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Hawke LD, Bastidas-Bilbao H, Cappe V, van Kesteren MR, Stewart DE, Gupta M, Simpson AIF, Campbell BH, Castle D, Stergiopoulos V. Medical Assistance in Dying for Mental Illness as a Sole Underlying Medical Condition and Its Relationship to Suicide: A Qualitative Lived Experience-Engaged Study: Aide Médicale à Mourir Pour Maladie Mentale Comme Seule Condition Médicale Sous-Jacente et Son Lien Avec le Suicide: Une Etude Qualitative Engagée Dans l'Expérience Vécue. Can J Psychiatry 2024; 69:314-325. [PMID: 37885204 PMCID: PMC11032095 DOI: 10.1177/07067437231209658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
OBJECTIVE This lived experience-engaged study aims to understand patient and family perspectives on the relationship between suicidality and medical assistance in dying when the sole underlying medical condition is mental illness (MAiD MI-SUMC). METHOD Thirty individuals with mental illness (age M = 41.8 years, SD = 14.2) and 25 family members (age M = 47.5 years, SD = 16.0) participated in qualitative interviews examining perspectives on MAiD MI-SUMC and its relationship with suicide. Audio recordings were transcribed and analysed using reflexive thematic analysis. People with lived experience were engaged in the research process as team members. RESULTS Four main themes were developed, which were consistent across individuals with mental illness and family members: (a) deciding to die is an individual choice to end the ongoing intolerable suffering of people with mental illness; (b) MAiD MI-SUMC is the same as suicide because the end result is death, although suicide can be more impulsive; (c) MAiD MI-SUMC is a humane, dignified, safe, nonstigmatized alternative to suicide; and (4) suicidality should be considered when MAiD MI-SUMC is requested, but suicidality's role is multifaceted given its diverse manifestations. CONCLUSION For patient-oriented mental health policy and treatment, it is critical that the voices of people with lived experience be heard on the issue of MAiD MI-SUMC. Given the important intersections between MAiD MI-SUMC and suicidality and the context of suicide prevention, the role that suicidality should play in MAiD MI-SUMC is multifaceted. Future research and policy development are required to ensure that patient and family perspectives guide the development and implementation of MAiD MI-SUMC policy and practice.
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Affiliation(s)
- Lisa D. Hawke
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | | | - Vivien Cappe
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | | | - Donna E. Stewart
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Centre for Mental Health, University Health Network, Toronto, Ontario, Canada
| | - Mona Gupta
- Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - Alexander I. F. Simpson
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | | | - David Castle
- Department of Psychiatry, University of Tasmania, Hobart, Tasmania, Australia
- Statewide Mental Health Service, Hobart, Tasmania, Australia
| | - Vicky Stergiopoulos
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
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Vijh R, Kouyoumdjian FG, Iwajomo T, Simpson AIF, Jones R, de Oliveira C, Kurdyak P. Chronic Psychotic Disorders and Correctional Involvement: A Population-Based Matched Case-Control Study in Ontario, Canada. Can J Psychiatry 2024; 69:196-206. [PMID: 37501606 PMCID: PMC10874599 DOI: 10.1177/07067437231189468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Abstract
OBJECTIVE Individuals with chronic psychotic disorders are overrepresented in correctional facilities, but little is known about factors that increase the risk of correctional involvement. The objective of this study was to compare individuals with chronic psychotic disorders who were released from correctional facilities in Ontario to individuals with chronic psychotic disorders but no correctional involvement on sociodemographic, clinical, and prior mental health-related health service utilization characteristics. METHOD All individuals with chronic psychotic disorders who were released from a provincial correctional facility in Ontario in 2010 were matched (1:2) by age and sex to Ontario residents with chronic psychotic disorders and no correctional involvement. Covariates included sociodemographic (rural residence, marginalization such as residential instability quintile, material deprivation quintile, dependency quintile, and ethnic concentration quintile) and clinical (duration of chronic psychotic disorder and comorbidities) characteristics, and mental health-related health service utilization characteristics (primary care physician, psychiatrist and emergency department visits, and hospitalizations) 1 and 3 years prior to correctional involvement. The association between correctional involvement and prior health service utilization was measured by estimating incidence rate ratios using Poisson and negative-binomial regressions. RESULTS Individuals with correctional involvement (N = 3,197) lived in neighbourhoods with higher material deprivation and residential instability, and had a shorter duration of illness, and more psychosocial comorbidities (e.g., behavioural issues and depression) than individuals without correctional involvement (N = 6,393). Adjusting for sociodemographic and clinical variables, individuals with correctional involvement had a higher rate of mental health-related primary care physician visits, emergency department visits, and hospitalizations but a lower rate of psychiatrist visits prior to correctional involvement, compared to individuals without correctional involvement. CONCLUSIONS Despite higher mental health-related comorbidities and higher rates of accessing acute mental health services among individuals with chronic psychotic disorders and correctional involvement, visits to psychiatrists prior to involvement were low.
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Affiliation(s)
- Ruchi Vijh
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada
| | - Fiona G. Kouyoumdjian
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
- ICES, Toronto, Ontario, Canada
| | - Tomisin Iwajomo
- ICES, Toronto, Ontario, Canada
- Institute of Mental Health Policy Research, CAMH, Toronto, Ontario, Canada
| | | | - Roland Jones
- Division of Forensic Psychiatry, CAMH, Toronto, Ontario, Canada
| | - Claire de Oliveira
- ICES, Toronto, Ontario, Canada
- Institute of Mental Health Policy Research, CAMH, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Paul Kurdyak
- ICES, Toronto, Ontario, Canada
- Institute of Mental Health Policy Research, CAMH, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
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Stergiopoulos V, Bastidas-Bilbao H, Gupta M, Buchman DZ, Stewart DE, Rajji T, Simpson AIF, van Kesteren MR, Cappe V, Castle D, Shields R, Hawke LD. Care considerations in medical assistance in dying for persons with mental illness as the sole underlying medical condition: a qualitative study of patient and family perspectives. BMC Psychiatry 2024; 24:120. [PMID: 38355467 PMCID: PMC10865571 DOI: 10.1186/s12888-024-05541-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 01/19/2024] [Indexed: 02/16/2024] Open
Abstract
BACKGROUND Persons with mental illness as their sole underlying medical condition are eligible to access medical assistance in dying (MAiD) in a small number of countries, including Belgium, the Netherlands, Luxemburg and Switzerland. In Canada, it is anticipated that people experiencing mental illness as their sole underlying medical condition (MI-SUMC) will be eligible to request MAiD as of March 17th 2024. To date, few studies have addressed patient and family perspectives on MAiD MI-SUMC care processes. This study aimed to address this gap and qualitatively explore the perspectives of persons with lived experience of mental illness and family members on care considerations during MI-SUMC implementation. METHODS Thirty adults with lived experience of mental illness and 25 adult family members residing in Ontario participated in this study. To facilitate participant engagement, the semi-structured interview used a persona-scenario exercise to discuss perspectives on MAiD MI-SUMC acceptability and care considerations. Framework analysis was used to inductively analyze data using NVivo 12 Pro. Steps, processes, or other care considerations suggested by the participants were charted in a framework matrix after familiarization with the narratives. Key themes were further identified. A lived-experience advisory group participated in every aspect of this study. RESULTS Six themes were developed from the patient and family narratives: (1) Raising MAiD MI-SUMC awareness; (2) Sensitive Introduction of MAiD MI-SUMC in goals of care discussions; (3) Asking for MAiD MI-SUMC: a person-focused response; (4) A comprehensive circle of MAiD MI-SUMC care; (5) A holistic, person-centered assessment process; and (6) Need for support in the aftermath of the decision. These themes highlighted a congruence of views between patient and family members and described key desired process ingredients, including a person-centred non-judgmental stance by care providers, inter-professional holistic care, shared decision making, and the primacy of patient autonomy in healthcare decision making. CONCLUSIONS Family and patient perspectives on the implementation of MAiD MI-SUMC offer important considerations for service planning that could complement existing and emerging professional practice standards. These stakeholders' perspectives will continue to be essential in MAiD MI-SUMC implementation efforts, to better address the needs of diverse communities and inform improvement efforts.
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Affiliation(s)
- Vicky Stergiopoulos
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada.
