Competency to Stand Trial

Abstract

In the completion of CST evaluations, evaluators frequently utilize collateral records and third-party information. One such source of collateral used increasingly in recent years is media produced by defendants on social networking sites (SNS). Its potential use can present several challenges for evaluators. This chapter addresses some of those challenges, including whether SNS data should be used, how it should be obtained, and how it should be considered during a competency evaluation. Various clinical applications of SNS data are considered, such as its use in assessing present mental state, how the intended audience of SNS productions affect the assessment, and how it is considered during competency restoration. Legal and ethical concerns CST evaluators face when utilizing SNS are described, including issues related to informed consent, the reliability and relevance of the data, and the impact on evaluator bias. We conclude with the use of two case examples that highlight these matters.

Appendices

Case Profile 1

3.1.1 Type of Evaluation

Competency to Stand Trial

3.1.2 Case Context

Mr. Daniel Thomas was a 37-year old man who was undergoing an evaluation of his competency to stand trial. The evaluation took place within an inpatient prison hospital over the course of several weeks. He was charged with several counts related to impersonating a federal official.

3.1.3 Sources of Information

• 1. Clinical interviews with Mr. Thomas

• 2. Court Order, dated 10/30/2018;

• 3. Criminal Complaint, dated 06/28/2017;

• 4. Indictment, dated 07/12/2018;

• 5. Criminal Docket, printed 01/02/2019;

• 6. Competency Evaluation by Dr. Franklin, dated 10/26/2018;

• 7. 276 pages of discovery material, including investigative reports;

• 8. Incident/Investigation Reports from the Village of Montgomery Police Department, dated 11/12/2015 to 12/01/2015;

• 9. Federal Bureau of Prisons records from 06/27/2018 to 05/24/2019;

• 10. Medical records from Local Community Hospital, dated 11/13/2015 to 01/22/2016;

• 11. Medical records from State Hospital – Celebration, dated 10/26/2017 to 10/28/2017;

• 12. Medical records from Blank Health System, dated 01/13/2019;

• 13. Psychological Evaluation by Dr. Thomas, dated 10/19/2015;

• 14. Psychological Evaluation by Dr. Jones, dated 10/27/2015;

• 15. Psychological Evaluation by Dr. Smith, dated 10/29/2015;

• 16. Psychiatric records from Dr. Gonzalez, dated 01/29/2015 to 05/26/2018;

• 17. Review of Mr. Thomas’s social media material including personal websites, Facebook, Instagram, Youtube, and Amazon Video on 03/12/2019;

• 18. Telephone interviews with Mr. Thomas’s mother, Jane Thomas, from 03/11/2019 to 05/16/2019;

• 19. Telephone interview with Mr. Thomas’s acquaintance, Frank Burns, on 04/02/2019;

• 20. Telephone interview with Mr. Thomas’s acquaintance, Alan Foster, on 04/08/2019;

• 21. Telephone interview with Mr. Thomas’s civil attorney, Kyle Wooley, on 04/22/2019.

• 22. The following psychological tests (and relevant versions) were administered separately to Mr. Thomas and his mother:

  • a. Adaptive Behavior Assessment System Third Edition (ABAS-3)

  • b. Conners’ Adult ADHD Rating Scales – Self-Report: Long Version (CAARS-S:L and CAARS-O: L)

3.1.4 Relevant Background

Mr. Thomas is single, never married, and was most recently living with his parents. He has lived independently at intervals when provided financial support. He graduated high school and earned a certificate in sports management at a state university. He has never maintained steady employment. He has no prior criminal history nor a history of alcohol or substance abuse. Besides asthma that is well controlled with treatment, he is physically healthy with no history of head trauma, seizures, or other significant ailments.

Mr. Thomas was identified as having mental health problems from a very young age. Diagnoses he received by the time he was a teenager included Asperger’s, Tourette’s syndrome, bipolar disorder, and schizoaffective disorder. He was described by family and treatment providers as having “grandiose” beliefs, ideas, and plans for many years that persisted despite engagement in various psychiatric and psychological treatments. These included claims he was a sports agent who had several professional athletes as clients, he produced several realty television programs, he was “semi-famous” on YouTube and other social media outlets, he had millions of dollars in sports memorabilia, and he started various companies and product lines (e.g., hair gel, skin cream).

The most notable concern related to his competency was the potential delusional beliefs he had about being an authorized federal agent, the basis for the criminal charges. The prosecution alleged he personally printed out and constructed official-looking badges and credentials and displayed those on social media. Mr. Thomas denied having done anything illegal and indicated he was unfairly targeted because he was suing Twitter for several million dollars after his account was terminated for posting inappropriate content.

