Deinstitutionalization, changes in both criminal and civil law, and the use of the criminal justice system to manage problematic behavior by individuals with serious mental illnesses have affected the number of people entering forensic mental health systems. This review examines data revealing trends in demand for forensic services in Canada, the United States, and internationally. The number of beds and resources allocated to forensic mental health services has steadily increased not only in Canada, but in other countries across the world. In Canada, the number of new accused entering the system doubled annually from 1992 to 2004. In the United States, the number of individuals found not guilty by reason of insanity (NGRI), forensic beds and forensic expenditures have all increased dramatically in recent years. Furthermore, countries in