Competency Assessment in Maryland Criminal Cases: Standard, Exam, and Rulings

Competency assessment in Maryland criminal cases is the process a court uses to decide whether a defendant is mentally able to understand the proceedings against them and help their own lawyer defend the case. Under Maryland Code, Criminal Procedure § 3-101, a defendant is “incompetent to stand trial” if they cannot do one or both of those things.¹ That two-part test controls every competency question in the state, from the moment the issue is raised through examination, hearing, and whatever happens next.

The Standard a Maryland Court Applies

Maryland’s definition tracks the U.S. Supreme Court’s 1960 decision in Dusky v. United States, which requires a “sufficient present ability to consult with his lawyer with a reasonable degree of rational understanding” along with “a rational as well as factual understanding of the proceedings.”²

In practical terms, the defendant needs to grasp what they are charged with, what the possible penalties are, and how a trial works. They also need to be able to communicate meaningfully with their attorney, follow testimony, and make decisions about the case. A serious mental illness diagnosis does not, by itself, make someone incompetent. The question is about present ability, not about any label.

One point worth separating out: competency is not the same as the insanity defense. Competency looks at the defendant’s mental state now, during the case. Maryland’s “not criminally responsible” defense looks backward to the defendant’s mental state when the alleged offense occurred, and it runs on a different track under § 3-109 and § 3-111. The competency question is resolved first because a defendant who cannot understand the case cannot meaningfully enter any plea.

How Competency Gets Raised

Under § 3-104, if a defendant appears incompetent to the court at any point before or during trial, or if the defendant personally alleges incompetence, the court must stop and determine competency based on evidence presented on the record.³ The defense attorney, the prosecutor, or the judge can raise it. There is no special threshold. A judge who notices a defendant seems confused or unable to follow what is happening can trigger the inquiry on that observation alone.

The issue is not frozen once addressed. The court can reconsider competency at any time before final judgment, so a defendant who was competent at arraignment but has deteriorated by trial can still have the question revisited.³

The Examination

Once competency is in question, the court can order the Maryland Department of Health to examine the defendant. Section 3-105 lets the court set the conditions: the examination may be conducted on an outpatient basis or while the defendant is held in custody, depending on the nature of the charge. For defendants examined outside custody, the court must set bail or authorize release on recognizance.⁴

If a defendant in custody has such a severe mental disorder or intellectual disability that holding them in a regular correctional facility would be dangerous, the court can order placement in a designated medical facility or arrange an immediate examination through a community forensic screening program.⁴

Psychiatrists or psychologists working for or contracted by the Health Department usually conduct the evaluation. They use clinical interviews, standardized psychological testing, and reviews of medical and legal records. Their findings address the two statutory prongs: whether the defendant can understand the proceedings and whether they can assist in their defense.

Two protections matter during this phase. Statements the defendant makes during the examination cannot be used against them in the criminal case, a shield written directly into § 3-105. And a defendant held for examination can challenge the legality of that detention at any time through a habeas corpus petition.⁴

After the examination, the Health Department sends a report to the court, the prosecutor, and defense counsel. The defendant is entitled to receive it within seven days of the court’s order, though the court can extend that deadline for good cause. If the examiner concludes the defendant is incompetent, the report must also include a supplementary opinion on whether the defendant would pose a danger to themselves or others if released.⁴

How the Court Rules on the Report

The Health Department’s report is evidence, not a verdict. Under § 3-104 the court makes the ultimate finding based on the record, and both sides can present additional evidence. A defendant who disagrees with the evaluation can challenge the findings, call their own expert witnesses, or offer other testimony bearing on their mental state. The right to counsel, rooted in the Sixth Amendment, applies at every stage of the competency process.⁵ If a defendant is deaf or does not communicate in English, § 3-103 requires the court to appoint an interpreter throughout the proceedings. A finding of competency sends the case back on its normal track as soon as practicable.

What Happens if the Defendant Is Found Incompetent

A finding of incompetence splits into two paths under § 3-106, depending on dangerousness.

