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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 - PowerPoint PPT Presentation
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Developing Court Competence Developing Court Competence Through MusicThrough MusicMarch 24, 2012March 24, 2012
WRAMTA Regional ConferenceWRAMTA Regional ConferenceSalt Lake City, UTSalt Lake City, UT
Mary E. Alvarado, MT-BCMary E. Alvarado, MT-BC
Yu-Chuan Chen, MTYu-Chuan Chen, MT
Atascadero State HospitalAtascadero State Hospital
Atascadero State Hospital – A Atascadero State Hospital – A Quick LookQuick Look
• Current Population +/- Current Population +/- 10001000
• All Adult Male Forensic All Adult Male Forensic • Mentally Disordered OffendersMentally Disordered Offenders• Not Guilty by Reason of Not Guilty by Reason of
InsanityInsanity• Referrals from CDCRReferrals from CDCR• Incompetent to Stand TrialIncompetent 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• 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
• 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
• 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• 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
• 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: Mary Alvarado: MALVARADO@ash.dmh.ca.govYu-Chuan Chen: Yu-Chuan Chen: YCHEN@ash.dmh.ca.gov
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