Vanessa Leite
Forensic Critique #1
Box 100
July 13, 2012

EVALUATION A 1. Was there a mental disease or defect at the time of the crime? If yes, what type?
I believe Ms. Y exhibited a deficit during the crime and would attribute that deficit to some kind of developmental and intellectual impairment. The evaluation mentioned review of previous assessments in which Ms. Y was given a diagnosis of Mild Mental Retardation (Code 317). This type of diagnosis includes criteria of an IQ level of 50-55 to 70, an ability to achieve social and vocational skills for minimum self-support, but also may need supervision and guidance. Individuals diagnosed with MMR also tend to show impairment in communication, self-care, social and interpersonal skills, home living, use of community resources, self-direction, academic skills, work, health, leisure, and safety. Ms. Y has a history of being able to obtain work that requires minimal skills but demonstrated an inability in performing simple addition and subtraction as well as being unable to iron a shirt. Also, supplemental information indicates a lack of mental capacity consistent with what is indicated by the current assessment. The need for assistance is more critical for individuals diagnosed with MMR when they experience unusual social or economic stress. These individuals are able to live independently or in supervised settings with proper support. Ms. Y has also shown a lack of understanding of the event in which she wrote a “hot check” which she feels is the reason for her current case rather than the violation of her probation.
In addition, per the report Ms. Y was placed in the Intellectually Impaired range according to results from the Raven Standard Progressive Matrices, which is a test that also takes into account an individual’s language barrier. The Neurobehavioral Cognitive Status Exam also indicated her to be severely impaired in the area of Reasoning which includes an assessment of judgment. This is significant to her case as she would not be able to understand finances and the principle of writing a check and potential consequences. She reported that she pled guilty to the misdemeanor but only because she was told to do and the individual at the Welfare Department was suppose to explain her situation to the state. There seems to be a disconnect with her ability to understand the offense is the violation of her probation in not reporting the misdemeanor to her probation officer. She is focused entirely on the check instead and feels she has not done anything wrong.

2. What appeared to be the causation of the offense?
It seems the causation of the offense is Ms. Y’s inability to understand and use good reasoning skills to report to her probation officer that she had written a bad check. This is consistent with an individual with MMR to demonstrate a lack of self-direction and communication skills. This is based on the statement made by Ms. Y to the evaluator that she made the assumption “Mr. Mason of the Welfare Department had taken care of the matter…” and that a letter would be written to the state with an explanation of her situation. It appears that she has a limited understanding of the fact that writing a bad check is wrong, but did not feel as though that is what she did and therefore, did not report the incident to her probation officer. She also felt her guilty plea was made due the thought of not having another option and does not believe she committed a wrongful act and the case is surrounding that issue, not the violation of her probation. She also exhibited a lack of reasoning to communicate with her probation officer despite the assumption the incident would be rectified. Also, when she did inform her probation officer, he gave the option to her to serve her probation in a halfway house. She declined the option stating she did not believe she did anything wrong and that it would be proven in court she did not write a bad check. This, again, demonstrated her lack of understanding the reason behind her charge.

3. Was there volitional impairment? If yes, what factors is that based on?

I do not believe there was a deliberate intention to appear impaired. The collateral information reviewed by the examiner also indicated Ms. Y possesses intellectual impairment as well as reports by her family. Her family reportedly provided statements testifying to Ms. Y’s inability to care for herself, and being in need of assistance. Also, previous assessments and the most current evaluation presented with results illustrating her deficits. The examiner’s observations during the evaluation indicated the confusion and inability to understand the nature of her case. Ms. Y was cooperative with the procedures and conveyed a willingness to assist the examiner in his assessments. The detection of MMR is sometimes difficult because individuals with this impairment have a tendency to try and hide their limitations. However, those limitations appear under stressful circumstances such as this evaluation in which she was unable to explain her answers with more detail or even grasp the nature of offense.
Ms. Y also became frustrated during testing as the course of certain measures of intelligence and cognitive ability became more complex. I believe it is unlikely she has the capacity to intentionally demonstrate impairment given her reported history and collateral information which is consistent with the current assessment.

4. What are your findings for competency for this evaluation? Does it meet the burden and standards of proof? Explain—write your findings and justify your position for competency to stand trial.

