Early Mental Health Treatment and Domestic Violence Outcomes in Psychosis: A Population-Based Cohort Study

Evidence for effective interventions among individuals with psychosis who perpetrate domestic violence (DV) remains limited. In this population, justice system involvement frequently occurs during periods of inadequately managed mental health symptoms.

We examined whether early mental health treatment following a DV charge reduces subsequent DV reoffending among individuals with psychosis.

We conducted a population-based retrospective cohort study of individuals in New South Wales, Australia, with a recorded diagnosis of psychosis who were subsequently charged with a DV offense. The primary exposure was receipt of mental health treatment within 1 month following the index DV charge. The primary outcome was time to the first subsequent DV charge. Secondary outcomes included time to first DV conviction, violent DV charge, and violent DV conviction. Time-to-event analyses were performed using competing risks regression.

During a median follow-up of 4 years, 3,513 of 8,458 individuals (41.5%) were charged with a subsequent DV offense. Among men, early mental health treatment was associated with reduced risk across all DV outcomes, including any DV charge (adjusted sub distribution hazard ratio [sHR] 0.86, 95% CI [0.79, 0.93]), conviction (sHR 0.81, 95% CI [0.73, 0.89]), violent charge (sHR 0.83, 95% CI [0.75, 0.93]), and violent conviction (sHR 0.78, 95% CI [0.68, 0.89]). There was no evidence of an association between early treatment and DV reoffending among women.

These findings support integrating timely psychiatric care into DV offender management for men with psychosis, while indicating that alternative, sex-responsive strategies may be required for women with psychosis.