Cognitive abilities and expert assessment practices in fitness to stand trial evaluations : an Australian study based on the legal standard of Presser

Background: Fitness to stand trial (FST) is a cornerstone of western legal systems. Mental health experts play a crucial role in assisting the courts’ fit or unfit determinations. Research has identified psychiatric variables and cognition as important for FST. However, the specific cognitive abilities relevant to FST remains largely untested. Further, there is no research examining these variables within the Australian legal context. Aims: The aim of the current body of research was to examine the role of cognition in FST assessments within an Australian context and in relation to the legal criteria of R v Presser. Methods: The aim of the research reported in the present thesis was achieved by: 1) conducting a systematic literature review evaluating the evidence for specific cognitive abilities in predicting FST; 2) evaluating FST reports produced in NSW (2005-2010) in order to determine the evidence for specific cognitive abilities, psychiatric disorders and neurological dysfunction impacting FST and to inform expert assessment practices; 3) conducting semi-structured interviews with lawyers and forensic mental health experts in order to evaluate views regarding the role of europsychological assessment in FST cases and the relevance of cognitive abilities. Results: Findings suggested that cognitive abilities, specifically verbal memory, nonverbal abilities and executive functioning, were relevant to the question of FST within the Australian legal context. Neurological disorders were also important in predicting a defendants' FST. Expert assessment techniques were highly variable. Reporting on the legal criteria of Presser was also variable. Finally, lawyers and mental health practitioners acknowledged an important role for neuropsychology within FST assessments; however understanding about the discipline of neuropsychology and its application was limited. Several key areas of improvement were identified and recommended. Implications: Further research exploring the relationship between specific cognitive abilities and FST determinations is warranted as well as further education for both lawyers and forensic mental health experts conducting FST assessments in order to improve the quality and standard of FST reports.