An important study that was recently published in Social Psychiatry and Psychiatric Epidemiology (impact factor 2.918) investigates, from a Canadian perspective, the demand for forensic psychiatric services and changes in sociodemographic, clinical and offense-based characteristics of forensic patients over a 25-year period.
Researchers explored all forensic admissions from 1987 to 2012 resulting in a disposition of Not Criminally Responsible on account of Mental Disorder (NCRMD) (N=2533).
They found a substantial increase in the number of new forensic admissions over time. Since this may result in concerns regarding pressures on forensic inpatient and outpatient services (lengthier wait times for available beds, as well as individuals waiting in higher security settings than their clinical needs require), the current study drew attention to specific characteristics that changed significantly.
Psychotic spectrum disorders remain overwhelmingly the most common, but the major change is a steady rise in comorbidity, particularly for substance use disorders. Among forensic patients in particular, substance misuse often represents one of the most critical risk factors for ongoing mental instability, violence and offending, and is often the most challenging barrier to successful community reintegration. The presence of both substance misuse and personality pathology, whether comorbid with a primary mood or psychotic disorder, was found to significantly prolong the amount of time under the Ontario Review Board (ORB).
Also age and offense-based characteristics were found as key factors over time. The current results indicate that young, substance abusing individuals of diverse ethno-racial backgrounds and who commit relatively low-level violence comprise an increasing proportion of Ontario’s forensic population, and suggest that treatment must be optimized to best serve the needs of these individuals.
The authors believe that these findings emphasize the need for expanded rehabilitative programming that actively focuses on addiction services and best-practice models for concurrent disorders.
The article full text is available at:
Penney SR, Seto MC, Crocker AG, Nicholls TL, Grimbos T, Darby PL, Simpson AIF. Changing characteristics of forensic psychiatric patients in Ontario: a population-based study from 1987 to 2012. Soc Psychiatry Psychiatr Epidemiol. 2019;54(5):627-638. doi: 10.1007/s00127-018-1619-6.