When do physicians request competency evaluations?

Fifty consecutive requests for competency evaluations were reviewed retrospectively to determine the characteristics of the request. The data from this study suggest that requests for competency are seen within certain discrete, demographically varied categories; are often urgent; are usually not the result of a functional Axis I disorder; are more common for patients with previously diagnosed organic mental disorders; are often stimulated by patients who do not participate in diagnostic or treatment plans or by patients who threaten to leave against medical advice; are less frequently concerned with informed consent; and are more common in younger patients. Overall, patients are as likely to be judged competent as incompetent. Elements of the mental status examination that are crucial to the assessment of competency are delineated.