Adult Psychiatry· 28 min read
Incompetent to Stand Trial: What It Means and How It Works in North Carolina
When a criminal defendant is found “incompetent to stand trial,” the case does not end. The trial pauses. The person is typically placed in a psychiatric facility for treatment, and the court waits to see whether their mental state can be restored to the point where the trial can proceed. None of that is obvious from news coverage, which tends to treat the finding as an ending rather than a pause. This article is a plain-English walk-through of what the concept actually means, how the evaluation works, what a court does with the result, and how the process operates specifically in North Carolina.
The topic draws attention whenever a high-profile case involves a finding of incapacity, but the underlying legal and clinical framework is old, well-established, and applied thousands of times a year in courtrooms across the country. Understanding it is useful whether you are directly affected, professionally involved, or simply trying to make sense of something you read in the news.
This article describes the competency to stand trial process in general terms and the North Carolina statutory framework as it currently exists. It does not comment on any specific case, pending or decided, and should not be read as doing so.
Defense counsel weighing a capacity-to-proceed motion can retain a forensic psychiatrist for the defense to evaluate the defendant independently.
Attorneys handling one of these cases in North Carolina can work through the procedure in the competency guide for NC attorneys, which covers raising the issue, the court-ordered examination, and the dismissal clock under G.S. 15A-1008.
What “Incompetent to Stand Trial” Actually Means
The American legal system rests on an old principle: a person should not be tried for a crime if their mental state prevents them from understanding what is happening to them or participating meaningfully in their own defense. This principle predates the American founding. It traces back to English common law and reflects a basic idea about fairness. A trial is not just something done to a defendant. It is a proceeding the defendant is expected to participate in, by consulting with counsel, making decisions, and responding to evidence. A person who cannot do those things is not receiving a trial in any meaningful sense.
“Competency to stand trial” is the legal term for the question of whether a defendant has the present mental ability to participate in their criminal proceedings. A defendant who lacks that ability is described as incompetent to stand trial, or in some jurisdictions, incapable of proceeding. Both terms describe the same concept.
The key word in the definition is “present.” Competency is always about the defendant’s mental state right now, at the time of the proceeding, not their mental state at the time of the alleged crime. This distinction is critical and is the source of most public confusion about the concept, which is addressed in more detail below.
The Dusky Standard: The Legal Baseline in Every US Jurisdiction
The legal standard for competency to stand trial in the United States comes from a 1960 Supreme Court case, Dusky v. United States, 362 U.S. 402. The case involved a defendant named Milton Dusky who had been diagnosed with schizophrenia. A lower court had found him competent to stand trial because he was “oriented to time and place and had some recollection of events.” The Supreme Court reversed that finding and held that the standard required more than basic orientation.
The Court established a two-part test that has applied in every American jurisdiction since. A defendant is competent to stand trial if they have:
- Sufficient present ability to consult with their lawyer with a reasonable degree of rational understanding, AND
- A rational as well as factual understanding of the proceedings against them.
Both parts must be satisfied. A defendant who can recite the charges against them but believes their lawyer is a federal agent sent to frame them does not meet the standard. A defendant who has a good working relationship with their lawyer but no factual understanding of what a trial is also does not meet the standard. The test looks at both the cognitive and the relational dimensions of participating in one’s own defense.
The word “rational” in the Dusky standard does significant work. It is not enough for a defendant to know factually that there is a judge, a prosecutor, and a charge. The defendant must be able to engage with those facts in a rational rather than delusional way. A defendant who understands the factual structure of a trial but whose thinking about it is dominated by psychotic delusions is not competent under Dusky, even if their factual knowledge appears intact on surface questioning. This distinction has been reinforced by later Supreme Court decisions, including Drope v. Missouri, 420 U.S. 162 (1975), which established that courts have an affirmative duty to inquire into competency whenever there is reasonable cause to doubt it.
Every state has enacted legislation consistent with Dusky. The specific statutory language varies, but the underlying test does not. Competency to stand trial is a matter of federal constitutional law, and no state can apply a lower standard.
