The high rates of substance use and mental disorder among homeless people in inner Sydney confirms the need for increased access to treatment for these conditions in this setting. Homelessness among those with mental illness might be reduced by developing alternative housing models, and supporting people with multiple problems to retain tenancy.

Background There are not many longitudinal studies examining people experiencing homelessness and interacting with the criminal justice system over time. Aims To describe the type of criminal offences committed, court outcomes, identify probable predictors of reoffending, and estimate the criminal justice costs in a cohort of homeless hostel clinic attendees. Method A retrospective cohort study of 1646 people attending a homeless clinic who had had contact with the criminal justice system (CJS) in New South Wales (NSW), Australia, using linked clinic, criminal offence, health and mortality data from 1 July 2008 to 30 June 2021. Initial comparisons were made with the 852 clinic attendees without CJS contact in the period. Multivariable logistic regression was used to identify predictors of recidivism. Results There were 16,840 offending episodes, giving an offence rate of 87.8 per 100 person‐years (95%CI: 86.5–89.1). The most common index offences were acts intended to cause injury (22%), illicit drug (17%) and theft‐related (12%) offences. Most people (83%) were found guilty of the index offence and received a fine (37%) or community‐based sentence (29%). Total court finalisation costs were AUD $11.3 million. Three‐quarters of those convicted reoffended within 24 months. Offenders were more likely to be younger, have a diagnosis of personality disorder (AOR: 1.31; 95% CI: 1.04–1.67), a substance use disorder (AOR: 1.60; 95% CI 1.14–2.23) and/or to have a previous charge dismissed on mental health grounds (AOR: 1.79; 95% CI: 1.31–2.46). Within the offending cohort, reoffenders had almost twice the odds of having theft‐related offences as their principal index offence (AOR: 1.85; 95% CI: 1.29–2.66). Conclusions This longitudinal study finding of not only a high rate of criminal justice contact, but also a high rate of recidivism among people who have been homeless, lends support to a need for strategies both to address the root causes of homelessness and to provide a comprehensive systems‐based response to reduce recidivism, that includes secure housing as well as mental health and substance use treatment programmes for homeless offenders.

Objective To quantify outcomes for patients of forensic psychiatric rehabilitation in NSW. Methods Data on 245 conditionally released forensic patients was extracted from the Mental Health Review Tribunal (MHRT) files and matched to several state-wide datasets. Descriptive statistics were generated to establish the cohort characteristics, rates of reoffending and social and clinical outcomes. Results At conditional release, social circumstances for the majority of patients were improved. Clinically, the cohort was more stable, though many did not remain stable over time. Only one-fifth of the sample received a further criminal charge. Conclusion Preliminary evidence suggests that forensic rehabilitation services in NSW are effective.

Naturally, as with many cross-sectional cohort studies examining associations between independent characteristics and outcomes, causation is not able to be inferred. The authors agree that contact with the criminal justice system, mental disorders and/or substance use may both precede and contribute to homelessness. Although we do not infer a causal relationship, the high proportion of the cohort released from prison (∼30%) and the high rate of recidivism during the study show that the existing interventions are not preventive.The authors look forward to prospective studies that may be able to disentangle the contribution and the effects of criminal recidivism, mental illness, substance use, and homelessness and seek to offer evidence-based solutions to provide stable accommodation.