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Deinstitutionalization, changes in both criminal and civil law, and the use of the criminal justice system to manage problematic behavior by individuals with serious mental illnesses have affected the number of people entering forensic mental health systems. This review examines data revealing trends in demand for forensic services in Canada, the United States, and internationally. The number of beds and resources allocated to forensic mental health services has steadily increased not only in Canada, but in other countries across the world. In Canada, the number of new accused entering the system doubled annually from 1992 to 2004. In the United States, the number of individuals found not guilty by reason of insanity (NGRI), forensic beds and forensic expenditures have all increased dramatically in recent years. Furthermore, countries in Western Europe – Austria, Denmark, England, Germany, Ireland, Italy, the Netherlands, Spain and Switzerland – have reported an increase of 110%, on average, in the number of forensic beds between 1990 and 2006. These increases have implications for both forensic and non-forensic mental health services. Suggestions to reduce forensic demand and increase the successful reintegration of forensic clients into the community are discussed. [ABSTRACT FROM PUBLISHER]