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Purpose We sought to identify trends and characteristics associated with the availability of tailored mental health services for individuals involved in the criminal justice system and ordered to treatment by a court, nationally in the US and by state. Methods We used National Mental Health Services Survey to identify outpatient mental health treatment facilities in the US (2016 n  = 4744; 2018 n  = 4626; 2020 n  = 4869). We used clustered multiple logistic regression to identify changes over time as well as facility- and state-level factors associated with the availability of specialty court-ordered services. Results Slightly more than half of the outpatient mental health treatment facilities offered specialized services for individuals ordered to treatment by a court, with wide variation between states. Nationally, there was a significant increase in the odds of offering court-ordered treatment in 2020 compared to 2016 (aOR = 1.16, 95% CI = 1.06–1.27, p  < 0.01). Notable associations included offering integrated substance use treatment (versus none, aOR = 2.95, 95% CI = 2.70–3.22, p  < 0.0001) and offering trauma therapy (versus none, aOR = 2.05, 95% CI = 1.85–2.27, p  < 0.0001). Conclusion The availability of mental health services for individuals ordered to treatment by a court is growing nationally but several states are lagging behind. Court ordered treatment is a promising strategy to improve health and reduce reliance on the carceral system as a healthcare provider. At the same time, we express caution around disparities within behavioral health courts and advocate for equity in access to incarceration alternatives.

Background The reduction of violence risk and crime recidivism is the core marker of progress in forensic psychiatry treatment for mentally disordered offenders, and commonly used to decide upon discharge from prison-based security clinics. While dynamic risk is expected to relate to treatment progress, static risk is expected to predict discharge from prison-based treatments. Integrated risk-protection assessment is thought to facilitate prediction of treatment outcome. Methods In a two-year prospective observational cohort study using a repeated measures design, we monitored treatment as usual induced changes in violence and protective factors, in 117 offenders of a medium-security forensic clinic in Switzerland. Mixed-effects and multinomial logistic regression models were used to predict longitudinal risk and protection evolution, length of stay, and discharge locations. Results Forensic psychiatry treatment was indeed associated with decrease in dynamic risk and enhanced protection, contrary to static risk. After 18–24 months of treatment, protective factors counterbalanced risk factors. For risk, both a numeric scale and a structured professional judgement approach equally showed significant improvement over time. For protection and integrated risk-protection, structured professional judgement ratings failed to show significant treatment-related change. Discharge to low-security psychiatry wards was predicted only by favorable baseline risk, protection, and integrated risk-protection, but not by their treatment-related evolution. Longer length of stay was predicted by higher baseline total risk only. Conclusions Study results confirm the need to distinguish dynamic from static risk in forensic psychiatric treatment monitoring, and to include integrated risk-protection measures. Treatment length and discharge are predicted by the offenders’ baseline risk profile, but not by the evolution of risk and protection factors. A structured professional judgment approach in risk and protection assessment leads to different longitudinal results than the use of numeric scale scores.

Compared to men inmates, women display decreased prevalence of severe mental disorder but increased occurrence of substance use disorders (SUD) and higher rates of previous contacts with mental health services. The group of women in detention is highly heterogeneous according to the status of incarceration (pre-trial detention (PTD), sentence execution (SE) and court ordered treatments (COT)). Studies focusing on the comparison of sociodemographic patterns, detention-related and clinical variables between these groups are still lacking. We explored these parameters in 136 women admitted for acute psychiatric care in the sole Geneva forensic unit during a nine year period (2014–2023). Sociodemographic and detention-related data included age, nationality, marital status, presence of children, education attainment, most frequently speaking language, social support, employment before conviction and type of offenses. Clinical variables included the main ICD-10 diagnosis, presence of concomitant SUD, type of personality disorders, presence of suicidal thoughts and attempts at admission, as well as number and mean duration of stays. PTD and SE women had at least 9 years of formal education in 38.9% and 30.3% of cases. Most women in PTD (77.7%), SE (56.6%) and COT (56.2%) groups were Swiss or European citizens. The level of French knowledge was excellent in most of the cases. 43.8% of COT women had at least one child and this percentage is even higher for PTD and SE cases. The employment rate before conviction was also quite high, mainly for PTD and SE (61.1% and 60.6%) and, in a lesser degree, for COT (43.8%) women. Significant social support was present in the vast majority of women without any significant group difference. The distribution of type of offenses did not differ between the three types of detention with a predominance of physical violence, and drug trafficking. The number of stays during the period of reference was significantly higher in COT compared to both SE and PTD women. History of previous inpatient care was also significantly more frequent in COT that SE and PTD women. Adjustment and affective disorders were more often found in SE and PTD cases, these diagnoses were absent in the COT group. In contrast, a main diagnosis of psychotic disorders was found in 62.5% of COT cases compared to only 21.2% in SE and 24.1% in PTD cases. The number of stays, history of inpatient care and diagnosis of psychosis were independent predictors of COT status. In conclusion, the present data reveal the good social integration and emotional support of women needing acute psychiatric care in prison independently of the type of detention. Clinically, women in PTD and SE display more often emotional distress whereas those in COT suffer from acute psychotic symptoms with previous history of psychiatric care and multiple inpatient stays.

