{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T12:16:54Z","timestamp":1791634614388,"version":"4.3.4"},"reference-count":74,"publisher":"SAGE Publications","issue":"3","license":[{"start":{"date-parts":[[2019,6,15]],"date-time":"2019-06-15T00:00:00Z","timestamp":1560556800000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100004440","name":"Wellcome Trust","doi-asserted-by":"publisher","award":["099009\/Z\/12\/Z"],"award-info":[{"award-number":["099009\/Z\/12\/Z"]}],"id":[{"id":"10.13039\/100004440","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Med Sci Law"],"published-print":{"date-parts":[[2019,7]]},"abstract":"<jats:p>Fitness to plead refers to a criminal defendant\u2019s ability to participate at trial. The purpose of fitness-to-plead laws is to protect the rights of vulnerable individuals who are unable to defend themselves in court and to preserve natural justice in the legal system while balancing the needs to see justice served and protection of the public. Early legal systems treated mentally disordered defendants with leniency, but over time those found unfit to plead have been subjected to indefinite incarceration, breaching their right to liberty while protecting their right to a fair trial. Conversely, the threshold for being found unfit is high, and there are concerns that many unfit defendants are being unfairly subjected to trial. The approaches to balancing the competing demands have changed over time and have led to confusing and contradictory practices. In order to understand better how and why the current problems have come to exist, this paper analyses the historical development of the legal framework for fitness to plead from Medieval England to the turn of the 21st century. It isolates core dilemmas: (a) what the normative standard of fitness to plead is and whether the current test for determining fitness adequately reflects this standard; (b) whether fitness to plead should be disability neutral or whether unfitness requires the presence of a psychiatric diagnosis; and (c) how the courts should deal with those found unfit to plead, including insuring against the deprivation of liberty of innocents while ensuring the public are adequately protected.<\/jats:p>","DOI":"10.1177\/0025802419856761","type":"journal-article","created":{"date-parts":[[2019,6,15]],"date-time":"2019-06-15T13:23:06Z","timestamp":1560604986000},"page":"187-196","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":15,"title":["Unfitness to plead in England and Wales: Historical development and contemporary dilemmas"],"prefix":"10.1177","volume":"59","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8487-7106","authenticated-orcid":false,"given":"Penelope","family":"Brown","sequence":"first","affiliation":[{"name":"Institute of Psychiatry, Psychology and Neuroscience, King\u2019s College London, UK"},{"name":"South London and Maudsley NHS Foundation Trust, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2019,6,15]]},"reference":[{"key":"bibr1-0025802419856761","volume-title":"Trials and punishments","author":"Duff RA.","year":"1991"},{"key":"bibr2-0025802419856761","doi-asserted-by":"crossref","first-page":"176","DOI":"10.6000\/1929-4409.2012.01.17","volume":"1","author":"Shah A.","year":"2012","journal-title":"Int J Criminol Sociol"},{"key":"bibr3-0025802419856761","doi-asserted-by":"publisher","DOI":"10.1080\/14789940903174139"},{"key":"bibr4-0025802419856761","first-page":"2","volume":"3","author":"Vassall-Adams G","year":"2006","journal-title":"Counsel"},{"key":"bibr5-0025802419856761","unstructured":"Northern Ireland Law Commission. Report: Unfitness to Plead. Northern Ireland Law Commission, http:\/\/www.nilawcommission.gov.uk\/report_-_unfitness_to_plead_-_nilc_16__2013_.pdf (2013)"},{"key":"bibr6-0025802419856761","volume-title":"Review of the Crimes (Mental Impairment and Unfitness to be Tried) Act 1997","author":"Victorian Law Reform Commission","year":"2014"},{"key":"bibr7-0025802419856761","first-page":"231","volume-title":"Rethinking rights-based mental health laws","author":"Peay J.","year":"2010"},{"key":"bibr8-0025802419856761","unstructured":"Law Commission of England and Wales. Unfitness to plead (consultation paper no. 197). \nLondon: \nThe Stationery Office, 2010."