An Attempted Meta-Analysis of the Competency Restoration Research: Important Findings for Future Directions

The competence to stand trial literature is vast, whereas the literature on competency restoration pales in comparison. Although such research has accumulated since the 1970s, no quantative synthesis of it has been conducted. Therefore, we considered over 1,000 publications and attempted to conduct the first meta-analysis of restoration data - using 51 independent competency restoration samples published over a 40-year period (1975-2013) with 12,781 defendants - ultimately concluding that the restoration literature does not currently lend itself to meta-analysis. Still, several important findings arose: (a) the base rate for competency restoration was 81% and the median length of stay (LOS) was 147 days overall and 175 days in single restoration group studies; (b) reported competency restoration procedures were overwhelmingly nonspecific across studies and not reported in more than half of them; (c) most studies used correlational designs, with only five studies comparing restored with unrestored defendants, and no useable existing pre- versus post-treatment studies; and (d) competence assessment instruments were used in fewer than one-third of studies, traditional psychological measures were used in fewer than one-quarter, with data presented in such a way as to eliminate the potential for quantitative aggregation and analyses. Overall, our findings are concerning because, despite 40 years of research, the available data essentially highlight the characteristics of those engaging in restoration and do not address variables associated with final restoration status. In addition, we continue to have no collective empirical understanding of the utility of competency or traditional assessment instruments in the restoration context. Finally, virtually no published data reflect specific intervention efforts that lead to competence restoration.