3.1.5 Behavioral Observations and Mental Status

At first, Mr. Thomas presented as calm and alert. He was dressed appropriately but mildly disheveled. He was oriented to the city and facility, but not the state. He knew the date. He was pleasant and cooperative, and his speech was clear; however, his thoughts wandered at times and he made several grandiose statements about being law enforcement personnel and having a high IQ. Conversely, he acknowledged having trouble “comprehending things.” He had some difficulty providing details and a coherent narrative. His affect was odd and labile. At one point during the initial interview he described his cell mate at a prior facility having committed suicide (which was later not substantiated), at which point he began crying and stated he has been “traumatized.” His sleep has reportedly been poor for some time. Earlier he began laughing uncontrollably while describing the prior forensic examiner getting into psychology “in order to get laid.”

Mr. Thomas frequently presented as demanding and inappropriate with staff. Staff noted that he would enter the nurses’ station despite prompts that he was not allowed to do so without being invited. He received one incident report for threatening bodily harm for sending a threatening email to his attorney and two for assaulting without serious injury.

During subsequent clinical interviews, aspects of Mr. Thomas’s mental status varied considerably. On some occasions, he presented as calm and clear. His speech increased in rate when he spoke of his complaints, but it remained coherent and understandable. He could be interrupted and did not speak over the evaluator. On other occasions, Mr. Thomas became visibly agitated, rocked in his seat, and raised his voice. He was resistant to limit-setting in these interviews and spoke over the evaluator. During these times he did not appear to self-initiate strategies to calm himself, but when strongly redirected to pause and collect himself, he was able to do so. In addition, he laughed loudly and unrestrainedly at times that were incongruent with the topic of conversation (e.g., when asked what a less serious charge than his would be, he replied “a notary violation”). Mr. Thomas’s level of cooperation also varied. At times he appeared eager to provide information or to prove the extent of his legal knowledge. However, he often engaged in evasive responses as well, providing incorrect answers and then laughing, or denying that he had ever made particular statements. His sleep and appetite varied. He complained of getting too little sleep due to the ambient noise and light on a particular locked unit, but noted this improved after he was moved to different unit. He variably reported gaining/losing too much weight, but records revealed no significant changes. His personal hygiene ranged from fair to disheveled.

During the course of the CST assessment, Mr. Thomas frequently bragged about and highlighted many accomplishments. For example, he stated, “I’m famous as a reality TV star and sports marketing agent.” He added that he has signed many famous athletes and received his Association of Tennis Professional (ATP) tour card in 2009. However, he stated some have claimed he is a fraud and he is suing them for breach of contracts. However, he also sought to explain and clarify what he believed were misperceptions the authorities and others had about him. For example, he denied ever claiming to be a federal law enforcement officer, but rather was a “leading member” of several fraternal organizations, such as volunteer firefighter and police groups (e.g., Neighborhood Watch). In order to determine the veracity of his claims, the evaluator first reviewed the available records and spoke to his mother, with whom he was reportedly very close. His mother indicated her son was “very delusional” and recounted several of the claims noted above. She affirmed he had extensive baseball memorabilia but doubted its value. She also corroborated he has made several online videos and received a sports agent certificate after completing courses at a local university (from where he claimed to have earned a degree and was a university “alumni”). Mr. Thomas’ mother noted that while he is fairly intelligent and can initially appear convincing, he has never had the ability to follow through or succeed in his ventures.

3.1.6 Summary of Test Results

To supplement extensive testing conducted by prior examiners, Mr. Thomas and his mother each completed the Adaptive Behavior Assessment System Third Edition (ABAS-3). The ABAS-3 is a comprehensive assessment of adaptive abilities needed to effectively and independently carry out skills needed to care for oneself, interact with others, and complete necessary tasks.

Mr. Thomas’ General Adaptive Composite (GAC) and Conceptual and Social adaptive domain standard scores fall in in the extremely low range (all at or below the second percentile), as rated by both himself and his mother. While Mr. Thomas rated his own skills in the Practical adaptive domain in the low range (sixth percentile), his mother rated his abilities in this domain in the extremely low range (0.2nd percentile). Mr. Thomas’ scores and his mother’s scores in the GAC and all adaptive domains were significantly different. However, the magnitude of the difference between these ratings is not particularly rare compared to other individuals of his age. His self-ratings indicate a rare and statistically significant strength of his practical skills (e.g., taking care of himself, managing his health and safety, using community resources) over his social skills and his conceptual skills (i.e., communication, academic skill, ability to be self-directed). Mrs. Thomas’s ratings of her son indicate a relatively rare and statistically significant strength of her son’s social skills over his conceptual and practical skills. It is interesting to note that Mr. Thomas indicated on 54 items that he is not able to perform particular behaviors because he does not have the skills to do so or has some limitation in performing the behavior. By contrast, Mrs. Thomas indicated on only one item that her son cannot perform the behavior. In sum, although the severity of the ratings differed between Mr. Thomas and his mother, both sources of data are supportive of impairment in his adaptive functioning either due to a deficit in skill or his performance of the skill.

