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

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 di...