Incompetency Is Not the Insanity Defense
This is the most common public misunderstanding about competency, and it is worth addressing directly. Incompetency to stand trial and the insanity defense are two different legal concepts at two different points in the process. They are not the same thing, they are not raised at the same time, and they are not decided by the same standard.
Competency to stand trial is about the defendant’s mental state right now, at the time of the trial proceedings. The question is whether the person sitting in the courtroom today can understand and participate in what is happening. If the answer is no, the trial cannot go forward until the answer becomes yes. The underlying criminal charges are not resolved by a finding of incompetency. They are paused.
The insanity defense is about the defendant’s mental state at the time of the alleged crime. The question is whether, at the moment the conduct occurred, the defendant was so impaired by mental illness that they should not be held criminally responsible for it. The specific standard for the insanity defense varies by state. Some states use the M’Naghten rule, which focuses on whether the defendant knew the nature and quality of the act or knew that it was wrong. Other states use variations including the Model Penal Code standard or the product test. Some states have abolished the insanity defense entirely.
The two concepts can appear in the same case. A defendant can be found competent to stand trial (meaning their present mental state allows them to participate in the proceedings) and still raise an insanity defense at trial (arguing that their mental state at the time of the alleged crime should exempt them from criminal responsibility). Conversely, a defendant can be found incompetent to stand trial (meaning the case cannot proceed at all right now) without the question of insanity ever being reached. The insanity question only becomes relevant if and when the case actually goes to trial.
Treating competency and insanity as the same thing produces confusion about what a finding of incompetency actually means. A finding of incompetency is not a verdict. It is not a finding of not guilty. It is not a finding that the defendant did not commit the act. It is a finding that the trial itself cannot proceed until the defendant’s mental state is restored to the point where meaningful participation is possible.
How the Question of Competency Gets Raised
Competency can be raised at any point in a criminal case. It is most often raised before trial, but it can come up during trial, during a plea proceeding, or even at sentencing. Any significant change in the defendant’s mental state at any point in the process can trigger a new competency inquiry.
The question can be raised by several parties: the defense attorney, the prosecutor, or the court itself. The Supreme Court held in Drope v. Missouri that when there is reasonable cause to doubt a defendant’s competency, the court has an affirmative duty to inquire, regardless of whether either party has formally raised the issue. This means a judge who observes a defendant behaving in ways that suggest serious mental illness should order a competency evaluation even if no one has asked for one.
In practice, most competency questions are raised by defense counsel. Defense attorneys spend the most time with their clients and are usually the first to notice when a client cannot understand the charges, cannot discuss defense strategy coherently, or appears to be responding to internal stimuli that have nothing to do with the case. A defense attorney who believes their client may be incompetent has an ethical obligation to raise the issue. Some clients resist, because the finding means the trial is delayed and they may be transferred to a psychiatric facility. The attorney raises the issue anyway, because proceeding with a client who is not capable of assisting in their defense is a constitutional problem.
Prosecutors can also raise competency. A prosecutor who has seen a defendant in multiple court appearances and observed behavior suggesting serious mental illness may raise the issue even though doing so will slow the case down. In other situations, the court itself raises the issue, particularly when the defendant’s behavior in court is so disordered that proceeding would clearly be improper.
What a Competency Evaluation Actually Looks At
Once the question is raised and the court orders an evaluation, a forensic mental health professional, usually a forensic psychiatrist or a forensic psychologist, meets with the defendant to conduct a structured assessment. The evaluation typically takes between 90 minutes and several hours, sometimes spread across multiple sessions if the defendant’s mental state varies or if collateral information is needed.
A competency evaluation is not a general psychiatric assessment. It is a targeted examination of specific functional abilities relevant to participating in a criminal proceeding. A defendant can be seriously mentally ill and still competent to stand trial. Mental illness alone does not answer the competency question. The evaluator has to determine whether the illness is interfering with the specific abilities the Dusky standard requires.
