Intellectual and developmental disabilities and Ontario’s forensic inpatient system: a population-based cohort study

ABSTRACT

Individuals with intellectual and developmental disabilities (IDD) in forensic inpatient beds are both complex and understudied. Previous studies have been limited and largely based on smaller clinical samples. We used data from a population-based cohort of Ontario adults with IDD (H-CARDD cohort, n = 66,000) to describe their prevalence in forensic inpatient beds during 2005–2015 and compare their demographic and clinical profiles with non-IDD forensic patients. Results show that forensic patients with IDD and without IDD have similar profiles, with the exception that patients with IDD are more likely to have a psychiatric disorder and to be younger, rural, and have high or very high morbidity. Strong support was found for disproportionate admission: individuals with IDD are 12.2% of forensic inpatients but only 0.8% of the general population (d = 1.57). Support for disproportionate utilization was less dramatic and mixed. Little difference was found in terms of the per cent of longer-stay (treatment) admissions or multiple forensic admissions; however, patients with IDD did have longer number of bed days over 10 years (averaging 220.6 days more, d = 0.28). A better understanding of the barriers to discharge for individuals with IDD will support implementation of appropriate pathways out of the hospital.

KEYWORDS:

• Forensic psychiatry
• forensic psychiatric inpatients
• learning (intellectual disabilities)
• population-based cohort
• prevalence

Acknowledgements

This research is part of the Health Care Access Research and Developmental Disabilities (H-CARDD) Program. The authors gratefully acknowledge the Province of Ontario for their support of this work through their research grants programme. This study was supported by the Institute for Clinical Evaluative Sciences (ICES), which was funded by an annual grant from the Ontario Ministry of Health and Long-Term Care (MOHLTC). The opinions, results and conclusions herein are those of the authors and do not reflect that of the Province or the data providers. No endorsement by the Province, MOHLTC, or ICES is intended or should be inferred. Parts of this material are based on data and information compiled and provided by the Canadian Institute for Health Information (CIHI). However, the analyses, conclusions, opinions, and statements expressed herein are those of the authors, and not necessarily those of CIHI. The Johns Hopkins ACG® system Version 7 was used for this research.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

This work was supported by the Government of Ontario through their research grants program.