Digital twin technology in forensic mental health

Forensic mental health services face significant challenges in managing violence and self-harm risks, optimizing therapeutic security, and planning pathways for individuals with serious mental disorders within criminal justice systems. Traditional risk assessment tools provide static snapshots that degrade over time and offer limited personalization. Digital twin technology, which creates dynamic, data-driven computational replicas of real-world entities, presents a transformative opportunity to enhance decision-making in this complex field. This narrative review synthesizes emerging concepts, opportunities, and risks surrounding the use of digital twin technology in forensic mental health, examining how this innovation could augment clinical practice while addressing critical ethical and legal considerations. We conducted a narrative review of recent literature on digital twins in healthcare, digital psychiatry, risk management in forensic mental health, and related ethical frameworks, synthesizing findings from peer-reviewed journals, consensus statements, and policy documents to map plausible applications, technical constraints, and governance requirements specific to forensic mental health contexts. Digital twins could enhance violence and self-harm risk management through continuous updating, personalize care pathways across prisons, courts, and secure hospitals, optimize ward staffing and security protocols, and support rights-respecting care planning. However, deployment requires robust attention to data provenance, algorithmic fairness, transparency, clinical validity, and human rights safeguards. We identify a staged translational pathway with essential guardrails for safe implementation. While digital twin technology holds considerable promise for forensic mental health, realizing these potential demands rigorous validation, strong governance frameworks, and sustained co-design with service users, clinicians, and legal stakeholders to ensure safety and rights protection.