Criminal responsibility and mental illness in Ireland 1850-1995: fitness to plead

Objectives: To describe forensic and clinical characteristics of unfit to p lead defendants in Ireland between 1850 and 1995 as well as outcome in term s of length of stay in custody and ultimate disposal of cases. These data a re 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 litt le previous research on the use of fitness to plead procedures in Ireland w hich 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 profil e was completed on each subject with data drawn from hospital records and e ntered onto a database for analysis. Results: The use of the fitness to plead procedures peaked in the period 19 10-20, 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 viole nt crime. Three quarters of defendants were psychotic on admission. The mea n length of detention was 14.3 years and only 4% were ultimately returned f or trial. Conclusions: The decline in the number of fitness to plead findings is prob ably related to the reluctance of defendants to use the procedure due to th e resulting prolonged period of detention. The introduction of a formal jud icial review procedure to reassess the appropriateness of detention is urge ntly required to protect the civil liberties of those found to be unfit to plead.