Complex Care and Recovery Program, Forensic Division, Centre for Addiction and Mental Health, 1001 Queen Street West, Toronto, M6J 1H4, Canada.
Department of Psychiatry, University of Toronto, Toronto, Canada.
Soc Psychiatry Psychiatr Epidemiol. 2019 May;54(5):627-638. doi: 10.1007/s00127-018-1619-6. Epub 2018 Oct 27.
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.
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.
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.
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.
量化过去 25 年来安大略省法医精神病学服务的需求，并调查法医患者的社会人口学、临床和犯罪特征是否随时间发生变化。
我们调查了 1987 年至 2012 年期间所有导致无刑事责任能力的法医入院情况（N=2533）。我们展示了具有特定社会人口学、临床和犯罪特征的患者的年度比例，并调查了法医系统任期是否随入院年份、精神诊断或索引犯罪而变化。
在此期间，法医入院人数稳步增加，特别是患有合并物质使用障碍和非白种人种族背景的个体。犯下严重暴力行为的比例仍然较低，且随时间呈下降趋势。合并人格、神经或物质使用障碍以及犯下暴力犯罪会显著延长法医系统任期。早些年进入系统的人相比最近入院的人，出院速度较慢。
定义描述法医人群增长趋势的特征具有重要的政策意义，因为法医服务成本高昂且涉及到重大的自由损失。目前的结果表明，年轻、滥用物质、来自不同种族背景的个体以及犯下相对低水平暴力行为的个体在安大略省的法医人群中所占比例不断增加，这表明必须优化治疗以最好地满足这些个体的需求。
