Life Beyond the Forensic Unit: A Systematic Review and Meta-analysis of Patient Reoffending, Hospital Readmission, and Mortality Rates Following Discharge to the Community
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Background
Forensic patients often have complex and costly healthcare needs and risks, even following discharge from secure care. However, little is known about these patients’ health and justice outcomes after community reintegration.
Aims
To estimate the incidence of key post-discharge outcomes among community-discharged forensic patients, including any reoffending, violent reoffending, reconvictions, readmissions, all-cause mortality, and suicide.
Method
We systematically searched PsycINFO, Embase, CINAHL, Medline, PubMed, and ProQuest Dissertations from database inception to May 2025 (PROSPERO CRD42024529265). Random-effect meta-analyses were used to generate pooled incidence estimates, with heterogeneity quantified using prediction intervals.
Results
A total of 49 studies met inclusion criteria ( n = 18,871) and contributed to the meta-analyses. The pooled incidence rate per 100,000 person-years was: any reoffending 3,889 (95% CI 2,055–7,359; 95% PI 290–52,136); violent reoffending 1,851 (95% CI 1,229–2,789; 95% PI 201–17,068); reconvictions 3,291 (95% CI 2,591–4,179; 95% PI 950–11,394); readmissions 7,945 (95% CI 5,507–11,463; 95% PI 1,225–51,548); all-cause mortality 1,789 (95% CI 1,341–2,388; 95% PI 673–4,756); and suicide 407 (95% CI 319–519; 95% PI 225–735).
Conclusion
Overall, the reoffending rate for forensic patients discharged to the community waslower than that reported for other cohorts of people charged with general and violent offences. However, despite typically receiving long admission periods, discharged forensic patients continue to experience high rates of readmission, all-cause mortality, and suicide relative to other psychiatric patient groups in the community. Together, our findings highlight a need for enhanced post-discharge suicide support for forensic patients living in the community to better facilitate successful, long-term reintegration.
