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The concept of unfitness to plead is central to conduct of a fair trial for someone accused of a crime. The historical origins go back several centuries, developing through a number of legislative changes. The modern concept of unfitness to plead arose from a number of legal cases in the 19th century. The Criminal Procedure (Insanity and Unfitness to Plead) Act 1991 followed a number of concerns over existing legislation. More recently, there have been a number of amendments made through the Domestic Violence, Crime and Victims Act 2004. This paper reviews the history and changes in legislation to the present day, and provides an example of the practical application of fitness to plead in practice. It also reviews relevant research and attempts to consider the future of this important medico‐legal term.

Increasing research evidence highlights the importance of recognising a person's learning disability early in their journey through the Criminal Justice System (CJS) and highlights the need for liaison and diversion schemes. This practice paper seeks to raise awareness of the importance of mental capacity and its alignment (or lack there of) with the issue of fitness to plead.

The Law Commission's recent consultation has highlighted the disparity of the Pritchard Test and the Mental Capacity Act 2005, and has considered several provisional proposals for consideration. As a learning disability nurse within a Youth Offending Service, the author encounters young people on court Orders who struggle to understand the criminal justice process. To highlight the significance of this, and its relationship to practice, the paper proposes to discuss a young person's case.

Early recognition of a person's needs and mental capacity are crucial to ensure the right pathway is taken through the criminal justice system. Whether this be supporting the person to undertake their Order and delivery of an appropriate and understandable intervention or diversion away from the criminal justice system into services. Information sharing and working together are key factors to success.

This paper seeks to highlight the difficulties and dilemmas facing staff working within the criminal justice system in relation to the identification and support needs of people with learning difficulties. Learning disability nurses and those professionals working within learning disability services have a significant part to play in this area of work and can help to ensure that people with learning disabilities do not face double jeopardy and injustice.

Although precise numbers are unknown, it is generally acknowledged that between 5‐10% of the offending population are people with learning disabilities. While there are few provisions that explicitly target defendants with learning disabilities there is a general recognition in law that defendants must be able to understand and participate effectively in the criminal proceedings of which they are a part. The implications of the principle of effective participation are that criminal prosecution may be deemed inappropriate for certain defendants with learning disabilities, in which case they may be diverted away from criminal justice and into health care. There is scope for a variety of measures to be put into place to support defendants with learning disabilities to maximise their chances of participating effectively. However, in terms of statutory provision, there is a lack of parity between vulnerable witnesses and vulnerable defendants. Further, the absence of effective screening procedures to identify defendants' learning disabilities means that their support needs often go unrecognised and unmet.

This case report highlights initial difficulties in identifying poor effort and malingering in relation to memory, cognitive deficits and mental disorder. We provide information on the outcome for a man charged with murder who was found to be unable to stand trial as a result of poor memory. After being sentenced by way of a hospital and restriction order, he was found upon inpatient assessment to be malingering and was remitted back to prison in order to continue his murder trial. We comment on the psychological tests, physical investigations and inpatient assessment required to confirm the presence of memory malingering.

The purpose of this paper is to provide an update for readers on recent issues relating to adult safeguarding, together with signposting of papers in this issue of the journal.

A review of recent media, news and policy related items was undertaken and key findings are reported.

A range of findings and information pertinent to adult safeguarding is presented in the paper for readers to consider.

Some of the issues and perspectives presented in the paper may be of relevance for professional practice and readers may wish to disseminate such aspects to colleagues in order to inform practice initiatives.

The paper provides an update and overview of recent topics that are linked to adult safeguarding and protection and draws these together in an accessible format.

Mentally disordered offenders (MDO), contary to general belief, are not the sole concern of specialist and secure services. Their numbers are far greater in the community. Instead of denying involvement with and responsibility for this group, mainstream mental health services need to recognise the reality of their presence on their caseloads and take steps to provide services to them. However this client group often has complex needs that may transcend the capacity of individual key workers or single agencies to meet. This has important implications for the training, supervision and support of individual staff, and for improved liaison and inter‐agency working, particularly with forensic practitioners in prisons and secure mental health services.

This paper aims to investigate the use of Part VI of the Criminal Procedure (Scotland) Act 1995 (CPSA) for people with Learning Disability (LD) and/or Autism. This is in the context of a recent review commissioned by the Scottish Government into whether the provisions in the Mental Health (Care and Treatment) (Scotland) Act 2003 (MHA) meet the needs of these groups which would also affect associated legislation such as CPSA.

All CPSA orders active on the 3 January 2018 were identified and analysed for a number of variables including diagnoses, detention length, level of hospital security and medication use.

Of the 580 people on CPSA orders, 69 (11.9%) had LD and 27 (4.7%) had possible/definite Autism. Most people with LD (56.5%) did not have a mental illness or personality disorder. Most (81.2%) had mild LD. There were two patients whose only diagnosis was Autism. Mean duration of detention was longer for those with LD than for those without. Most patients with LD alone were prescribed medication (61.5%) and, if in hospital, were managed in low secure units (59%).

The results indicate that people with LD or Autism are differently affected by the application of the CPSA from other people with mental disorders, and that this is potentially discriminatory, if it is not objectively justified . It supports the stance from the recent review that to reduce the potential for discrimination, substantial changes to MHA and CPSA should be considered in the wider review of the MHA in Scotland.

There is little published literature about the number of home visits provided to patients within forensic intellectual disability units, and there is no published data on variables that affect home visits. There is a need for a baseline audit that can formulate standards for future practice. The paper aims to discuss these issues.

This paper describes the home visit programme within a forensic intellectual disability service, and a baseline audit of the programme. The audit measured the number of home visits, any factors that adversely affect home visits, and the extent of family contact. The authors propose audit standards for evaluation of good practice in this area.

The audit involved 63 patients over a one-year period. In total, 81 per cent of patients had some form of family contact and 54 per cent of patients at least one home visit. However, 19 per cent of patients had no contact with their family due to a variety of reasons. There were no significant differences in the number of home visits between men and women, patients on civil vs criminal sections or those treated “within area” or “out of area”. Patients in rehabilitation wards had significantly more visits than those in low or medium secure.

Conventional wisdom is that reduced family contact is the direct result of patients being placed “out of area”. The results of this audit suggest that, at least in this group, the reasons may be much more nuanced and that the current definition of “out of area” has to be improved to incorporate the actual distance between the patient’s current family home and the service. Audit standards have been proposed to monitor family contact and home visits. Future work should focus on the relationship between family contact and treatment outcomes.