Beyond the Sentence: Clinical and Social Determinants of Forensic Hospitalization Duration in Northern Israel

Purpose: Involuntary psychiatric hospitalization under court orders requires careful balancing of legal obligations and clinical needs. Identifying factors that influence the length of these hospital stays helps clarify the relationship between legal frameworks and psychiatric treatment. This study aims to describe the socio-demographic, clinical, and legal profiles of individuals hospitalized under court warrants and to identify factors independently associated with the duration of forensic hospitalization. Methods: A retrospective study was conducted on 119 patients discharged between 2018 and 2023. Data were collected from medical and legal records, including socio-demographic details, psychiatric diagnoses, offense types, hospital stay lengths, and legal proceedings. Results: Most patients were men (91.6%) diagnosed with schizophrenia or schizoaffective disorder (97.5%), with high rates of comorbid substance use disorder (79.0%) and unemployment (85.7%). The median hospital stay was 19.0 months, representing 40% of the maximum statutory sentence. Patients with low-severity offenses served a larger share of their maximum sentence (47%) than those with high-severity offenses (24%). Time to first discretionary leave was the strongest predictor of total stay duration in univariable analysis. Conclusion: The finding that patients with minor offenses have longer hospital stays than those with serious offenses confirms that clinical factors, rather than offense severity, primarily influence discharge decisions. These findings support moving toward personalized, clinically focused, and family-inclusive forensic discharge planning while maintaining public safety.