (Allwine, 2010).  The second thing he noted is that as a teen, he had discovered the “Lost Rock of Creation”, and it had five animal faces carved in it, which he promptly sent to the CIA, and that he thought that his mother was a witch and his father a member of the KGB at the time of crime commission.  I needed lab-work to ensure that all of his vital organs such as liver, and kidneys are functioning properly, and for him to have a physical examination as well to rule out any other medical reasons causing symptoms (Spearing, 2002).
Collateral Contact Information on Wilson
It is important to talk to any family members able to be reached, clergy, family friends, and any agencies involved with him and his care.  The reason is for assessing genetic ties, and personality traits to the schizophrenia that seems to be causing his symptoms and these people will know him best (Greene et al, 2006).  They will also be able to provide details as to the specifics of his symptoms.  Because of Wilson’s mild mental retardation coupled with the symptoms presented, Wilson’s GAF score was only 38 upon intake.
 After gathering the data from key contacts, Dr Mitihrumgehen and I decided that the best course of action for restoration would be to change Edward’s medicine from Clozaril® that he was taking before, to Haldol®, since it can be injected, and he will not need to take pills every day.  Since it is longer lasting, may have less side effects on patient, and will not require as frequent dosing.  It may have fewer side effects because everyone reacts differently to medication (Spearing, 2002).
Wilson’s Competency Questions 
Competency to stand trial rests on the ability to confer with one’s counsel, to understand the charges brought against him, and to assist counsel in own defense (Greene et al, 2006).  In order to establish competency in Mr. Wilson there are questions I will have to ask in relation to legal proceedings, roles each player assumes in the legal process, the charges that have been brought against him, and if he understands the possible results that could happen when the trial is over.  During the course of a week, I have asked him about the pending charges he faces.  I have also asked what the judge, juror, and lawyer’s roles are in the proceedings.  I have asked him if he still believed his mother was a witch, and his father a member of the KGB.  I have observed him interacting with counsel, and have concluded that Edward Wilson, despite the fact that he is back on medication and somewhat stabilized, is not competent enough to stand trial (Greene, et al, 2006).
Wilson’s Competency Findings
When Wilson was asked about the trial, and the players involved, he still displayed delusional thoughts, such as the Judge works for the KGB, as well as his father. According to Edward, the jurors were perceived by him to be a coven of witches waiting for his mother to lead them.  He also did not appear to be able to converse with his lawyer very well, as he believes that counsel is spying on him.  He received a low score on the Competency Screening Test (CST), which I administered, and is the initial test for competency (Greene et al, 2006).
The CST testing consists of 22 questions which measures competency from the client answers according to Greene et al (2006).  A reasonable response nets a score of two, while, a response that is questionable rates one point.  If an answer were not acceptable, or unreasonable, the respondent would receive a zero for that question.  The higher score received, the more competent one is.  Mr. Wilson also completed the Interdisciplinary Fitness Interview (IFI).  This assesses patient knowledge of eleven psychopathological symptoms, and five areas of the judicial system. In Edward’s case, he received scores that were below acceptable for competency (Greene et al, 2006). 
Future Violence Assessment
According to Spearing (2002), normally people diagnosed with schizophrenia are not prone to violence anymore than someone without the disease; however, those with paranoid schizophrenia especially when not on antipsychotic medication are prone to violence.  In the case of Edward Wilson, we have changed the medicine to Haldol®, in order to ensure that it is easier for the patient to stay medicated, as it is a longer lasting medicine and doses are taken less frequently.  I would say that as long as Edward stays on the Haldol®, propensity for future violence is slim, however if patient refuses medicine, or strays from the regimen the possibility is much larger due to the paranoid delusions and hallucinations that this form of the disease is known for.
A large portion of the work that forensic psychologist perform deals with assessing competency notes Greene et al (2006).  Some of these competency tests are for other reasons, but good portions of these cases are to assess competency to stand trial.  This is because in the United States one must be competent in order to stand trial.  This means that one can assist with their case, confer with counsel, understand the charges brought against them, and understand the roles of the players involved such as the judge, jury, and counsel (Greene et al, 2006).
In the case of Edward Wilson, while he is somewhat more stable at this time, is still displaying signs of delusional thoughts and paranoia, which is common amongst paranoid schizophrenics.  While he is currently on Haldol®, and stabilized, the medicine only helps the frequency of the symptoms, and has not eliminated them entirely.  At this time, I feel that with the length of time this trial may take, and the current situations with this disease, that Mr. Wilson’s mental state is conducive to stand trial at this time.  I would recommend that he stay in psychiatric care at this junction, and for him to be retested after a period of three months.

Allwine, R. PharmD, BCPS, (2010).  Medications: Clozaril® (clozapine).  National Alliance on Mental Illness.  Retrieved From: http://www.nami.org/Template.cfm?Section=About_Medications&template=/ContentManagement/ContentDisplay.cfm&ContentID=8176
Greene, E., Heibrun, K., Fortune, W.H., Nietzel, M.T. (2006).  Psychology and the Legal System (6th Ed.).  Florence, Kentucky.  Cengage Learning
Narbha, (2008).  Northern Arizona Regional Behavioral Health Authority.  PM Section 13.0 FORMS AND ATTACHMENTS.  Retrieved From:  http://www.narbha.org/for-providers/provider-resources/provider-policy-manual/forms-attachments/
Schacter, D.L., Gilbert, D.T., & Wegner D.M. (2009).  Psychology.  New York, NY.  Worth                    Publishers
Spearing, M.K. (2002).  Overview of Schizophrenia.  NIH Publication.  Retrieved from:             http://www.schizophrenia.com/family/sz.overview.htm#schiz3

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