- University of Toronto, Toronto, Ontario, Canada.
| | | | - Mona Gupta
- Centre hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - Daniel Z Buchman
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- University of Toronto, Toronto, Ontario, Canada
| | - Donna E Stewart
- University of Toronto, Toronto, Ontario, Canada
- University Health Network, Toronto, Ontario, Canada
| | - Tarek Rajji
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- University of Toronto, Toronto, Ontario, Canada
| | - Alexander I F Simpson
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- University of Toronto, Toronto, Ontario, Canada
| | | | - Vivien Cappe
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - David Castle
- University of Tasmania, Hobart, Tasmania, Australia
- Statewide Mental Health Service, Hobart, Tasmania, Australia
| | - Roslyn Shields
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Lisa D Hawke
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- University of Toronto, Toronto, Ontario, Canada
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Chatterjee S, Simpson AIF, Wilkie T. A Comprehensive Framework to Advance Equity, Diversity, and Inclusion in a Forensic Service. J Am Acad Psychiatry Law 2023; 51:486-493. [PMID: 37704258 DOI: 10.29158/jaapl.230027-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 09/15/2023]
Abstract
Minority and Indigenous populations have disproportionate representation within forensic mental health services. Social determinants of health and systemic discrimination have contributed to the difficulties these populations have in accessing care, as well as significant differences in care trajectories. In addition, staffing and structural equity, diversity, and inclusion (EDI) challenges permeate forensic systems as in other health care settings. There is little literature to guide forensic mental health services in how best to provide equitable, diverse, and inclusive practices for patients, families, and staff. The forensic service at a major urban center in the Canadian province of Ontario has adapted an EDI framework to describe the processes employed to organize and integrate EDI principles and initiatives within a culture of learning and continuous improvement. This Forensic EDI Framework is composed of six domains: Organizational Commitment, Staff/Workforce Competencies, Service Access and Delivery, Promoting Responsiveness, Community Outreach, and Data Collection. Initiatives within each of these domains form the foundation of a sustainable platform for forensic service EDI practices that will promote lasting change.
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Affiliation(s)
- Sumeeta Chatterjee
- Dr. Chatterjee is Person in Charge, Forensic Service, Centre for Addiction and Mental Health, Toronto, Canada, and Director, Forensic Psychiatry Subspecialty Program and Assistant Professor, University of Toronto. Dr. Simpson is Chair in Forensic Psychiatry, The Centre for Addiction and Mental Health and University of Toronto, and Professor, Department of Psychiatry, University of Toronto. Dr. Wilkie is Deputy Physician in Chief, Medical Affairs and Practice, and Chief, Division of Forensic Psychiatry, The Centre for Addiction and Mental Health; and Associate Professor, University of Toronto.
| | - Alexander I F Simpson
- Dr. Chatterjee is Person in Charge, Forensic Service, Centre for Addiction and Mental Health, Toronto, Canada, and Director, Forensic Psychiatry Subspecialty Program and Assistant Professor, University of Toronto. Dr. Simpson is Chair in Forensic Psychiatry, The Centre for Addiction and Mental Health and University of Toronto, and Professor, Department of Psychiatry, University of Toronto. Dr. Wilkie is Deputy Physician in Chief, Medical Affairs and Practice, and Chief, Division of Forensic Psychiatry, The Centre for Addiction and Mental Health; and Associate Professor, University of Toronto
| | - Treena Wilkie
- Dr. Chatterjee is Person in Charge, Forensic Service, Centre for Addiction and Mental Health, Toronto, Canada, and Director, Forensic Psychiatry Subspecialty Program and Assistant Professor, University of Toronto. Dr. Simpson is Chair in Forensic Psychiatry, The Centre for Addiction and Mental Health and University of Toronto, and Professor, Department of Psychiatry, University of Toronto. Dr. Wilkie is Deputy Physician in Chief, Medical Affairs and Practice, and Chief, Division of Forensic Psychiatry, The Centre for Addiction and Mental Health; and Associate Professor, University of Toronto
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Bastidas-Bilbao H, Stergiopoulos V, Cappe V, van Kesteren MR, Stewart DE, Gupta M, Simpson AIF, Dawthorne M, Rajji TK, Castle D, Hawke LD. Walking Alongside: Views of Family Members on Medical Assistance in Dying for Mental Illness as the Sole Underlying Medical Condition. Qual Health Res 2023; 33:1140-1153. [PMID: 37773095 PMCID: PMC10626980 DOI: 10.1177/10497323231197365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/30/2023]
Abstract
Medical assistance in dying (MAiD) was introduced into Canadian federal legislation in 2016. Mental illness as the sole underlying medical condition (MI-SUMC) is currently excluded from eligibility; such exclusion is scheduled to expire on March 17, 2024. Irremediability, capacity, quality of life, autonomy, family involvement, and healthcare system constraints have been debated intensively. Recent studies have not explored the views of family members of persons with mental illness on MAiD MI-SUMC. This study aimed to fill this knowledge gap. Twenty-five Ontario residents who had a loved one with mental illness participated. A persona-scenario exercise was designed to explore participants' views on MAiD MI-SUMC in hypothetical situations. Reflexive thematic analysis was used to analyze the data. A lived experience-advisory panel was engaged throughout the study. Seven themes were developed: Witnessing suffering; A road with barriers and limitations; Societal barriers; The unknowns of mental illness; Individual choices: the life or death that a person wants; MAiD MI-SUMC as an acceptable choice when suffering cannot be relieved with available treatments and supports; and The emotional outcome. Participants constructed their views based on their experience of supporting a loved one with mental illness. MAiD MI-SUMC was perceived as a multifaceted issue, whose acceptability and potential introduction required a concurrent exploration and discussion of the challenges arising due to limitations of the healthcare system, the opportunities and limits to family involvement, and the value of patient autonomy.
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Affiliation(s)
| | - Vicky Stergiopoulos
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- University of Toronto, Toronto, ON, Canada
| | - Vivien Cappe
- Centre for Addiction and Mental Health, Toronto, ON, Canada
| | | | - Donna E. Stewart
- University of Toronto, Toronto, ON, Canada
- University Health Network, Toronto, ON, Canada
| | - Mona Gupta
- Centre Hospitalier de L'Université de Montréal, Montréal, QC, Canada
| | - Alexander I. F. Simpson
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- University of Toronto, Toronto, ON, Canada
| | | | - Tarek K. Rajji
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- University of Toronto, Toronto, ON, Canada
| | - David Castle
- University of Tasmania, Hobart, TAS, Australia
- Statewide Mental Health Service, Hobart, TAS, Australia
| | - Lisa D. Hawke
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- University of Toronto, Toronto, ON, Canada
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McLaughlin P, Brady P, Carabellese F, Carabellese F, Parente L, Uhrskov Sorensen L, Jeandarme I, Habets P, Simpson AIF, Davoren M, Kennedy HG. Excellence in forensic psychiatry services: international survey of qualities and correlates. BJPsych Open 2023; 9:e193. [PMID: 37828908 PMCID: PMC10594163 DOI: 10.1192/bjo.2023.578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 08/30/2023] [Accepted: 09/07/2023] [Indexed: 10/14/2023] Open
Abstract
BACKGROUND Excellence is that quality that drives continuously improving outcomes for patients. Excellence must be measurable. We set out to measure excellence in forensic mental health services according to four levels of organisation and complexity (basic, standard, progressive and excellent) across seven domains: values and rights; clinical organisation; consistency; timescale; specialisation; routine outcome measures; research and development. AIMS To validate the psychometric properties of a measurement scale to test which objective features of forensic services might relate to excellence: for example, university linkages, service size and integrated patient pathways across levels of therapeutic security. METHOD A survey instrument was devised by a modified Delphi process. Forensic leads, either clinical or academic, in 48 forensic services across 5 jurisdictions completed the questionnaire. RESULTS Regression analysis found that the number of security levels, linked patient pathways, number of in-patient teams and joint university appointments predicted total excellence score. CONCLUSIONS Larger services organised according to stratified therapeutic security and with strong university and research links scored higher on this measure of excellence. A weakness is that these were self-ratings. Reliability could be improved with peer review and with objective measures such as quality and quantity of research output. For the future, studies are needed of the determinants of other objective measures of better outcomes for patients, including shorter lengths of stay, reduced recidivism and readmission, and improved physical and mental health and quality of life.
