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Carabellese F, Parente L, Kennedy HG. Reform of Forensic Mental Health Services in Italy: Stigma and Blaming the Messenger: Hermenoia. INTERNATIONAL JOURNAL OF OFFENDER THERAPY AND COMPARATIVE CRIMINOLOGY 2022:306624X221113531. [PMID: 35861358 DOI: 10.1177/0306624x221113531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
About 40 years after the reforms leading to the closure of psychiatric hospitals (Ospedale Psichiatrico [OP]) in Italy in favor of a widespread model with a strong rehabilitation emphasis, Italy has chosen to close High Security Hospitals as well (Ospedale Psichiatrico Giudiziario [OPG]). The new forensic treatment model is expected to be more respectful of the person, including the perpetrators of violent crimes, and aims to be less stigmatizing and more rehabilitative. Despite the favorable premises of the reform (Law n. 81/2014), Italian psychiatrists are now obliged to answer calls to give evidence on strictly legal issues such as the social dangerousness of the mentally ill offender drawing on evidence or paradigms that many believe do not belong to medical knowledge. Psychiatrists must now learn to communicate about the relationship between psychiatry and society as required by law. This public expression engages with the cultural climate of society. Otherwise, the risk is of increasing the level of complexity leading to real misunderstandings that paradoxically may feed the stigma. The Italian reform provides an opportunity for reflection on some issues concerning psychiatric action, on how the public perceives the mentally ill and their psychiatrists, on the relationship between psychiatry and the world of law, on clinical methodologies for structured professional judgment, on public communication regarding severe mental illness, and the risk that psychiatrists may inadvertently be blamed for conveying an unwelcome message about mental illness and social dangerousness-we have called this social sensitivity against psychiatrists "hermanoia," blaming the messenger. The authors do not provide certain solutions but propose good practices.
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Hilton NZ, Ham E, Kim S. The influence of changes in clinical factors on high-security forensic custody dispositions. BEHAVIORAL SCIENCES & THE LAW 2022; 40:467-479. [PMID: 35403230 DOI: 10.1002/bsl.2569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 02/10/2022] [Accepted: 03/17/2022] [Indexed: 06/14/2023]
Abstract
The demand for forensic psychiatric beds is increasing, while many individuals are "stuck" in the system. Index offense severity and other legal considerations are associated with longer forensic stays but factors amenable to change such as symptoms of mental illness and aggression may also influence forensic decisions. We examined forensic review board decisions over time among 89 men admitted to a high-security forensic hospital. Almost half received a disposition to remain at their first hearing. Overall, dispositions were not associated with violence risk. The odds of a disposition to remain were higher for men with more in-hospital assaults and higher scores on a measure of clinical factors. Dispositions changed over time and this change was sensitive to clinical factors. We conclude that decisions were consistent with a cascading system of loosening security over time. Further longitudinal research following large samples through the forensic system is recommended.
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Affiliation(s)
- N Zoe Hilton
- Waypoint Research Institute, Waypoint Centre for Mental Health Care, Penetanguishene, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Elke Ham
- Waypoint Research Institute, Waypoint Centre for Mental Health Care, Penetanguishene, Ontario, Canada
| | - Soyeon Kim
- Waypoint Research Institute, Waypoint Centre for Mental Health Care, Penetanguishene, Ontario, Canada
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
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Domingue JL, Jacob JD, Perron A, Pariseau-Legault P, Foth T. (Re)construction identitaire et pratique infirmière en psychiatrie légale : réflexion critique sur les commissions d’examen. Rech Soins Infirm 2021:118-126. [PMID: 33485280 DOI: 10.3917/rsi.143.0118] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Introduction : The caritative impact of nursing care provided in forensic mental health settings is rarely questioned.Context : Caritative nursing care is indirectly regulated by the Review Board (RB), a para-judicial court which ensures public safety.Objective : This study presents a critical reflection on the political and social effects of the RB, forensic psychiatry hospitals and practices of forensic mental health nurses.Method : The reflection is centered on the concepts of biopower, degradation ceremonies, moral career and identity (re)construction.Results : ‘Therapeutic’ nursing practices are useful for disciplinary purposes in the forensic psychiatric hospital, insofar as they permit the identification and management of dangerous persons. However, the practices also fall within the biopolitical scope of the RB, since they assist the latter in ensuring public safety.Discussion : The forensic psychiatric environment can prove problematic for nurses, requiring a double allegiance, whereby their responsibilities to patients (consent and confidentiality) and to the institution (protection of the public) can lead to tension.Conclusion : The analytical framework of the study allows for a reassessment of other presumed processes in psychiatric environments, which nonetheless constitute just as many rituals of identity (re)construction.
