Fitness to Stand Trial in India: Demographic, Clinical, and Legal Profiles of Court-Referred Defendants

Psychiatric illnesses and intellectual disabilities commonly occur in the criminal justice system and may impair an individual's ability to participate effectively in legal proceedings. Fitness to stand trial (FST) is an important safeguard for ensuring fair trial processes. This retrospective chart review examined the demographic, clinical, and legal profiles of 159 court-referred individuals assessed for FST at a major tertiary forensic psychiatry centre in New Delhi (India) between January 2017 and December 2022. Data on sociodemographic variables, ICD-10 diagnoses, current mental status, alleged offences, and FST outcomes were analysed using chi-square/Fisher's exact tests and multivariate logistic regression. The sample was predominantly male (81.1%) with a mean age of 37.9 years (SD 14.2). Psychotic disorders were the most frequent diagnosis (35.2%), followed by bipolar affective disorder and intellectual disability. Violent offences constituted 62.9% of alleged crimes. Overall, 54.7% were found fit to stand trial. Active psychiatric symptoms (adjusted OR 47.2, 95% CI 6.1-365.3) and organic mental disorder or intellectual disability (adjusted OR 22.5, 95% CI 4.8-105.6) independently predicted unfitness. Active psychopathology and cognitive impairment were the strongest determinants of unfitness, highlighting the need for structured assessment tools and restoration programmes under the Bharatiya Nagarik Suraksha Sanhita 2023.