By Righton Smith

            The American criminal justice system is built on the promise of a fair trial. That promise falters when prosecutors pursue cases against defendants with significant mental impairments or fail to carry their burden. Current competency standards, shaped by Dusky v. United States,[1] focus narrowly on a defendant’s ability to communicate with counsel. Ambiguities in the law, lenient procedures, and inconsistent psychiatric evaluations create a system where incompetent defendants may still face trial, while others may be released without ever receiving the treatment needed. Strengthening these standards is essential to protect due process and ensure that justice is not just procedural, but actual.

            One of the fundamental principles of the American criminal justice system hinges on the idea that prosecuting an individual who is mentally incompetent violates due process.[2] This right ensures a fair trial, as according to the Supreme Court in Medina v. California competence is considered “the foundational right for the effective exercise of a defendant’s other rights.”[3] These rights include, but are not limited to, the right to counsel, to confront witnesses, and to testify or remain silent.[4] The current standard for competency to stand trial is articulated in Dusky v. United States.[5] Dusky requires an accused to have “sufficient present ability to consult with his lawyer with a reasonable degree of rational understanding. . . and [must have] a rational as well as factual understanding of the proceedings against him.”[6] The existing legal framework and its practical application reveal several areas where stricter competency standards are necessary to vigorously uphold this fundamental due process right while also balancing the need to protect the welfare of the people.

            The flexibility and the ambiguity in applying the Dusky test is a significant aspect that suggests this need for stricter standards. Namely, the mere presence of “some degree of mental illness” or “limited intellectual ability” does not automatically render the accused incompetent.[7] These are “merely relevant factors” to be considered in the midst of proceedings.[8] Furthermore, the use or addiction to illegal substances does not result in incompetence, though “the influence of drugs or the effects of drug withdrawal” could be debilitating enough.[9] This broad consensus can inherently lead to a slippery slope of impaired individuals being deemed competent or competent individuals being deemed incompetent. The spectrum is wide. A stricter standard would require that such significant mental health conditions or severe substance use disorders create a stronger presumption of incompetence that would require the state to meet a higher burden to prove otherwise.

            The distinction between a defendant’s capacity to assist counsel and their actual willingness to do so also presents a unique point of concern. The standard focuses on the accused’s “capacity to assist in preparing his or her defense,” not “whether he or she actually cooperates.”[10] This means a defendant who essentially can coherently confer but refuses to engage with their attorney could still be found competent. Even if this behavior is due to paranoid delusions or severe apathy.[11] For instance, even where an accused who spent court sessions scribbling bizarre pictures and muttering conspiracy theories, experts can agree he is still deemed competent to stand trial, despite his inability to sustain a rational conversation. This highlights how a purely “capacity” focused standard overlooks the ultimate inability of an accused to mount an effective defense. This can justify a shift towards requiring active engagement or a more definitive assessment of the underlying reasons for the non-cooperation.

            Additionally, the Supreme Court’s decision in Medina v. California introduced a type of procedural leniency that directly undermines the protective intent of the competency doctrine.[12] Medina allows states to establish a presumption of competence and requires the defendant to bear the burden of proving incompetence by a preponderance of the evidence.[13] This decision was heavily criticized by Justice Blackmun and Justice Stevens in the dissent, who argue that “a Constitution that forbids the trial and conviction of an incompetent person tolerates the trial and conviction of a person about whom the evidence of competency is so equivocal and unclear.”[14] Justice Blackmun also emphasizes that “the right to be tried while competent is the foundational right for the effective exercise of a defendant’s other rights.”[15] Requiring a potentially incompetent defendant to prove their own mental incapacity introduces an “unacceptably high risk that persons will be tried and convicted who are unable to follow or participate in the proceedings determining their fate.”[16] This dissent essentially highlights that the State is in a superior position to gather evidence of competency over a defendant. The State has direct, unfettered access to a defendant in custody and possesses the resources for the necessary psychiatric evaluations and commitment if needed.[17] Stricter standards would necessitate placing the burden of proving competence on the prosecution in order to adequately protect the underlying due process right.[18] This would further align with other instances where the government bears the burdens for issues that implicate certain constitutional rights.