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Kapoor R, Wasser TD, Funaro MC, Norko MA. Hospital treatment of persons found not guilty by reason of insanity. BEHAVIORAL SCIENCES & THE LAW 2020; 38:426-440. [PMID: 32897589 DOI: 10.1002/bsl.2484] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 07/08/2020] [Accepted: 08/08/2020] [Indexed: 06/11/2023]
Abstract
After being found not guilty by reason of insanity (NGRI), individuals are typically admitted to a secure forensic hospital for evaluation and treatment. This patient population can pose a challenge to clinicians in the hospital setting due to significant violence risk, complex psychiatric presentations, and scrutiny from oversight boards and the public. This article reviews the scientific literature around several key aspects of hospital-based treatment of insanity acquittees, including the management of inpatient aggression, the provision of specific treatments to acquittees, the assessment of violence risk and readiness for release, and the process of community transition. The authors conclude that the existing literature is heavily weighted toward the study of risk assessment and recidivism, with relatively little attention paid to the study of therapeutic modalities and recovery-oriented care in this population.
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Affiliation(s)
- Reena Kapoor
- Law & Psychiatry Division, Department of Psychiatry, Yale School of Medicine, New Haven, CT, 06519, USA
| | - Tobias D Wasser
- Law & Psychiatry Division, Department of Psychiatry, Yale School of Medicine, New Haven, CT, 06519, USA
| | - Melissa C Funaro
- Harvey Cushing/John Hay Whitney Medical Library, Yale University, 333 Cedar St, New Haven, CT, 06520-8014, USA
| | - Michael A Norko
- Law & Psychiatry Division, Department of Psychiatry, Yale School of Medicine, New Haven, CT, 06519, USA
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McCullough S, Stanley C, Smith H, Scott M, Karia M, Ndubuisi B, Ross CC, Bates R, Davoren M. Outcome measures of risk and recovery in Broadmoor High Secure Forensic Hospital: stratification of care pathways and moves to medium secure hospitals. BJPsych Open 2020; 6:e74. [PMID: 32684202 PMCID: PMC7443913 DOI: 10.1192/bjo.2020.61] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Placements within high secure forensic hospitals consist of wards providing various different levels of relational security. They should form a coherent pathway through secure care, based on individual patient risks and needs. Moves to less secure wards within high secure forensic hospitals and moves on to lower secure hospital settings have rarely been systematically studied. AIMS The aim of this study was to ascertain if placements within Broadmoor High Secure Hospital and moves from Broadmoor to medium secure hospitals corresponded to measures of violence risk, programme completion and recovery. METHOD A 13-month prospective cohort study was completed. Patients (n = 142) were rated at baseline for violence risk (Historical, Clinical and Risk - 20), therapeutic programme completion and recovery (DUNDRUM tool) and overall functioning (Global Assessment of Functioning). Placements on the care pathway and moves on to medium secure hospitals were observed. RESULTS Placements on the care pathway within the high secure hospital were associated with dynamic violence risk (F = 16.324, P<0.001), therapeutic programme completion (F = 4.167, P = 0.003), recovery (F = 2.440, P = 0.050) with better scores on these measures being found in the rehabilitation wards and the poorest scores on the highest levels of dependency. Moves to medium secure hospitals were associated with better scores on dynamic risk of violence (F = 33.199, P<0.001), therapeutic programme completion (F = 9.237 P<0.001), recovery (F = 6.863, P = 0.001). CONCLUSIONS Placements within Broadmoor Hospital formed a coherent pathway through high secure care. Moves to less secure places were influenced by more than reduction in violence risk. Therapeutic programme completion and recovery in a broad sense were also important.
