Factors associated with referrals to high security forensic services among people with severe mental illness and receiving inpatient care in prison [2019]

• A mentally ill prisoner may be referred to a high security forensic services (HSFS).

• The aim was to identify predictors associated with admission to HSFS among a sample of male prisoners.

• Previous admission to HSFS, diagnosis of psychosis and cannabis use disorder were related to referral to HSFS.

• Diagnosis of personality disorder was inversely associated to referral to HSFS.

• Improving of interventions in preventing criminal recidivism and forensic admission should be considered.

Prison mental health care is a significant topic which has been already studied and described in literature, particularly because of important implications both in the prison and in the health care system. It’s not uncommon that inmates suffering from mental disorders are referred to high security forensic services (HSFS) but, to date, studies assessing factors associated with relevant referrals to these services are missing. So, the aim of our study is to investigate socio-demographic, criminological, psychopathological and toxicological variables among those who were referred to HSFS as compared to their non-referred counterpart.

We conducted a cross-sectional study recruiting 159 subjects receiving prison inpatient care in an Italian jail, between January 2010 and August 2015. No subjects were excluded from the study. The mean age was 39.

About half of included prisoners suffered from personality disorder while one-third from psychotic disorders. >60% of the subjects had comorbid substance use disorders. The odds of being referred to HSFS were related to previous admission (odds ratio [OR] = 5.34, 95% confidence interval [CI] 1.66–17.16), diagnosis of psychosis (OR = 2.79, 95% CI 1.11–7.04) and cannabis use disorder (OR = 2.68, 95% CI 1.14–6.28). Personality disorder was inversely associated to the referral to forensic facilities (OR = 0.37, 95% CI 0.14–0.97).

Mental health services should improve preventive measures for vulnerable prisoners in order to reduce criminal recidivism and forensic readmission.

Enrico Capuzzi, Elena Pini, Maria Rosaria Malerba, Francesca Cova, Annamaria Lax, Sara Mauri, Alessandra Ornaghi, Milena Provenzi, Paola Rubelli, Maria Ripalta Sergio, Emanuele Truisi, Massimo Clerici
International Journal of Law and Psychiatry, Volume 62, January–February 2019