Offenders with Mental Disorder on Five Continents: A Comparison of Approaches to Treatment and Demographic Factors Relevant to Measurement of Outcome

Abstract

Specialist forensic mental health service development continues worldwide. Given their generally small size and slow patient turnover, aggregating multi-site data could aid in the study of their effectiveness, safety, and value for money. The study compares such context of care and treatment philosophies in nine countries. National databases on demographics, mental disorders, and offending were identified. Participating forensic mental health practitioners independently rated likely outcomes for standard cases of serious offenders with psychosis or personality disorder. Gender distribution was similar between populations, but there were differences in age distribution and proportions of ethnic groups. Rates of psychosis were similar, but there were considerable population-based differences in substance misuse disorder rates, other substance misuse indicators and in criminal conviction statistics. Case analysis confirmed shared preferences for mental health disposals for people with psychosis, and penal disposals otherwise, with differences only in process details. Criminal recidivism was thus found to be a poor comparative measure between these countries, as it was impossible to adjust fully for differences in crime classification and measurement. Clinical outcome measures may be less vulnerable to national differences, but prevalence and type of substance misuse must be rated precisely when sharing or comparing service outcome data between nations.