A retrospective records study of patterns in mental health and criminal justice service use by people found not criminally responsible on account of mental disorder.

BACKGROUND: While the presence or absence of previous healthcare and criminal justice system (CJS) contacts in the histories of mentally ill offenders has been well-studied, the frequency of these contacts and when they occur in the period leading up to an index criminal event has received less research attention. AIMS: To explore patterns of healthcare and CJS use in the year prior to a criminal act leading to a Not Criminally Responsible on Account of Mental Disorder (NCRMD) finding in Canada. METHODS: In this 3-year retrospective records study, the case files of all patients newly admitted to the British Columbia forensic psychiatric system after a finding of NCRMD between 1st July 2012 and 31st July 2015 were reviewed. Data were extracted on healthcare and CJS use for the 12 months before the act leading to the NCRMD finding. Time-based descriptive statistics and two-step cluster analysis were used to investigate service use patterns. RESULTS: Among 94 eligible patients, only four had no service contacts in the year leading up to the index event, leaving 90 in the cohort for further analysis. On average, these 90 patients had seven contacts with health or criminal justice services in the year prior to the index offence. Cluster analysis revealed a high healthcare pathway group who had had many healthcare and few CJS contacts; a limited service user group who had had few contacts of any kind and a heavy service user group who had had a high volume of contacts with both types of service providers. CONCLUSIONS: The different patterns of patient contact prior to the index event imply that each practitioner-type has distinct and temporally relevant opportunities to provide preventative interventions to their patients or user groups.

Psychological and Sociological Perspectives on Suicide: A Multi-Level Examination of Suicidal Thoughts and Attempted Suicide among Prisoners.

Informed by psychological and sociological perspectives, the present study aimed to improve knowledge on the nature of suicidal thoughts and attempted suicide among adult prisoners. Analyzing data from a nationally representative sample of 18,185 prisoners housed in 287 state and 39 federal prisons across the United States highlight: (a) key micro-level factors associated with suicidal thoughts and attempted suicide, along with some distinct predictive patterns for suicidal thoughts versus attempted suicide; (b) similarities and differences between male and female prisoners concerning the predictive patterns of suicidal thoughts and attempted suicide; (c) the relationship between macro-level prison characteristics and prisoner suicidality. Discussion points toward a direction for future research on prisoner suicidality, as well as recommendations for managing at-risk prisoners.

The relationship between age and suicidal thoughts and attempted suicide among prisoners.

BACKGROUND: Suicide is a major problem across the lifespan, yet rates are highest among middle-aged and older adults; a trend which remains relatively stable across varying sociological settings, including prisons. Despite this understanding, there is limited knowledge on the nature of suicidal thoughts and attempts among older prisoners, especially with respect to how they compare to younger counterparts. The present study aimed to increase insight into the relationship between age and suicidal thoughts and attempted suicide among prisoners, with particular focus on factors that may explain age-based variability. RESULTS: Cross-sectional data were drawn from a nationally representative sample of 18,185 prisoners housed within 326 prisons across the United States. In general, analyses revealed that: (a) attempted suicide was more commonly reported among younger prisoners, while suicidal ideation was more commonly reported among older prisoners; (b) the relationship between age and probability of reporting suicidal thoughts and behavior is curvilinear; (c) younger and older prisoners exhibit somewhat differing predictive patterns of suicidal thoughts and behavior (e.g., physical illness is directly associated with suicidal history for younger prisoners, whereas the effect of physical illness on suicidal history for older prisoners is mediated by depression). CONCLUSIONS: There is evidence to suggest that suicidal thoughts and behavior may manifest differently for younger and older prisoners, with differing patterns of risk. More research is needed on age-based variability in suicidal thoughts and attempted suicide among prisoners, as well as those factors that might explain this variability. Importantly, future research must continue to investigate the nature of suicidal thoughts and behavior among older prisoners.

In custody deaths of men related to mental illness and substance use: A cross-sectional analysis of administrative records in Ontario, Canada.

Highly publicized incidents of in-custody deaths have drawn attention to the well-being of individuals who are held in custodial settings and have contributed to questions surrounding the role played by mental illness and substance use. The data for this descriptive study consist of administrative records from the Office of the Chief Coroner of Ontario. Section 10(4) jury verdicts filed from January 1, 1996 through December 31, 2010 were drawn for analysis. The final sample includes 478 males who died while in custody. Logistic and multinomial regressions were conducted to assess how a history of mental illness and substance use is related to deaths in custody and how those deaths vary across custodial jurisdictions. Approximately half of all deaths in custody occurred among those with a history of mental illness or substance use and those deaths disproportionately occurred in local police or provincial custody, compared to those held in federal custody. Further, the joint effects of a co-occurring history of mental illness and substance use were found to be statistically significant with the strongest effects observed in local police custody. The results from this study underscore concerns surrounding the well-being of individuals with a history of mental illness or substance use and who come into contact with the criminal justice system. With more offenders presenting with complex mental-health and substance-use problems, the implications for local police become apparent in the context of developing policies and practices directed towards preventing deaths.

'Forensic' labelling: an empirical assessment of its effects on self-stigma for people with severe mental illness.

Increasingly, specialized 'forensic' mental health services are being developed to address the criminogenic and clinical needs of people with mental illness who are involved in the criminal justice system. Theoretically, the construction of such specialized services can produce simultaneous positive benefits and negative consequences. This mixed methods study examined and compared the level of self-stigma that was experienced by people who receive compulsory community-based treatment services in the forensic (n=52) and civil (n=39) mental health systems of British Columbia, Canada. The quantitative findings indicate that 'forensic' labelling was not associated with elevated levels of self-stigma. Quantitative level of self-stigma was significantly associated with psychiatric symptom severity, history of incarceration, and history of homelessness. The qualitative findings suggest that access to high-quality, well-resourced forensic mental health services may, for some service users, come at the risk of increased exposure to social and structural stigma. Together, these findings reveal some of the strengths and weaknesses that are associated with organizing forensic mental health services using a specialized service delivery model.