The Conners’ Adult ADHD Rating Scales (CAARS) was also administered. The CAARS are a set of easily administered self- and observer-rated instruments to assess for symptoms and behaviors related to Attention-Deficit/Hyperactivity Disorder (ADHD) in adults ages 18 and up. Mr. Thomas was administered the CAARS - Self-Report: Long Version (CAARS-S:L), and his mother completed the CAARS Observer: Long Version (CAARS - O:L) . Mr. Thomas’ Inconsistency Index was elevated (score of 9), so the results of his self-report are considered with caution. Although Mr. Thomas’s ratings of symptom severity were less severe than his mother’s ratings, they both reported a similar pattern of impairment. Data from both sources indicate Mr. Thomas experiences clinically significant symptoms of ADHD, including both inattentive and hyperactive-impulsive symptoms.

3.1.7 Diagnostic Conclusions

Based on all available data, it was determined that Mr. Thomas met criteria for the following diagnoses:

• Autism Spectrum Disorder, Level 1

• Attention Deficit-Hyperactivity Disorder, Combined presentation

• Bipolar I Disorder, Current or most recent episode hypomanic

• Narcissistic Personality Disorder

• Tourette’s Disorder

3.1.8 Summary of Data Relevant to Psycho-Legal Question

As part of the discovery, printed copies of Mr. Thomas’s website pages were obtained, where he purportedly made several unsubstantiated claims. This included postings about his affiliation with federal law enforcement and credentials he allegedly manufactured. While those claims and allegations were up for some dispute, the discovery did not contain any evidence that challenged his many other claims. Two acquaintances of Mr. Thomas were also contacted. Both individuals characterized Mr. Thomas as frequently embellishing the truth and misrepresenting their relationship. For example, one was a law enforcement officer who recognized Mr. Thomas’s disabilities and “took him under [my] wing” as part of a volunteer police officer program. This lasted for less than two weeks and Mr. Thomas had no official duties with the department. However, he later falsely and publicly claimed that he and the officer were “partners in the war on drugs” and completed many assignments together.

Mr. Thomas insisted he could prove his claims if the evaluator obtained material he has produced online. He specified several items that could readily be verified. For example, he said he is rather well known for several realty shows he produced and starred in, as well for being a regular guest on the show of a famous radio personality. At that point of the evaluation, it was clear Mr. Thomas was fairly bright and had a good factual understanding of the proceedings. Further, his speech and the form of his thinking was within normal limits. The primary concern as it related to his competency dealt with whether or not he had delusional beliefs that impacted his ability to make rational decisions and work with his attorney. The working hypotheses included that his claims were true, delusional, or party true and partly delusional. If there was some truth to his claims, it could certainly be the case his claims were simply grossly exaggerated for personal gain. In order to test the hypotheses, it appeared necessary to obtain additional data. Online searches and speaking to additional third parties familiar with Mr. Thomas’s activities appeared the only viable way this could be done.

Prior to searching social media Mr. Thomas was questioned about the extent of his social media presence, in order to ascertain where to find the material he reportedly produced. He readily described the material, including videos he had produced on Amazon Prime and YouTube. In the search, the evaluator discovered he had in fact produced several videos, some of which were worthy enough to be distributed by Amazon. The videos were “reality tv” in nature, where Mr. Thomas discussed his great successes despite his disabilities (i.e., he repeatedly stated he had Tourette’s, bipolar disorder, and Asperger’s). He also called in and spoke several times to a national radio personality, who seemed to engage Mr. Thomas in much debate and argument on political issues. After reviewing all the content, the evaluator wondered whether Mr. Thomas was perhaps being exploited by these media sources, and/or he was taking advantage of his disabilities for personal gain and notoriety. Mr. Thomas initially characterized himself as being a major contributor and writer for the radio program and stated his videos had an enormous following or viewership.

3.1.9 Clinical Forensic Opinion

The area of competency that remained of greatest concern for Mr. Thomas was his ability to assist counsel in his defense. Discussions with him about the evidence and pleas resulted in irritation, some hostility, and rigid opinions as to how he wished to proceed. Also, his ability to remain calm and coherent during court proceedings was of some concern. When extremely agitated, anxious, and embarrassed, Mr. Thomas had difficulty controlling his emotions. In the past this included verbal and physical outbursts. However, he demonstrated good ability to calmly discuss these topics on occasion. In addition, Mr. Thomas may have difficulty testifying coherently in a stressful situation such as a trial, and where contradictory information to his rigid thought patterns is presented. To further complicate matters, Mr. Thomas asserted several times he would intentionally “lose it” on the stand and “look crazy” and not be able to testify due to his “delusions, fantasies, and grandiose beliefs.” While on one hand he saw himself as incapable of proceeding, on the other hand he viewed himself as highly intelligent and wanted to challenge the allegations.