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Affiliation(s)
- Patrick McLaughlin
- National Forensic Mental Health Service, Central Mental Hospital, Portrane, Dublin, Ireland; and DUNDRUM Centre for Forensic Excellence, Academic Department of Psychiatry, Trinity College Dublin, Dublin, Ireland
| | - Philip Brady
- National Forensic Mental Health Service, Central Mental Hospital, Portrane, Dublin, Ireland; and DUNDRUM Centre for Forensic Excellence, Academic Department of Psychiatry, Trinity College Dublin, Dublin, Ireland
| | - Felice Carabellese
- Interdisciplinary Department of Medicine, Section of Criminology and Forensic Psychiatry, University of Bari ‘Aldo Moro’, Puglia, Italy
| | - Fulvio Carabellese
- Interdisciplinary Department of Medicine, Section of Criminology and Forensic Psychiatry, University of Bari ‘Aldo Moro’, Puglia, Italy
| | - Lia Parente
- Interdisciplinary Department of Medicine, Section of Criminology and Forensic Psychiatry, University of Bari ‘Aldo Moro’, Puglia, Italy
| | - Lisbeth Uhrskov Sorensen
- Department for Forensic Psychiatry, Aarhus University Hospital Psychiatry, Aarhus, Denmark; and Institute of Clinical Medicine, Health, Aarhus University, Aarhus, Denmark
| | - Ingeborg Jeandarme
- Knowledge Centre for Forensic Psychiatric Care (KeFor), OPZC Rekem, Rekem, Belgium; and KU Leuven, Leuven, Belgium
| | - Petra Habets
- Knowledge Centre for Forensic Psychiatric Care (KeFor), OPZC Rekem, Rekem, Belgium; and Tilburg University, Tilburg, The Netherlands
| | - Alexander I. F. Simpson
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada; and Department of Psychiatry, Temerty School of Medicine, University of Toronto, Toronto, Canada
| | - Mary Davoren
- National Forensic Mental Health Service, Central Mental Hospital, Portrane, Dublin, Ireland; DUNDRUM Centre for Forensic Excellence, Academic Department of Psychiatry, Trinity College Dublin, Dublin, Ireland; and Interdisciplinary Department of Medicine, Section of Criminology and Forensic Psychiatry, University of Bari ‘Aldo Moro’, Puglia, Italy
| | - Harry G. Kennedy
- DUNDRUM Centre for Forensic Excellence, Academic Department of Psychiatry, Trinity College Dublin, Dublin, Ireland; Interdisciplinary Department of Medicine, Section of Criminology and Forensic Psychiatry, University of Bari ‘Aldo Moro’, Puglia, Italy; and Institute of Clinical Medicine, Health, Aarhus University, Aarhus, Denmark
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Sirotich F, Law SF, Simpson AIF, Nakhost A. Examining the Prevalence and Forms of Leveraged Treatment Pressure and Its Relationship to Personal Recovery: A Canadian Cross-Sectional Study. Community Ment Health J 2023; 59:1352-1363. [PMID: 37097490 DOI: 10.1007/s10597-023-01122-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 03/17/2023] [Indexed: 04/26/2023]
Abstract
Across jurisdictions, the use of 'leverage' to promote adherence to mental health treatment is widespread. However, little research exists on the possible association between the application of leverage and personal recovery. We examined the prevalence of various forms of leverage in a Canadian context and compared these rates with those in other jurisdictions. Additionally, we examined the relationship between two prominent forms of leverage (financial and housing) and the experience of personal recovery. Structured interviews were conducted with people receiving community-based mental health care in Toronto, Canada. Rates of overall leverage in our sample were similar to rates reported in other jurisdictions. Personal recovery was negatively associated with financial leverage but was not associated with housing leverage. Our results highlight the importance of separately examining the relationship of specific forms of leverage and personal recovery and raise questions for future research about the possible effect of financial leverage on recovery.
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Affiliation(s)
- Frank Sirotich
- Data Analytics, Research and Evaluation Department, Canadian Mental Health Association, Toronto Branch, 700 Lawrence Ave. West, Ste 480, Toronto, ON, M6A 3B4, Canada.
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor St. West, Toronto, ON, M5S 1V4, Canada.
| | - Samuel F Law
- Mental Health and Addictions Service, St. Michael's Hospital-Unity Health Toronto, 36 Queen St. East, Toronto, ON, M5B 1W8, Canada
- Department of Psychiatry, University of Toronto, 250 College St, Room 832, Toronto, ON, M5T 1R8, Canada
| | - Alexander I F Simpson
- Department of Psychiatry, University of Toronto, 250 College St, Room 832, Toronto, ON, M5T 1R8, Canada
- Forensic Psychiatry Division, Centre for Addiction and Mental Health, 1001 Queen St. West, Toronto, ON, M6J 1H4, Canada
| | - Arash Nakhost
- Department of Psychiatry, McGill University, 1033 Pine Ave West, Montreal, QC, H3A 1A1, Canada
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Penney SR, Lam AA, Kolla N, Martin K, Belfry K, Simpson AIF. Homicide in the context of psychosis: analysis of prior service utilisation and age at onset of illness and violence. BJPsych Open 2023; 9:e171. [PMID: 37724335 PMCID: PMC10594185 DOI: 10.1192/bjo.2023.567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 08/01/2023] [Accepted: 08/18/2023] [Indexed: 09/20/2023] Open
Abstract
BACKGROUND Public stigma and fear are heightened in cases of extreme violence perpetrated by persons with serious mental illness (SMI). Prevention efforts require understanding of illness patterns and treatment needs prior to these events unfolding. AIMS To examine mental health service utilisation by persons who committed homicide and entered into forensic care, to investigate the adequacy of mental healthcare preceding these offences. METHOD Forensic patients across two mental health hospitals in Ontario with an admitting offence of homicide between 2011 and 2021 were identified (n = 112). Sociodemographic, clinical and offence-related variables were coded from the health record and reports prepared for the forensic tribunal. RESULTS Most patients (75.7%) had mental health contacts preceding the homicide, with 28.4% having a psychiatric in-patient admission in the year prior. For those with service contacts in the year preceding, 50.9% had had only sporadic contact and 70.7% were non-adherent with prescribed medications. Victims were commonly known to the individual (35.7%) and were often family members in care-providing roles (55.4%). Examination of age at onset of illness and offending patterns suggested that most persons admitted to forensic care for homicide act in the context of illness and exhibit a low frequency of pre-homicide offending. CONCLUSIONS Many individuals admitted to forensic care for homicide have had inadequate mental healthcare leading up to this point. Effective responses to reduce and manage risk should encompass services that proactively address illness-related (e.g. earlier access and better maintenance in care) and criminogenic (e.g. substance use treatment, employment and psychosocial supports) domains.
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Affiliation(s)
- Stephanie R. Penney
- Complex Care and Recovery Program, Forensic Division, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; and Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Austin A. Lam
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Nathan Kolla
- Complex Care and Recovery Program, Forensic Division, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; and Waypoint Centre for Mental Health Care, Penetanguishene, Ontario, Canada
| | - Krystle Martin
- Ontario Shores Centre for Mental Health Sciences, Whitby, Ontario, Canada
| | - Kimberly Belfry
- Waypoint Centre for Mental Health Care, Penetanguishene, Ontario, Canada
| | - Alexander I. F. Simpson
- Complex Care and Recovery Program, Forensic Division, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; and Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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Mangaoil RA, Cleverley K, Peter E, Simpson AIF. The experiences of nurses following seclusion or restraint use and immediate staff debriefing in inpatient mental health settings. J Adv Nurs 2023; 79:3397-3411. [PMID: 37005978 DOI: 10.1111/jan.15667] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 02/18/2023] [Accepted: 03/23/2023] [Indexed: 04/04/2023]
Abstract
AIM The aim of this study is to explore nurses' experiences of seclusion or restraint use and their participation in immediate staff debriefing in inpatient mental health settings. DESIGN This research was conducted using a descriptive exploratory design and data were gathered through in-depth individual interviews. METHODS The experiences of nurses following seclusion or restraint use and their participation in immediate staff debriefing were explored via teleconference, using a semi-structured interview guide. Reflexive thematic analysis was used to identify prevalent themes from the data. RESULTS Interviews (n=10) were conducted with nurses from inpatient mental health wards in July 2020. Five themes emerged through the data analysis: (i) ensuring personal safety; (ii) grappling between the use of least-restrictive interventions and seclusion or restraint use; (iii) navigating ethical issues and personal reactions; (iv) seeking validation from colleagues and (v) attending staff debriefing based on previous experience. The themes were also analysed using Lazarus and Folkman's Transactional Model of Stress and Coping. CONCLUSION Staff debriefing is a vital resource for nurses to provide and/or receive emotion- and problem-focused coping strategies. Mental health institutions should strive to establish supportive working environments and develop interventions based on the unique needs of nurses and the stressors they experience following seclusion or restraint use. PATIENT OR PUBLIC CONTRIBUTION Nurses in both frontline and leadership roles were involved in the development and pilot test of the interview guide. The nurses who participated in the study were asked if they can be recontacted if clarification is needed during interview transcription or data analysis.
