Patients with psychosis who recently experienced criminal sanctions have an increased risk of mortality, particularly from external causes such as overdose and suicide, compared to those without recent legal involvement, according to a recent study.
The cohort study involving over 83,000 patients with psychosis in New South Wales, Australia, found an association between recent criminal sanctions and increased mortality risk. Among patients younger than 65 years, recent imprisonment and mental health court diversion were associated with the highest risks for both all-cause and external-cause mortality. The adjusted hazard ratio (aHR) for all-cause mortality among those with prior imprisonment was 1.69 (95% confidence interval [CI], 1.50-1.91), while the aHR for external-cause mortality reached 2.64 (95% CI, 2.27-3.06). For those in mental health court diversion, the aHR was 1.43 for all-cause mortality (95% CI, 1.23-1.66) and 2.08 for external-cause mortality (95% CI, 1.72-2.50).
External causes of death, such as overdose and suicide, were frequently observed, especially in those recently released from prison. In contrast, participants currently imprisoned demonstrated a lower mortality risk, which may be attributable to the structured prison environment, though suicide risk remains a concern within this setting.
These findings, published in JAMA Network Open, suggest a role for cross-sector interventions to address overlapping clinical, social, and systemic determinants of mortality in justice-involved patients with psychosis. The researchers suggest that integrated care models—including mental health and substance use treatment—could help mitigate health risks in this population. They also indicate that additional resources could support mental health court diversion programs in reducing mortality risk among patients with psychosis involved in the criminal legal system.
Full disclosures can be found in the published study.