Overall, Mr. Thomas appeared to have an adequate factional knowledge of court proceedings. Although he had some misunderstandings, he demonstrated the ability to retain corrective feedback. Though some gaps in knowledge may remain, there was no evidence to suggest he would not be able to learn new information with the assistance of an attorney. His ability to rationally understand his legal situation was more complicated to determine. At baseline, his difficulty with attention, narcissistic personality, and rigid patterns of thinking make it hard for Mr. Thomas to hear and consider information that may be damaging to his sense of self or that contradicts his personal desires, which change frequently. However, when directed to engage in calming techniques and communication skills, he is able to interact appropriately, consider new information in his decision-making processes, and engage in more rational evaluation of his options. In sum, although his abilities to demonstrate rational understanding of his legal situation and to work to assist his attorney may be difficult for him, he has demonstrated the capability to do so with some assistance.

3.1.10 Recommendations

The following considerations may be useful for Mr. Thomas in moving forward with his legal proceedings. He should continue taking his medications as prescribed and comply with other treatment recommendations. In interviews, he has been responsive to firm limit setting and redirection when he begins to digress or perseverate on a given topic. This practice would be helpful in maintaining appropriate interactions with his attorney. Finally, he has demonstrated some benefit from practicing emotion regulation and distress tolerance skills (i.e., acting mindfully, pausing and observing thoughts and feelings before reacting). Continued practice of these skills would benefit Mr. Thomas in tolerating the stress of legal proceedings.

3.1.11 How Did Social Media Impact This Case?

Watching and reviewing the SNS data was useful in accomplishing three things. First, it helped establish that, in fact, Mr. Thomas was the creator and participant of material that had some considerable viewership. The SNS data, which included a website, audio recordings, and YouTube and Amazon Prime videos, clearly depicted him in images, voice, and video. Further, Mr. Thomas was very familiar with the content. Therefore, there was never any question about authorship.

Second, the review helped put the material and Mr. Thomas’s claims in better perspective. While Mr. Thomas had some level of “success,” his media and online following was not nearly as grand as he reported it to be. For instance, the Amazon videos were very brief, of non-professional quality (in the evaluator’s opinion), and were not viewed by a large audience. Also, Mr. Thomas did not help write or contribute in any substantial way to the radio program. The program simply allowed him to call in multiple times to engage in debate on political topics. He was never paid in that role or for any of the online videos he produced.

Third, reviewing the material allowed the evaluator to question Mr. Thomas in greater detail about his thinking and reasoning. At first, it was not clear how much of what he said in the videos reflected genuine beliefs versus statements designed to entertain and lead to greater viewership. During interviews, the evaluator was able to test not only the nature of his beliefs, but how rigidly he held those views. Mr. Thomas initially described being a “celebrity” and important producer with strong conviction. However, when gently challenged about the significance of his roles and contributions, he acknowledged not having made any money, written or co-produced anything for the radio program, or had the number of viewers he previously claimed. It became apparent that, while Mr. Thomas’s reported activities had a firm foundation in reality, he grossly embellished his importance and success. His claims became muted and more in line with what truly occurred once challenged and pressed for greater detail. His presentation was not consistent with rigidly held delusions, rather he demonstrated considerable flexibility and willingness to acknowledge the overstatements he made. It appeared Mr. Thomas’s strong need to be recognized led him to exaggerate his accomplishments. What was also apparent was that Mr. Thomas had a strong need to be recognized, which led him to exaggerate. Further, he acknowledged his grandiose and bombastic presentation style was designed for attention and “shock value.”

Amidst Mr. Thomas’s many reports, he also claimed to be a famous “porn star” and cited pornographic websites where he has performed. Interestingly, upon a routine medical examination as part of his inpatient CST evaluation, staff noted Mr. Thomas had a penile implant. Mr. Thomas indicated having enlargement done to promote his pornographic career. While the implant was present, his claim of pornography fame had questionable veracity given reports by his mother, his lack of any wealth, and other questionable claims. This claim created a more interesting, but problematic situation and raised some ethical and personal concerns. On the one hand, it may have been useful to establish whether Mr. Thomas’s claims were true. But would this mean the evaluator would have to search pornographic websites and view pornography? If one were to proceed in that manner, could the salacious material prejudice the evaluator’s view of Mr. Thomas or negatively impact the opinions? What if the evaluator was repulsed or had strong emotional reactions to what was viewed? If so, questions could be raised about the neutrality and objectivity of the evaluator.

One option to avoid the possible bias (or the perception of bias) was to ask a third party (perhaps an assistant or colleague) to briefly review the sites in order to verify or refute his claims. This would allow the evaluator to at least determine whether his report had any basis in reality or required any further follow up. A final option, as this evaluator saw it, and the one ultimately taken, was to not explore whether Mr. Thomas had a pornography career. Given Mr. Thomas made numerous grandiose claims which were verifiable through SNS data, it did not seem necessary to turn over yet another stone. Whether a false statement by Mr. Thomas or not, at that point there were several examples and a clearer picture of his clinical presentation. Further, the pornography claim had no direct bearing on his competency or thinking about his case. While evaluators do not always know when something will turn out to be probative until they review it, one must consider the potential prejudicial effects and whether additional data is necessary to reach one’s opinions. In this case, it was deemed unnecessary and potentially prejudicial.