},{"key":"bibr9-0025802419856761","unstructured":"Law Commission of England and Wales. Unfitness to plead. Volume 1: report. Law Com No 364. \nLondon: \nThe Stationery Office, 2016."},{"key":"bibr10-0025802419856761","unstructured":"Law Commission of England and Wales. Unfitness to plead. Volume 2: draft legislation. Law Com No 364. \nLondon: \nThe Stationery Office, 2016."},{"key":"bibr11-0025802419856761","first-page":"451","volume":"7","author":"Loughnan A.","year":"2016","journal-title":"Crim LR"},{"key":"bibr12-0025802419856761","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijlcj.2015.07.002"},{"key":"bibr13-0025802419856761","first-page":"399","volume":"17","author":"Arstein-Kerslake A","year":"2017","journal-title":"Hum Rights Law Rev"},{"key":"bibr14-0025802419856761","doi-asserted-by":"publisher","DOI":"10.1080\/10383441.2014.1013177"},{"key":"bibr15-0025802419856761","first-page":"770","volume":"24","author":"Freckelton I","year":"2017","journal-title":"Psychiatry Psychol Law"},{"key":"bibr16-0025802419856761","unstructured":"Committee on the Rights of Persons with Disabilities. Guidelines on Article 14 of the Convention on the Rights of Persons with Disabilities: The Right to Liberty and Security of Persons with Disabilities. UNCRPD, https:\/\/www.ohchr.org\/Documents\/HRBodies\/CRPD\/14thsession\/GuidelinesOnArticle14.doc (2015)."},{"key":"bibr17-0025802419856761","unstructured":"Aristotle.\n                      The Nicomachean Ethics. Book III\n                      . (trans D Ross). Oxford: Oxford University Press, 2009, pp.38\u201342."},{"key":"bibr18-0025802419856761","doi-asserted-by":"publisher","DOI":"10.4324\/9781315712413"},{"key":"bibr19-0025802419856761","volume-title":"Crime and insanity in England. 1. The historical perspective","author":"Walker N.","year":"1968"},{"key":"bibr20-0025802419856761","volume-title":"Fitness to plead in England and Wales","author":"Grubin D.","year":"1996"},{"key":"bibr21-0025802419856761","doi-asserted-by":"crossref","unstructured":"Duff R. Moral and criminal responsibility: answering and refusing to answer, https:\/\/ssrn.com\/abstract=3055111 (2017, accessed 5 June 2019).","DOI":"10.2139\/ssrn.3087771"},{"key":"bibr22-0025802419856761","first-page":"748","author":"Grubin D.","year":"1993","journal-title":"Crim LR"},{"key":"bibr23-0025802419856761","volume-title":"Historia placitorum coronae: the history of the pleas of the crown","author":"Hale M","year":"1847"},{"key":"bibr24-0025802419856761","doi-asserted-by":"publisher","DOI":"10.2307\/3475205"},{"key":"bibr25-0025802419856761","volume-title":"The origins of adversary criminal trial","author":"Langbein JH","year":"2003"},{"key":"bibr26-0025802419856761","doi-asserted-by":"publisher","DOI":"10.1093\/acprof:oso\/9780199698592.001.0001"},{"key":"bibr27-0025802419856761","unstructured":"Peay J. Fitness to plead and core competencies: problems and possibilities. LSE Legal Studies Working Paper No 2\/2012, https:\/\/papers.ssrn.com\/sol3\/papers.cfm?abstract_id=1991265 (2012, accessed 5 June 2019)."