Individuals with dementia may encounter the Criminal Justice System (CJS), including the police and courts, in different capacities: as victims, witnesses or perpetrators of crimes (related or not to the diagnosis). The Living Well with Dementia strategy makes the following statement: ‘People with dementia access all services and so need informed understanding and support from all the services they come into contact with, not only from specialist dementia services. Awareness and skills are therefore needed in all sections of the workforce and society (e.g. housing, emergency services, employers, utilities, public sector services, GP receptionists, criminal justice system staff), not just those involved with dementia care.’ WhilE we think it is important to highlight this policy initiative, this chapter does not analyse how it has been implemented within the CJS. We are limiting our discussion to the legal issues relating to four areas: crimes committed against people with dementia; crimes committed by people with dementia; dementia in secure settings; and discharge of restricted patients on conditions that amount to deprivation of liberty.

People with intellectual disability may be subject to unfitness to plead proceedings in court due to the nature of their disability. In addition, people withintellectual disability in England and Wales are also subject to legislation such as the Mental Capacity Act 2005 and the Mental Health Act 1983 (as amended in 2007). This chapter explores issues with current fitness to practise proceedings for people with intellectual disability in relation to the Mental Capacity Act and the Mental Health Act, including the use of Sections 35 and 36.

The right to a fair trial is embedded in human rights law. For a trial to be fair, the accused needs to be an active participant – to understand what they have been charged with and to be able answer that charge in a meaningful way. Laws relating to fitness to plead, or competence to stand trial, have developed in many jurisdictions and are designed to protect vulnerable defendants and in some cases divert them into healthcare. There are concerns that the law is not currently fit for purpose. Defendants with neurodevelopmental disorders face particular challenges when accused of a criminal charge at court. Many present with communication deficits, poor understanding and cognitive impairments, stereotyped and other abnormal behaviours, and lack of theory of mind. Identifying those who are unfit to plead can be problematic. In this chapter, we describe legal frameworks for fitness to plead and consider how neurodevelopmental disorders can impact an individual’s ability to participate effectively in their trial. We consider how best to identify, assess and support vulnerable defendants to improve their experience at court and ensure their fair trial rights are upheld.