Competency to Stand Trial Evaluations | Nationwide Expertise
Every year, tens of thousands of criminal proceedings across the United States are paused due to questions about a defendant’s mental competence. For judges, attorneys, and families, these are not just clinical questions — they’re constitutional ones. A determination of incompetence may change the entire trajectory of a criminal case. Dr. Lisa Long brings decades of real-world forensic experience to bear on some of the most sensitive matters in the justice system, delivering high-quality evaluations and expert consultations through a secure, telehealth-based model.
With her extensive forensic experience — including roles as head forensic unit psychologist at Central State Forensic Psychiatric Hospital in Georgia and forensic psychologist at the Kentucky Correctional Psychiatric Center — Dr. Long now provides competency-to-stand trial (CST) evaluations across all PSYPACT-participating states. She evaluates both detained and non-detained defendants and offers rebuttal reports and testimony support in litigation.
Nationwide Scope of Services
In her PSYPACT-licensed practice, Dr. Long offers both evaluation and consultation services across all participating states. She routinely works with:
Defendants in custody at jails or hospitals that permit secure, confidential tele-evaluation
Defendants out on bond or under court supervision
Defense or prosecution teams requesting expert evaluation or rebuttal opinion
Attorneys preparing for competency hearings, restoration plans, or pretrial strategy
These services are available for pretrial competency assessments, second opinions, restoration evaluations, and forensic consultations. All evaluations are structured to meet jurisdictional standards and follow the AAPL Practice Guideline for CST Evaluations.
What Is Competency to Stand Trial?
In U.S. criminal law, competency to stand trial is grounded in the Sixth and Fourteenth Amendments, ensuring that a defendant can:
Understand the nature and purpose of legal proceedings
Rationally and factually comprehend their situation
Consult with legal counsel with a reasonable degree of understanding
The landmark case Dusky v. United States (1960) set the federal standard: a defendant must have "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."
Common Scenarios That Raise CST Concerns
Observed signs of mental illness, psychosis, intellectual disability, or dementia
Incoherent communication or paranoid thinking
Inability to track court events or understand charges
Lack of capacity to assist with defense strategy or decisions
Courts, attorneys, or concerned parties can request an evaluation to assess whether competency is impaired and if restoration is possible.
Dr. Long’s Comprehensive Evaluation Process
Every competency evaluation Dr. Long conducts is informed by both clinical expertise and a rigorous understanding of legal thresholds. Her approach is methodical, trauma-informed, and respectful of the defendant’s dignity and rights. Whether evaluating a first-time offender with untreated schizophrenia or a defendant in a high-profile felony case, Dr. Long tailors her process to the individual.
Components of a CST Evaluation:
Review of Case Materials
Police reports, court filings, psychiatric records
Clinical Interview
Mental status, functional legal understanding, and decisional capacity
Mental Status Examination (MSE)
Mood, perception, thought content, insight, and judgment
Standardized Psychological Testing
Cognitive, neuropsychological, and malingering assessments
Collateral Interviews (as needed)
Attorneys, family members, past providers
Written Report
Forensic analysis, diagnostic impressions, and legal opinion
Expert Testimony (if requested)
In-person or virtual testimony to clarify findings for the court
If Deemed Competent — or Not: Legal Pathways After Evaluation
What happens next depends entirely on the evaluator’s findings and the court’s decision:
If Found Competent:
Legal proceedings resume without delay
Defendant is expected to participate meaningfully in trial strategy, testimony, and plea decisions
Attorneys may request continued monitoring if symptoms fluctuate
If Found Incompetent to Stand Trial:
Court proceedings are paused
The defendant is typically referred for competency restoration, which may involve hospitalization, outpatient treatment, or medications
Restoration efforts must be least restrictive and appropriate to the defendant’s condition
If Competency Cannot Be Restored:
Charges may be dismissed if restoration is not possible within a legally allowable timeframe
Civil commitment may be considered in some jurisdictions for public safety
Defense counsel may seek other protective legal remedies
Dr. Long’s reports clearly delineate both clinical findings and legal implications, helping courts and attorneys navigate these outcomes.
National Trends and Systemic Concerns
Recent estimates suggest 25,000 to 94,000 CST evaluations are conducted annually in the U.S. Despite their frequency, many states face backlogs, litigation, and clinician shortages. The lack of national data collection systems compounds these issues. A 2021 review in The Journal of the American Academy of Psychiatry and the Law noted that outdated methods for estimating CST volume hinder policy reforms and funding efforts.
Dr. Long’s telehealth model — compliant with HIPAA and forensic standards — addresses these challenges by expanding access to quality evaluations nationwide, especially in jurisdictions with few trained evaluators.
Landmark Legal Precedents Shaping CST Evaluations
Dusky v. United States (1960) — Established the foundational standard for competency: defendants must have both a rational and factual understanding of the proceedings and be able to consult with counsel with a reasonable degree of rational understanding.
Drope v. Missouri (1975) — Reinforced that courts have a duty to raise competency concerns sua sponte if there is any evidence suggesting the defendant may be incompetent — even if defense counsel does not bring it up.
Godinez v. Moran (1993) — Clarified that the standard for competency to stand trial also applies when a defendant wishes to plead guilty or waive constitutional rights, reinforcing a unified threshold.
Indiana v. Edwards (2008) — Allowed courts to require that a defendant with a severe mental illness be represented by counsel, even if they are competent to stand trial, distinguishing trial participation from self-representation.
Sell v. United States (2003) — Provided strict criteria for when the government may forcibly medicate a defendant to restore competency, balancing state interests against individual liberty.
Cost of a Competency to Stand Trial Evaluation
The cost of a forensic competency-to-stand-trial evaluation can vary based on the complexity of the case, the volume of records to review, and whether expert testimony is required. Dr. Long’s comprehensive CST evaluations are tailored to meet the evidentiary standards of the court and include a detailed written report. Optional services may include expert testimony, collateral interviews, or rebuttal evaluations.
For context, a 2013 estimate published in The Handbook of Forensic Psychology placed the average cost of a CST evaluation in the U.S. at approximately $5,000 per defendant, assuming standard components and preparation time. While costs may vary slightly across jurisdictions and providers, this figure is widely used as a benchmark for high-quality, court-admissible evaluations.
Dr. Long’s pricing remains competitive with national standards and reflects the value of specialized forensic training, national licensure through PSYPACT, and her ability to provide responsive services across all participating states.
Nationwide Availability
Dr. Long conducts CST evaluations in all PSYPACT member states. Services are conducted via HIPAA-compliant platforms, using secure procedures for evaluations in both correctional facilities and the community.
To request an evaluation or case consultation, please submit a referral below.