Lauren Meaux and Dr. Cox Published in Psychology, Public Policy, and Law!

Kois, L., *Meaux, L.T., Cox, J., & Kelley, S. (2021). Evaluators' experiences with combined competence to proceed and mental state evaluations. Psychology, Public Policy, and Law.

Combined evaluations of competence to proceed (CTP) and mental state at the time of the offense (MSO) are commonplace, yet underexamined in the literature. Given the high stakes faced by defendants and substantial arguments that can be made for and against combined evaluations, it is imperative that we understand how practitioners navigate this process. In this exploratory practitioner study (N = 43), we surveyed professional practices and beliefs concerning combined evaluations as well as how, per practitioners’ self-reports, they were influenced by jurisdictional policy. As is recommended in nascent areas of research, we undertook both quantitative and qualitative methods. Many evaluators reported a disconnect between the spirit of adjudicative competence and the combined CTP/MSO evaluation process. On the whole, evaluators reported that combined evaluations accounted for 29% of their CTP and/or MSO referrals, but only 10 (23.3%) reported that their jurisdiction specifically addressed how to conduct them. They tended to endorse that seemingly incompetent defendants cannot consent to MSO evaluations, and so MSO reports should not be submitted for these defendants. They provided some consensus that seemingly incompetent defendants can provide useful information later integrated into MSO evaluations and that CTP and MSO opinions should be documented separately. We recommend that jurisdictions include statutory language directing evaluators to refrain from submitting MSO opinions when they believe defendants are incompetent, for jurisdictions to explicitly require separate CTP and MSO reports and to distinguish disclosure rules for each report type, and further professional discussion about the nature and process of combined evaluations.