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Affiliation(s)
| | - Carolyn Stanley
- North East London Forensic Mental Health Services, Camlet Lodge, Chase Farm Hospital and Barnet, Enfield and Harringey NHS Trust, UK
| | - Helen Smith
- Broadmoor Hospital and West London NHS Trust, UK
| | - Molly Scott
- Broadmoor Hospital and West London NHS Trust, UK
| | | | | | | | - Rob Bates
- Broadmoor Hospital and West London NHS Trust, UK
| | - Mary Davoren
- Broadmoor Hospital and West London NHS Trust, UK
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Kirchebner J, Günther MP, Sonnweber M, King A, Lau S. Factors and predictors of length of stay in offenders diagnosed with schizophrenia - a machine-learning-based approach. BMC Psychiatry 2020; 20:201. [PMID: 32375740 PMCID: PMC7201968 DOI: 10.1186/s12888-020-02612-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Accepted: 04/20/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Prolonged forensic psychiatric hospitalizations have raised ethical, economic, and clinical concerns. Due to the confounded nature of factors affecting length of stay of psychiatric offender patients, prior research has called for the application of a new statistical methodology better accommodating this data structure. The present study attempts to investigate factors contributing to long-term hospitalization of schizophrenic offenders referred to a Swiss forensic institution, using machine learning algorithms that are better suited than conventional methods to detect nonlinear dependencies between variables. METHODS In this retrospective file and registry study, multidisciplinary notes of 143 schizophrenic offenders were reviewed using a structured protocol on patients' characteristics, criminal and medical history and course of treatment. Via a forward selection procedure, the most influential factors for length of stay were preselected. Machine learning algorithms then identified the most efficient model for predicting length-of-stay. RESULTS Two factors have been identified as being particularly influential for a prolonged forensic hospital stay, both of which are related to aspects of the index offense, namely (attempted) homicide and the extent of the victim's injury. The results are discussed in light of previous research on this topic. CONCLUSIONS In this study, length of stay was determined by legal considerations, but not by factors that can be influenced therapeutically. Results emphasize that forensic risk assessments should be based on different evaluation criteria and not merely on legal aspects.
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Affiliation(s)
- Johannes Kirchebner
- University Hospital of Psychiatry Zurich, Department of Forensic Psychiatry, Zurich, Switzerland.
| | - Moritz Philipp Günther
- grid.412004.30000 0004 0478 9977University Hospital of Psychiatry Zurich, Department of Psychiatry, Psychotherapy and Psychosomatics, Zurich, Switzerland
| | - Martina Sonnweber
- grid.412004.30000 0004 0478 9977University Hospital of Psychiatry Zurich, Department of Forensic Psychiatry, Zurich, Switzerland
| | - Alice King
- grid.412004.30000 0004 0478 9977University Hospital of Psychiatry Zurich, Department of Forensic Psychiatry, Zurich, Switzerland
| | - Steffen Lau
- grid.412004.30000 0004 0478 9977University Hospital of Psychiatry Zurich, Department of Forensic Psychiatry, Zurich, Switzerland
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Martin K, Martin E. Factors influencing treatment team recommendations to review tribunals for forensic psychiatric patients. BEHAVIORAL SCIENCES & THE LAW 2016; 34:551-563. [PMID: 27147124 DOI: 10.1002/bsl.2244] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Revised: 03/14/2016] [Accepted: 03/23/2016] [Indexed: 06/05/2023]
Abstract
It is the responsibility of forensic psychiatric hospitals to detain and treat patients, gradually reintegrating them into society; decisions to release patients must balance risk to the public with maintaining the least restrictive environment for patients. Little is known about the factors considered when making such decisions and whether these factors have been empirically linked to future risk of violence. The current study explores the factors predictive of forensic treatment teams' recommendations for patients under the care of the Ontario Review Board (ORB). Factors differ depending on level of security; decisions on medium secure units were influenced by the presence of active symptoms and patients' overall violence risk level and decisions made on minimum secure units were influenced by the number of critical incidents that occurred within the recommendation year. Understanding the factors used to make recommendations to the ORB tribunal helps treatment teams to reflect on their own decision-making practices. Furthermore, the results serve to inform us about factors that influence length of stay for forensic psychiatric patients. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Krystle Martin
- Ontario Shores Centre for Mental Health Sciences, Whitby, ON, Canada
| | - Erica Martin
- Ontario Shores Centre for Mental Health Sciences, Whitby, ON, Canada
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Keune LH, de Vogel V, van Marle HJC. Methodological development of the Hoeven Outcome Monitor (HOM): A first step towards a more evidence based medicine in forensic mental health. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2016; 45:43-51. [PMID: 26922409 DOI: 10.1016/j.ijlp.2016.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
To comply with the need for a more evidence based risk assessment and management in forensic mental health, an outcome monitor is being developed in the Dutch forensic psychiatric centre Van der Hoeven Kliniek in Utrecht, the Hoeven Outcome Monitor (HOM). Conform evidence based medicine (EBM) guidelines, the HOM is subdivided into three consecutive stages, (1) the evaluation stage, (2) the aetiology stage and (3) the implementation stage. In this article an account is provided for the design of the evaluation stage. To account for predicaments in previous research that pertain to a lack of uniformity and disregard of specific context- and patient-related characteristics, a macro-, meso- and micro-treatment evaluation instrument is developed. This instrument provides for the first step to build an evidence base for specific interventions and treatments in forensic psychiatry.