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Affiliation(s)
| | - Kristin Cleverley
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
- Chair in Mental Health Nursing Research, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada
| | - Elizabeth Peter
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
- Co-Chair, American Academy of Nurses' Bioethics Expert Panel
| | - Alexander I F Simpson
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Chair in Forensic Psychiatry, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada
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Penney SR, Faziluddin S, Simpson AIF, Socha P, Wilkie T. Risk, resilience, and recovery in forensic mental health: An integrated conceptual model. Behav Sci Law 2023; 41:280-291. [PMID: 36898979 DOI: 10.1002/bsl.2615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 02/13/2023] [Accepted: 02/27/2023] [Indexed: 06/18/2023]
Abstract
In this paper we describe a novel, integrated conceptual model that brings together core elements across structured tools assessing risk for future violence, protective factors, and progress in treatment and recovery in forensic mental health settings. We argue that the value of such a model lies in its ability to improve clinical efficiencies and streamline assessment protocols, facilitate meaningful participation of patients in assessment and treatment planning activities and increase the accessibility of clinical assessments to principal users of this information. The four domains appearing in the model (treatment engagement, stability of illness and behavior, insight, and professional and personal support) are described, and common clinical manifestations of each domain within a forensic context are illustrated. We conclude with a discussion of the types of research that would be needed to validate a concept model such as the one presented here as well as implications for clinical practice and implementation.
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Affiliation(s)
- Stephanie R Penney
- Complex Care and Recovery Program, Forensic Division, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Suraya Faziluddin
- Complex Care and Recovery Program, Forensic Division, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Factor Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | - Alexander I F Simpson
- Complex Care and Recovery Program, Forensic Division, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Patti Socha
- Complex Care and Recovery Program, Forensic Division, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Factor Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | - Treena Wilkie
- Complex Care and Recovery Program, Forensic Division, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
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11
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Bastidas-Bilbao H, Stergiopoulos V, van Kesteren MR, Stewart DE, Cappe V, Gupta M, Buchman DZ, Simpson AIF, Castle D, Campbell BH, Hawke LD. Searching for relief from suffering: A patient-oriented qualitative study on medical assistance in dying for mental illness as the sole underlying medical condition. Soc Sci Med 2023; 331:116075. [PMID: 37441977 DOI: 10.1016/j.socscimed.2023.116075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 06/28/2023] [Accepted: 07/02/2023] [Indexed: 07/15/2023]
Abstract
Medical assistance in dying (MAiD) was introduced into Canadian legislation in 2016. Mental illness as the sole underlying medical condition (MI-SUMC) is excluded from eligibility; this is expected to change in 2024. Incurability, intolerable suffering, capacity to make healthcare decisions, and suicidality have been publicly debated in connection with mental illness. Few studies have explored the views of persons with mental illness on the introduction and acceptability of MAiD MI-SUMC; this study aimed to fill this gap. Thirty adults, residing in Ontario, Canada, who self-identified as living with mental illness participated. A semi-structured interview including a persona-scenario exercise was designed to discuss participants' views on MAiD MI-SUMC and when it could be acceptable or not. Reflexive thematic analysis was used to inductively analyze data. Codes and themes were developed after extensive familiarization with the dataset. A lived-experience advisory group was engaged throughout the study. We identified six themes: The certainty of suffering; Is there a suffering threshold to be met? The uncertainty of mental illness; My own limits, values, and decisions; MAiD MI-SUMCas acceptable when therapeutic means, and othersupports, have been tried to alleviate long-term suffering; and Between relief and rejection. These themes underline how the participants' lived experience comprised negative impacts caused by long-term mental illness, stigma, and in some cases, socioeconomic factors. The need for therapeutic and non-therapeutic supports was highlighted, along with unresolved tensions about the links between mental illness, capacity, and suicidality. Although not all participants viewed MAiD MI-SUMC as acceptable for mental illness, they autonomously embraced limits, values, and decisions of their own along their search for relief. Identifying individual and contextual elements in each person's experience of illness and suffering is necessary to understand diverse perspectives on MAiD MI-SUMC.
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Affiliation(s)
| | - Vicky Stergiopoulos
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | | | - Donna Eileen Stewart
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; Centre for Mental Health and Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Vivien Cappe
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Mona Gupta
- Centre hospitalier de l'Université de Montréal, Département de Psychiatrie, Montréal, Québec, Canada
| | - Daniel Z Buchman
- Education and Professional Practice Office, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Dalla Lana School of Public Health and University of Toronto Joint Centre for Bioethics, University of Toronto, Toronto, Ontario, Canada
| | - Alexander I F Simpson
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; Forensic Division, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - David Castle
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | | | - Lisa D Hawke
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.
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12
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Lam AA, Penney SR, Simpson AIF. Serious Mental Illness and Sexual Offending in Forensic Psychiatric Patients. Sex Abuse 2023; 35:103-126. [PMID: 35446740 DOI: 10.1177/10790632221088012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
The role of serious mental illness among those who sexually offend is not well understood. We investigated clinical and risk-related areas of difference between male forensic psychiatric patients with (n = 86) and without (n = 245) a sexual offense history, including the age at which indications of mental disorder and criminal offending first emerged, from a registry of Ontario patients adjudicated Not Criminally Responsible on account of Mental Disorder (NCRMD) from 1999-2012. We further explored motivations for offending among a subset of patients deemed NCRMD for a sexual offense specifically (n = 41). While no differences were found in the age onset of illness or offending across those with and without a sexual offending history, the former group was rated as having higher levels of historical/static risk for violence. Forensic patients with a sexual offense history were also more likely to offend against a stranger, and less likely to offend against a family member. Sexual index offenses were psychotically-motivated in the majority of cases, but with a meaningful proportion appearing to reflect criminogenic motivations, especially substance use and paraphilic interests. Results suggest greater similarity than difference among forensic patients with and without a sexual offense history, but also highlight an important divergence from the literature showing that victims of sexual offenses are frequently known to the individual committing them.
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Affiliation(s)
- Austin A Lam
- Temerty Faculty of Medicine, 12366University of Toronto, Toronto, ON, Canada
- Complex Care and Recovery Program, Forensic Division, 7978Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Stephanie R Penney
- Temerty Faculty of Medicine, 12366University of Toronto, Toronto, ON, Canada
- Complex Care and Recovery Program, Forensic Division, 7978Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, 7938University of Toronto, Mississauga, ON, Canada
| | - Alexander I F Simpson
- Complex Care and Recovery Program, Forensic Division, 7978Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, 7938University of Toronto, Mississauga, ON, Canada
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13
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Simpson AIF, Tran J, Jones RM. Ethical considerations regarding mental disorder and medical assistance in dying (MAiD) in the prison population. Med Sci Law 2023; 63:3-5. [PMID: 36571789 DOI: 10.1177/00258024221146725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Affiliation(s)
| | | | - Roland M Jones
- University of Toronto, Canada
- Centre for Addiction and Mental Health (CAMH), Canada
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14
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Penney SR, Simpson AIF. Suicide risk assessment. Lancet Psychiatry 2022; 9:938. [PMID: 36403595 DOI: 10.1016/s2215-0366(22)00313-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 08/19/2022] [Indexed: 11/19/2022]
Affiliation(s)
- Stephanie R Penney
- Complex Care and Recovery Program, Forensic Division, Centre for Addiction and Mental Health, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON M6J 1H4, Canada.
| | - Alexander I F Simpson
- Complex Care and Recovery Program, Forensic Division, Centre for Addiction and Mental Health, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON M6J 1H4, Canada
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15
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Khan B, Simpson AIF. Another Call to Action for Integrating Culture into Forensic Therapeutics. J Am Acad Psychiatry Law 2022; 50:434-439. [PMID: 35710129 DOI: 10.29158/jaapl.210139-21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Forensic mental health services provide care for many people of minority ethnicity whose over-representation in these areas is a result of complex structural inequities in society. The need for cross-cultural understanding has long been advocated in forensic practice. Guidance on the integration of culture into forensic assessment has been well described, but little has been written about cultural responsiveness in forensic rehabilitation and recovery-based services. Cultural responsiveness is commonly expressed as a strategic goal for forensic providers, but there is little reported evidence of how to address and measure the effectiveness of cultural responsiveness initiatives. Equity of outcome by ethnicity should be the aim of forensic services, and this requires systematic measurement. Cultural safety, rather than cultural competence, has been promoted as the patient experience services should strive for. A measurement-based care framework can provide tools to evaluate service responses systematically and iteratively to address the challenges in achieving delivery of culturally safe forensic services.
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Affiliation(s)
- Bushra Khan
- Bushra Khan is Resident Physician, PGY3, University of Toronto, Clinician-Scientist Program, and Alexander I. F. Simpson is Chair in Forensic Psychiatry and Clinician Scientist, Centre for Addiction & Mental Health; University of Toronto
| | - Alexander I F Simpson
- Bushra Khan is Resident Physician, PGY3, University of Toronto, Clinician-Scientist Program, and Alexander I. F. Simpson is Chair in Forensic Psychiatry and Clinician Scientist, Centre for Addiction & Mental Health; University of Toronto.
