Fitness/Competency to Stand Trial: A Conceptual Overview, Review of Existing Instruments, and Cross-Validation of the Nussbaum Fitness Questionnaire

Abstract

Competency to Stand Trial or Fitness to Stand Trial (FST) is the most frequent referral issue facing forensic mental health professionals (FMHPs) and consumes considerable scarce resources in the process. This article summarizes minimalist and expanded legal approaches to FST and briefly describes three instruments developed by FMHPs to structure FST assessments. We then present evidence supporting the validity of the Nussbaum Fitness Questionnaire for efficiently screening individuals for fitness and blatant or subtle malingering. The paper ends with a number of suggestions to optimize use of these instruments within the current set of forensicmental health practices. Specifically, it is suggested that use of the screening instrument could reliably eliminate up to 70 % of current referrals for complete assessments while the more in-depth semistructured interviews be utilized to confirm unfitness, especially when the mental health professional has more than trivial doubt regarding an individual’s FST. [Brief Treatment and Crisis