Case Profile 2

3.1.1 Type of Evaluation

Competency to Stand Trial

3.1.2 Case Context

The defendant in this case, 35-year-old Mr. Randall Scott, was ordered by the District Court to undergo a period of hospitalization and treatment to determine whether there was a substantial probability his competency to stand trial could be restored in the foreseeable future. The evaluation took place within an inpatient prison hospital over the course of several months. Mr. Scott was charged with Communicating Threats.

3.1.3 Sources of Information

• 1. Clinical interviews (ongoing)

• 2. Evaluation of Competency to Stand Trial-Revised (ECST-R; 09/16/13)

• 3. Court Order, dated 06/06/13

• 4. PACER information

• 5. Criminal Complaint, dated 02/27/13

• 6. Forensic Evaluation by Kathleen Harris, Ph.D., dated 05/20/13

• 7. Copies of Donald Trump’s Facebook page

• 8. Copies of Mr. Scott’s Facebook page

• 9. Compact Disc containing a video of Mr. Scott’s interview with law enforcement officials, dated 02/26/13

• 10. Criminal History

• 11. Livingstone College Transcript

• 12. National Crime Information Center (NCIC) criminal history

• 13. Telephone interview with Angelina Bowen, sister of Mr. Scott

• 14. Telephone interview with Phillip Carroll, Defense Counsel for Mr. Scott

• 15. Telephone interview with Mark Fletcher, AUSA

3.1.4 Relevant Background

Mr. Scott readily provided information about his personal background. The information he provided was consistent with information reported by Dr. Harris.

Mr. Scott reported he was born in Colorado Springs, Colorado, to the non-marital union of Justin Bowen and Angelina Scott. He noted his parents married shortly after he was born and he is the oldest of eight children. His youngest sibling is currently 14-years-old. Mr. Scott was “not sure” when he met his developmental milestones, but indicated he did not believe he was delayed in meeting them. He described his parents as “strict, but I got whooping’s. They were strict, but also lenient. They were fair.” He indicated he never experienced or witnessed any abuse. Mr. Scott reported his mother died in 2008 from cancer. He described he has a “good relationship” with his family and was in close contact with them prior to his arrest. His father continues to reside in Colorado. When asked if his father might visit him, Mr. Scott indicated he would not want his father to visit because “it is weird for them to think of me as a mental patient.” He indicated his father is employed in the t-shirt screening business.

Mr. Scott indicated he has never been married and has no children. However, for a period of time he was under the impression that he had two children. He stated that on two occasions, shortly after he began dating a woman she informed him she was pregnant. Paternity tests subsequently indicated he is not the father of either child. He described that he considers himself to have been a parent to both children. He indicated he has had three serious relationships in his life. Two were the aforementioned relationships and the third ended last year, but was 5 years in duration. He indicated his most recent relationship ended due to his legal issues. When asked about friendships, Mr. Scott noted he had friends growing up, “but they weren’t really my friends. There were just playing on my intelligence. Any idea I had they were trying to sketch it away from me.” He provided several examples in which he believed his friends were trying to steal his business ideas or girlfriends from him.

Regarding his education, Mr. Scott reported he graduated from Livingstone College in Pueblo, Colorado with a Bachelor of Arts in History. He described himself as a B student who was active in extracurricular activities. However, his transcript indicates he earned a Grade Point Average of 2.4, which is approximately equivalent with a D average. Mr. Scott’s Bachelor of Arts in History was conferred on 05/05/03. He noted that in high school he lettered in Football and Basketball and participated in Chess Club, Science Club, and Debate Club. He reported he was in a fight during the sixth grade with another student who was bullying him. As a result, he was suspended for 6 days. He noted this is the only time he was in trouble at school.

Mr. Scott reported he was employed as a teacher, but resigned due to a “misunderstanding about the curriculum.” He explained he was teaching the curriculum, but “it was the extra stuff I brought to the table that got me out of favor with the principal.” He noted he was showing videos to students about “how to break a slave.” He acknowledged the videos were graphic and may not have been appropriate for school. Mr. Scott stated he has also worked to start a magazine, in a group home, as a counselor and mentor, and as a dispatcher for a car transport company. He stated he has never been fired from any job. He reported he has no military history.

Mr. Scott reported he has several criminal convictions, which is consistent with his criminal record from National Crime Information Center (NCIC). He stated he was arrested for Possession of a Stolen Vehicle and given probation. He was also convicted of Possession with Intent to Sell and Deliver Cocaine and again given probation. Mr. Scott stated he was arrested for Assault on a Female, but these charges were dismissed. He reported he has never been sentenced to prison.