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16
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de Oliveira C, Kouyoumdjian FG, Iwajomo T, Jones R, Simpson AIF, Kurdyak P. Health Care Costs of Individuals With Chronic Psychotic Disorders Who Experience Incarceration in Ontario. Psychiatr Serv 2022; 73:760-767. [PMID: 34932392 DOI: 10.1176/appi.ps.202100150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Little is known about the health care costs of individuals with chronic psychotic disorders who experience incarceration. This study sought to address this knowledge gap. METHODS The authors analyzed linked 2007-2010 correctional and administrative health care data on sex- and age-matched individuals with chronic psychotic disorders with and without known incarceration in prison for up to 2 years in the Ontario correctional system. Mean 1-year health care costs (overall and by sex) in the year before incarceration (when release occurred in 2010) were estimated from third-party payer data and compared between the two groups. Costs were calculated in 2018 Canadian dollars. RESULTS Individuals who experienced incarceration (N=3,197) had mean 1-year costs of $15,728 in the year before incarceration, whereas those who did not (N=6,393) had 1-year costs of $11,588. This difference was mostly due to costs arising from psychiatric hospitalizations, emergency department visits, and physician services. The main factors associated with the difference were incarceration in the following year (increase of $4,827, p<0.001), being age 18-29 years compared with ages 30-39 or 40-49 (increase of $4,448 and $4,218, respectively, p<0.001), and chronic psychotic disorder duration of 1-2 years compared with ≤1 year duration (increase of $6,812, p=0.004). Women who experienced incarceration had higher costs than incarcerated men ($20,648 vs. $14,763). CONCLUSIONS Individuals with chronic psychotic disorders who experienced incarceration had higher health care costs than comparable individuals who did not. These higher health care costs may signal the need for interventions and policies that help individuals with psychotic disorders avoid criminal justice system involvement.
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Affiliation(s)
- Claire de Oliveira
- ICES, Toronto (de Oliveira, Kouyoumdjian, Iwajomo, Kurdyak); Institute for Mental Health Policy Research (de Oliveira, Iwajomo, Kurdyak) and Division of Forensic Psychiatry (Jones, Simpson), Centre for Addiction and Mental Health, Toronto; Department of Family Medicine, McMaster University, Hamilton, Ontario (Kouyoumdjian); Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto (Jones, Simpson)
| | - Fiona G Kouyoumdjian
- ICES, Toronto (de Oliveira, Kouyoumdjian, Iwajomo, Kurdyak); Institute for Mental Health Policy Research (de Oliveira, Iwajomo, Kurdyak) and Division of Forensic Psychiatry (Jones, Simpson), Centre for Addiction and Mental Health, Toronto; Department of Family Medicine, McMaster University, Hamilton, Ontario (Kouyoumdjian); Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto (Jones, Simpson)
| | - Tomisin Iwajomo
- ICES, Toronto (de Oliveira, Kouyoumdjian, Iwajomo, Kurdyak); Institute for Mental Health Policy Research (de Oliveira, Iwajomo, Kurdyak) and Division of Forensic Psychiatry (Jones, Simpson), Centre for Addiction and Mental Health, Toronto; Department of Family Medicine, McMaster University, Hamilton, Ontario (Kouyoumdjian); Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto (Jones, Simpson)
| | - Roland Jones
- ICES, Toronto (de Oliveira, Kouyoumdjian, Iwajomo, Kurdyak); Institute for Mental Health Policy Research (de Oliveira, Iwajomo, Kurdyak) and Division of Forensic Psychiatry (Jones, Simpson), Centre for Addiction and Mental Health, Toronto; Department of Family Medicine, McMaster University, Hamilton, Ontario (Kouyoumdjian); Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto (Jones, Simpson)
| | - Alexander I F Simpson
- ICES, Toronto (de Oliveira, Kouyoumdjian, Iwajomo, Kurdyak); Institute for Mental Health Policy Research (de Oliveira, Iwajomo, Kurdyak) and Division of Forensic Psychiatry (Jones, Simpson), Centre for Addiction and Mental Health, Toronto; Department of Family Medicine, McMaster University, Hamilton, Ontario (Kouyoumdjian); Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto (Jones, Simpson)
| | - Paul Kurdyak
- ICES, Toronto (de Oliveira, Kouyoumdjian, Iwajomo, Kurdyak); Institute for Mental Health Policy Research (de Oliveira, Iwajomo, Kurdyak) and Division of Forensic Psychiatry (Jones, Simpson), Centre for Addiction and Mental Health, Toronto; Department of Family Medicine, McMaster University, Hamilton, Ontario (Kouyoumdjian); Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto (Jones, Simpson)
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17
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Patel M, Chahal J, Simpson AIF. Teaching Advocacy Through Community-Based Service Learning: A Scoping Review. Acad Psychiatry 2022; 46:238-247. [PMID: 33738761 DOI: 10.1007/s40596-021-01411-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 01/28/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE Advocacy has been identified as a core element within the practice of medicine and thus a key component to medical education. However, there are challenges regarding teaching and evaluation of advocacy within medical education. Community-based service learning (CBSL) has emerged as a valuable educational tool to foster knowledge and skills related to advocacy. CBSL is particularly relevant to psychiatry, given the extent of engagement with underserved communities and opportunities to advance learning in these environments. A scoping review was conducted to identify current educational strategies and outcomes related to advocacy training among medical learners in the context of CBSL. METHODS Between July and October 2019, the authors searched PsycINFO, MEDLINE, Embase, ERIC, Web of Science, Scopus, and ProQuest for English language literature with no date limits and retrieved 2,813 articles and abstracts; 68 were included in this review. Two reviewers independently screened articles and extracted data. Data were then charted, analyzed, and discussed with the research team. RESULTS Seven key themes related to approaches to advocacy education were identified: (1) type of community partner; (2) populations served; (3) program participants; (4) program structure; (5) evaluation of learner outcomes; (6) sustainability; and (7) challenges and limitations. CONCLUSIONS This scoping review provides insights into the variety of CBSL-based advocacy program formats and evaluation methods, which is of particular importance to psychiatry. There is heterogeneity in the methodology by which CBSL is implemented and how outcomes are measured. A list of recommendations for future areas of inquiry is provided.
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Affiliation(s)
- Mitesh Patel
- Centre for Addiction and Mental Health, Toronto, ON, Canada
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18
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Penney SR, Morgan A, Simpson AIF. Motivational Influences and Trajectories to Violence in the Context of Major Mental Illness. J Interpers Violence 2021; 36:NP10572-NP10593. [PMID: 31530072 DOI: 10.1177/0886260519876719] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Developmental trajectories regarding the age onset of violence and offending have not routinely considered the role of major mental illness (MMI). In parallel, despite several studies investigating the relationship between MMI, violence and offending, fewer have identified motivational processes that may link illness to these outcomes in a more direct and proximal manner. This study investigates whether subtypes of forensic psychiatric patients deemed Not Criminally Responsible on account of Mental Disorder (N = 91) can be identified based on the age onset of mental illness and offending behavior, and whether information on motivational influences for offending-elicited both from the patient directly and detailed collateral information-contributes to the clinical utility of this typology. Results indicated that most patients reported engaging in violence (51%) or antisocial behaviors (72%) prior to the onset of MMI, but that the index offense(s) resulting in forensic admission were predominantly psychotically motivated. In contrast to patients for whom the onset of MMI occurred prior to offending, patients exhibiting premorbid violence had higher levels of risk and criminogenic need; they were more likely to be diagnosed with personality and substance use disorders, and to have conventional (i.e., non-illness-related) motivations ascribed to their index offense. Findings are consistent with the existing literature regarding subgroups of mentally disordered offenders, but provide new information regarding proximal risk factors for violence through better identification of motivational processes.
