Objectives: To describe forensic and clinical characteristics of unfit to plead defendants in Ireland between 1850 and 1995 as well as outcome in terms of length of stay in custody and ultimate disposal of cases. These data are compared with studies from the US and the UK. The White Paper on Mental Health (1995) highlights the need for significant change in the management of mentally ill defendants who come before the courts. The current criteria for the assessment of fitness to plead date from 1836. There has been little previous research on the use of fitness to plead procedures in Ireland which might guide future law reform.
Method: This is a retrospective study of demographic, forensic and clinical data on an almost complete sample of 488 unfit to plead patients admitted to the Central Mental Hospital between 1850 and 1995. A standardised profile was completed on each subject with data drawn from hospital records and entered onto a database for analysis.
Results: The use of the fitness to plead procedures peaked in the period 1910-20, and has fallen into substantial decline since then. Defendants were usually male, with a mean age of 37 years who had been charged with a violent crime. Three quarters of defendants were psychotic on admission. The mean length of detention was 14.3 years and only 4% were ultimately returned for trial.
Conclusions: The decline in the number of fitness to plead findings is probably related to the reluctance of defendants to use the procedure due to the resulting prolonged period of detention. The introduction of a formal judicial review procedure to reassess the appropriateness of detention is urgently required to protect the civil liberties of those found to be unfit to plead.