The role of cognition in fitness to stand trial: a systematic review

The aim of the current paper was to systematically review the quality and design of the literature examining cognition and fitness to stand trial (FST). Ten empirical studies published between 1970 and July 2013 met the inclusion criteria. All studies utilised cross-sectional designs and six were prospective. Study quality was appraised based on FST research guidelines. The study quality was highly variable. Intelligence was controlled statistically in only half of the included studies. Cognitive processes, specifically, processing speed, verbal memory and visuoperceptual skills differentiated fit and unfit groups. Aspects of executive functioning, including social knowledge and abstract thinking, influenced FST. Future studies should use prospective consecutive designs and multivariate statistical strategies that control for potential confounds. Comprehensive assessment across a number of cognitive domains is needed in order to validate research conducted to date and guide forensic assessment of FST.     

Actions taken in response to mental health screening at reception into prison

Screening for mental health problems on reception into custody has been criticised. However, there have been few studies on care pathways through custody as a result of screening identification. We aimed to identify what actions were taken as a result of screening positive for suicidal ideation and mental health problems. Case records for 2166 prisoners newly received into five prisons in England and documented contact with health care professionals in the following month were examined by hand over a four-month period. Altogether, 3% of prisoners were screened as having current suicidal ideas, of whom 30% had no contact with mental health services or risk assessment documentation. Another 21% of new receptions received psychotropic medication, for whom over 60% received no primary mental health assessment, and only 36% received psychotropic medication in prison. Care pathways need to be defined, and screening needs to be delivered as originally intended by initial screen for life-threatening matters, followed by a later, comprehensive assessment of health needs.