Treatment in forensic setting

• Reason for the forensic mental health system:

  • Society believes it is unfair to punish people for criminal acts if they have a mental illness that prevents them from understanding their actions or the consequences
• The system aims to help rehabilitate and re-integrate people into the community
• Myths of Mental Health:

  • Stigma leads to discrimination and disrespect
  • Double stigma when unfairly labeled as 'dangerous'
• Rules in Canada's criminal justice system are set out in the Criminal Code of Conduct

  • Must also follow the Mental Health Act
• After arrest:

  • Police can charge with an offence
  • Take to hospital for assessment under MHA
  • Release without charge
• Involuntary Hospitalization:

  • Doctor assesses
  • Form 1 filled out for longer inpatient psychiatric assessment
  • Can be kept involuntarily for up to 72 hours
  • Form 3 for up to two weeks
  • Form 4 for ongoing involuntary admission
• Forensic Assessment:

  • Conducted by a Forensic Psychiatrist
  • Assessment presented in court
  • Judge makes decisions based on the report
  • Options for NCR: Absolute discharge, conditional discharge, or detention order
• Ontario Review Board (ORB):

  • Panel includes a psychiatrist, mental health professional, lawyer, community member with mental health background, and chairperson
  • Responsible for deciding on release to the public, security level, hospital placement, community integration, and support
• ORB Decisions:

  • Made by majority vote
  • Considers risk to the public, mental health status, societal integration, and individual needs
• Ending Relationship with ORB:

  • No longer under ORB authority with absolute discharge or fit to stand trial
  • Support may still be needed to avoid re-entry into the system
• Mandatory Treatment:

  • Cannot deny treatment, can be administered involuntarily
• Study on Forensic Mental Health Population:

  • Provides updated description post landmark court cases
  • Unfit to stand trial if unable to understand proceedings, consequences, or communicate with counsel
• Key Insights from the Study:

  • Psychotic spectrum disorders common
  • Substance use disorders overrepresented
  • Substance use critical risk factor
  • Risk assessments important for violence prevention
  • Family members as victims a concern
• Purpose of correctional services:

  • Punishment
  • Protect Society
  • Protect the accused
  • Confirm the Identity of the accused
• Yelling at a child as punishment or reinforcement:

  • If it increases the behavior, it is a reinforcement
• Offender Management Programs (OMPS):

  • Superficial in approach
  • Experienced ill resources
  • Unlikely to engender change
  • Prison Climate characterized by lack of interest among correctional staff and lack of empathy
• Rehabilitation within Prison Policy:

  • Buffeted by Changes in social trends, competing political ideologies, and conflicting research evidence about effectiveness
  • The position of rehabilitation within the prison has never been stable
• The 20th century was characterized by the rise of a rehabilitative ideal focusing on social welfare and the psychological treatment of prisoners based on sociological and psychological factors
• Optimism by Dissemination of Evidence:

  • Target criminogenic needs: Needs that are Changeable (Dynamic), lack of education, lack of employment, substance abuse, low self-regulation
  • Effective in reducing crime
• Throughcare:

  • Rehabilitation interventions implemented in prison are more likely to be effective if they are followed up after release and if the transition from custody to the community is planned and coordinated from an early stage in the sentence
• From Panel Policy to Rehabilitative Practice:

  • The implementation has been undermined by the nature of the institution itself: overcrowding, short-staffed, views of people who work in the prison are important, positive vs negative attitudes about the prospective of offender reform
• Findings: Nature of organizational support for treatment:

  • Prisoners believed that the institution took little responsibility for rehabilitation
  • Responsibility devolved to the individual to proactively pursue any rehabilitative opportunities
• Characteristics of interventions to support rehabilitation:

  • Lack of support
  • OMP: Attendance to these programs is mandatory and becomes self-serving
  • Work Placement: Work for prisoners
  • Boredom is a concern for prisoners, who are often mentally and emotionally ill-prepared for the reality of confinement
• The complexion of prison climate:

  • Staff interest in rehabilitation: Prisoner rehabilitation was not generally seen to be a key concern of correctional staff
  • Staff-prisoner interaction