Substance use disorders and unauthorized drug use in an Australian forensic mental health hospital

Purpose Substance use disorders (SUDs) are prevalent in forensic mental health hospitals, complicating rehabilitation and safety. Despite this, little is known about the extent of ongoing substance use. This study aimed to determine the prevalence of SUDs, investigate unauthorized substance use during admission and identify associated risk factors within a secure forensic mental health hospital. Design/methodology/approach This retrospective study reviewed medical records of 95 inpatients at an Australian forensic mental health hospital. Patient characteristics were compared between those who used unauthorized substances during admission and non-users, with multiple logistic regression modeling used to identify key predictors. Findings A diagnosis of SUD was present in 73% of patients. During admission, 43% used unauthorized substances, with 29% using illicit substances. Individuals who engaged in substance use had a significantly higher prevalence of SUD history, intravenous drug use and diagnoses of personality disorders when compared to non-users. They were also more likely to be younger, Australian-born, have a longer hospital stay and be admitted to a lower secure unit. Stimulant use disorder was a predictor for any unauthorized substance use, while longer length of stay was strongly associated with substance use. Predictors for illicit use additionally included cannabis use disorder and the diagnosis of a personality disorder. Originality/value This study confirms the high prevalence of SUDs and ongoing substance use occurring within forensic mental health hospitals, highlighting the need to develop targeted clinical interventions. The findings are discussed considering how they inform risk management and policy development in forensic settings.