Factual Understanding of the Proceedings
The evaluator assesses whether the defendant understands the basic factual structure of the case and the court. Does the defendant know what they are charged with? Do they understand what a judge does, what a prosecutor does, what a defense attorney does? Do they understand what a plea means, what a trial is, and what the possible consequences of conviction are? Do they understand their basic rights, including the right to remain silent and the right to a jury trial?
Factual understanding is the lower of the two bars. Many defendants with significant mental illness can demonstrate factual understanding if asked direct questions. The harder part is what comes next.
Rational Understanding of the Proceedings
Beyond the facts, the defendant has to be able to think about those facts in a rational way. This is where delusional thinking becomes relevant. A defendant who factually knows that the prosecutor is the person trying to convict them, but who believes the prosecutor is a demon who has taken human form to persecute them, does not have a rational understanding of the proceedings. A defendant who knows what a plea bargain is but cannot rationally weigh the options because their decision-making is dominated by paranoid beliefs is also not meeting the standard.
Rational understanding is where most incompetency findings actually turn. Factual knowledge is relatively easy to demonstrate. Rational engagement with that knowledge is the harder test, and the one psychotic illness most often disrupts.
Ability to Consult With Counsel
The second prong of Dusky is the ability to consult with one’s attorney with a reasonable degree of rational understanding. The evaluator assesses whether the defendant can give their attorney a coherent account of the events in question, can understand and respond to legal advice, can make decisions about how to proceed, and can maintain the kind of working relationship that allows defense counsel to actually represent them.
A defendant who cannot trust their attorney because of paranoid delusions, who cannot communicate coherently enough to describe what happened, or whose thinking is so disorganized that they cannot hold a conversation about the case is not meeting this prong. The bar is not a perfect working relationship. It is a reasonable one. Defendants and attorneys disagree all the time, and disagreement is not incompetency. The question is whether meaningful collaboration is possible at all.
Mental Illness Alone Is Not the Test
One of the most important clinical principles in competency evaluations is that a diagnosis by itself does not answer the competency question. A defendant can have schizophrenia, bipolar disorder, severe depression, or cognitive impairment and still be competent to stand trial if those conditions are not interfering with the specific functional abilities required. Conversely, a defendant can have a less severe-sounding diagnosis but be rendered incompetent by how that condition is affecting their current functioning.
The evaluator’s job is to link the clinical picture to the functional abilities. A finding of incompetency should explain not just that the defendant has a mental illness, but exactly how that illness is interfering with their understanding of the proceedings or their ability to consult with counsel. A finding of competency should explain why, despite any mental illness that may be present, the defendant still has the functional abilities the Dusky standard requires. This is a harder analysis than simply reporting a diagnosis, and it is what distinguishes a good competency evaluation from a poor one.
Forensic Psychiatric Evaluations in North Carolina
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Baghel Psychiatry, PLLC | Shantanu Baghel, DO | (910) 612-6015 | sbaghel@thebh.us
The Competency Hearing and the Court’s Decision
Once the evaluation is complete, the evaluator submits a written report to the court. The report typically includes a description of the evaluation process, the clinical findings, an analysis of how any clinical issues relate to the Dusky standard, and the evaluator’s opinion about whether the defendant is competent to stand trial. The opinion is just that, an opinion. The final decision about competency is made by the judge, not by the evaluator.
The judge holds a hearing to determine the competency question. Both sides can introduce evidence. The evaluator may be called to testify and explain their findings, and either party may call additional expert witnesses to support a contrary opinion. If the two sides disagree about competency, the court may order a second evaluation by a different expert. The defendant is typically present at the hearing, though the court can make accommodations if the defendant’s condition makes presence difficult or counterproductive.
The standard of proof at a competency hearing is lower than the standard for a criminal conviction. It is usually a preponderance of the evidence, meaning the party arguing for the court’s finding needs to show it is more likely than not to be correct. The specific allocation of the burden of proof varies by jurisdiction. In some jurisdictions the defendant bears the burden of showing incompetency; in others the state bears the burden of showing competency once the question has been raised.
