Hospitalization of Accused Under Assessment Order (AUAO) to determine if the person could stand trial is probably one of the most controversial forensic psychiatric acts. The subject of assessment order is relatively well studied in psychiatry and law; but the clinical characteristic of hospitalized AUAO has been scantly investigated with conflicting results. Moreover, recent growth of judicial demands for assessment, threatening the stability of care and funding for regular psychiatric beds, needs some empirical justification.

To examine clinical characteristics of all consecutive cases of hospitalized AUAO in Western Quebec between 1991 and 2006.

File information was collected for all adult admissions during study period. First, a descriptive analysis of the clinical characteristics of 270 hospitalized AUAO was performed. Then, a comparative prevalence study, using Relative Risk (RR) measure, was conducted on 2132 cases (148 AUAO and 1984 regular) of first admission.

Hospitalized AUAO, were mostly males (84%) and had a median age of 36 years. Most subjects admitted only once (91%), with an average of 33 days in the hospital. Compared with other first time in-patients, they were significantly more likely to be males (RR = 5.3) suffering from substance-induced disorders (RR = 7.1), personality disorders (RR = 4.4) and schizophrenia (RR = 1.5).

These results suggest that AUAO are mainly suffering from substance-induced and personality disorders. It might then be proposed that a large portion of assessments should be done by community-based evaluation teams in lieu of hospitalization.