Background Both the frequency of court-ordered treatments (COT) for offenders and prevalence of mental disorders among regular prison inmates steadily increased in most western countries. Whether there are major sociodemographic and clinical differences between these two populations is still matter of debate. Methods We compared the sociodemographic and clinical characteristics in a representative sample of 139 regular prison inmates versus 61 offenders with COT admitted during a 5-year period in an acute psychiatric care unit located in the central prison of the Geneva county. Fisher exact, unpaired Student’s t and Mann–Whitney U tests were used to compare demographic and clinical variables between COT patients and regular inmates. In addition, univariate and multivariable ordered logistic regression models were built to identify the sociodemographic and clinical determinants of COT. Results COT patients were significantly older, less frequently married, with better education attainment, predominantly French-speaking, of the Christian religious group and with regular religious practice. History of psychiatric outpatient care was significantly more frequent in this group. Unlike the significantly higher occurrence of adjustment disorders in regular prisoners, psychosis was the main diagnosis in COT patients. When all diagnostic categories were taken into account in multivariable models, the presence of personality and psychotic disorders were the stronger predictors of COT status. Conclusions Our data reveal that offenders with COT represent a clinically distinct group with an overrepresentation of personality and psychotic disorders. Moreover, they show that, at least in the Swiss penitentiary system, COT patients are less exposed to acculturation issues compared to regular inmates.

We explored personal, social, and legal factors associated with different types of mental health treatment orders in one Missouri metropolitan court where the majority of system-involved youth are African-American. The research question under investigation is: with objective assessment information at their disposal, do judges order mental health treatment based on indicators of need or do they follow the pattern found in other studies where demographic and legal variables are key indicators? The bivariate results indicate that while males and females do not differ in mental health status, they do differ in psychosocial needs and offense patterns. In the multivariate analysis, the mental health treatment specific model indicates that commonly used indicators of need, prior mental health status and being female are related to receiving treatment orders. In the substance abuse treatment specific model, the significant factors are closely aligned with need: drug offenses, substance abuse problems, and negative influence of peers.

The purpose of our study was to examine rates of consent to participate in research in voluntarily and involuntarily hospitalized psychiatric patients in order to evaluate factors that may influence the decision to participate in research. We used logistic regression models to evaluate differences and found that involuntary patients were less likely to consent to participate. After adjustment for covariates, we found that consent rates did not differ between the involuntary and voluntary population, but that lower Global Assessment of Functioning (GAF) scores and psychosis negatively affected the decision to consent to research. We discuss the implications of our findings.

The study investigated differences in demographic and psychological variables between treatment completers and dropouts among abusive men entering a court-mandated treatment program. An additional goal was to create a predictive model that would correctly identify men at greatest risk of dropping out of the program. The authors used a secondary analysis of 137 men randomly selected from a larger pool of 784 men. Analysis indicated that very few of the demographic and psychological variables differentiated between treatment completers and dropouts. However, a logistic regression model was developed that correctly predicted treatment completion for 75 percent of the sample. Implications of the findings for improving retention rates among men attending court-mandated batterer treatment programs are discussed.

Compulsory admission is commonly regarded as necessary and justified for patients whose psychiatric condition represents a severe danger to themselves and others. However, while studies on compulsory admissions have reported on various clinical and social outcomes, little research has focused specifically on dangerousness, which in many countries is the core reason for compulsory admission.AimsTo study changes in dangerousness over time in adult psychiatric patients admitted by compulsory court order, and to relate these changes to these patients' demographic and clinical characteristics. In this explorative prospective observational cohort study of adult psychiatric patients admitted by compulsory court order, demographic and clinical data were collected at baseline. At baseline and at 6 and 12 month follow-up, dangerousness was assessed using the Dangerousness Inventory, an instrument based on the eight types of dangerousness towards self or others specified in Dutch legislation on compulsory admissions. We used descriptive statistics and logistic regression to analyse the data. We included 174 participants with a court-ordered compulsory admission. At baseline, the most common dangerousness criterion was inability to cope in society. Any type of severe or very severe dangerousness decreased from 86.2% at baseline to 36.2% at 6 months and to 28.7% at 12 months. Being homeless at baseline was the only variable which was significantly associated with persistently high levels of dangerousness. Dangerousness decreased in about two-thirds of the patients after court-ordered compulsory admission. It persisted, however, in a substantial minority (approximately one-third).Declaration of interestNone.