Department of Psychology, Université de Montréal, Institut national de psychiatrie légale Philippe-Pinel, Montréal, QC, Canada.
School of Social Work and Criminology, Université Laval, Institut national de psychiatrie légale Philippe-Pinel, Québec City, QC, Canada4440.
Can J Psychiatry. 2022 Dec;67(12):907-917. doi: 10.1177/07067437221076723. Epub 2022 Feb 7.
The objective of the present study is to describe the patterns of health service use and of prescription claims in the year preceding an offense leading to a verdict of not criminally responsible on account of a mental disorder (NCRMD).
Provincial health administrative databases were used to identify medical services, hospitalizations, and ambulatory prescription claims among 1,014 individuals found NCRMD in Québec. Contacts in the year preceding the offense were analyzed using descriptive analyses and latent class analysis.
Overall, 71.4% of subjects were in contact with services for mental health reasons within a year of their NCRMD offense. Among those that received services and not hospitalized for psychiatric reasons at the time of the offense, 20.7% committed the NCRMD offense within a week of the most recent mental health contact. Among those that had at least one prescription claim for an antipsychotic, 45.8% were not taking any antipsychotic at the time of the offense. Latent class analysis provided a multidimensional representation of mental health service use and showed that 58.4% of subjects had no or very rare contact with services.
Many forensic patients are likely to have experienced service disruption or discontinuity while in the community, for reasons that may relate to perceived need for care, to service organization, or to the acceptability, availability, and accessibility of services. Given the serious impact of the "forensic" label on the lives of service users, not to mention the increased pressure on resources, the considerable economic costs, and the impact on victims, there is reason to advocate for a greater involvement of mental and physical health service providers in early prevention of violence, which requires reorganizing resources to share the forensic knowledge upstream, before an offense is committed.
本研究旨在描述导致被判无刑事责任精神障碍（NCRMD）的犯罪行为前一年的健康服务使用模式和处方索赔模式。
利用省级卫生行政数据库，对魁北克省 1014 名被判 NCRMD 的个体进行了医疗服务、住院和门诊处方索赔的识别。使用描述性分析和潜在类别分析对犯罪前一年的接触情况进行了分析。
总体而言，71.4%的受试者在被判 NCRMD 犯罪行为的前一年内因精神健康原因与服务有过接触。在那些因精神原因未住院且在犯罪时接受过服务的人中，20.7%的人在最近一次心理健康接触后的一周内犯下了 NCRMD 犯罪。在至少有一次抗精神病药物处方的人中，45.8%的人在犯罪时未服用任何抗精神病药物。潜在类别分析提供了精神健康服务使用的多维表示，显示 58.4%的受试者没有或很少接触服务。
许多法医患者在社区中可能经历过服务中断或不连续，原因可能与护理需求、服务组织、服务的可接受性、可用性和可及性有关。鉴于“法医”标签对服务使用者生活的严重影响，更不用说对资源的压力增加、巨大的经济成本和对受害者的影响，有理由主张精神和身体健康服务提供者更多地参与早期预防暴力，这需要重新组织资源，在上游共享法医知识，即在犯罪发生之前。
