Criminal Sanctions, Psychosis, and Mortality

SPECIAL REPORT: FORENSIC PSYCHIATRY PART 2

In a retrospective cohort study of adult with psychotic disorders (N=83,071) from New South Wales, Australia, researchers investigated the link between psychosis, criminal sanctions, and mortality rates following discharge from a hospital for acute psychosis. Researchers tracked criminal sanctions, including mental health court diversion, community sanction, current imprisonment, and recent prior imprisonment.

The researchers found 31.1% of participants experienced 1 or more recent criminal sanctions or mental health court diversions during the follow up period; 10.85% were imprisoned, and 9.7% received mental health court diversion.

Over the course of the study, 11,355 participant deaths were reported. Participants younger than 65 made up 5790 deaths and those 65 and older reported 5565 deaths. In the 65 and older group, 94.2% were disease related, compared to 52.5% in those younger than 65. Disease related deaths were the leading cause in those younger than 65 who had not experienced recent criminal sanction and those with recent community sanction.

Suicide was the leading cause in those with recent mental health court diversion and those currently imprisoned. Accidental drug overdose was the leading cause in those with recent prior imprisonment.

Researchers found mortality rates increased with age and are higher in men.

Recent criminal sanctions, including mental health court diversion, were associated with a higher likelihood of death in patients not currently imprisoned compared with those with no recent sanction.

Reference

1. Spike E, Srasuebkul P, Butler T, et al. Mortality, criminal sanctions, and court diversion in people with psychosis. JAMA Netw Open. 2024;7(10):e2442146.