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Affiliation(s)
- Stephanie R Penney
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- University of Toronto, Ontario, Canada
| | - Andrew Morgan
- University of Toronto, Ontario, Canada
- Ontario Shores Centre for Mental Health Sciences, Whitby, Canada
| | - Alexander I F Simpson
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- University of Toronto, Ontario, Canada
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19
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Alavi N, Stephenson C, Omrani M, Gerritsen C, Martin MS, Knyahnytskyi A, Zhu Y, Kumar A, Jagayat J, Shirazi A, Moghimi E, Patel C, Knyahnytska Y, Simpson AIF, Zaheer J, Andersen J, Munshi A, Groll D. Delivering an Online Cognitive Behavioral Therapy Program to Address Mental Health Challenges Faced by Correctional Workers and Other Public Safety Personnel: Protocol for a Mixed Methods Study. JMIR Res Protoc 2021; 10:e30845. [PMID: 34088656 PMCID: PMC8367142 DOI: 10.2196/30845] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 06/03/2021] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Public safety personnel have regular and often intense exposure to potentially traumatic events at work, especially workplace violence in the case of correctional workers. Subsequently, correctional workers are at higher risk of developing mental health problems such as posttraumatic stress disorder. Public safety personnel are up to 4 times more likely to experience suicidal ideation, suicidal attempts, and death by suicide compared to the general population. Despite this high prevalence, help-seeking behaviors from public safety personnel are low due to stigma and irregular work hours limiting access to care. Innovative treatments are needed to address these challenges. OBJECTIVE This study will investigate the efficacy of an electronically delivered cognitive behavioral therapy (e-CBT) program tailored to correctional workers' mental health problems. METHODS This study is composed of 4 phases. In phase 1, we will interview correctional workers individually and in focus groups to identify personal, social, and cultural factors affecting their mental health and barriers to care. Phase 2 will use the information gathered from the interviews to develop gender- and diagnosis-specific e-CBT modules. These will be presented to a new group of participants who will provide further feedback on their usability and accessibility. In phase 3, we will randomly assign participants to either an e-CBT or treatment as usual arm. The program will be evaluated with validated symptomatology questionnaires and interviews. Phase 4 will use this additional information to fine-tune the e-CBT modules for a larger-scale randomized controlled trial design comparing the e-CBT program to in-person CBT. All e-CBT modules will be delivered through a secure online platform. RESULTS The study received ethics approval in December 2020, and participant recruitment began in March 2021. Participant recruitment has been conducted through targeted advertisements and physician referrals. To date, there have been 15 participants recruited for Phase 1, and it is expected to conclude in July 2021, with phase 2 beginning in September 2021. Complete data collection and analysis from all phases are expected to conclude by July 2023. Linear and binomial regression (for continuous and categorical outcomes, respectively) will be conducted along with interpretive qualitative methods. CONCLUSIONS If proven efficacious and feasible, this e-CBT program can provide a high-quality and clinically validated resource to address the mental health problems of correctional workers. Additionally, findings can contribute to the development of innovative treatments for other public safety professions. TRIAL REGISTRATION ClinicalTrials.gov NCT04666974; https://www.clinicaltrials.gov/ct2/show/NCT04666974. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/30845.
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Affiliation(s)
- Nazanin Alavi
- Department of Psychiatry, Faculty of Health Sciences, Queen's University, Kingston, ON, Canada
- Centre for Neuroscience Studies, Faculty of Health Sciences, Queen's University, Kingston, ON, Canada
| | - Callum Stephenson
- Department of Psychiatry, Faculty of Health Sciences, Queen's University, Kingston, ON, Canada
- Centre for Neuroscience Studies, Faculty of Health Sciences, Queen's University, Kingston, ON, Canada
| | - Mohsen Omrani
- Department of Psychiatry, Faculty of Health Sciences, Queen's University, Kingston, ON, Canada
- Centre for Neuroscience Studies, Faculty of Health Sciences, Queen's University, Kingston, ON, Canada
- OPTT Inc, Toronto, ON, Canada
| | - Cory Gerritsen
- Forensic Early Intervention Service, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Department of Psychological Clinical Science, University of Toronto, Toronto, ON, Canada
| | - Michael S Martin
- Health Services Sector, Correctional Service Canada, Ottawa, ON, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Alex Knyahnytskyi
- Department of Psychiatry, Faculty of Health Sciences, Queen's University, Kingston, ON, Canada
| | - Yiran Zhu
- Faculty of Health Sciences, Queen's Unviersity, Kingston, ON, Canada
| | - Anchan Kumar
- Department of Psychiatry, Faculty of Health Sciences, Queen's University, Kingston, ON, Canada
| | - Jasleen Jagayat
- Department of Psychiatry, Faculty of Health Sciences, Queen's University, Kingston, ON, Canada
| | - Amirhossein Shirazi
- Department of Psychiatry, Faculty of Health Sciences, Queen's University, Kingston, ON, Canada
- Centre for Neuroscience Studies, Faculty of Health Sciences, Queen's University, Kingston, ON, Canada
- OPTT Inc, Toronto, ON, Canada
| | - Elnaz Moghimi
- Department of Psychiatry, Faculty of Health Sciences, Queen's University, Kingston, ON, Canada
| | - Charmy Patel
- Department of Psychiatry, Faculty of Health Sciences, Queen's University, Kingston, ON, Canada
| | - Yuliya Knyahnytska
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- General Psychiatry Division, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Alexander I F Simpson
- Department of Forensic Psychiatry, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Juveria Zaheer
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Judith Andersen
- Department of Psychology, University of Toronto Mississauga, Mississauga, ON, Canada
| | - Alpna Munshi
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Dianne Groll
- Department of Psychiatry, Faculty of Health Sciences, Queen's University, Kingston, ON, Canada
- Canadian Institute for Military and Veteran Health Research, Kingston, ON, Canada
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20
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Chaimowitz GA, Simpson AIF. Charting a New Course for Forensic Psychiatry. J Am Acad Psychiatry Law 2021; 49:157-160. [PMID: 34131057 DOI: 10.29158/jaapl.210013-21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Affiliation(s)
- Gary A Chaimowitz
- Dr. Chaimowitz is Professor of Psychiatry, Department of Psychiatry and Behavioural Neurosciences, McMaster University, St Josephs Healthcare, Hamilton, ON, Canada. Dr. Simpson is Chair of Forensic Psychiatry, Department of Psychiatry, Centre for Addiction and Mental Health + University of Toronto, Toronto, ON, Canada.
| | - Alexander I F Simpson
- Dr. Chaimowitz is Professor of Psychiatry, Department of Psychiatry and Behavioural Neurosciences, McMaster University, St Josephs Healthcare, Hamilton, ON, Canada. Dr. Simpson is Chair of Forensic Psychiatry, Department of Psychiatry, Centre for Addiction and Mental Health + University of Toronto, Toronto, ON, Canada
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21
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Jones RM, Manetsch M, Gerritsen C, Simpson AIF. Patterns and Predictors of Reincarceration among Prisoners with Serious Mental Illness: A Cohort Study: Modèles et prédicteurs de réincarcération chez les prisonniers souffrant de maladie mentale grave : Une étude de cohorte. Can J Psychiatry 2021; 66:560-568. [PMID: 33155829 PMCID: PMC8138736 DOI: 10.1177/0706743720970829] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND A small proportion of people who have serious mental illness and rapid and frequent incarcerations account for a disproportionate amount of overall service use and cost. It is important to describe such individuals, so that services can respond more effectively. METHODS We investigated a cohort of 4,704 incarcerated men and women who were discharged from a correctional mental health service and followed for a median of 535 days. We investigated social, clinical, demographic, and offense characteristics as predictors of return to the service using Cox survival analyses. Secondly, we characterized individuals as high-frequency service users as those who had 3 or more incarcerations during a 1-year period and investigated their characteristics. RESULTS We found that a higher rate of return to custody was associated with schizophrenia spectrum/bipolar affective disorder (BPAD), personality disorder traits, crack cocaine and methamphetamine use, and unstable housing. Charges of theft/robbery and breach of probation were also positively associated, and sex assault was negatively associated with return to custody. Within a 1-year time period, we found 7.2% of individuals were high-frequency service users, which accounted for 19.5% of all reincarcerations. CONCLUSION Identification of the characteristics of those with mental illness in custody, especially those who have high-frequency returns to custody, may provide opportunity to target resources more effectively. The primary targets of intervention would be to treat those with schizophrenia/BPAD and substance use problems, particularly those using stimulants, and addressing homelessness. This could reduce the problem of repeated criminalization of the mentally ill and reduce the overall incarceration rate.