After hearing the evidence, the judge issues a finding. If the defendant is found competent, the case proceeds as any other criminal case would. If the defendant is found incompetent, the trial pauses and the court moves into the next phase of the process.
What Happens When a Defendant Is Found Incompetent
A finding of incompetency does not mean the defendant is released. It means the trial cannot proceed until their mental state is restored. The next step is usually commitment to a secure psychiatric facility for treatment aimed at restoring competency, a process usually referred to simply as restoration.
Restoration typically involves psychiatric treatment: medication for the underlying illness, individual and group work focused on helping the defendant understand the legal process, and ongoing assessment of whether the functional abilities required by Dusky are returning. For many defendants with psychotic illnesses, appropriate medication stabilizes symptoms enough to restore competency within weeks or months. For defendants with severe or treatment-resistant illnesses, restoration can take longer. For defendants with intellectual disability, dementia, or other non-restorable conditions, restoration may not be possible at all.
Restoration happens in a secure setting, not in the community. Defendants who are found incompetent are generally committed to a state psychiatric hospital or a specialized forensic unit, where they remain while treatment proceeds. They are not “free” during this period. They are in custody, just of a different kind than a jail.
Periodic re-evaluations are conducted during the restoration period to assess progress. When the treatment team believes the defendant has been restored to competency, they submit a report to the court, which then holds a new competency hearing to make a fresh determination. If the court agrees the defendant is now competent, the criminal case resumes where it left off. If the court does not agree, restoration efforts continue.
There are constitutional limits on how long the restoration process can go on. The Supreme Court held in Jackson v. Indiana, 406 U.S. 715 (1972), that a defendant cannot be held indefinitely on competency grounds alone. If it becomes clear that the defendant will not be restored to competency in the foreseeable future, the state must either initiate civil commitment proceedings under its ordinary civil commitment laws or release the defendant. The criminal case may be dismissed, though this dismissal is often without prejudice, meaning charges can potentially be refiled if competency is later restored.
How Competency to Stand Trial Works in North Carolina
North Carolina’s statutory framework for competency is found in Article 56 of Chapter 15A of the General Statutes, specifically G.S. 15A-1001 through 15A-1008. The state terminology is slightly different from the federal and general-use term. North Carolina uses “capacity to proceed” and “incapable of proceeding” rather than “competency to stand trial” and “incompetent to stand trial.” The concepts are the same, but practitioners in North Carolina courts will typically use the state terminology.
The North Carolina Statutory Standard
G.S. 15A-1001(a) sets the North Carolina standard. It provides that no person may be tried, convicted, sentenced, or punished for a crime when, by reason of mental illness or defect, the person is unable to do any one of the following:
- Understand the nature and object of the proceedings against them
- Comprehend their own situation in reference to the proceedings
- Assist in their defense in a rational or reasonable manner
The statute is written in the disjunctive, meaning the inability to do any one of these three things is enough to support a finding of incapacity. A defendant does not have to fail all three prongs. North Carolina courts have made clear that the existence of mental illness alone is not sufficient. There must be a connection between the mental illness and at least one of the three functional abilities listed in the statute. This is consistent with the Dusky analysis discussed above: diagnosis by itself does not answer the legal question.
How the Question Is Raised in North Carolina
Under G.S. 15A-1002(a), the question of a defendant’s capacity to proceed may be raised at any time by the prosecutor, the defendant, the defense counsel, or the court. The parties may stipulate that a defendant is capable of proceeding, but they may not stipulate to incapacity. That determination can only be made by the court after a hearing.
Evaluation Pathways in North Carolina
North Carolina offers several pathways for obtaining a capacity evaluation. The defense may file an ex parte motion to fund its own expert to conduct an evaluation, which is often the preferred approach when the defense wants control over the evaluation process and the resulting report. Alternatively, a party may request that the court appoint a specific expert. Finally, the court may order an evaluation by a Local Examiner or by the state facility.
