If, by chance, it wasn't on the Criminal Law course syllabus in law school, every practicing criminal defense attorney quickly becomes familiar with the U.S. Supreme Court case Dusky v. United States, 362 U.S. 402 (1960). The court ruled that the test for determining whether a criminal defendant is competent to stand trial is "whether he has sufficient present ability to consult with his lawyer with a reasonable degree of rational understanding—and whether he has a rational as well as factual understanding of the proceedings against him." Even though state statutes regarding adjudicative competence vary, they all follow the Dusky guidelines.

In 2007, a dozen psychiatrists authored the American Academy of Psychiatry and the Law 70-page document, "AAPL Practice Guideline for the Forensic Psychiatric Evaluation of Competence to Stand Trial." Its stated purpose: "This document provides practical guidance to psychiatrists who agree to perform forensic evaluations of adjudicative competence. Psychiatrists in active private sector, public sector, or academic practice developed this Practice Guideline after an in-depth review of relevant professional publications and case law and after comparing actual practices of clinicians in a broad range of geographic and work settings." It is not light reading.