Imprisonment following discharge from mental health units: A developing trend in New Zealand.

Introduction: Contemporary models of care for people with mental disorders continue to shift to community-based care, requiring fewer inpatient mental health beds, shorter inpatient lengths of stay, and less use of coercion. It has been suggested that some mentally unwell people, whose behavior can no longer be safely contained in overstretched mental health units where seclusion and restraint are discouraged, are now left to the criminal justice system to manage. It is unclear whether the risk of imprisonment following discharge from a mental health unit has increased over recent years.

New justice system responses to mentally impaired defendants in New Zealand.

On 16 March 2020 the District Court in Auckland, New Zealand, had its first sitting as a court dedicated exclusively to cases where issues of fitness to stand trial or insanity had been raised. The impetus for these court sittings, called 'the CPMIP Court' [after the Criminal Procedure (Mentally Impaired Persons) Act 2003], was to reduce delays for mentally impaired defendants, and improve the coverage and efficiency of mental health advice to the Court from both Court Liaison Nurses and Health Assessors (Psychiatrists and Psychologists). This article looks at the model in operation and reflects on some early outcome data, as the possibility of further expansion of this model is contemplated in other regions.

Characteristics of Older Defendants Referred for Forensic Evaluations.

This study aimed to provide a descriptive analysis of the geriatric forensic population referred to a Regional Forensic Psychiatric Service by the court for evaluation (as inpatient, outpatient, or while incarcerated) in New Zealand, over a 7-year period. Data were collected retrospectively from forensic hospital records, including court-ordered reports for those aged 60 and older. Two-fifths (42%) of the 97 referred study subjects were diagnosed with some form of cognitive impairment such as dementia.

Prison mental health in-reach teams in Aotearoa New Zealand: A national survey.

The STAIR in-reach model of care for prisoners with serious mental illness focuses on screening, triage, assessment, interventions and reintegration by using the principles of assertive community treatment. An evidence base exists for the efficacy for its use in Aotearoa New Zealand. However, little is known about its adoption throughout the country.

Comparative outcomes for a national cohort of persons convicted of murder, with and without serious mental illness, and those found not guilty by reason of insanity on a murder charge: A 25-year follow-up study.

Background: Serious mental illness (SMI) is common among persons sentenced to life imprisonment for murder, yet little is known about how this affects rehabilitation, prospects of parole, or risk to the community.

Aim: The aim of this study is to compare outcomes for a national cohort of offenders charged with murder who were either convicted and sentenced to life in prison or placed on a forensic hospital order.

Methods: The 386 cases of murder charges in New Zealand between 1988 and 2000 were divided into three groups: perpetrators without SMI sentenced to life imprisonment (n = 313), perpetrators with SMI but sentenced to life imprisonment (n = 32), or those with such illness and found not guilty by reason of insanity (NGRI) who received a forensic hospital order (n = 41).

Impact of an assertive community treatment model of care on the treatment of prisoners with a serious mental illness.

Objectives: This study aims to describe the impact of a mental health assertive community treatment prison model of care (PMOC) on improving the ability to identify prisoner needs, provide interventions and monitor their efficacy.

Methods: We carried out a file review across five prisons of referrals in the year before the implementation of the PMOC in 2010 ( n = 423) compared with referrals in the year after ( n = 477).

Results: Some improvements in the identification of needs and providing interventions were detected.

From positive screen to engagement in treatment: a preliminary study of the impact of a new model of care for prisoners with serious mental illness.

Background: The high prevalence of serious mental illness (SMI) in prisons remains a challenge for mental health services. Many prisoners with SMI do not receive care. Screening tools have been developed but better detection has not translated to higher rates of treatment.

A prison mental health in-reach model informed by assertive community treatment principles: evaluation of its impact on planning during the pre-release period, community mental health service engagement and reoffending.

Background: It is well recognised that prisoners with serious mental illness (SMI) are at high risk of poor outcomes on return to the community. Early engagement with mental health services and other community agencies could provide the substrate for reducing risk.

Aim: To evaluate the impact of implementing an assertive community treatment informed prison in-reach model of care (PMOC) on post-release engagement with community mental health services and on reoffending rates.

Capacity of forensic patients to consent to treatment.

Objective: Lack of capacity to consent to psychiatric treatment has been promoted as a better basis for compulsion than mental disorder plus risk of harm. Previous research has examined how that legal change would affect acutely unwell inpatients. There is little research on forensic patients.

Patterns of mental health service contact before and after forensic mental health contact in New Zealand.

Objective: To describe patterns of mental health service contact before and after contact with a regional forensic mental health service (FMHS) to assist regional mental health service planning.

Method: All new referrals to Auckland Regional FMHS in 2006 were audited for contact with mental health services in the three years before and three years after their contact in 2006.

Results: A total of 925 identified individuals were referred to the Auckland Regional FMHS in 2006, predominantly through the court (81%) or prison (17%).

Forcing family involvement in patient care: legislative and clinical issues.

Objective: Families have an important role in the recognition and treatment of mental illness in their family members. However, the extent to which families are consulted during compulsory assessment processes has received little attention. In 2000, mandatory family/whānau consultation was introduced in New Zealand.

Insanity acquittee outcomes in New Zealand.

Objective: This paper examines clinical and forensic outcomes for defendants found not guilty by reason of insanity in New Zealand, and explores the implications for policy development and clinical rehabilitation in this population.

Method: All insanity acquittees disposed of by the courts as special patients after 1976 and released before 2004 are described. Their duration of inpatient care, rates of reconviction and rehospitalization following release are examined.

Mentally abnormal homicide in New Zealand as defined by legal and clinical criteria: a national study.

Background: Homicides by people with mental illness have been studied using either clinical or legal categorization of the homicide as abnormal. No previous study has employed both definitions in the same population.

Method: A retrospective study of all homicides in New Zealand between 1988 and 2000 considered mentally abnormal homicide using a legal definition (when the courts deemed a contribution of mental illness was present) and a clinical definition (defined as the presence of a discharge diagnosis from inpatient mental health treatment) of 'mentally abnormal'.

Barriers to care in severe mental illness: accounts from perpetrators of intra-familial homicide.

Objective: To review perceptions of barriers to receiving effective mental health care described by patients who had committed intra-familial homicide in the context of untreated severe mental illness.

Method: Semi-structured interviews addressed issues such as support, help-seeking, experience of illness, and what participants felt might have helped prevent the death(s). Transcripts were analysed for themes related to barriers to help-seeking.

Homicide and mental illness in New Zealand, 1970-2000.

Background: Homicides by mentally ill persons have led to political concerns about deinstitutionalisation.

Aims: To provide accurate information about the contribution of mental illness to homicide rates.

Method: Retrospective study of homicide in New Zealand from 1970 to 2000, using data from government sources.