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Affiliation(s)
- Lobke H Keune
- Research Department Van der Hoeven Kliniek, P.O. Box 174, 3500 DA, Utrecht, The Netherlands.
| | - Vivienne de Vogel
- Research Department Van der Hoeven Kliniek, P.O. Box 174, 3500 DA, Utrecht, The Netherlands.
| | - Hjalmar J C van Marle
- Forensic Psychiatry, Erasmus University Medical Centre and Erasmus School of Law Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, DP-0424, The Netherlands
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Nagtegaal MH, Boonmann C. Conditional Release of Forensic Psychiatric Patients Consistent with or Contrary to Behavioral Experts' Recommendations in the Netherlands: Prevalence Rates, Patient Characteristics and Recidivism After Discharge from Conditional Release. BEHAVIORAL SCIENCES & THE LAW 2016; 34:257-277. [PMID: 27256002 DOI: 10.1002/bsl.2224] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Revised: 01/25/2016] [Accepted: 01/29/2016] [Indexed: 06/05/2023]
Abstract
The present study examined a group of 447 Dutch forensic psychiatric patients on conditional release (CR). After a brief overview of the Dutch CR system for forensic psychiatric patients is presented, two sets of factors were studied: factors associated with behavioral experts' recommendations on CR readiness (prevalence rates of recommendations in contrast to or consistent with the judge's decision on CR, written vs. oral recommendations and consensus among parties); and characteristics of forensic psychiatric patients on CR imposed consistent with or contrary to behavioral experts' recommendations (i.e., demographic variables, psychopathology, judicial background and outcomes of violent behavior). Patients on CR consistent with or contrary to the behavioral experts' recommendations did not differ in demographic background variables and psychopathology. Patients on CR contrary to the behavioral experts' recommendations, however, had more prior convictions, and their index offense more often included a sex offense and a property offense (with or without violence) as compared to patients on CR consistent with the behavioral experts' recommendations. In addition, decisions contrary to the behavioral experts' recommendations were more often reached after a 3-month continuation adjournment and after an appeal. Also, patients on CR contrary to the behavioral experts' recommendations were less often found to have been on trial leave before their CR. Finally, recidivism rates were found to be much higher for those on CR contrary to, as compared with those on CR consistent with the behavioral experts' recommendations. However, when corrected for other well-known static predictors of recidivism, this significant difference was no longer prevalent. The implications for evaluators' CR readiness reports and lessons that may be learned from the Dutch forensic psychiatric CR system are discussed. Copyright © 2016 John Wiley & Sons, Ltd.
