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Changing characteristics of forensic psychiatric patients in Ontario: a population-based study from 1987 to 2012

Abstract

Purpose

To quantify the demand for forensic psychiatric services in Ontario over the past 25 years and investigate whether the sociodemographic, clinical and offense-based characteristics of forensic patients have changed over time.

Methods

We investigated all forensic admissions from 1987 to 2012 resulting in a disposition of Not Criminally Responsible on account of Mental Disorder (N = 2533). We present annual proportions of patients with specified sociodemographic, clinical and offense characteristics, and investigate whether the duration of forensic system tenure varies as a function of admission year, psychiatric diagnosis, or index offense.

Results

There has been a steady increase in forensic admissions over this time period, particularly individuals with comorbid substance use disorders and individuals of non-Caucasian ethno-racial background. The proportion of persons committing severe violence has remained low and has decreased over time. Having a comorbid personality, neurological, or substance use disorder significantly increased forensic system tenure, as did committing a violent offense. Individuals who came into the system in earlier years had slower rates of discharge compared to more recent admissions.

Conclusions

Defining the trends characterizing the growth of the forensic population has important policy implications, as forensic services are costly and involve a significant loss of liberty. 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.

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Notes

  1. 1.

    Some individuals had more than one NCRMD disposition for separate offenses, and so were registered more than once over the study period.

  2. 2.

    Admittedly, there is some degree of subjectivity when classifying offense severity, particularly whether sexual offenses represent more or less serious offenses as compared to non-sexual violent crimes. We note that just four individuals in the sample had both a sexual and severely violent index offense, and none of these four included homicides. Seventy-two had both sexual and (non-severe) violent offense, with common assault being the most common violent charge accompanying the sexual offense. Results were unchanged whether these individuals were classified as sexual or violent offenders.

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Acknowledgements

We would like to thank the Honorable Justice Richard Schneider, Angie Baggetta, Sheila McDermott, Chloe Vice and other staff at the Ontario Review Board office for their generous support of this project. In addition, we wish to thank the research analysts who collected the data: Stephanie Fernane, Bronwyn Mackenzie, Crystal Li and Daphne Vrantsidis. This study was funded by the Ontario Mental Health Foundation and Ministry of Health and Long Term Care. Dr. Nicholls would like to acknowledge the consecutive salary support of the Canadian Institutes of Health Research New Investigator Award and Michael Smith Foundation for Health Research Scholar Award.

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Correspondence to Stephanie R. Penney.

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Penney, S.R., Seto, M.C., Crocker, A.G. et al. Changing characteristics of forensic psychiatric patients in Ontario: a population-based study from 1987 to 2012. Soc Psychiatry Psychiatr Epidemiol 54, 627–638 (2019). https://doi.org/10.1007/s00127-018-1619-6

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Keywords

  • Psychiatric services
  • Mentally ill persons
  • Forensic mental health
  • Time trends
  • Crime