I do not believe Ms. Y is competent to stand trial, but I also believe that further testing would need to be performed using instruments designed specifically for persons with MR, such as the Competency Assessment for Standing Trial for Defendants with Mental Retardation (CAST-MR). This test addresses the elements of the Dusky standard and it would assist in objectively emphasizing her mental state that is consistent with interviews and previous reports. The current assessment, in addition to previous assessments and interviews with family, indicate Ms. Y lacks the mental capacity to understand the nature of the offense as well as its consequences. She has not received any diagnosis on Axis I suggesting a disorder that could be aided with medication or some kind of therapeutic setting. Instead, her diagnoses indicate a pervasiveness that is, for the most part, unalterable. Despite findings that suggest individuals with MMR have the potential to be restored to competency it is unlikely in Ms. Y’s case that she will achieve restoration without a program designed specifically for defendants with MR. She displayed difficulty in being able to recall the facts/chronology of the events and was unable to relay information in a way that was able to be understood. She expressed a willingness to cooperate with the examiner as she felt it would be of benefit to her being proven not guilty of writing a bad check, which is her belief of the entire purpose of the assessment when in reality it is for violating her probation. Also, she was unable to complete simple tasks during administration of cognitive testing measures as well as omitting a significant number of questions on the MMPI-2. In addition, per previous reports, Ms. Y has been described as lacking the proper mental capacity to understand her situation and also lacking the ability to care for herself without some sort of supervision and/or assistance.
Ms. Y also had been given the option of serving her probation in a halfway house. This would provide her the proper supervision in an environment considered to be safe as opposed to returning to the prison setting. She declined the option because she lacks the understanding of her offense of probation violation and does not realize she may potentially return to prison. It is known that individuals with intellectual impairment tend to suffer more in prison for various reasons. These reasons include being brutalized by other prisoners, are unable to cooperate with standard regimens, and thereby do not accumulate the credits needed for release or other privileges. While Ms. Y does not understand her limitations, she also does not understand the potential consequences for her offense.

5. What are your opinions on the use of the MMPI-2 for this assessment?

I believe the use of the MMPI-2 was not the most appropriate measure. Ms. Y’s results of the Neurobehavioral Cognitive Status Exam indicated her disorientation and lack of ability to use proper reasoning skills that would have indicated the use of the personality test to be inappropriate. While the examiner did use the audiotape to administer the test, she omitted a significant number of questions which would invalidate the findings. Furthermore, the examiner then proceeded to read the questions to Ms. Y at which time she demonstrated difficulty in answering and vacillated between answers. The examiner attempted to have Ms. Y explain her answers which again invalidated the results. I think the examiner’s attempt to read the questions and request further explanation resulted in frustration and anxiety in Ms. Y and may have contributed to a desperation for her to appear virtuous and normal.
I think the examiner may have been able to gain a more clear depiction of Ms. Y’s personality using the TAT or the Sentence Completion Test. They are projective tests that allow an examiner to gain a better understanding of an individual’s personality, motivations, self-perception, problem-solving skills, and view of the world. I think this may have provided a more reliable account of Ms. Y’s mental capacity in determining her competence.

6. Are there cultural considerations to integrate into findings?

There are cultural considerations that need to be included in the results of the evaluation. Ms. Y stated she felt English was her primary language. But her first language was Spanish and based on the previous diagnosis of MMR, her lack of ability in clearly explaining her situation and providing an understandable account would indicate that she may not have a sufficient grasp of the English language. In addition, she married at age 16 with the idea that it would take her away from her family but it was not the outcome and she continued to live with them. Her husband and other relationships also asked her to stop working, which may have contributed to her lack of exposure to environments that may have provided her with learning opportunities. These opportunities may have provided her with better social and vocational skills and increased her intellectual capacity.
Ms. Y had reported that she was the youngest of seven children and that her family would treat her like a “baby”. Also, her parents were described as fighting a lot; her mother was “confused” and her father “used to drink heavily” and reportedly raped her when she was 16 years old. Ms. Y’s ethnicity, Hispanic, is also known to not always acknowledge issues in an external environment but rather to keep things within their immediate circle. In her case, the chaotic home life was not conducive to dealing properly with issues and may also have contributed to possible developmental delays.

7. What is your prediction about time required to attain competency?

I do not believe that Ms. Y has the potential to attain competency to stand trial. I believe that with her limited mental capacity and an extensive period of time having been in the legal system, it is not possible for her to gain a sufficient understanding of her offense. I believe she has an understanding of what is right and wrong given she acknowledged that writing a “hot check” is wrong and having pled guilty on a previous occasion to possession with intent to distribute marijuana. However, I do not believe that she has a sufficient understanding of probation and what it means to maintain accountability to the probation officer for any incident regarding legal issues. This includes having the belief that you are not guilty of an offense and it will be take care of by another supervisor. Ms. Y did not demonstrate the self-direction to still utilize accountability and thoroughness in communicating effectively to ensure that all parties involved in her supervision are aware of the circumstances. She appears to understand simple right and wrong, but anything more complex is lost to her.