When asked about his medical history, Mr. Scott indicated he experienced a concussion when he played football in college (approximately age 20). He also noted he was unconscious on one occasion from alcohol and believes someone put something in his drink. He noted he experienced asthma as child and used an inhaler, but no longer experienced these difficulties.

Mr. Scott maintained he had no history of mental health problems and never received any kind of treatment. He reported he began using marijuana at age 15 and stopped in 2010. As noted, he has a prior conviction for selling cocaine, but reported he did not use cocaine. Mr. Scott described himself as an occasional drinker. When asked about treatment for addiction, Mr. Scott indicated he had received treatment for gambling addiction because he was online gambling.

During a telephone interview with Angelina Bowen, Mr. Scott’s sister, she reported her brother has no history of mental health difficulties. She reported that when he was arrested and sent for a mental health evaluation, the family was “shocked.” She noted Mr. Scott was living with her at the time of his alleged activities and subsequent arrest. She noted he was helpful around the house, took care of her children, and appeared “fine.” She reported he went to the library for long periods each day and she assumed he was trying to find employment. He did not mention his Facebook activities to her. Ms. Bowen noted Mr. Scott shared his belief that he and Richelle Carey were “soul mates.” Ms. Bowen stated she wanted to believe his statements, but found them unusual.

3.1.5 Behavioral Observations and Mental Status

Mr. Scott’s mental status was largely stable and unchanging during this evaluation period. His hygiene and grooming were well maintained. He was alert and correctly oriented to his person, place, situation, and time. Attention and memory functions were assessed as grossly intact. His speech was normal in rate, rhythm, and volume. No articulation deficits were present. He reported he was not experiencing any perceptual disturbances and did not appear to be responding to internal stimuli. No mood disturbances were endorsed or observed. Affect was euthymic. He reported he had no thoughts to harm himself or anyone else. Eye contact was appropriate.

One significant change in Mr. Scott’s mental status was the presence of delusions. Initially, Mr. Scott expressed delusions that he was part of a Facebook game controlled by engineers at Facebook in which he was forced to participate. He believed there was a game because his personal Facebook page became filled with information from newscasters, political figures, and other media sources. This information filled his page so that he was no longer receiving updates from his friends. He believed this was happening because he had a “page of privilege” and because he was a “person of privilege.” This privilege allowed him to make posts on the pages of celebrities (e.g., Donald Trump and George W. Bush) and this ability was special to him. Most other Facebook users were not able to post on celebrity pages like Mr. Scott. As part of Mr. Scott’s special abilities, he was able to make “reads” from the information that was on the sidebar of his page. Mr. Scott espoused his belief that he had special information/secrets that he could not share with others, which he learned through Facebook. As part of his delusions, he believed he had a special connection to several media personnel (e.g., Dan Abrams and Richelle Carey). These individuals were feeding him special information about breaking news. For example, he believed he was the individual to break news that Michael Strahan was hired for the Kelly and Michael show. Mr. Scott believed that by going through this Facebook game he had “become a better human being” and he did not “live like people in the world. People that are here. The criminal aspect. There is a lustful aspect. I don’t look at people with lust. I don’t judge people. I have a lot of knowledge from what I learned from Facebook.”

Mr. Scott also had delusions about his relationship with Richelle Carey. He explained that her profile kept coming up on his page, meaning that he and Richelle Carey were soul mates and he was going to be married to her, even though he had never met or corresponded with her.

Over the course of several months, Mr. Scott was informed the evaluator considered these beliefs delusions and not reality based. Initially, he was resistant to this information, however over time the rigidity of Mr. Scott’s beliefs loosened and at the completion of his evaluation he disregarded those beliefs. While Mr. Scott does not articulate that he was experiencing a mental illness with delusions, he has indicated he was mistaken. When asked about the change, he stated, “When three doctors all tell you are wrong, you gotta listen.”

During his stay at the facility, Mr. Scott frequently went to recreation, the library, or watched TV. He went to the dining hall for meals and to laundry to exchange his clothing. Mr. Scott navigated the institution without difficulty. He lived with a cellmate without complaint and worked with staff easily. He was polite and cooperative with both inmates and staff.

3.1.6 Summary of Test Results

Mr. Scott was not given any psychological assessment measures during his hospitalization.

