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.