The 23-year-old alleged attacker is charged with killing 10 people in a Colorado supermarket in March 2021.

Court proceedings against Ahmad Al Aliwi Alissa, 23, have been paused for more than a year since Judge Ingrid Bakke first found him to be mentally incompetent in December 2021 and sent him to the state mental health hospital for treatment.

During a brief hearing on Friday in the city of Boulder, Bakke said a new report from the hospital reached the same conclusion. Doctors added in the report that they still think Alissa has a “reasonable likelihood” of reaching competency, Bakke said.

She did not elaborate on the report, which is not publicly available. Concerns about Alissa’s mental health were raised by his defence immediately after the March 2021 shooting, but details have not been made public.

Court documents addressing one of his evaluations in 2021 said he was provisionally diagnosed with an unspecified mental health condition limiting his ability to “meaningfully converse with others”.

Alissa was not in the courtroom on Friday. He is charged with murder and multiple attempted murder counts for endangering the lives of 26 other people. He has not been asked yet to enter a plea and his lawyers have not commented about the allegations.

These brief hearings are held periodically to check in on whether doctors believe Alissa can understand legal proceedings and work with his lawyers to defend himself.

In the US, competency is a different legal issue than a plea of not guilty by reason of insanity, which involves the assertion that someone’s mental health prevented them from understanding right from wrong when a crime was committed.

Alissa is accused of opening fire outside and inside a King Soopers store in the college town of Boulder, killing customers, workers, and a police officer who rushed in to try to stop the attack. Alissa, who lived in the nearby suburb of Arvada, surrendered after another officer shot and wounded him, authorities said.

Investigators have not revealed a possible motive. They said Alissa passed a background check to legally buy a Ruger AR-556 pistol six days before the shooting.