Part 1 | Understanding the Insanity Defense in South Carolina – Competency Explained

People often toss around the term “insanity defense” as if it’s a catch-all. It’s not. In fact, before we even get to insanity, the first legal question that must be answered is competency. This post is the first in a three-part series on South Carolina’s insanity defense and focuses on what it means to be competent to stand trial.

What Competency Means in South Carolina

Competency is about today. It doesn’t ask whether someone was “insane” when a crime allegedly occurred — it asks whether they can understand what’s happening in court right now, and whether they can assist in their own defense.

Two questions guide the court’s decision:

1. Does the person understand the nature of the proceedings?

2. Can they meaningfully assist their attorney in preparing a defense?

If either answer is no, the court pauses the case and orders a competency evaluation.

How Competency Evaluations Work

In South Carolina, competency evaluations are conducted through forensic programs contracted with the Department of Mental Health.

One of the primary providers is the Medical University of South Carolina (MUSC) Forensic Psychiatry Program, which operates under the university’s Community & Public Safety Psychiatry Division.

MUSC conducts competency evaluations for a number of Lowcountry and surrounding counties under contract with the Department of Mental Health. Courts in other parts of the state may rely on different evaluators or local forensic facilities.

During a forensic evaluation, psychologists or psychiatrists determine whether the individual:

• Understands the role of the judge, prosecutor, and defense attorney

• Grasps how court proceedings work

• Can participate and communicate with counsel

If state evaluators find a person competent but their attorney disagrees, a private evaluation can be requested.

Common Reasons a Person Is Found Not Competent

From our experience, there are several situations that can lead a person to be found not competent to stand trial:

• Active delusions or psychosis with no awareness of their mental illness

• Very low cognitive functioning or developmental disability that prevents understanding of the process

• Complex medical or neurological issues, such as stroke or brain injury, that limit comprehension

Mental illness alone doesn’t automatically mean incompetency. What matters is whether the condition interferes with a person’s ability to understand what’s happening in court and to work with their attorney.

What Happens If Someone Is Found Not Competent

There are generally two outcomes once a person is found not competent:

1. Not competent, likely to restore – The person is committed to a state mental health facility for treatment aimed at restoring competency. Once they’re found competent, their criminal case resumes.

2. Not competent, not likely to restore – The prosecutor may file a separate case in probate court seeking long-term involuntary commitment. This is a civil process with its own standard of proof and a separate hearing.

If someone is not competent due to permanent conditions, like brain damage or very low IQ, hospitalization at a mental institution may not be appropriate. Each case is highly specific and requires experienced legal and medical review.

Why These Cases Are Complex

Competency sits at the intersection of criminal law and mental health. The questions are legal, medical, and ethical all at once. Determining whether someone truly understands court proceedings is rarely straightforward.

That’s why these cases require experience on both sides — working with forensic evaluators and understanding how prosecutors and judges interpret reports. A single evaluation can determine whether someone ever faces trial, so it’s critical that the process be handled carefully and completely.

Why You Need an Experienced Attorney

Competency law is nuanced. A qualified criminal defense attorney can:

• Recognize early signs that competency may be an issue

• File motions requesting evaluation

• Know which evaluators and facilities are used in your county

• Work with forensic experts to ensure fair, accurate assessments

• Navigate both criminal and probate court processes

If you believe a loved one is not capable of understanding their charges or assisting in their defense, it’s essential to involve an attorney who understands both criminal law and mental health procedure.

For more on South Carolina’s forensic evaluation process, visit the South Carolina Department of Mental Health – Forensic Services.

FAQ: Competency and the Insanity Defense

What’s the difference between competency and insanity?

Competency is about a person’s mental state now. Insanity addresses their mental state at the time of the alleged crime.

Who performs competency evaluations in South Carolina?

MUSC’s Forensic Psychiatry Program handles many Lowcountry counties, while other areas may use different evaluators.

How long does an evaluation take?

Typically several weeks, depending on scheduling, testing, and court review.

Can defense attorneys request additional evaluations?

Yes. If an attorney disagrees with a state evaluation, a private one can often be requested.

What happens after a person is restored to competency?

The criminal case resumes and moves forward through the normal court process.

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Final Thoughts

Competency is one of the most misunderstood parts of the criminal justice system — but it’s also one of the most important. It determines whether someone can participate meaningfully in their own defense and whether a case can legally move forward.

If you’re worried that a loved one may not be competent to stand trial, don’t navigate that process alone. Contact Erin Bailey Law to discuss your case and get guidance from a team that understands how South Carolina’s forensic evaluation system works.