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Affiliation(s)
- Roland M Jones
- 7978Centre for Addiction and Mental Health (CAMH), University of Toronto, Ontario, Canada.,Department of Psychiatry, 7938University of Toronto, Ontario, Canada
| | - Madleina Manetsch
- 7978Centre for Addiction and Mental Health (CAMH), University of Toronto, Ontario, Canada.,Forensic Psychiatric Clinic, Adolescent Forensic Psychiatry, University Psychiatric Clinics, Basel, Switzerland
| | - Cory Gerritsen
- 7978Centre for Addiction and Mental Health (CAMH), University of Toronto, Ontario, Canada.,Department of Psychiatry, 7938University of Toronto, Ontario, Canada
| | - Alexander I F Simpson
- 7978Centre for Addiction and Mental Health (CAMH), University of Toronto, Ontario, Canada.,Department of Psychiatry, 7938University of Toronto, Ontario, Canada
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22
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Sirotich F, Law S, Nakhost A, Simpson AIF. Understanding the effects of 'leverage' on personal recovery: A call for research. Psychiatry Res 2021; 299:113839. [PMID: 33713936 DOI: 10.1016/j.psychres.2021.113839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 02/23/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Frank Sirotich
- Research and Evaluation Department, Canadian Mental Health Association, Toronto Branch, Toronto, Ontario, Canada; Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada.
| | - Samuel Law
- Mental Health and Addictions Service, St. Michael's Hospital, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Arash Nakhost
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Alexander I F Simpson
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; Forensic Division, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
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23
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Mahentharan M, Kouyoumdjian FG, de Oliveira C, Iwajomo T, Simpson AIF, Jones R, Kurdyak P. Prevalence and Predictors of Reincarceration after Correctional Center Release: A Population-based Comparison of Individuals with and without Schizophrenia in Ontario, Canada: Prévalence et prédicteurs de la réincarcération après la libération d'un centre correctionnel : une comparaison dans la population-de personnes souffrant ou non de schizophrénie en Ontario, Canada. Can J Psychiatry 2021; 66:376-384. [PMID: 32856464 PMCID: PMC8172346 DOI: 10.1177/0706743720953018] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Individuals with schizophrenia are overrepresented in correctional facilities relative to their population-based prevalence. The purpose of this study was to determine the rate and predictors of reincarceration of individuals with schizophrenia after release from correctional facilities. METHODS This was a retrospective cohort study that included all people released from Ontario's provincial correctional facilities from January 1 to December 31, 2010. Individuals with schizophrenia were identified using a population-based algorithm. The primary outcome was time to reincarceration. Covariates included sociodemographic characteristics (age, sex, neighborhood income quintile, urban/rural residence), health service utilization (primary care physician visits, psychiatrist visits, psychiatric and nonpsychiatric hospitalizations, emergency department visits), and other clinical comorbidity. Survival analysis was used to examine the association between schizophrenia and reincarceration. RESULTS Among 46,928 individuals, N = 3,237 (7%) had a diagnosis of schizophrenia. Approximately 67.5% of these individuals were reincarcerated within 5 years following their first release in 2010, compared to 58.8% of individuals without schizophrenia. Individuals with schizophrenia were 40% (HR = 1.39, 95% CI, 1.33 to 1.45) more likely to be reincarcerated following release than the control group after adjusting for demographic characteristics. This association reduced to 8% (HR = 1.08, 95% CI,1.03 to 1.14) after adjusting for prior health service utilization, prior correctional involvement, and comorbidities. CONCLUSION Individuals with schizophrenia were more likely to experience reincarceration after release from correctional facilities. This risk is partly explained by prior correctional involvement, health service utilization, and comorbidities. Future research should focus on risk factors predicting the higher reincarceration rate and interventions to reduce correctional involvement.
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Affiliation(s)
- Mayuri Mahentharan
- Insitute for Mental Health Policy Research, CAMH, Toronto, Ontario, Canada
| | - Fiona G Kouyoumdjian
- Department of Family Medicine, 3710McMaster University, Hamilton, Ontario, Canada.,ICES, Toronto, Ontario, Canada
| | - Claire de Oliveira
- Insitute for Mental Health Policy Research, CAMH, Toronto, Ontario, Canada.,ICES, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Ontario, Canada
| | - Tomisin Iwajomo
- Insitute for Mental Health Policy Research, CAMH, Toronto, Ontario, Canada.,ICES, Toronto, Ontario, Canada
| | | | - Roland Jones
- Division of Forensic Psychiatry, 7978CAMH, Toronto, Ontario, Canada
| | - Paul Kurdyak
- Insitute for Mental Health Policy Research, CAMH, Toronto, Ontario, Canada.,ICES, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Ontario, Canada
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24
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Simpson AIF, Gerritsen C, Maheandiran M, Adamo V, Vogel T, Fulham L, Kitt T, Forrester A, Jones RM. A Systematic Review of Reviews of Correctional Mental Health Services Using the STAIR Framework. Front Psychiatry 2021; 12:747202. [PMID: 35115956 PMCID: PMC8806032 DOI: 10.3389/fpsyt.2021.747202] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Accepted: 12/13/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Rising demand for correctional mental health services (CMHS) in recent decades has been a global phenomenon. Despite increasing research, there are major gaps in understanding the best models for CMHS and how to measure their effectiveness, particularly studies that consider the overall care pathways and effectiveness of service responses. The STAIR (Screening, Triage, Assessment, Intervention, and Re-integration) model is an evidence-based framework that defines and measures CMHS as a clinical pathway with a series of measurable, and linked functions. METHOD We conducted a systematic review of the reviews of CMHS elements employing PRISMA guidelines, organized according to STAIR pillars. We assessed the quality of included studies using the AMSTAR-2 criteria. Narrative reviews were read and results synthesized. RESULTS We included 26 review articles of which 12 were systematic, metaanalyses, and 14 narrative reviews. Two systematic reviews and seven narrative reviews addressed screening and triage with strong evidence to support specific screening and triage systems. There was no evidence for standardised assessment approaches. Eight systematic reviews and seven narrative reviews addressed interventions providing some evidence to support specific psychosocial interventions. Three systematic reviews and six narrative reviews addressed reintegration themes finding relatively weak evidence to support reintegration methods, with interventions often being jurisdictionally specific and lacking generalizability. CONCLUSIONS The STAIR framework is a useful way to organize the extant literature. More research is needed on interventions, assessment systems, care pathway evaluations, and reintegration models.
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Affiliation(s)
- Alexander I F Simpson
- Forensic Psychiatry, Centre for Addiction and Mental Health, University of Toronto, Toronto, ON, Canada
| | - Cory Gerritsen
- Department of Forensic Psychiatry, Centre for Addiction and Mental Health, University of Toronto, Toronto, ON, Canada
| | | | - Vito Adamo
- Department of Forensic Psychiatry, Centre for Addiction and Mental Health, University of Toronto, Toronto, ON, Canada
| | - Tobias Vogel
- Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Lindsay Fulham
- Department of Forensic Psychiatry, Centre for Addiction and Mental Health, University of Toronto, Toronto, ON, Canada
| | - Tamsen Kitt
- Department of Psychology, Centre for Addiction and Mental Health, University of Toronto, Toronto, ON, Canada
| | - Andrew Forrester
- Forensic Psychiatry, Department of Psychological Medicine and Clinical Neursciences, School of Medicine, Cardiff University, Cardiff, United Kingdom
| | - Roland M Jones
- Department of Forensic Psychiatry, Centre for Addiction and Mental Health, University of Toronto, Toronto, ON, Canada
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25
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Simpson AIF, Chatterjee S, Darby P, Jones RM, Maheandiran M, Penney SR, Saccoccio T, Stergiopoulos V, Wilkie T. Management of COVID-19 Response in a Secure Forensic Mental Health Setting: Réponse à la gestion de la COVID-19 dans un établissement sécurisé de santé mentale et de psychiatrie légale. Can J Psychiatry 2020; 65:695-700. [PMID: 32573397 PMCID: PMC7312094 DOI: 10.1177/0706743720935648] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVES The coronavirus disease 2019 (COVID-19) pandemic presents major challenges to places of detention, including secure forensic hospitals. International guidance presents a range of approaches to assist in decreasing the risk of COVID-19 outbreaks as well as responses to manage outbreaks of infection should they occur. METHODS We conducted a literature search on pandemic or outbreak management in forensic mental health settings, including gray literature sources, from 2000 to April 2020. We describe the evolution of a COVID-19 outbreak in our own facility, and the design, and staffing of a forensic isolation unit. RESULTS We found a range of useful guidance but no published experience of implementing these approaches. We experienced outbreaks of COVID-19 on two secure forensic units with 13 patients and 10 staff becoming positive. One patient died. The outbreaks lasted for 41 days on each unit from declaration to resolution. We describe the approaches taken to reduction of infection risk, social distancing and changes to the care delivery model. CONCLUSIONS Forensic secure settings present major challenges as some proposals for pandemic management such as decarceration or early release are not possible, and facilities may present challenges to achieve sustained social distancing. Assertive testing, cohorting, and isolation units are appropriate responses to these challenges.
