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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]

The purpose of this study was to develop an expertise-based prognostic model for the treatment of complex posttraumatic stress disorder (PTSD) and dissociative identity disorder (DID). We developed a survey in 2 rounds: In the first round we surveyed 42 experienced therapists (22 DID and 20 complex PTSD therapists), and in the second round we surveyed a subset of 22 of the 42 therapists (13 DID and 9 complex PTSD therapists). First, we drew on therapists' knowledge of prognostic factors for stabilization-oriented treatment of complex PTSD and DID. Second, therapists prioritized a list of prognostic factors by estimating the size of each variable's prognostic effect; we clustered these factors according to content and named the clusters. Next, concept mapping methodology and statistical analyses (including principal components analyses) were used to transform individual judgments into weighted group judgments for clusters of items. A prognostic model, based on consensually determined estimates of effect sizes, of 8 clusters containing 51 factors for both complex PTSD and DID was formed. It includes the clusters lack of motivation, lack of healthy relationships, lack of healthy therapeutic relationships, lack of other internal and external resources, serious Axis I comorbidity, serious Axis II comorbidity, poor attachment, and self-destruction. In addition, a set of 5 DID-specific items was constructed. The model is supportive of the current phase-oriented treatment model, emphasizing the strengthening of the therapeutic relationship and the patient's resources in the initial stabilization phase. Further research is needed to test the model's statistical and clinical validity. [ABSTRACT FROM AUTHOR]