Psychiatric symptoms and criminogenic risk in people with mental illness: Comparing patients across forensic and...

Because approximately 50% of psychiatric patients present with current or past criminal legal involvement, we aimed to compare factors associated with criminal legal involvement across three inpatient psychiatric groups: patients with mental illness with legal involvement, patients with mental illness without legal involvement, and patients found not guilty by reason of insanity (NGRI).

We hypothesized that participants in the three groups would not differ in psychiatric symptomatology but that participants with mental illness and legal histories would report higher criminal risk scores than the NGRI and mental illness only groups.

Participants consisted of 74 people with mental illness and prior legal involvement, 68 people with mental illness only from a private hospital's psychiatric unit, and 207 forensic state hospital patients acquitted NGRI. We used multivariate analysis of variance, discriminant function analyses, and analysis of variance to test group differences.

Criminal risk factors, criminal attitudes, and social support accurately classified 64.9%-75.2% of participants into their respective groups. Additionally, people with mental illness and past legal involvement scored higher than both mental illness-only and NGRI groups on the total criminal risk score, criminal friend scores, and total perceived social support. The NGRI group produced the lowest psychiatric symptom severity scores.

People with mental illness involved in the legal system demonstrate the highest indicators of criminal risk, further showing that both psychiatric needs and criminal risk should be the target of treatment for this population. We also found that patients adjudicated NGRI showed the lowest psychiatric symptom severity, which may be due to sustained treatment in a stable therapeutic milieu. (PsycInfo Database Record (c) 2026 APA, all rights reserved).