8. What are your treatment recommendations?

I would recommend that Ms. Y remain under the supervision and guidance of her probation office, but that she also is provided assistance by someone who will be more aware of circumstances and can attest to her activity within the community. This may mean being a more permanent resident in a halfway house to provide structure while still maintaining a sense of independence.
I would also recommend that Ms. Y be trained in a hands-on setting to obtain vocational skills so she may be able to gain employment in a facility that requires exposure to more simple tasks and does not expose her to potentially complex issues, i.e., having a history of being fired for allegedly stealing money.

EVALUATION B

A. What are the strengths of this report?
The examiner referred to multiple sources of collateral information regarding legal and psychological history of the client prior to the current assessment. The examiner included quotes and some behavioral observations regarding the clients thought process as well as physical appearance. B. What are the weaknesses of this report?
I think a significant weakness of this report is the lack of cognitive, intelligence, or personality assessment. The examiner seemed to pull forward previous information, from four to five months prior, as current. He also appears to base his own information on what was included in the previous reports and that perhaps he approached the evaluation with a preconceived idea of the client. He makes assumptions as to possible issues such as substance use but does not attempt to gather more information regarding evidence to support or deny those assumptions. He also does little to ask the client to further explain his statements, but instead adds his own interpretation of what the client was mostly likely intending to say. For example, the client made a statement of “when I was in the house…” the examiner included his own assumption that the client meant the house where the crime occurred. Furthermore, the examiner refers to collateral sources as being insufficient in determining MSO but does not perform any objective measures for gathering more information that would provide evidence of some kind of psychological disturbance or even malingering. The examiner provides the opinion that he does not feel the client is mentally stable, but does not offer treatment recommendations more specific to targeting competency. C. Do you agree with the findings? Why or why not? What else is needed to arrive at a conclusion?
I do not necessarily agree with the findings as the examiner did not perform any structured measures to determine the client’s cognitions or personality details. He seems to have asked random questions based off of such measures but did not reports structured results and intertwined his own subjective perspectives accordingly. He also seems to only reiterate findings from other psychology reports. I think that specifically he needed to utilize measures that are designed for assessing competency as well as to raise the question of whether the client is malingering as a way to gain reduction of the charges and/or sentencing. The client was able to identify various elements of the court as well as the charge against him and the potential consequences. D. What was the most salient information used to make a determination?
The examiner mostly used information he has received from other psychological reports, medical records and bizarre statements made by the client when he was interviewed. He based his opinion on prior determinations made by psychologists and the diagnoses associated with those findings. He also provided an unstructured interview, yet included questions seeking relevant information regarding the client’s legal situation and mental status. E. What tests would you have administered and why? Do you think the client could have been malingering?
I would have administered a Mini Mental Status Exam to gain a structured and formal assessment of the client’s orientation and cognitive state. This would provide a more determinant indication of any disoriented thinking and lack of reasoning skills. The examiner made a note of some symptoms that may or may not suggest depression, so I would have administered the Beck Depression Inventory for a more accurate conclusion. I would have included administration of the WAIS-IV as the client had reportedly completed up to two semesters in community college. This would help determine the client’s level of intelligence more accurately at the time of the evaluation and would contribute to the evidence comprising the examiner’s final conclusion. I also would have administered a PAI to assess the client’s personality and perception of himself as well as his world view. I would also consider administering a Rorschach as it is an instrument of personality and malingering based on projective measures. The client was able to sit through a three-hour interview and was described as being cooperative, pleasant, and communicative although not always appearing lucid. This may suggest that the client would be able to sustain attention long enough to complete the personality assessment within the 60 minutes that is typically required to administer it. I would choose the PAI so that I would be able to compare his results to those that are considered to be within the clinical range and what would be expected for individuals who have a true psychopathology as well as any substance-related issues given that he had THC in his system at the time of his arrest. I would also administer the M-FAST and SIRS in order to determine symptoms of malingering. I do believe there is potential for malingering considering the charge against the client and potential consequences. Also, the client was able to acknowledge the charge against him and what could happen if he were found guilty and even commented in once instance that a statement he made did not make sense. He has been evaluated on numerous occasions to determine his competence but it was not noted in the current evaluation if there was any question as to the faking of psychotic symptoms in the previous reports. It may be possible the client is continuing to display symptoms as a way to delay the trial or to achieve permanent status as being mentally unstable in order to gain a lesser sentence of commission into a long-term mental facility.