Background and objectives: Previous studies have shown that the assessment of fitness for custody is influenced by external factors. In this study, we analyzed whether the changes that occurred in the period 2015–2016 (predominant involvement of forensic medicine, significant increase in the proportion of the population with a migration background) had an impact on the examination of fitness for custody in the Halle/Saale area (Germany). Material and methods: A retrospective analysis of 1271 examinations of fitness for custody from the period 2013–2018 was carried out. Therefore, two periods (2013–2015 and 2016–2018) were considered and the various parameters were evaluated using several statistical programs. Results: In terms of the reasons for examination, there was a significant decrease in alcohol intoxication and a significant increase in psychiatric illnesses (p = 0.016) in the period 2016–2018. Regardless of the time period there was an increase in examination time of approximately 3.5 min for examinations of people with a migration background. In comparison of the two time periods, fewer persons examined were fit for custody without restrictions and significantly more were fit for custody with restrictions only (p = <0.001). Discussion and conclusion: The present study confirmed the influence of external factors on examination of fitness for custody. With the predominant involvement of forensic medicine, there was a significant increase in persons with limited fitness for custody. The increased proportion of persons with a migration background resulted in a broader variety of indications as well as an increase in examination time and the involvement of interpreters. For the future guarantee of the examinations, these changed circumstances must be taken into account, also including appropriate payment.