Criminal Arrests and the Threshold for Competence

To the Editor: The article by Quanbeck and colleagues (1) in the July issue outlined the relationship between criminal arrests and community treatment history among patients with bipolar disorder. Specifically, the study found that patients who had been arrested were more likely to be male, to have a history of substance abuse, and to have a treatment history characterized by more frequent, briefer hospitalizations. Patients in the comparison group were more likely to have been treated under a mental health conservatorship and held in the hospital under civil commitment law. The authors suggested that legal interventions that promote stabilization of mania in an inpatient setting as well as drug screening may help prevent criminal offenses among patients with bipolar disorder.

The findings of this study suggest to me that one of the legal interventions that needs to be addressed is the level at which people are deemed to be mentally competent. The findings suggest that the group with more rearrests was deemed to be competent on the grounds that they were not held under mental health conservatorship or civil commitment. The fact that they committed more crimes suggests that they were not really competent and therefore that the standard for competence is set too low. In the same issue of Psychiatric Services a study of the Clark County Mental Health Court program by Herinckx and colleagues (2) provided clear evidence that patients who are provided with more treatment commit fewer crimes. This finding suggests that these persons are not committing crimes because they are inherently criminal in nature but because they are ill.

Both these articles suggest to me that the current competency laws are contributing to the criminalization of the mentally ill. I suggest that the threshold for competence needs to be reevaluated by the medical and legal professions if patients with mental illness are going to be treated instead of criminalized.

Dr. Kane is a clinical psychiatrist in private practice in Prince George, British Columbia.