The standardization of assessments of fitness to stand trial is an important issue in forensic psychiatry. Courts have specified what constitutes fitness. However, since evaluators performing competency examinations according to their own style still arrive at a variety of conclusions, a move toward standardization hopes to make competency testing more reliable.
The Metfors Fitness Questionnaire (MFQ) is presented by authors David Nussbaum, Mimi Mamak, Helene Tremblay, Percy Wright and June Callaghan (Am J Forensic Psychology. Vol 16, pp. 41-45,1968) as just such a standardized assessment, The MFQ is a 19 item self-report questionnaire focusing on basic fitness to stand trial issues. The authors combined this questionnaire with a 20 minute psychometric cognitive battery and compared the results of these, blindly, to the results of a traditional psychiatric fitness to stand trial examination. The results were promising.
Of 44 individuals who completed the study, 7 had been found unfit by standard psychiatric screening. The MFQ plus the brief cognitive battery correctly identified these 7 as unfit. Three individuals found fit by psychiatric screening were found unfit by the experimental method. The authors argue that this reflects excellent performance for a screening technique, particularly for a low base rate event such as a finding of incompetence.
The authors conclude that legal fitness is grounded in a cognitive psychological framework. The authors note that individuals in the unfit group had a premorbid IQ estimated to be in the below average range while those in, the fit group were estimated to have been in the average range.
Interesting findings, but they will not impact fitness assessments any time soon. The results, of course, require replication and, as the authors' note, cultural and demographic factors (language spoken, for instance) may significantly determine the usefulness of this screening methodology In various centers. More important, while the MFQ and cognitive battery are designed as a screening assessment, any attorney unsatisfied with the results can, and undoubtedly will, call for a traditional fitness assessment. The MFQ and cognitive battery may ultimately be most useful for research purposes and for producing supportive evidence when fitness findings are contested. Nussbaum, D., Mamak, M., Tremblay, H., Wright, Z & Callaghan, J. The Metfors Fitness Questionnaire (MFO=Q): a self-report measure for screening competency to stand trial. American Journal of Forensic Psychology Vol.16, No.3,41-65, (1998).