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Salem L, Crocker AG, Charette Y, Earls CM, Nicholls TL, Seto MC. Housing Trajectories of Forensic Psychiatric Patients. BEHAVIORAL SCIENCES & THE LAW 2016; 34:352-365. [PMID: 27138216 DOI: 10.1002/bsl.2223] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2015] [Revised: 11/15/2015] [Accepted: 11/16/2015] [Indexed: 06/05/2023]
Abstract
The objectives of this study were to describe the disposition and housing trajectories of individuals found Not Criminally Responsible on account of Mental Disorder (NCRMD), and the factors that predict different trajectories. To do so, disposition and housing status were coded for 934 NCRMD patients over a 36-month follow-up period. Sequential data analysis resulted in four distinct trajectories: detention in hospital, conditional discharge in supportive housing, conditional discharge in independent housing, and absolute discharge to unknown housing. The likelihood of a placement in supportive housing compared with detention significantly decreased for individuals with a higher index offense severity. Less restrictive trajectories were significantly predicted by clinical factors. The results revealed little change in the disposition and housing trajectories of NCRMD patients. Furthermore, decisions about disposition and housing placement reflect a knowledge-practice gap between risk factors known to be predictive of community resources use in the forensic population. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Leila Salem
- Université de, Montréal, QC, Canada
- Douglas Mental Health University Institute, Montréal, QC, Canada
| | - Anne G Crocker
- Douglas Mental Health University Institute, Montréal, QC, Canada
- McGill University, Montréal, QC, Canada
| | - Yanick Charette
- Douglas Mental Health University Institute, Montréal, QC, Canada
- Yale University, New Haven, CT
| | | | - Tonia L Nicholls
- University of British Columbia & British Columbia Mental Health & Substance Use Services, Vancouver, BC, Canada
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Norko MA, Wasser T, Magro H, Leavitt-Smith E, Morton FJ, Hollis T. Assessing Insanity Acquittee Recidivism in Connecticut. BEHAVIORAL SCIENCES & THE LAW 2016; 34:423-443. [PMID: 27061306 DOI: 10.1002/bsl.2222] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
For over 30 years now the movement and status of insanity acquittees in Connecticut has been supervised by the Psychiatric Security Review Board (PSRB). During this time, 365 acquittees have been committed to the jurisdiction of the PSRB, 177 individuals have achieved conditional release (CR) and 215 acquittees have been discharged from PSRB jurisdiction. This article examines revocation of CR by the PSRB, arrests of acquittees on CR, and provides the first report of arrests following discharge from the PSRB's jurisdiction. The literature on relevant aspects of recidivism is reviewed and compared with findings in Connecticut. There is little available literature about recidivism of insanity acquittees following release from supervision. In the present sample of individuals discharged from the PSRB, 16% were rearrested, a rate that compares favorably with other discharged populations of offenders. For discharged acquittees, community supervision on CR prior to discharge from the PSRB had a statistically significant effect on decreasing the risk of subsequent rearrest, as did both the length of stay in the hospital and the duration of commitment to the PSRB. This article presents descriptive information about revocations, arrests on CR, and arrests following discharge. These data are consistent with criminal justice studies demonstrating the value of community supervision in lowering recidivism. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Michael A Norko
- Division of Forensic Services, Connecticut Department of Mental Health and Addiction Services
| | | | | | - Erin Leavitt-Smith
- Division of Forensic Services, Connecticut Department of Mental Health and Addiction Services
| | - Frederic J Morton
- Division of Forensic Services, Connecticut Department of Mental Health and Addiction Services
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Wilson CM, Nicholls TL, Charette Y, Seto MC, Crocker AG. Factors Associated with Review Board Dispositions following Re-hospitalization among Discharged Persons found Not Criminally Responsible. BEHAVIORAL SCIENCES & THE LAW 2016; 34:278-294. [PMID: 27041680 DOI: 10.1002/bsl.2220] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
In the Canadian forensic mental health system, a person found Not Criminally Responsible on account of Mental Disorder (NCRMD) and given a conditional discharge returns to the community while remaining under the jurisdiction of a provincial/territorial Review Board. However, the individual can be re-hospitalized while on conditional discharge, for reasons such as substance use, violation of conditions, or violence. We investigated whether being re-hospitalized has an impact on the factors associated with the subsequent Review Board disposition. Persons found NCRMD from the three largest Canadian provinces who were conditionally discharged at least once during the observation period were included in the sample (N = 1,367). These individuals were involved in 2,920 disposition hearings; nearly one-third of patients (30%) were re-hospitalized after having been conditionally discharged by the Review Board. The factors examined included the scales of the Historical Clinical Risk Management-20 and salient behavior that occurred since the previous hearing, such as substance use or violence. The greater presence of clinical items resulted in a greater likelihood of a hospital detention decision at the next hearing. The effect was larger for the re-hospitalized group than for the group who successfully remained in the community since the last hearing. The results suggest that dynamic factors, specifically indicators of mental health, are heavily weighted by the Review Boards, consistent with the literature on imminent risk and in line with the NCRMD legislation. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Catherine M Wilson
