Mental health services costs within the Alberta criminal justice system

Jacobs, Philip; Moffatt, Jessica; Dewa, Carolyn S.; Nguyen, Thanh Hung; Zhang, Ting; Lesage, Alain

doi:10.1016/j.ijlp.2016.04.008

Cited by 10 publications

(10 citation statements)

References 15 publications

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“…[ 3 ] In Alberta, Canada, the estimated cost of a not-criminally-responsible forensic case is €190,000 per year. [ 6 ] In Sweden, approximately 1000 patients (around 10 per 100,000 population) are inpatients in forensic psychiatric hospitals at any given time, with an estimated annual cost per patient of €250,000 in 2014 prices. [ 7 ]…”

Section: Introductionmentioning

confidence: 99%

Mortality, Rehospitalisation and Violent Crime in Forensic Psychiatric Patients Discharged from Hospital: Rates and Risk Factors

et al. 2016

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ObjectivesTo determine rates and risk factors for adverse outcomes in patients discharged from forensic psychiatric services.MethodWe conducted a historical cohort study of all 6,520 psychiatric patients discharged from forensic psychiatric hospitals between 1973 and 2009 in Sweden. We calculated hazard ratios for mortality, rehospitalisation, and violent crime using Cox regression to investigate the effect of different psychiatric diagnoses and two comorbidities (personality or substance use disorder) on outcomes.ResultsOver mean follow-up of 15.6 years, 30% of patients died (n = 1,949) after discharge with an average age at death of 52 years. Over two-thirds were rehospitalised (n = 4,472, 69%), and 40% violently offended after discharge (n = 2,613) with a mean time to violent crime of 4.2 years. The association between psychiatric diagnosis and outcome varied—substance use disorder as a primary diagnosis was associated with highest risk of mortality and rehospitalisation, and personality disorder was linked with the highest risk of violent offending. Furthermore comorbid substance use disorder typically increased risk of adverse outcomes.ConclusionViolent offending, premature mortality and rehospitalisation are prevalent in patients discharged from forensic psychiatric hospitals. Individualised treatment plans for such patients should take into account primary and comorbid psychiatric diagnoses.

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Section: Introductionmentioning

confidence: 99%

Mortality, Rehospitalisation and Violent Crime in Forensic Psychiatric Patients Discharged from Hospital: Rates and Risk Factors

et al. 2016

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“…Although forensic services plan and work extensively to be able to admit new patients and stay on top of bed demands, the advent of a potentially large HRA group may cause a reduction in bed flow such that inmates in need of transfer to forensic care could be delayed, only to languish in correctional settings (Olley et al, 2009). There are also potentially large economic implications due to the cost of forensic inpatient beds ($274,723 per case per year) compared to outpatient forensic services ($881 per case per year), for example (Jacobs et al, 2014).…”

Section: Discussionmentioning

confidence: 99%

Examining the high-risk accused designation for individuals found not criminally responsible on account of mental disorder.

Goossens¹,

Nicholls²,

Charette³

et al. 2019

Canadian Psychology / Psychologie canadienne

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In 2014, the Canadian government amended the Criminal Code, allowing courts to designate some individuals found not criminally responsible on account of mental disorder (NCRMD) as high-risk accused (HRA). As a result, individuals found HRA face significant new restrictions for transitioning through the forensic system. This study examined the relevance of the HRA designation by simulating the retrospective application of the legislative criteria to the National Trajectory Project (NTP) sample of 1,800 persons found NCRMD between 2000 and 2005 in Quebec, Ontario, and British Columbia, followed until 2008. Focusing on all individuals who had committed a serious contact offense (part of the first HRA criterion) in the NTP sample, we selected variables from the NTP database based on the remaining legislative criteria. We found that an HRA designation could apply to up to 1 in 4 individuals found NCRMD. The HRA group had been under the supervision of the Review Board for a longer period of time than had the non-HRA group. The HRA group reoffended at rates similar to those for the non-HRA group. Our results suggest that the HRA criteria do not identify a subgroup of persons found NCRMD who present an elevated risk of harm to others. Moreover, the findings suggest that NCRMD-accused with serious personal index offenses were already conservatively managed by the Review Boards. As such, a HRA designation based largely on offense severity is likely to miss its mark in terms of improving public safety.

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“…15 In addition, treating a patient in forensic MH services incurs costs almost five times greater compared to general MH services. 19 Some observers have also argued that this leads to a loop effect, with more resources allocated to forensic rather than general MH services, making access to care in the community increasingly difficult. 2,20 Canadian studies have highlighted that nearly three quarters of people found NCRMD had been hospitalized for psychiatric reasons before the offense, 12,21 which is similar to what was found in New Zealand.…”

Section: Abstract Forensic Mental Health Mental Health Services Viole...mentioning

confidence: 99%

mentioning

confidence: 99%

Care Pathways, Health Service Use Patterns and Opportunities for Justice Involvement Prevention Among Forensic Mental Health Clients

et al. 2022

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Objectives The objective of the present study is to describe the patterns of health service use and of prescription claims in the year preceding an offense leading to a verdict of not criminally responsible on account of a mental disorder (NCRMD). Methods Provincial health administrative databases were used to identify medical services, hospitalizations, and ambulatory prescription claims among 1,014 individuals found NCRMD in Québec. Contacts in the year preceding the offense were analyzed using descriptive analyses and latent class analysis. Results Overall, 71.4% of subjects were in contact with services for mental health reasons within a year of their NCRMD offense. Among those that received services and not hospitalized for psychiatric reasons at the time of the offense, 20.7% committed the NCRMD offense within a week of the most recent mental health contact. Among those that had at least one prescription claim for an antipsychotic, 45.8% were not taking any antipsychotic at the time of the offense. Latent class analysis provided a multidimensional representation of mental health service use and showed that 58.4% of subjects had no or very rare contact with services. Conclusions Many forensic patients are likely to have experienced service disruption or discontinuity while in the community, for reasons that may relate to perceived need for care, to service organization, or to the acceptability, availability, and accessibility of services. Given the serious impact of the “forensic” label on the lives of service users, not to mention the increased pressure on resources, the considerable economic costs, and the impact on victims, there is reason to advocate for a greater involvement of mental and physical health service providers in early prevention of violence, which requires reorganizing resources to share the forensic knowledge upstream, before an offense is committed.

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Mental health services costs within the Alberta criminal justice system

Cited by 10 publications

References 15 publications

Mortality, Rehospitalisation and Violent Crime in Forensic Psychiatric Patients Discharged from Hospital: Rates and Risk Factors

Mortality, Rehospitalisation and Violent Crime in Forensic Psychiatric Patients Discharged from Hospital: Rates and Risk Factors

Examining the high-risk accused designation for individuals found not criminally responsible on account of mental disorder.

Care Pathways, Health Service Use Patterns and Opportunities for Justice Involvement Prevention Among Forensic Mental Health Clients

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