Misdemeanor cases and some felony cases are typically evaluated by Local Examiners, who are forensic evaluators approved by the state and working in community settings. Felony cases, particularly serious ones, are evaluated by Pre-Trial Evaluation Services at Central Regional Hospital in Butner, which is the state’s main forensic psychiatric facility. The observation period for state facility evaluations is capped by statute; G.S. 15A-1002 permits observation and evaluation at a state facility for up to 60 days, with additional extensions possible up to a statutory maximum.
The Hearing and the Court’s Findings
When a capacity evaluation is ordered, the hearing is held after the evaluation is complete. Under G.S. 15A-1002(b1), the court must make findings of fact supporting its determination of capacity. The evaluator’s report is admissible at the hearing, and either party may call the evaluator or other expert witnesses to testify. The judge, not the evaluator, makes the final determination.
What Happens After a Finding of Incapacity in North Carolina
G.S. 15A-1003 governs what happens when a defendant is found incapable of proceeding. The presiding judge determines whether there are reasonable grounds to believe the defendant meets the criteria for involuntary civil commitment under Chapter 122C of the General Statutes. If those grounds exist, the judge issues a custody order and the defendant is transferred to an appropriate facility for commitment proceedings. For defendants charged with violent crimes, the custody order must direct that the defendant be taken directly to a 24-hour psychiatric facility.
The capacity-to-proceed statutes do not themselves lay out a detailed restoration protocol. Restoration in North Carolina typically occurs at a state psychiatric hospital, where the defendant receives treatment aimed at restoring the functional abilities the statute requires. Periodic reports on the defendant’s status are sent to the court, and the question of capacity can be revisited as the defendant’s condition changes.
Recent Changes: Iryna’s Law
North Carolina’s capacity-to-proceed framework was modified by Session Law 2025-93, commonly referred to as Iryna’s Law, which took effect on December 1, 2025. The portions of Iryna’s Law that affect capacity-to-proceed proceedings include the following:
- Prior to the dismissal of criminal charges on the basis of incapacity to proceed, the district attorney may file a motion asking the court to determine whether the defendant should be evaluated for involuntary civil commitment under Chapter 122C. This allows the state to pursue civil commitment as a separate track when criminal charges are being dismissed.
- Criminal charges dismissed because of incapacity to proceed are not automatically expunged from the defendant’s record. This is a change from prior practice and means that a dismissal on incapacity grounds leaves a record trail that may be relevant to future proceedings.
- Notice requirements were expanded for actions regarding defendants found incapable to proceed, with additional parties required to receive notice of certain proceedings.
A separate provision of Iryna’s Law that creates a new procedure requiring involuntary commitment proceedings for certain pretrial defendants (G.S. 15A-533(b1)) was originally scheduled to take effect December 1, 2025 but has been delayed to December 1, 2026. As of this writing, that provision is not yet in force.
These changes do not alter the core substantive standard for capacity to proceed. The G.S. 15A-1001(a) three-prong test remains the same. What has changed is what happens at the back end of the process, particularly around the transition from criminal to civil proceedings and the handling of records when charges are dismissed.
Common Misconceptions About Competency to Stand Trial
“Incompetent Means the Defendant Gets Off”
This is the most common public misunderstanding. A finding of incompetency is not a verdict. It does not resolve the criminal case. It pauses the case and places the defendant in a secure psychiatric setting for treatment aimed at restoration. If restoration succeeds, the case proceeds. If restoration fails after a constitutionally reasonable period, the state may pursue civil commitment as an alternative. In either scenario, the defendant is not walking free.
“Incompetent Is the Same as Insanity”
Addressed at length above. Competency is about present ability to participate in the trial. Insanity is about mental state at the time of the alleged crime. Different concepts, different standards, different points in the process.
