The Utilization of Clinical Neuropsychological Services within a Forensic Psychiatric Hospital Setting: Treatment Outcomes, Stakeholder Perspectives, and Future Directions

OBJECTIVE: Research is needed to demonstrate how neuropsychological services influence clinical outcomes. The current study examined the use and perceived utility of clinical neuropsychological evaluations within a forensic psychiatric hospital with a high prevalence of schizophrenia spectrum disorders (SSD). METHOD: This cross-sectional observational study used a multi-method design, integrating survey data from multidisciplinary staff (n = 99) with archival review of hospital records for patients who received neuropsychological evaluations in 2022 (n = 62). The survey assessed staff perceptions of the clinical utility of neuropsychological evaluations, and archival data captured how often evaluation findings were documented in treatment plans, discharge summaries, and forensic evaluation reports. RESULTS: Staff reported high satisfaction with neuropsychological evaluations as a component of clinical care and endorsed their incremental value in informing diagnostic, treatment, and forensic decisions. Neuropsychological evaluation findings were documented in 48% of discharge summaries and 58% of forensic evaluation reports overall. Documentation occurred significantly more frequently for incompetent to stand trial (IST) patients than for non-IST patients in both discharge summaries (64% vs. 11%, respectively, p = .016) and forensic evaluation reports (80% vs. 39%, p = .012; Fisher's exact tests). CONCLUSIONS: Findings support the clinical utility of neuropsychological evaluations within forensic psychiatric settings, particularly for patients hospitalized as IST receiving competence restoration. Implications for clinical practice and policy are discussed, along with recommendations to enhance neuropsychological service utilization for individuals with SSD.