Homeless mentally disordered defendants: competency to stand trial and mental status findings.

D. A. Martell, R. Rosner and R. B. Harmon,
Bull. Amer. Acad. Psychiatry & the Law 22(2): 289-95, 1994.
This study examines relationships between homelessness and findings of incompetency to stand trial in a sample of mentally disordered offenders. All 263 defendants referred for competency evaluation over a six-month period by the Criminal and Supreme Courts in Manhattan were studied. Each defendant was evaluated by two forensic psychiatrists using a structured interview protocol. After removing "false-positive" referrals, 42 percent of the mentally disordered defendants referred to this setting were found to have been homeless at the time of their instant offense, making them more than 40 times more likely to be homeless than the general population and 21 times more likely to be homeless than the rest of the city's mentally ill population. Homeless mentally disordered defendants were significantly more likely to be found incompetent to stand trial than domiciled defendants (p < .007) but also presented with significantly higher levels of psychopathology. Examination of mental status findings revealed that homeless defendants were more likely to be psychotic, including a higher incidence of formal thought disorder and ideas of reference. The relationship between homelessness and incompetency seems to be mediated by psychotic symptoms, suggesting that these defendants are not being found incompetent because they are homeless, but that homeless defendants are more likely to be psychotic and to exhibit a greater degree of psychopathology. The clinical and public policy implications of these findings are discussed.