(NewsNation) — The highly publicized case of Lori Vallow, the Idaho woman accused of killing two of her children, has raised questions about her mental status, especially as more information has come out about the “doomsday” beliefs she and her husband, Chad Daybell, shared.

The question of whether Vallow, who is also charged in connection with the death of Daybell’s wife, is mentally fit to stand trial has been raised — and last year, it was decided that she is.

However, this wasn’t always the case — in May 2021, she was found mentally unable to stand trial in separate charges of concealment of evidence.

After she was initially ruled mentally unfit, Vallow was committed to the custody of the Idaho Department of Health and Welfare “for care and treatment at an appropriate facility,” by court order, NBC News reported.

Judge Steven Boyce later ordered that she be transferred from the Department of Health and Welfare, and returned to the custody of the Fremont County sheriff.

Documents reported on by CNN showed that the court determined that Vallow was “restored to competency” and “fit to proceed” after her time in treatment.

Idaho’s competency laws

Idaho does not allow an insanity defense in any charge of criminal conduct. If someone is decided to be mentally unfit, the court can order a competency evaluation, which is conducted by the state’s Department of Health and Welfare.

“Generally speaking, the issue of competency is very different than when we talk about if someone is legally insane,” NewsNation legal contributor Jesse Weber said. “All that competency means is, do they understand what is happening? Are they competent to stand trial? Do they understand the charges? Do they understand what is happening? Because if they do not understand, then by law, they cannot be tried.”

Richard Blok, an Idaho criminal defense attorney, says there are two basic reasons someone could be considered mentally unfit to stand trial: They lack the capacity to understand the proceedings, or they can’t assist in their own defense. 

“Do they understand who the judge is, who their defense attorney is, the prosecutors, and what their roles are in the case?” Blok said. “Obviously, if someone just doesn’t even understand that their defense attorney is there to help them, that’s going to be pretty tricky.”

If the person is deemed mentally competent, and no one challenges it, the trial moves forward, Blok said. If they are decided to be mentally unfit to stand trial, they must be committed to a treatment facility with the Health and Welfare Department for a maximum of 90 days, per Idaho code.

Someone could be considered unable to stand trial at first, Blok said, “but with some treatments and meds, whatever else they may have needed, some time, they can become competent to stand trial.” In many cases, people with very serious mental health issues are found competent to stand trial, he added.

“It’s a pretty low bar to get over,” Blok said.

Stuck in a loop

Ross Edmunds, an administrator at Idaho’s Department of Health and Welfare, told the Idaho Statesman that there have been times when a defendant will have their competency restored, only to return to jail and have to undergo the whole process again because they “decompensate.”

“Imagine the difference in the environment,” he told the newspaper. “You’re at a hospital with us. You’re around nurses and behavioral health experts, and now, all of a sudden, you’re back into a jail cell.”

In Idaho, 595 people were admitted to the hospital for restoration of competency between 2021 and 2022 because of mental illness, Edmunds said. Of these, 516 returned to the justice system, according to the Idaho Statesman.

Those that remained stayed in the care of the Department of Health and Welfare or went to outpatient services and residential care.

Idaho isn’t the only state where competency can be changed. California defense attorney Mark Geragos has previously said on “CUOMO” that he has seen a number of cases like this in his line of work, cases in which people become incompetent leading up to the trial after being competent at one point in time.

“It’s a conundrum. We’ve also talked about the problem with the criminal justice system,” Geragos said. “It’s not equipped to deal with people who have mental health challenges, especially to the degree that it appears that (Vallow) has.”

There’s a possibility Vallow could be considered mentally incompetent over the course of the trial. If that happens, there would be a pause in the proceedings while she is evaluated, Weber said.

“I think, though, in these circumstances, it is more likely there would be a mistrial and the case has to start over,” Weber said.

Opening arguments in the Vallow trial started this week. On Friday, according to the East Idaho News, Zulema Pastenes, who was married to Vallow’s late brother, Alex Cox, testified.