What Is a Mental Competency Evaluation?

The new St. Elizabeths building. Photograph courtesy of the hospital.

Albrecht Muth, indicted this week for first-degree murder in the beating death of his wife, Viola Drath, is at St. Elizabeths Hospital completing a full evaluation to determine whether he is competent to stand trial. A follow-up hearing is scheduled for Wednesday in the courtroom of Judge Russell F. Canan, who eventually has to determine if and when the case will proceed. A source at Superior Court said it was uncertain whether Muth would be able to make the hearing.

Canan ordered the competency evaluation following a period of time in which Muth went on and off fasts, jeopardizing his health and landing him at United Medical Center with dehydration. Doctors there said he suffered from “psychosis,” quoting him as claiming his fast was ordered by the archangel Gabriel.

We talked with Dr. KyleeAnn Stevens, head of forensic services at St. Elizabeths, about what is involved in a competency evaluation. She supervised Muth’s case, and while she could not talk specifically about him or his treatment, she did talk about the evaluation process in general.

We asked whether a patient who is competent could fool the doctors, pretending to be incompetent in order to possibly win an insanity plea. “Certainly that can happen,” she said. “What we have is the capability to provide 24-hour observation and monitoring, and we have a number of trained professionals working with the individual.” Asked the same question, a forensics expert formerly with St. Elizabeths said, “Absolutely yes,” patients can fool their evaluators. But, he added, “It’s hard to pretend for 30 days on a 24-hour basis.”

The evaluation process involves many components, but it begins with a general assessment by doctors, social workers, and nurses. New arrivals are not called inmates or patients but rather “individuals in care,” and they are admitted to a specific unit, called a house. Treatment may include medication, but not to restore competency. If that were deemed medically necessary, doctors would have to obtain a court order. If a patient refuses medication, according to Stevens, “We determine whether they have the capacity to refuse.”

The forensic psychiatrist formerly connected to St. Elizabeths said that typically, patients are not “locked up” but are permitted into “the general forensic population” if they are determined to be nonviolent. This source could only speak on the condition that his name not be used, as he may be called upon as an expert witness in the Muth case.

Stevens said that to be deemed competent to stand trial, patients must demonstrate a factual understanding of the legal process, which includes the charges against them, the penalties, recognition of the key players in the courtroom, and a grasp of any plea options. “Do they understand what is going on in their case? Are they free of delusional beliefs or paranoia about the process in general, and can they apply the generalized knowledge to their specific situation?” explained Stevens.

They also must be able to consult with a lawyer “with a reasonable degree of rational understanding,” he said, adding, “Sometimes people choose not to speak with their lawyer, or want to represent themselves or get a new lawyer, but that doesn’t mean they are incompetent.” Muth wanted to serve as his own lawyer but now has representation from the DC Public Defender Service.

Intensive group therapy sessions are part of the process and can occur three to four times a week. There can be a mock trial, in which the patient is allowed to become familiar with the courtroom process. In that instance, doctors and nurses who are familiar with court proceedings play the judge, lawyers, witnesses, and jury members. This scenario gives the medical team an additional opportunity to evaluate the patient.

When the evaluation is completed, the doctors make their assessment, which is outlined in a letter to the presiding judge. “By and large the letter stands alone,” said Stevens. “We do offer testimony when requested.” As of Friday, according to a Superior Court source, the Muth evaluation letter had not yet been delivered to Judge Canan.

Carol Ross Joynt