Competency evaluations in a general hospital

This study describes 90 requests for competency evaluation received by a psychiatry consultation service between 1983 and 1986. Most of the requests were prompted by a patient's refusal to accept a physician's recommendations regarding treatment or disposition. Delirium and dementia accounted for the majority of diagnoses in the population deemed incompetent. Consultees were more likely to follow recommendations for further medical evaluation than to obtain recommended guardianships, living-skill assessments, or neuropsychometric testing. Guardianships were established for only seven of 26 patients deemed incompetent. This study demonstrates the need for consulting psychiatrists to be aware of the forensic issues of competency.