The concept of fitness to plead has its origins in the medieval courts of England, where the ritual of court proceedings demanded that accused individuals respond to the charges against them. Being fit to plead, however, has involved into a fundamental principle of British law and those legal systems that have evolved from it, and it is now associated with the principle of a fair trial. But in spite of its long heritage, the meaning of being fit to plead, its implications and its consequences all remain vague. Little research has taken place in relation to the concept or its applications in England and Wales, and much of what has been said about fitness to plead has taken place in a factual vacuum.; This book is the result of extensive research into both the development of the concept of fitness to plead and its application. It is based on a review of all individuals found unfit in England and Wales between 1976 and 1988 and provides detailed information about those found unfit to plead and the circumstances associated with their findings, together with follow-up of the psychiatric and legal outcomes. Problems with the working of the law in relation to fitness to plead are discussed and recent changes to it are critically reviewed. The end result is a full consideration of whether the modern concept of fitness to plead protects individuals from unfair trials, and the courts from miscarriages of justice.