Patterns and correlates of health service contact prior to serious offences by people with severe mental illness.

BACKGROUND: Contact with health services prior to offences committed by people with mental illness is an opportunity for intervention and prevention. This study examines the pattern and correlates of health service contact by people with severe mental illness before a serious offence. METHOD: Linkage of a cohort of 477 Forensic Patients found not guilty due to mental illness between 1990 and 2016, and statewide databases of contact with emergency departments, hospital admission and outpatient mental health services in the state of New South Wales, Australia. RESULTS: A total of 84% of the sample had contact with any health service and 76% had contact with an outpatient mental health service prior to the index offence. About two-thirds of the sample had contact with a mental health service in the year before the offence. Factors independently associated with the absence of contact at any point prior to the index offence were non-English-speaking background, being engaged in employment or study, and an absence of childhood abuse or neglect. Although nearly every Forensic Patient had a psychotic illness at the time of the index offence, psychosis was not diagnosed at the time of 61/106 (57.5%) emergency department presentations, in 54/174 (31.0%) hospital admissions and 149/222 (67.1%) attendances at outpatient mental health services prior to the offence. CONCLUSIONS: Most Forensic Patients had contact with health services prior to their offences but many were not identified as having a psychotic illness. Although the symptoms of psychosis may have emerged in the period between contact and the offence, the findings suggest that emerging or underlying psychosis were missed or attributed to other conditions.

Psychiatric rehabilitation in secure forensic settings in NSW: Measuring outcomes.

OBJECTIVE: To quantify outcomes for patients of forensic psychiatric rehabilitation in NSW. METHODS: Data on 245 conditionally released forensic patients was extracted from the Mental Health Review Tribunal (MHRT) files and matched to several state-wide datasets. Descriptive statistics were generated to establish the cohort characteristics, rates of reoffending and social and clinical outcomes. RESULTS: At conditional release, social circumstances for the majority of patients were improved. Clinically, the cohort was more stable, though many did not remain stable over time. Only one-fifth of the sample received a further criminal charge. CONCLUSION: Preliminary evidence suggests that forensic rehabilitation services in NSW are effective.

First Nations Peoples in the forensic mental health system in New South Wales: Characteristics and rates of criminal charges post-release.

BACKGROUND: It is well established that First Nations Peoples in Australia are overrepresented within the criminal justice system. However, First Nations Peoples appear to be comparatively underrepresented in the forensic mental health system, and little is known about their outcomes once released from secure care. OBJECTIVE: To compare the characteristics and rates of repeat criminal justice contact for a criminal charge of First Nations and non-First Nations forensic patients in New South Wales. METHODS: Data on the sample were extracted from the New South Wales Mental Health Review Tribunal paper and electronic files matched to the Bureau of Crime Statistics and Research Reoffending Database. Characteristics of First Nations and non-First Nations patients were compared using univariate logistic regression analysis. Univariate and multivariate Cox proportional hazard regression was used to determine predictors of post-release criminal charges. RESULTS: Key differences in the sociodemographic, clinical and forensic characteristics of First Nations compared with non-First Nations forensic patients were identified. The time to first criminal justice contact following release was significantly shorter for First Nations forensic patients (p < 0.01). CONCLUSION: The findings of this study confirm that First Nations forensic patients have distinct and complex needs that are apparent at entry to the forensic mental health system and that their poorer criminal justice contact rates following release from secure care indicate that these needs are not being adequately met either during treatment or once in the community. Responses to these study findings must consider the complex and continuing impact of colonisation on First Nations Peoples, as well as the need for solutions to be culturally safe.

Rates of homicide and homicide associated with severe mental illness in NSW between 1993 and 2016.

OBJECTIVE: To describe the characteristics of offenders found not guilty on the grounds of mental illness (NGMI) in New South Wales and rates of NGMI and other homicide verdicts. METHOD: Demographic, legal and clinical data after referral to the NSW Mental Health Review Tribunal following an NGMI verdict for homicide matched with results from the National Homicide Monitoring Program. RESULTS: Between 1993 and 2016, a total of 2159 homicide offenders were dealt with by the NSW courts, including 169 (7.8%) who were found NGMI. Over this period, the rate of non-NGMI homicide convictions fell from 1.83 per 100,000 per annum to 0.65 per 100,000 per annum (Kendall's tau = -0.79, p ⩽ 0.001) while the rate of NGMI homicide fluctuated, with an average annual rate of about 0.1 per 100,000 per annum (Kendall's tau = 0.17, p = 0.23). There was no association between the annual rates of NGMI and non-NGMI homicides (Pearson r = -0.3, p = 0.16) but falling rate of non-NGMI homicide meant that the proportion of NGMI offences doubled from 5.5% in the first 12 years to 11% in the second 12 years. Nearly all (88.7%) of those found NGMI had a schizophrenia-related psychosis. However, there were high rates of psychiatric comorbidity including substance use disorder (60.7%) and a history of a prior head injury (41.1%). Most (83.4%) of the NGMI offenders had previous contact with mental health services, but only half of these had received treatment with antipsychotic medication. CONCLUSION: The fall in conviction for homicide offences in the last 24 years has not been matched by a reduction in NGMI homicide verdicts. More assertive treatment of emerging psychosis and comorbid substance use disorders, and improved continuity of care of chronic psychosis might prevent some homicides.

Characteristics and re-offending outcomes of 'limiting-term' forensic patients found unfit to stand trial in New South Wales, Australia.

There are little published data on the characteristics or outcomes of offenders found unfit to stand trial who receive a 'qualified finding of guilt' in a Special Hearing in New South Wales (NSW) and are detained for a 'limiting term' (LT) under the supervision of the NSW Mental Health Review Tribunal (MHRT). We examined NSW MHRT records linked to re-offending data, to report on the characteristics and outcomes of 69 LT patients in a cohort spanning two decades. The most common diagnoses were schizophrenia (54%) and intellectual disability (33%). Patients were detained on average for 4.2 years, which is slightly shorter than the average maximum term imposed. Of the 55 people for whom criminal record data were available, 9.1% were charged with an offence during the first year post-release and 60% overall were charged for at least one post-release offence during a follow-up period ranging from 4.7 to 11.1 years.