Criminal Offense, Psychiatric Diagnosis, and Psycholegal Opinion: An Analysis of 894 Pretrial Referrals Janet I. Warren, DSW; W. Lawrence Fitch, JD; Park Elliott Dietz, MD, MPH, PhD; and Barry D. Rosenfeld, MA This article presents the results of a study of 894 criminal defendants referred by Virginia courts for evaluation of competency to stand trial or criminal responsibility. All evaluations were conducted on an outpatient basis by mental health profession- als who had received specialized training in forensic evaluation. Findings as to the referral questions posed, the criminal offenses charged, and the clinical diagnoses and psycholegal opinions offered by the evaluators are described. Statistical anal- yses demonstrate significant relationships between both diagnosis and criminal charge and the psycholegal opinion rendered. The psychiatric or psychological evalu- defense or raise the issue of competency ation of persons charged with or con- to stand trial.'-"actors associated with victed of crime has been the subject of various legal outcomes in competency much discussion in the psycholegal lit- and sanjty the length of h0s- erature. Studies have examined the rates ~'tallzatlon after acquittal by reason of of mental illness among criminals,' dif- insanity or a finding of incompetency to ferential treatment of the mentally ill by stand trial, ". "-I6 and recidivism among insanity acquittees and defendants police,' the demographic characteristics found incompetent."-'" of persons who interpose the insanity Very little attention, however, has Dr. Warren is assistant professor, General Medical Fac- ulty, Division of Medical Center Social Work and De- partment of Behavioral Medicine and Psychiatry, Uni- versity of Virginia: Mr. Fitch is associate professor and director of the Forensic Evaluation Training and Re- search Center, Institute of Law, Psychiatry and Public Policy, University of Virginia; Dr. Dietz is clinical professor of psychiatry, Biobehavioral Sciences at UCLA; and Mr. Rosenfeld is affiliated with the De- partment of Psychology, University of Virginia. Char- lottesville, VA. Address correspondence to Janet I. War- ren, D.S.W., Institute of Law, Psychiatry and Public Policy, Box 100, Blue Ridge Hospital, Charlottesville, VA 22901. been paid specifically to the relationship between criminal offense, psychiatric di- agnosis, and psycholegal opinion on such questions as competency to stand trial and legal insanity. This study rep- resents an effort to fill the void. It reflects an examination of 894 cases in which someone charged with a criminal offense was referred to a psychiatrist or psychol- ogist for evaluation before trial. Bull Am Acad Psychiatry Law, Vol. 19, No. 1, 1991 63