Adverse Childhood Experiences, Suicidality, and Aggression as Indicators of Polypharmacy Practice in Forensic Mental Health Systems

Pharmacotherapy is a front-line intervention used to address complex health concerns among forensic system consumers. Many are prescribed a polypharmacy pharmacotherapy regimen, though this may pose significant risks to physical health and well-being. Forensic consumers also have evidence of behavioral health concerns that may impact preferred treatment and prescribing practices. We examined the relationship between ACEs, suicide, self-harm, and inpatient aggression with psychotropic polypharmacy using retrospective data extracted from medical records from a US forensic mental health facility (N = 182). Nearly all participants (98.5%) prescribed any medication (72%) received a psychotropic polypharmacy regimen. ACEs were common, impacting 75.8% of the sample. ACEs, self-harm, and inpatient aggression, though not suicide attempts, were positively predictive of psychotropic polypharmacy in a series of regression analyses. Mediation analyses explored the interplay between ACEs, specific behavioral concerns, and psychotropic polypharmacy, though only models involving self-harm were significant. Implications for trauma-informed practice include an emphasis on consumer choice, empowerment, collaboration, and autonomy. Future research should investigate implementation of trauma-informed practices in forensic mental health settings and the effectiveness of nonpharmacological interventions that can be used to reduce dependence on psychotropic medications when managing forensic consumers' health concerns.