Changing characteristics of forensic psychiatric patients in Ontario: a population-based study from 1987 to 2012

Soc Psychiatry Psychiatr Epidemiol. 2019 May;54(5):627-638. doi: 10.1007/s00127-018-1619-6. Epub 2018 Oct 27.


Purpose: 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.

Methods: 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.

Results: 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.

Conclusions: 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.

Keywords: Crime; Forensic mental health; Mentally ill persons; Psychiatric services; Time trends.

MeSH terms

  • Adult
  • Comorbidity
  • Criminals / psychology*
  • Criminals / statistics & numerical data*
  • Female
  • Forensic Psychiatry / trends*
  • Humans
  • Male
  • Mental Disorders / epidemiology*
  • Middle Aged
  • Ontario / epidemiology
  • Patient Discharge / statistics & numerical data
  • Substance-Related Disorders / epidemiology*
  • Violence / statistics & numerical data