3.1.7 Diagnostic Conclusions

According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, (DSM-5) , by the American Psychiatric Association, Mr. Scott’s diagnosis is as follows:

• Delusional disorder, mixed type, first episode, in partial remission

The diagnosis of delusional disorder, mixed type, first episode, in partial remission has been assigned to Mr. Scott based on the presence of referential and grandiose delusions. Referential delusions are when an individual believes that certain gestures, comments, or environmental cues are a special message for him or her. In Mr. Scott’s case, he believed he was receiving special messages in Facebook. Grandiose delusions are defined as when an individual believes he or she has exceptional abilities, wealth, or fame. Mr. Scott believed he was a “person of privilege” and as a select Facebook user he could post on the celebrity pages. As Mr. Scott experienced both referential and grandiose delusions with no one being prominent over the other, he is assigned the mixed type specifier. The essential feature of delusional disorder is the presence of one or more delusions that persist for at least one month. There is evidence to suggest Mr. Scott was experiencing these delusions from 02/27/13, when a criminal complaint was filed based on his Facebook posts, until approximately 11/14/13. During interviews after 11/14/13, Mr. Scott disregarded his delusions and therefore, is considered to be in remission.

One distinguishing feature of delusional disorder is if hallucinations are present, they are typically not prominent and are related to the delusional theme. Mr. Scott has repeatedly denied experiencing hallucinations and does not appear to be experiencing perceptual disturbances. Individuals with delusional disorder typically do not experience marked impairment in their daily functioning apart from the delusion. As noted, Mr. Scott does not have significant impairments in his life, with the exception of his limited ability to find employment. Family members expressed surprise about his Facebook activity and his beliefs associated with it. He has maintained familial and romantic relationships, suggesting limited impairment. No impairments, other than those related to competency, were observed while he was hospitalized. In order to meet the criteria for this disorder, mood symptoms (depression or mania) are relatively brief. Mr. Scott did not display any symptoms consistent with a mood disorder. Finally, the disturbance is not due to the effects of a substance (e.g., drugs or alcohol) or due to a medical condition. Mr. Scott has endorsed limited use of drugs or alcohol. Consistent with his report, he was arrested for selling cocaine approximately 10 years ago. He noted he stopped using marijuana four years ago and is an occasional drinker, suggesting his delusions are unlikely to be associated with substance use. As noted, he did not require medical intervention while at the FMC.

Mr. Scott’s diagnosis is consistent with Dr. Harris’s assessment. However, as Mr. Scott now disregards his beliefs he is considered to be in partial remission.

3.1.8 Summary of Data Relevant to Psycho-Legal Question

Mr. Scott was charged with Communicating Threats. The criminal complaint alleges he posted the following messages on Facebook:

• “We pray for Favor in supplying a candidate at the [redacted] Elementary School in [redacted] in demonstrating full concentration in killing as many children as possible in our dedication and love to the Devil for all time. Where we hope to sustain our Reign of Evil for all time.”

• “We pray for Favor in supplying a candidate at [redacted] Middle School in killing as many kids possible in the Name of the Devil for all time. As we hope to secure our alignment and service to the Will of the Devil for years to come in providing our Blood in the Evils of the Devil for generations to come. As we serve the Devil for all time. On Both Knees We pray with Confidence to the Devil! AMEN!”

• “Richelle Carey and I pray for Favor in planting a Bomb at the [redacted] Arena in showing our Love and Dedication to the Purpose of the Devil. We pray for Favor in making sure we demonstrate a form of Evil in attack in planting a Bomb or Candidate at the Cosmos Club downtown in killing people in the surprise of Evil showing up at any time. We Pray for Favor in activating both plans if possible in showing our dedication and want in displaying our appetite for evil in the Image of the Devil. On Both Knees We confidently pray to the Devil! AMEN!”

• “Richelle Carey and I pray for Favor in making sure we hit a target in planting a Bomb at Privilege Night spot where hundreds of students will be sure to go in securing our purpose in priority. We pray for Favor in supplying a candidate to make sure we hit targets and increase our Reign of terror on People for years to come in forming our family in the Evils of the Devil for all time.”

Several other similar postings were alleged to have been made by Mr. Scott. The criminal complaint also indicated that at the time of his arrest, Mr. Scott admitted to law enforcement to making the threats. During his interview, Mr. Scott admitted to making the threats from library computers by posting messages from his Facebook account. He asked investigators if they were familiar with the Sandy Hook school shooting. When they responded they were familiar, he stated words to the effect that “it was all about the body count.”

As part of the discovery, Mr. Scott’s Facebook pages were obtained. Additionally, the Facebook pages where he made comments (e.g., Facebook page of Donald Trump) were also obtained.

3.1.9 Clinical Forensic Opinion

Mr. Scott’s attorney, Mr. Carroll, was interviewed regarding his concerns about Mr. Scott’s competency related deficits. Mr. Carroll described that Mr. Scott did not appear to understand the consequences of his postings. When discussing the case, Mr. Scott was focused on his beliefs and did not appear able to understand how his postings might be viewed by others. Additionally, Mr. Scott’s focus on his delusions interfered with discussions about his legal case.

