Does compulsory community treatment for discharged forensic hospital patients work? The recent evidence base.

Objective: Over the decades, research has demonstrated that Conditional Release Programs (CONREP) and Compulsory community treatment can reduce recidivism among forensic patients discharged from inpatient commitment. This study synthesizes current knowledge-including findings from a 2024 California Department of State Hospitals report-to evaluate the impact of involuntary community treatment on recidivism and patient outcomes.

Methods: We retrospectively analyzed 2613 patients discharged from California state hospitals between 2012 and 2017. Patients were either directly discharged to the community (N = 2011) or referred to CONREP (N = 602). Data on rearrests for general and violent offenses were obtained through 2018. Variables with established relationships to recidivism (e.g., commitment category, mental health diagnoses, lengths of stay) were included. Statistical analyses, including chi-square tests, Cox regression, and logistic regression, were conducted to compare recidivism rates and identify significant predictors.

Results: CONREP-treated patients demonstrated dramatically lower fixed recidivism rates at 1, 3, and 5 years compared with directly discharged patients. Direct discharge was associated with up to a sevenfold increased likelihood of rearrest within 1 year. The median time to rearrest was 400 days for directly discharged patients versus 500 days for CONREP patients (p < .004). Logistic regression revealed that direct discharge, younger age, and a higher number of state hospital commitments were significant predictors of rearrest.

Conclusions: Structured, court-supervised community treatment via CONREP substantially reduces recidivism among forensic patients, promoting safer community reintegration and improved outcomes. These findings support expanding CONREP services to enhance public safety and patient rehabilitation.