“Anyone With a Mental Illness Is Incompetent”
Not true. Mental illness, even serious mental illness, does not automatically render a defendant incompetent to stand trial. The question is always whether the illness is interfering with the specific functional abilities the legal standard requires. Many defendants with schizophrenia, bipolar disorder, or severe depression are competent to stand trial when their symptoms are stable or adequately treated. The evaluation looks at present functional ability, not diagnosis alone.
“The Evaluator Decides Whether the Defendant Is Competent”
No. The evaluator provides an opinion. The judge decides. Courts generally give significant weight to evaluator opinions, particularly when both sides have retained qualified experts who reach the same conclusion, but the ultimate decision is always judicial. Two evaluators can reach different conclusions, and when that happens, the court weighs the competing opinions and makes a determination based on the hearing record.
“Incompetency Is Permanent”
For most defendants, no. Competency is a function of the defendant’s present mental state, and present mental states change. Many defendants who are initially found incompetent are restored to competency through treatment within weeks or months. Only a small minority of defendants have conditions that cannot be restored, and for those defendants, the system has other pathways including long-term civil commitment.
Frequently Asked Questions
What does incompetent to stand trial mean?
Incompetent to stand trial means that a criminal defendant currently lacks the mental ability to understand the legal proceedings against them or to meaningfully assist their attorney in their own defense. It is a finding about the defendant’s present mental state at the time of the trial, not a finding about what happened at the time of the alleged crime. A defendant who is found incompetent cannot be tried until their mental state is restored to the point where participation is possible.
Is incompetent to stand trial the same as the insanity defense?
No. Competency to stand trial is about the defendant’s mental state at the time of the trial proceedings. The insanity defense is about the defendant’s mental state at the time of the alleged crime. Different concepts, different legal standards, raised at different points in the process. A defendant can be competent to stand trial and still raise an insanity defense. A defendant can also be found incompetent to stand trial without the insanity question ever being reached.
Who decides whether a defendant is competent to stand trial?
The judge decides. A forensic psychiatrist or psychologist conducts the evaluation and submits a report containing their opinion, but the final determination is a legal one made by the court after a competency hearing. Expert opinions are considered carefully, but the judge is not bound by them.
How long does a competency evaluation take?
The clinical evaluation itself usually takes between 90 minutes and several hours and may be conducted in one or multiple sessions. The full process, from the court ordering the evaluation to the evaluator submitting a report, can take weeks or months depending on scheduling, the availability of forensic examiners, and whether the defendant is evaluated in the community or committed to a state facility for observation.
What happens if a defendant is found incompetent to stand trial?
The trial pauses. The defendant is typically committed to a secure psychiatric facility for treatment aimed at restoring competency. Treatment usually includes medication, therapy, and education about the legal process. Periodic re-evaluations assess progress. When the treatment team believes competency has been restored, they report to the court, which holds a new competency hearing. If restored, the criminal case resumes. If not, the state may pursue civil commitment under its ordinary civil commitment laws.
How long does competency restoration take?
It varies significantly. For defendants whose symptoms respond well to appropriate medication, restoration can happen within weeks to a few months. For defendants with severe or treatment-resistant illnesses, or for those who refuse medication, restoration can take much longer. Some defendants have conditions such as advanced dementia or severe intellectual disability that cannot be restored at all, in which case the case moves into a different track.
Can a defendant refuse a competency evaluation?
In practice, no. Once a court orders a competency evaluation, the defendant is required to cooperate. A defendant who refuses to participate meaningfully may be evaluated based on available information, including observations by staff, collateral records, and other sources. Refusal itself is sometimes clinically informative.
What is the difference between a forensic psychiatrist and a regular psychiatrist?
A forensic psychiatrist has additional training in the intersection of psychiatry and the legal system, typically including a one-year forensic psychiatry fellowship after general psychiatry residency. Forensic psychiatrists are specifically trained to conduct evaluations for courts, attorneys, and other legal settings, and to translate clinical findings into language that addresses legal questions such as competency, criminal responsibility, and civil capacity. A forensic psychiatric evaluation is structured differently from a general clinical assessment because it is designed to answer a specific legal question rather than to treat the patient.