},{"key":"bibr28-0025802419856761","volume-title":"Commentaries on the laws of England in four books. Volume IV","author":"Blackstone W","year":"2002"},{"key":"bibr29-0025802419856761","unstructured":"Proceedings in the case of John Frith, for High Treason, at Justice Hall in the Old Bailey, on Saturday April 17:30 George 3rd\n                      (1790). Howells State Trials. Volume 22 (1783\u20131794) p. 308."},{"key":"bibr30-0025802419856761","unstructured":"R\n                      v\n                      Dyson\n                      [1831] 173 ER 135."},{"key":"bibr31-0025802419856761","unstructured":"R\n                      v\n                      Pritchard\n                      [1836] 7 C&P 303."},{"key":"bibr32-0025802419856761","unstructured":"R\n                      v\n                      Davies\n                      [1853] 3 Car & K 328."},{"key":"bibr33-0025802419856761","unstructured":"R\n                      v\n                      Moyle\n                      [2008] EWCA Crim 3059."},{"key":"bibr34-0025802419856761","unstructured":"R\n                      v\n                      Berry (John)\n                      [1978] 66 Cr App R 156."},{"key":"bibr35-0025802419856761","unstructured":"R\n                      v\n                      Robertson\n                      [1968] 1 WLR 1767."},{"key":"bibr36-0025802419856761","doi-asserted-by":"publisher","DOI":"10.1192\/bjp.62.259.763"},{"key":"bibr37-0025802419856761","volume-title":"Treatment without consent: law, psychiatry and the treatment of mentally disordered people since 1845","author":"Fennell P.","year":"1996"},{"key":"bibr38-0025802419856761","volume-title":"The insane and the law","author":"Pitt-Lewis G","year":"1895"},{"key":"bibr39-0025802419856761","unstructured":"Hitchens (1888) Taunton Assizes, Field J,\n                      Somerset County Herald\n                      , 18 Feb, 8."},{"key":"bibr40-0025802419856761","doi-asserted-by":"publisher","DOI":"10.1192\/bjp.183.4.292"},{"key":"bibr41-0025802419856761","unstructured":"R\n                      v\n                      Hadfield\n                      [1800] 27 St Tr 1281."},{"key":"bibr42-0025802419856761","doi-asserted-by":"publisher","DOI":"10.2307\/1409803"},{"key":"bibr43-0025802419856761","unstructured":"R\n                      v\n                      Roberts\n                      [1953] 3 WLR 178."},{"key":"bibr44-0025802419856761","unstructured":"R\n                      v\n                      Beynon (Henry)\n                      [1957] 2 QB 111."},{"key":"bibr45-0025802419856761","unstructured":"Home Department. Third Report of the Criminal Law Revision Committee: Criminal Procedure (Insanity). Cmnd. 2149 \nLondon: \nHMSO, 1963."},{"key":"bibr46-0025802419856761","unstructured":"R\n                      v\n                      Podola\n                      [1960] 1 QB 325."},{"key":"bibr47-0025802419856761","unstructured":"LexisNexis. Halsbury\u2019s laws of England. 5th ed. London: LNUK, 2015, volume 27, para 357."},{"key":"bibr48-0025802419856761","unstructured":"R\n                      v\n                      Vent (James Robert)\n                      [1936] 25 Cr App R 55."},{"key":"bibr49-0025802419856761","first-page":"220","author":"Samuels A.","year":"1995","journal-title":"Crim LR"},{"key":"bibr50-0025802419856761","first-page":"87","author":"Mackay R.","year":"1991","journal-title":"Crim LR"},{"key":"bibr51-0025802419856761","doi-asserted-by":"crossref","first-page":"203","DOI":"10.1111\/j.1468-2230.1964.tb01023.x","volume":"27","author":"Downey BW.","year":"1964","journal-title":"Mod L Rev"},{"key":"bibr52-0025802419856761","unstructured":"Home Office and DHSS. Report of the Committee on Mentally Abnormal Offenders (The Butler Report). Cmnd. 6244. \nLondon: \nHMSO, 1975."