The development of the care plan system for the restoration of competency to stand trial in forensic psychiatric patients
DOI:
https://doi.org/10.64838/jmht.2025.281715Keywords:
competency to stand trial, criminal patients, forensic psychiatry, psychiatric symptomsAbstract
Objective: To develop and test the care plan system for the restoration of competency to stand trial in forensic psychiatric patients.
Methods: This research and development involved five steps: 1) need analysis for system development 2) conceptual framework development of the system 3) prototype development of the system using the Appreciation-Influence-Control process with a multidisciplinary forensic-psychiatric team 4) validity testing and 5) pilot testing in three psychiatric patients with legal cases. Outcomes included the restoration of competency to stand trial within 90 days and the inter-rater agreement between two psychiatrists.
Results: The draft of the care plan system consisted of four components: 1) criteria for assessing psychiatric symptoms aligned with the criteria for competency to stand trial, covering 16 symptoms, 2) stage-specific patient care within treatment facilities, 3) the problem-focused therapeutic interventions, and 4) regular progress-monitoring meetings. The pilot testing demonstrated that two patients achieved the competency to stand trial within 90 days, while the other with chronic illness and cognitive impairment did not regain competency within 180 days. Inter-rater agreement on the competency to stand trial between psychiatrists was perfect, with a Cohen’s kappa coefficient of 1.0.
Conclusion: The system shows potential to enhance restoration of competency to stand trial in forensic psychiatric patients within 90 days and provides a standardized guidance for psychiatrists and multidisciplinary teams in competency assessment and rehabilitation. Further implementation in other treatment settings and more diverse populations is recommended to confirm the system’s effectiveness and applicability across different contexts.
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