With regard to the issue of competency to stand trial, Mr. Scott was administered the Evaluation of Competency to Stand Trial - Revised (ECST-R), which is a structured interview to assess the defendant’s factual understanding of the court proceedings (FAC), rational understanding of the current legal circumstances (RAC), and ability to consult with counsel (CWC). In addition to assessing competency to stand trial, the ECST-R also provides a systematic screening for a defendant’s feigned psychopathology as a deliberate attempt to avoid being found competent for proceedings. Mr. Scott obtained scores in the normal range on his factual and rational understanding of the proceedings. Further, his rational ability to consult with counsel and overall rational ability were also in the normal range. There was no evidence of feigned incompetency or endorsement of atypical psychological experiences.

Consistent with Dr. Harris’s report, Mr. Scott demonstrated a good understanding of the factual elements related to his case and legal proceedings. He correctly identified the responsibilities of the judge, defense counsel, and prosecution. He correctly named his charges and explained the meaning of the charge against him. He identified the role of the jury and contrasted that with a bench trial. Mr. Scott clearly identified the dangers of speaking to the prosecutor without his attorney present.

Mr. Scott demonstrated a rational understanding of the courtroom procedures. He could compare and contrast the best and worst potential outcomes in his case. He did not appear to have any delusional beliefs about the courtroom. He described how he should conduct himself while in court and to date had been able and willing to comport his behavior to the expectations of the courtroom.

Mr. Scott did not appear to have any irrational beliefs about his attorney, who he correctly identified. He described a scenario in which they had differing opinions and how he worked with his attorney to find a mutually agreeable solution. His expectations of his attorney were realistic. There is no evidence that he has delusional beliefs about his attorney.

At the time the ECST-R was completed (09/16/13), psychotic symptoms were evident during clinical interviews. Even though Mr. Scott correctly recited the charge against him, he could not appreciate how this charge applied to him. When asked to describe how the charge of “Communicating Threats” related to him, he provided delusional information about Facebook. During initial interviews, Mr. Scott’s delusions affected his ability to work with his attorney. He could not engage in a meaningful discussion about legal strategy.

The evaluator discussed Mr. Scott’s mental illness with him at length. He was provided information about his mental illness, the reasons for his diagnosis, and how his mental illness negatively affected his competency to stand trial. During this period, Mr. Scott’s views on Facebook became malleable and he eventually rejected them outright. At the completion of the evaluation period, Mr. Scott was able to meaningfully discuss the allegations against him and consider a variety of legal options. He no longer perseverated on his delusions. This was a significant change from his presentation during Dr. Harris’s evaluation and when he first arrived at the facility. This change is attributed to the remission in his mental illness.

The evaluator concluded Mr. Scott does not currently suffer from a mental disease or defect that would preclude him proceeding to trial. During clinical interviews, Mr. Scott demonstrated an understanding of the legal process. He was able to give a coherent and thorough overview of his involvement in the legal system, to include the proceedings related to the instant offense. There is no evidence to suggest that Mr. Scott does not understand the legal process, charges against him, or how to assist in his defense.

3.1.10 Recommendations

No specific recommendations were offered as part of this evaluation.

3.1.11 How Did Social Media Impact This Case?

The SNS data was helpful in this case for two main reasons. First, the basis for Mr. Scott’s present charges was the information he was alleged to have posted online. Mr. Scott reported to the evaluator and to law enforcement that he was the author of the SNS data and provided explanation of his meaning in the posts. Generally, the standard for competency includes “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 against him.” [Dusky v. United States, 362 U.S. 402 (1960)]. Assessing for a factual understanding for the judicial system and well as case-specific material is one component of competency assessment. In this case, showing Mr. Scott his Facebook posts and discussing how they formed some of the evidence that would potentially be used at a trial, was an essential part of the evaluation. Discussing this material with him provided a way to evaluate his ability to discuss, understand, and retain this information. In addition to providing information about Mr. Scott’s factual understanding, discussion about his posts provided information as to how Mr. Scott might work with an attorney.

Mr. Scott’s Facebook pages also provided valuable information about his past and present mental health functioning. During interviews, he and the evaluator looked at the pages together and discussed his delusional beliefs. Without discussing this material with Mr. Scott, his delusional belief system and how his mental status changed over time would not have been fully understood. For example, Mr. Scott’s Facebooks pages from 2 years prior to the alleged offense were substantially different in content and style than the posts from 2013. During the initial stages of my evaluation, Mr. Scott remained delusional and provided extensive information about his belief system. He explained how he could “make reads” from the sides of the pages and asserted he was in a romantic relationship with a well-known journalist. This was helpful when forming the diagnostic impressions. Likewise, when Mr. Scott began to reject his delusions, he and the evaluator reviewed the Facebook pages together and he articulated that his writing did not make sense. For example, he questioned why he capitalized words in the middle of the sentence when that was not needed (e.g., providing our Blood in the Evils of the Devil). Of note, his Facebook posts from prior to the onset of his mental illness were generally logical and grammatically correct. Reviewing and discussing his postings aided in the assessment of how his mental status changed over time, which in turn aided in determining if he continued to have a threshold condition.