Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 May 12;8(3):e92.
doi: 10.1192/bjo.2022.63.

Prevalence of mental disorders in defendants at criminal court

Penelope Brown  1 , Ioannis Bakolis  2 , Elizabeth Appiah-Kusi  3 , Nicholas Hallett  4 , Matthew Hotopf  5 , Nigel Blackwood  6
Affiliations

Prevalence of mental disorders in defendants at criminal court

Penelope Brown et al. BJPsych Open. .

Abstract

Background: Psychiatric morbidity in prisons and police custody is well established, but little is known about individuals attending criminal court. There is international concern that vulnerable defendants are not identified, undermining their right to a fair trial.

Aims: To explore the prevalence of a wide range of mental disorders in criminal defendants and estimate the proportion likely to be unfit to plead.

Method: We employed two-stage screening methodology to estimate the prevalence of mental illness, neurodevelopmental disorders and unfitness to plead, in 3322 criminal defendants in South London. Sampling was stratified according to whether defendants attended court from the community or custody. Face-to-face interviews, using diagnostic instruments and assessments of fitness to plead, were administered (n = 503). Post-stratification probability weighting provided estimates of the overall prevalence of mental disorders and unfitness to plead.

Results: Mental disorder was more common in those attending court from custody, with 48.5% having at least one psychiatric diagnosis compared with 20.3% from the community. Suicidality was frequently reported (weighted prevalence 71.2%; 95% CI 64.2-77.3). Only 16.7% of participants from custody and 4.6% from the community were referred to the liaison and diversion team; 2.1% (1.1-4.0) of defendants were estimated to be unfit to plead, with a further 3.2% (1.9-5.3) deemed 'borderline unfit'.

Conclusions: The prevalence of mental illness and neurodevelopmental disorders in defendants is high. Many are at risk of being unfit to plead and require additional support at court, yet are not identified by existing services. Our evidence challenges policy makers and healthcare providers to ensure that vulnerable defendants are adequately supported at court.

Keywords: Developmental disorders; forensic mental health services; human rights; psychiatry and law; psychotic disorders.

PubMed Disclaimer

Conflict of interest statement

None.

Figures

Fig. 1
Fig. 1
Study flowchart. ASRS, Adult Attention Deficit Hyperactivity Disorder Self-Report Scale; FTP-screen, screener for unfitness to plead, derived from the Fitness-to-Plead Assessment; LDSQ, Learning Disability Screening Questionniare; PriSnQuest, Prison Screening Questionnaire.
See this image and copyright information in PMC

References

    1. Fazel S, Hayes AJ, Bartellas K, Clerici M, Trestman R. Mental health of prisoners: prevalence, adverse outcomes, and interventions. Lancet Psychiatry 2016; 3(9): 871–81. - PMC - PubMed
    1. Forrester A, Till A, Simpson A, Shaw J. Mental illness and the provision of mental health services in prisons. Br Med Bull 2018; 127(1): 101–9. - PubMed
    1. Samele C, McKinnon I, Brown P, Srivastava S, Arnold A, Hallett N, et al. The prevalence of mental illness and unmet needs of police custody detainees. Crim Behav Ment Health 2021; 31(2): 80–95. - PubMed
    1. Taylor PJ, Eastman N, Latham R, Holloway J. Sentencing offenders with mental disorders, developmental disorders or neurological impairments: what does the new sentencing council guideline mean for psychiatrists? Br J Psychiatry 2021; 218(6): 299–301. - PubMed
    1. Ali A, Ghosh S, Strydom A, Hassiotis A. Prisoners with intellectual disabilities and detention status. Findings from a UK cross sectional study of prisons. Res Dev Disabil 2016; 53-4: 189–97. - PubMed