Voluntary and Forced Migrants in Forensic Mental Health Care

Abstract

Foreign-born migrants are at elevated risk for developing serious forms of mental illness, and are over-represented in criminal justice and forensic mental health settings. This study compares the clinical characteristics of forced (n = 60) and voluntary (n = 226) migrant patients in a Canadian forensic service to native-born patients (n = 234), and contrasts regions of birth represented in the current sample to the total adult migrant population in our catchment city (N = 2,537,410). Compared to Canadian-born patients, migrant patients were more likely to have a later-onset psychotic disorder as their only diagnosis, and less likely to have a personality disorder diagnosis. Migrant patients had more familial supports prior to illness onset, but were socially isolated near the time of forensic admission. Compared to the total adult migrant population, higher proportions of Caribbean, Central American, Eastern and Western African persons were represented in the forensic system, while fewer individuals from East and South Asia were represented. There was no effect of migrancy status on the duration of forensic hospitalization or community supervision. Findings suggest disproportionate minority representation among users of forensic services, and highlight what may be ineffective pathways to adequate mental health care among certain migrant groups.

Keywords:

• Psychiatric services
• forensic mental health
• migration

Acknowledgment

We would like to thank Jacob Roth for his assistance in data collection.

Disclosure statement

The authors have no conflicts of interest to report.

Notes

1 While it is important to distinguish persons of minority ethnic status and persons who are migrants, there is also considerable overlap among these groups. In Canada, for example, 65% of visible minorities were born outside the country and came to live in Canada as immigrants (National Household Survey, 2011).

2 Because the current sample of forensic service users draws from a hospital serving the GTA, this is the most appropriate source of comparison (e.g., as opposed to the entire province of Ontario).