The criminogenic, clinical, and social problems of forensic and civil psychiatric patients.

Abstract

Forensic psychiatric patients consume an increasing proportion of mental health resources in Canada and the United States. To inform mental health policy and practice, we compared the criminogenic, clinical, and social problems of forensic patients to those of civilly committed psychiatric patients in two Canadian studies. We predicted that forensic patients would score higher on criminogenic problems and lower on clinical and social problems than civil patients in two studies: one comparing 83 forensic and 189 civil inpatients on a clinician-completed form, the Resident Assessment Instrument-Mental Health, at an urban mental health center, and the second comparing 423 forensic and 178 civil patients assessed at different times using the Patient Problem Survey. The two studies were quite similar in their findings, despite differences in their samples, measures, and data collection methods. In both studies, forensic patients were similar to or lower than civil psychiatric patients in all criminogenic, clinical, and social problems. We conclude that forensic mental health services would benefit greatly by drawing from knowledge accumulated in the general psychiatric literature. This finding also supports the idea that many forensic patients can be appropriately diverted to nonforensic mental health services.

Effects of a Tobacco Ban on Long-term Psychiatric Patients

“…This was probably due to selection-only very violent civil patients would be expected to remain in the hospital for 2 years or more, while many forensic patients remain for years, nonviolent behavior notwithstanding. 48 Statistically significant differences obtained among smokers without parallel differences among nonsmokers are the ones that might be uniquely attributed to the tobacco ban. These are indicated in italics in Table 1.…”

International Trends in Demand for Forensic Mental Health Services

“…This further increases the demand for forensic services, which further reduces the availability of non-forensic services, resulting in a cycle whereby even more individuals are inadvertently forced to use the criminal justice system as an entry-point for mental health care. Seto et al (2004) have gone as far as to suggest that provincial mental health systems in Canada will become de facto forensic mental health systems if this cycle is not interrupted. This leads to the question, is there potential for forensication in other national mental health systems as well?…”

“…Priebe et al (2005) also suggested that increasing complexity in the clinical presentations of individuals with mental illness could result in forensic patients who are more difficult to treat and require more institutional care. Although forensic patients present with similar or fewer criminogenic, clinical, and social problems than civil psychiatric patients (Seto, Harris, & Rice, 2004), it has been reported that patients who move from general to forensic mental health services have more severe symptoms than those who remain in general mental health services (Hodgins, Müller-Isberner, & Allaire, 2006). Thus, if there has been an increase in the clinical severity of mental illness (e.g., comorbid disorders), then complexity of disorder may be a factor contributing to the increase in the number of forensic beds.…”

The use of a brief mental health screener to enhance the ability of police officers to identify persons with serious mental disorders

“…The RAI-MH instrument collects information from patients on more than 400 individual items measuring mental and physical health symptoms, sociodemographic characteristics, substance abuse, risk of harm to self or others, functional characteristics, and service utilization. Second, the instrument has good reliability and validity in inpatient psychiatry settings (Gibbons et al, 2008;Seto, Harris, & Rice, 2004;Urbanoski, Mulsant, Willett, Ehtesham, & Rush, 2012), with inter-rater agreement averaging 80% or more (Hirdes et al, 2002(Hirdes et al, , 2008. Third, with more than 41,000 individual mental health assessments available for analysis, the RAI-MH data represent a large population upon which to identify, analyze, and validate items as candidates for inclusion on a screener.…”

“…Third, as a pilot study, it was not possible to gather data from a randomized or matched control sample of police interactions with PSMD elsewhere in the province, although the results do compare favorably with other studies and data collected from different jurisdictions. Fourth, it was not possible to measure inter-rater reliability and obtain estimates of validity due to limited project resources and the relatively small sample size, although the individual items included on the screener as based on those in the RAI-MH have demonstrated good validity and reliability across diverse inpatient hospital settings (Gibbons et al, 2008;Seto et al, 2004;Urbanoski et al, 2012). Finally, the dependent variables were limited to police escort to hospital and admission, which does not reflect the current broad range of dispositions available to both police officers and clinicians.…”