Transparency and accountability are needed to clarify large differences in the use of forensic orders across...

Although wide variation in the use of community treatment orders mandating treatment for patients with mental illness is well known, there is much less information on the use of forensic orders mandating treatment for patients diverted from justice systems. We therefore examined the use of forensic mental health orders in Australia using routinely available data.

We completed a retrospective review of publicly reported data about forensic orders and health or criminal justice outcomes across Australia's jurisdictions. Data on the initiation and prevalence of forensic orders were extracted from annual reports by health and justice system entities with governance of forensic mental health patients. Linear mixed models were used to test for differences between jurisdictions in the number and rate of increase of forensic orders per capita open at the end of each calendar year, and the patterns of forensic order use and reporting were analysed for lessons regarding a minimum data set about the number of forensic orders, rates of re-offending, and vulnerable cohorts including Indigenous and female patients.

While larger states generally provided useful information about the health engagement of people on forensic orders, no states routinely reported recidivism data or fully addressed vulnerable cohorts, although Victoria provided some information about Indigenous patients and Victoria and Tasmania about female patients. There were significant differences between jurisdictions on both the number of forensic orders in place in 2003, and in the rate of increase in forensic orders between 2003 and 2020. Consistent with the relative number of forensic orders extant in 2003, Queensland showed a large and NSW a moderate rate of increase in the number of people on forensic orders per capita compared with Victoria and WA.

A standard set of minimum reported data is needed to monitor and interpret the causes and consequences of large variations in forensic systems across jurisdictions, with the greatest potential benefits for Indigenous and female patients.