Older male inpatients in secure mental health settings: an international comparison of mental illness, substance use, risk assessment, psychotropic and psychosocial treatment

Older adults represent one of the fastest-growing populations in secure mental health settings, yet their specific needs remain under-researched. This pilot study provides an international comparison of older forensic psychiatric inpatients across Switzerland, Canada, and the Netherlands. Using cross-sectional data from medical records, we examined demographic characteristics, psychiatric diagnoses, substance use, suicide attempts, psychotropic and psychosocial treatments, and risk assessment practices among male inpatients aged 50 and older. Despite high comparability in demographic and criminological profiles, notable differences emerged in clinical presentations, treatment modalities, and risk assessment tools used. The findings underscore the urgent need for age-sensitive forensic mental health services and standardized international approaches to care. Given the broadly similar demographic and sentencing profiles, comparability across countries appears plausible. Future prospective studies should examine clinical and criminal characteristics to determine whether observed differences reflect sample heterogeneity or system-level influences on diagnosis and risk assessment. This study contributes to the growing body of evidence necessary for developing tailored interventions and enhancing international collaboration in forensic psychiatry.