Does a finding of incompetent to stand trial get expunged from someone’s record?
This depends on the jurisdiction. In North Carolina, following the December 1, 2025 changes made by Iryna’s Law, criminal charges that are dismissed because of incapacity to proceed are not automatically expunged. The dismissal itself may occur but the record of the proceeding remains. Other jurisdictions have different rules. A specific question about how a particular case is handled should be directed to an attorney familiar with that jurisdiction’s law.
What is the Dusky standard?
The Dusky standard is the legal test for competency to stand trial in the United States, established by the Supreme Court in Dusky v. United States in 1960. It requires that a defendant have sufficient present ability to consult with their attorney with a reasonable degree of rational understanding, and a rational as well as factual understanding of the proceedings against them. Both parts must be met. Every American jurisdiction applies this standard or a state-law equivalent.
What does “incapable of proceeding” mean in North Carolina?
“Incapable of proceeding” is the North Carolina statutory term for incompetent to stand trial. Under G.S. 15A-1001(a), a defendant is incapable of proceeding if, by reason of mental illness or defect, they are unable to understand the nature and object of the proceedings, comprehend their situation in reference to the proceedings, or assist in their defense in a rational or reasonable manner. Failing any one of these three prongs is sufficient. The underlying concept is the same as the federal Dusky standard, just expressed in North Carolina’s statutory language.
Where do competency evaluations happen in North Carolina?
Evaluations in North Carolina can happen in several places. Defense-retained evaluations occur wherever the retained expert practices. Court-ordered evaluations of misdemeanors and some felonies are handled by Local Examiners working in community settings. Serious felony evaluations are typically conducted by Pre-Trial Evaluation Services at Central Regional Hospital in Butner, which is North Carolina’s main state forensic psychiatric facility.
The Bottom Line
Competency to stand trial is a rule about fairness. A person cannot be put through a criminal trial if their mental state prevents them from understanding what is happening or from participating meaningfully in their own defense. When a court finds a defendant incompetent, the trial pauses while the defendant receives treatment aimed at restoring the functional abilities the legal standard requires. The criminal case does not disappear. It waits. For most defendants, restoration succeeds and the case eventually proceeds. For those whose conditions cannot be restored, civil commitment provides a separate track under which the person’s ongoing need for supervision and treatment can be addressed.
The concept is often misunderstood because it sits at the intersection of law and psychiatry, and because it gets conflated with the insanity defense in popular conversation. The two are different things at different points in the process. Understanding the difference matters for anyone trying to make sense of how the system handles defendants with serious mental illness.
North Carolina’s version of the rule is codified in G.S. 15A-1001 through 15A-1008, uses the term “incapable of proceeding” rather than “incompetent to stand trial,” and was modified in 2025 by Iryna’s Law to change how charges are handled when dismissal is based on incapacity. The core substantive standard, a three-prong test drawn from the same constitutional tradition as the federal Dusky standard, has not changed. For more on how these questions arise in clinical practice and how involuntary commitment can intersect with the criminal process, see the related articles linked throughout this piece.
North Carolina Forensic Psychiatry
Board-certified forensic psychiatric evaluations. Capacity to proceed, criminal responsibility, civil matters.
Baghel Psychiatry, PLLC | Shantanu Baghel, DO | (910) 612-6015 | sbaghel@thebh.us
References
1. Dusky v. United States, 362 U.S. 402 (1960).
2. Drope v. Missouri, 420 U.S. 162 (1975).
3. Jackson v. Indiana, 406 U.S. 715 (1972).
4. Godinez v. Moran, 509 U.S. 389 (1993).
5. North Carolina General Statutes Chapter 15A, Article 56, sections 15A-1001 through 15A-1008 (2024, as amended by Session Law 2025-93).
6. North Carolina Session Law 2025-93 (“Iryna’s Law”), effective December 1, 2025.
7. North Carolina Department of Health and Human Services, Division of State Operated Healthcare Facilities, Forensic Services.