Incompetent but Not Dangerous

If the defendant is incompetent but not a danger to themselves or others, the court may set bail or authorize release on recognizance.⁶ The charges stay pending, but the defendant is not confined just because they are incompetent. That surprises many families: incompetence alone does not mean lockup.

Incompetent and Dangerous

If the defendant is both incompetent and dangerous due to a mental disorder or intellectual disability, the court orders commitment to a facility designated by the Health Department, which must admit the defendant within 10 business days. These facilities, which include the Clifton T. Perkins Hospital Center in Jessup, provide psychiatric treatment aimed at restoring competency. When the commitment is based on a mental disorder, the court can order the Health Department to evaluate the defendant within 48 hours of admission, build a treatment plan, and decide whether immediate treatment, including medication, is needed to prevent ongoing danger.⁶

Commitment continues until one of three things happens:

Competency is restored and the case resumes.
The defendant is no longer dangerous, even if still incompetent, and the court may release them on bail or recognizance.
There is no substantial likelihood the defendant will become competent in the foreseeable future, which forces the case onto a different path.

That third exit reflects a constitutional floor. In Jackson v. Indiana (1972), the U.S. Supreme Court held that a defendant cannot be held more than the reasonable period of time necessary to determine whether there is a substantial probability of attaining capacity in the foreseeable future.⁷ Maryland cannot warehouse an incompetent defendant indefinitely.

Forced Medication to Restore Competency

Whether the government can force a defendant to take antipsychotic medication to restore competency is one of the most contested questions in this area. In Sell v. United States (2003), the Supreme Court said yes, but only when four conditions are met:⁸

Bringing the defendant to trial serves an important governmental interest, with the court weighing factors like the seriousness of the charges and how long the defendant has already been detained.
The medication is substantially likely to restore competency and substantially unlikely to cause side effects that would undermine trial fairness.
Less restrictive treatments are unlikely to achieve the same result.
The specific medication is in the defendant’s best medical interest given its benefits and side effects.

This is a high bar, and the Sell framework applies when the defendant is not otherwise dangerous. If the defendant already poses a danger inside the facility, a separate line of authority dealing with institutional safety may give the government broader room to medicate.

Time Limits and Dismissal of Charges

Charges cannot sit on an incompetent defendant forever. Under § 3-107, the court must dismiss on these timelines:

For felonies and crimes of violence, the court dismisses after the lesser of five years or the maximum sentence for the most serious charge.
For all other offenses, the court dismisses after the lesser of three years or the maximum sentence for the most serious charge.

These limits apply whether or not the defendant is confined. The State can petition for an extension by showing extraordinary cause, but otherwise the clock keeps running. The court can also dismiss earlier if resuming the case would be unjust because too much time has passed, after notifying the prosecutor and any victim who has asked for notification.⁹

Dismissal is not the same as walking free. If the defendant is still dangerous because of a mental disorder, the state can pursue involuntary civil commitment under the Health-General Article. Section 10-632 requires a hearing officer to find, by clear and convincing evidence, that the person has a mental disorder, needs inpatient care, presents a danger to themselves or others, is unable or unwilling to be voluntarily admitted, and that no less restrictive option is available.¹⁰ Civil commitment is a separate legal process with its own protections, not an extension of the criminal case.

1
Maryland General Assembly. Maryland Code Criminal Procedure 3-101
2
Justia U.S. Supreme Court Center. Dusky v. United States, 362 U.S. 402 (1960)
3
Maryland State Judiciary. Maryland Criminal Procedure Article – Procedures After a Finding of Incompetent to Stand Trial
4
Maryland General Assembly. Maryland Code Criminal Procedure 3-105
5
Justia. U.S. Constitution Annotated – Sixth Amendment – Effective Assistance of Counsel
6
Maryland General Assembly. Maryland Code Criminal Procedure 3-106
7
Justia U.S. Supreme Court Center. Jackson v. Indiana, 406 U.S. 715 (1972)
8
Justia U.S. Supreme Court Center. Sell v. United States, 539 U.S. 166 (2003)
9
Maryland General Assembly. Maryland Code Criminal Procedure 3-107 – Dismissal of Charges
10
Maryland General Assembly. Maryland Code Health-General 10-632 – Involuntary Admission Hearings