- University of British Columbia & British Columbia Forensic Psychiatric Services Commission, British Columbia Mental Health and Substance Use Services, BC, Canada
| | - Tonia L Nicholls
- University of British Columbia & British Columbia Forensic Psychiatric Services Commission, British Columbia Mental Health and Substance Use Services, BC, Canada
| | | | - Michael C Seto
- Royal's Institute of Mental Health Research and Department of Psychiatry, University of Toronto, ON, Canada
| | - Anne G Crocker
- McGill University and Douglas Mental Health University Institute, Montreal, QC, Canada
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13
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Crocker AG, Nicholls TL, Seto MC, Roy L, Leclair MC, Brink J, Simpson AIF, Côté G. Research Priorities in Mental Health, Justice, and Safety: A Multidisciplinary Stakeholder Report. INTERNATIONAL JOURNAL OF FORENSIC MENTAL HEALTH 2015; 14:205-217. [PMID: 26681928 PMCID: PMC4673591 DOI: 10.1080/14999013.2015.1073197] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Accepted: 07/12/2015] [Indexed: 06/05/2023]
Abstract
This paper is based on the report following the National Research Agenda Meeting on Mental Health, Justice, and Safety held in Montreal on November 19, 2014, which convened academics; health, social, and legal professionals; and people with lived experience of mental illness from across Canada. The goal was to identify research priorities addressing relevant knowledge gaps and research strategies that can translate into public policy action and improvements in evidence-based services. Participants identified key challenges: (1) inadequate identification and response to needs by civil mental health services and frontline law enforcement, (2) limited specialized resources in forensic and correctional settings, (3) fragmented care and gaps between systems, (4) limited resources for adequate community reintegration, and (5) poor knowledge transfer strategies as obstacles to evidence-based policies. Knowledge gaps were identified in epidemiology and risk reduction, frontline training and programs, forensic and correctional practices, organizations and institutions, knowledge transfer, and rehabilitation. Finally, participants identified potential sources of support to conduct real time research with regard to data collection and sharing. The findings represent a roadmap for how forensic mental health systems can best proceed to address current challenges through research and practice initiatives, drawing from lived, clinical and research experiences of a multidisciplinary group of experts.
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Affiliation(s)
- Anne G. Crocker
- Department of Psychiatry, McGill University and Douglas Mental Health University Institute Research Center, Montreal, Quebec, Canada
| | - Tonia L. Nicholls
- Department of Psychiatry, University of British Columbia and BC Mental Health and Substance Use Services, Coquitlam, British Columbia, Canada
| | | | - Laurence Roy
- School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada; Douglas Mental Health University Institute Research Center, Montreal, Quebec, Canada
| | - Marichelle C. Leclair
- Douglas Mental Health University Institute Research Center, Montreal, Quebec, Canada
| | - Johann Brink
- Forensic Psychiatric Services Commission, BC Mental Health and Substance Use Services, Coquitlam, British Columbia, Canada
| | - Alexander I. F. Simpson
- Centre for Addiction and Mental Health, Complex Mental Illness, Forensic Division, Toronto, Quebec, Canada; Department of Psychiatry, University of Toronto, Quebec, Canada
| | - Gilles Côté
- Department of Psychology, Université du Québec à Trois-Rivières, Trois-Rivières Québec, Canada; Philippe-Pinel Institute, Research Center, Montreal, Quebec, Canada
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14
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Wilson CM, Crocker AG, Nicholls TL, Charette Y, Seto MC. The use of risk and need factors in forensic mental health decision-making and the role of gender and index offense severity. BEHAVIORAL SCIENCES & THE LAW 2015; 33:19-38. [PMID: 25693951 DOI: 10.1002/bsl.2162] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Canadian legislation makes Review Boards (RBs) responsible for rendering dispositions for individuals found Not Criminally Responsible on account of Mental Disorder (NCRMD) after considering public safety, the mental condition of the accused, and his/her potential for community reintegration. We reviewed 6,743 RB hearings for 1,794 individuals found NCRMD in the three largest Canadian provinces to investigate whether items from two empirically supported risk assessment measures, the Historical Clinical Risk Management-20 and the Violence Risk Appraisal Guide, were considered. Less than half the items were included in expert reports or in RBs' reasons for dispositions, and consideration of these items differed according to gender and index offense severity of the accused. These items included evidence-based risk factors and/or legally specified criteria: mental health, treatment, and criminal history. These results illustrate the gap between research on risk factors and the integration of this evidence into practice. In particular, we recommend the implementation of structured measures to reduce the potential for clinicians to be unduly influenced by gender and offense severity.
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Affiliation(s)
- Catherine M Wilson
- University of British Columbia & British Columbia Forensic Psychiatric Services Commission, British Columbia Mental Health and Substance Use Services
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