},{"key":"bibr53-0025802419856761","doi-asserted-by":"publisher","DOI":"10.1093\/oxfordjournals.bjc.a046717"},{"key":"bibr54-0025802419856761","first-page":"4","author":"White S.","year":"1992","journal-title":"Crim LR"},{"key":"bibr55-0025802419856761","first-page":"532","author":"Mackay R","year":"2000","journal-title":"Crim LR"},{"key":"bibr56-0025802419856761","unstructured":"Winterwerp\n                      v\n                      Netherlands\n                      (A\/33) [1979\u20131980] EHRR 387, ECHR."},{"key":"bibr57-0025802419856761","unstructured":"X\n                      v\n                      UK\n                      [1981] 4 EHRR 188."},{"key":"bibr58-0025802419856761","volume-title":"Mental health: the new law","author":"Fennell P.","year":"2007"},{"key":"bibr59-0025802419856761","volume-title":"A guide to the Mental Health Act 1983","author":"Bluglass R.","year":"1983"},{"key":"bibr60-0025802419856761","doi-asserted-by":"publisher","DOI":"10.1192\/pb.13.1.4"},{"key":"bibr61-0025802419856761","first-page":"604","author":"Emmins C.","year":"1986","journal-title":"Crim LR"},{"key":"bibr62-0025802419856761","unstructured":"The case of Glen Pearson.\n                      The Times\n                      , 21 November 1985."},{"key":"bibr63-0025802419856761","doi-asserted-by":"crossref","unstructured":"Hansard. HC Deb 16 April 1986 vol. 95, cc873.","DOI":"10.3109\/00498258609043510"},{"key":"bibr64-0025802419856761","unstructured":"Home Office. Mentally disordered offenders, restricted patients detained in special hospitals \u2013information for the special Hospitals Service Authority, 1990."},{"key":"bibr65-0025802419856761","unstructured":"Foggarty M. A plea for those unfit to plead. The Guardian, 7 February 1990."},{"key":"bibr66-0025802419856761","doi-asserted-by":"publisher","DOI":"10.1111\/j.1468-2230.1992.tb00931.x"},{"key":"bibr67-0025802419856761","first-page":"530","author":"Mackay R","year":"2007","journal-title":"Crim LR"},{"key":"bibr68-0025802419856761","unstructured":"R\n                      v\n                      M (John)\n                      [2003] EWCA Crim 3452."},{"key":"bibr69-0025802419856761","unstructured":"R\n                      v\n                      Stafford Prison Governer Ex p. Emery (Frederick\n                      ) [1909] 2 KB 81."},{"key":"bibr70-0025802419856761","doi-asserted-by":"publisher","DOI":"10.1017\/S0033291708004637"},{"key":"bibr71-0025802419856761","first-page":"466","volume":"34","author":"Exworthy T.","year":"2006","journal-title":"J Am Acad Psychiatry Law"},{"key":"bibr72-0025802419856761","first-page":"130","volume":"7","author":"Kerrigan K.","year":"2002","journal-title":"J Ment Health Law"},{"key":"bibr73-0025802419856761","unstructured":"R\n                      v\n                      Grant (Heather)\n                      [2001] EWCA Crim 2611."},{"key":"bibr74-0025802419856761","unstructured":"Home Office. Domestic Violence, Crime and Victims Act 2004. Circular 24\/2005. \nLondon: \nHome Office, 2005."}],"container-title":["Medicine, Science and the Law"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/0025802419856761","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/0025802419856761","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/0025802419856761","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T08:33:30Z","timestamp":1777624410000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/0025802419856761"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,6,15]]},"references-count":74,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2019,7]]}},"alternative-id":["10.1177\/0025802419856761"],"URL":"https:\/\/doi.org\/10.1177\/0025802419856761","relation":{},"ISSN":["0025-8024","2042-1818"],"issn-type":[{"value":"0025-8024","type":"print"},{"value":"2042-1818","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,6,15]]}}}