            The nature of psychiatric testimony and its application in competency evaluations also point to weaknesses in the current standards. Psychiatry is acknowledged as an “inexact science,” where “subtleties and nuances of psychiatric diagnosis render certainties virtually beyond reach in most situations.”[19] Clinicians often confuse legal incompetency with psychosis, or may overdiagnose incompetence for humanitarian reasons, or even underdiagnose due to a lack of legal sophistication.[20] This lack of accuracy and potential for misinterpretation means that the “legal question of competency” may not be sufficiently addressed.[21] Stricter standards would require psychiatric evaluations to focus explicitly on the Dusky[22] criteria and the defendant’s functional abilities in the legal context, not just clinical diagnoses. This could create a likelihood of enhancing the overall reliability of the findings. Moreover, Drope v. Missouri cautions that a defendant’s demeanor during trial “cannot be relied upon to dispense with a hearing on that very issue” of competence, specifically when there is “uncontradicted testimony of . . .[a] history of pronounced irrational behavior.”[23] This warning suggests that surface-level impressions of alertness should not outweigh substantial evidence of impairment. Stricter standards would elevate the weight given to complex medical histories and consistent patterns of specific behavior, rather than courtroom demeanor. Additionally, a court may impose a higher standard of competence for a defendant seeking to represent themselves than for merely standing trial. This directly acknowledges that the Dusky standard[24] for simply standing trial might not be sufficient for full engagement in the judicial process.[25] This disparity suggests that the baseline standard for competency to stand trial may itself be too low.

            Stricter competency standards would benefit society as a whole by reinforcing the principle of a fair and just criminal justice system. By rigorously ensuring that only individuals with a “sufficient present ability to consult with his lawyer with a reasonable degree of rational understanding . . . and a rational as well as factual understanding of the proceedings against him” stand trial, the government upholds its burden of due process.[26] It would also help protect the overall integrity and public confidence in judicial proceedings and state officials. Nevertheless, this approach could also lead to more accurate adjudications. More accurate adjudications could then help reduce the fiscal and administrative burdens associated with repeated, lengthy, and unnecessary competency evaluations and hospitalizations.[27] This approach would allow a more efficient allocation of both mental health and legal resources.

            In summary, the Constitution demands more than a mere inquiry into competency; it requires a safeguard against putting someone on trial who inherently cannot defend themselves. The Dusky standard[28], as applied today, is riddled with ambiguities that tilt the scales against the accused and allow the State to avoid its duty and not bear their burden. Stricter, clearer standards would close those gaps, force the government to prove competence, and ensure trials reflect true fairness.

[1] 362 U.S. 402 (1960).

[2] Drope v. Missouri, 420 U.S. 162 (1975).

[3] Medina v. California, 505 U.S. 437 (1992).

[4] Id. at 457.

[5] Dusky v. United States, 362 U.S. 402, 402 (1960).

[6] Id. at 402.

[7] 18 U.S.C. § 4241 (2025).

[8] Id.

[9] Id.

[10] Id.

[11] Id.

[12] Medina v. California, 505 U.S. 437, 437 (1992).

[13] Id. at 442.

[14] Id. at 456.

[15] Id. at 457 (Blackmun, J., dissenting).

[16] Id. at 464 (Blackmun, J., dissenting).

[17] Id. at 465.

[18] Id. at 458–459.

[19] Id. at 451.

[20] Bruce J. Winick, Restructuring Competency to Stand Trial, 32 UCLA L. Rev. 921, 923 n.4 (1985).

[21] Id.

[22] Dusky v. United States, 362 U.S. 402, 402 (1960).

[23] Drope v. Missouri, 420 U.S. 162, 180 (1975).

[24] Dusky, 362 U.S. at 402.

[25] 18 U.S.C. § 4241 (2025).

[26] Id.

[27] Winick, supra note 20 at 925.

[28] Dusky, 362 U.S. at 402.