To Admit or Not Admit: The Utility of Structured Decision-Making Tools in Forensic Mental Health Services in Aotearoa New Zealand

Abstract

A naturalistic, retrospective, whole-cohort design study was undertaken on all service users presented to an Admissions Panel at a forensic service in Auckland, Aotearoa New Zealand, for consideration of admission to an extended forensic care and rehabilitation (EFCR) pathway, over a six-year period (n = 141). Comparisons were made between those offered EFCR, and those not, to determine key socio-demographic, clinical, cultural, and offence-related variables including the use of the DUNDRUM-1 triage security scale in terms of their capacity to differentiate between the two groups. EFCR was offered in 64% of cases, or 55% for those not mandated by the Courts. We found a service user offered an EFCR pathway was more likely to be male, Māori (of Indigenous heritage), suffering from a psychotic illness and a substance use disorder, and to have a history of serious violent offending. However, those declined an EFCR still typically had complex forensic mental health needs but varied with respect to seriousness of their offending. We were also able to compare and contrast results to a similar UK study but also highlight that those declined EFCR still typically had complex forensic mental health needs.