Fitness to Stand Trial and Dementia: Considering Changes to Assessment to Meet Demographic Need

Abstract

Fitness to stand trial assessments conducted by forensic mental health specialists occur on a regular basis. The same standard has traditionally been used for close to thirty years. This paper examines an interesting case of a fitness assessment for a lawyer who was charged with a crime, which brings light to some facets of fitness assessments. Historically, it has been less common for individuals to be found unfit to stand trial related to Major Neurocognitive Disorder (Dementia) as compared to Psychotic Disorders. This lawyer’s medical conditions are discussed as well as their implications for an individual’s ability to be fit to stand trial. The criteria used in different legal decisions have varied in different cases. The variation has appeared to be related, at least in part, to the different diagnoses that may be impacting an individual at the time of their involvement with the legal system. We consider here the different interpretations of criteria related to fitness to stand trial, including the ability to communicate with counsel. Potential changes to fitness assessments will also be examined, including the idea of using standardized tools. The importance of these issues is made evident by the fact that Major Neurocognitive Disorder is becoming more prevalent, and these issues will likely be apparent more frequently in the future. A multi-disciplinary team approach may be an ideal way to examine the future direction of fitness assessments, including the involvement of allied health professionals.