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Affiliation(s)
- Alexander I F Simpson
- Complex Care and Recovery Program, Centre for Addition and Mental Health, Division of Forensic Psychiatry, Department of Psychiatry, University of Toronto, Ontario, Canada
| | - Sumeeta Chatterjee
- Complex Care and Recovery Program, Centre for Addition and Mental Health, Division of Forensic Psychiatry, Department of Psychiatry, University of Toronto, Ontario, Canada
| | - Padraig Darby
- Complex Care and Recovery Program, Centre for Addition and Mental Health, Division of Forensic Psychiatry, Department of Psychiatry, University of Toronto, Ontario, Canada
| | - Roland M Jones
- Complex Care and Recovery Program, Centre for Addition and Mental Health, Division of Forensic Psychiatry, Department of Psychiatry, University of Toronto, Ontario, Canada
| | - Margaret Maheandiran
- Complex Care and Recovery Program, Centre for Addition and Mental Health, Division of Forensic Psychiatry, Department of Psychiatry, University of Toronto, Ontario, Canada
| | - Stephanie R Penney
- Complex Care and Recovery Program, Centre for Addition and Mental Health, Division of Forensic Psychiatry, Department of Psychiatry, University of Toronto, Ontario, Canada
| | - Tania Saccoccio
- Complex Care and Recovery Program, Centre for Addition and Mental Health, Division of Forensic Psychiatry, Department of Psychiatry, University of Toronto, Ontario, Canada
| | - Vicky Stergiopoulos
- Complex Care and Recovery Program, Centre for Addition and Mental Health, Division of Forensic Psychiatry, Department of Psychiatry, University of Toronto, Ontario, Canada
| | - Treena Wilkie
- Complex Care and Recovery Program, Centre for Addition and Mental Health, Division of Forensic Psychiatry, Department of Psychiatry, University of Toronto, Ontario, Canada
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26
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Simpson AIF, Boldt I, Penney S, Jones R, Kidd S, Nakhost A, Wilkie T. Perceptions of procedural justice and coercion among forensic psychiatric patients: a study protocol for a prospective, mixed-methods investigation. BMC Psychiatry 2020; 20:230. [PMID: 32404082 PMCID: PMC7222335 DOI: 10.1186/s12888-020-02629-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 04/28/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The risk and recovery paradigms are the dominant frameworks informing forensic mental health services and have been the focus of increasing research interest. Despite this, there are significant gaps in our understanding of the nature of mental health recovery in forensic settings (i.e., 'secure recovery'), and specifically, the key elements of recovery as perceived by forensic patients and their treatment providers. Importantly, we know little about how patients perceive the forensic mental health system, to what extent they see it as fair and legitimate, and how these perceptions impact upon treatment engagement, risk for adversity, and progress in recovery. METHODS In this prospective, mixed-methods study, we investigate patient perceptions of procedural justice and coercion within the context of the forensic mental health system in Ontario, Canada (final N = 120 forensic patients and their primary care providers). We elicit patient self-assessments of risk and progress in recovery, and assess the degree of concordance with clinician-rated estimates of these constructs. Both qualitative and quantitative methods are used to assess the degree to which patient perceptions of coercion, fairness and legitimacy impact upon their level of treatment engagement, risk for adversity and progress in recovery. A prospective, two-year follow-up will investigate the impact of patient and clinician perspectives on outcomes in the domains of forensic hospital readmission, criminal reoffending, and rate of progress through the forensic system. DISCUSSION Results from this mixed-methods study will yield a rich and detailed account of patient perceptions of the forensic mental health system, and specifically whether perceptions of procedural fairness, justice and legitimacy, as well as perceived coercion, systematically influence patients' risk for adversity, their ability to progress in their recovery, and ultimately, advance through the forensic system towards successful community living. Findings will provide conceptual clarity to the key elements of secure recovery, and illuminate areas of similarity and divergence with respect to how patients and clinicians assess risk and recovery needs. In doing so, knowledge from this study will provide a deep understanding of factors that promote patient safety and recovery, and provide a foundation for optimizing the forensic mental health system to improve patient outcomes.
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Affiliation(s)
- Alexander I. F. Simpson
- grid.155956.b0000 0000 8793 5925Complex Care and Recovery Program, Centre for Addiction and Mental Health, 1001 Queen Street West, Toronto, Ontario M6J 1H4 Canada ,grid.17063.330000 0001 2157 2938Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Irene Boldt
- grid.155956.b0000 0000 8793 5925Complex Care and Recovery Program, Centre for Addiction and Mental Health, 1001 Queen Street West, Toronto, Ontario M6J 1H4 Canada ,grid.17063.330000 0001 2157 2938Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
| | - Stephanie Penney
- grid.155956.b0000 0000 8793 5925Complex Care and Recovery Program, Centre for Addiction and Mental Health, 1001 Queen Street West, Toronto, Ontario M6J 1H4 Canada ,grid.17063.330000 0001 2157 2938Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Roland Jones
- grid.155956.b0000 0000 8793 5925Complex Care and Recovery Program, Centre for Addiction and Mental Health, 1001 Queen Street West, Toronto, Ontario M6J 1H4 Canada
| | - Sean Kidd
- grid.155956.b0000 0000 8793 5925Complex Care and Recovery Program, Centre for Addiction and Mental Health, 1001 Queen Street West, Toronto, Ontario M6J 1H4 Canada ,grid.17063.330000 0001 2157 2938Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Arash Nakhost
- grid.17063.330000 0001 2157 2938Department of Psychiatry, University of Toronto, Toronto, Canada ,grid.415502.7Community Mental Health Services, St. Michael’s Hospital, 30 Bond St, Toronto, Ontario M5B 1W8 Canada
| | - Treena Wilkie
- grid.155956.b0000 0000 8793 5925Complex Care and Recovery Program, Centre for Addiction and Mental Health, 1001 Queen Street West, Toronto, Ontario M6J 1H4 Canada ,grid.17063.330000 0001 2157 2938Department of Psychiatry, University of Toronto, Toronto, Canada
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27
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Lam AA, Penney SR, Simpson AIF. A Review of the Prevalence of Psychosis in Sexual Homicide. J Am Acad Psychiatry Law 2020; 48:56-64. [PMID: 31753968 DOI: 10.29158/jaapl.003887-20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Despite a growing body of research on the association between psychosis and homicide and between psychosis and sexual offending, research on psychosis and sexual homicide is limited. The objective of this review was to estimate the prevalence of psychosis in sexual homicide and to explore the extent to which prior research has investigated symptoms of psychosis as a motivating or causal variable leading to incidents of sexual homicide. We hypothesized that psychosis is present in a minority of sexual homicide cases. Articles were identified by searching literature databases (i.e., PsycINFO, MEDLINE, EMBASE) and references of relevant articles. Eight studies were included. The overall prevalence of psychosis among individuals who committed sexual homicide ranged from 0 to 27 percent as measured in a broad array of diverse samples. Given that five of the eight studies reported psychosis rates to be five percent or less, our findings suggest that psychosis occurs in a minority of sexual homicide cases. None of the studies directly examined the causal or motivational properties of psychosis in driving these types of offenses, and this represents an important area of inquiry for future research.
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Affiliation(s)
- Austin A Lam
- Mr. Lam is a Research Trainee, Division of Forensic Psychiatry, Centre for Addiction and Mental Health, Toronto, Ontario, Canada. Dr. Penney is an Independent Scientist, Division of Forensic Psychiatry, Centre for Addiction and Mental Health, and Assistant Professor, Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada. Dr. Simpson is Chief of Forensic Psychiatry, Centre for Addiction and Mental Health, and Head of the Division of Forensic Psychiatry, Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Stephanie R Penney
- Mr. Lam is a Research Trainee, Division of Forensic Psychiatry, Centre for Addiction and Mental Health, Toronto, Ontario, Canada. Dr. Penney is an Independent Scientist, Division of Forensic Psychiatry, Centre for Addiction and Mental Health, and Assistant Professor, Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada. Dr. Simpson is Chief of Forensic Psychiatry, Centre for Addiction and Mental Health, and Head of the Division of Forensic Psychiatry, Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Alexander I F Simpson
- Mr. Lam is a Research Trainee, Division of Forensic Psychiatry, Centre for Addiction and Mental Health, Toronto, Ontario, Canada. Dr. Penney is an Independent Scientist, Division of Forensic Psychiatry, Centre for Addiction and Mental Health, and Assistant Professor, Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada. Dr. Simpson is Chief of Forensic Psychiatry, Centre for Addiction and Mental Health, and Head of the Division of Forensic Psychiatry, Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.
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Jones RM, Gerritsen C, Maheandiran M, Simpson AIF. Validation of the Clinical Global Impression-Corrections Scale (CGI-C) by Equipercentile Linking to the BPRS-E. Front Psychiatry 2020; 11:180. [PMID: 32265753 PMCID: PMC7100373 DOI: 10.3389/fpsyt.2020.00180] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 02/25/2020] [Indexed: 11/22/2022] Open
Abstract
Background: The Clinical Global Impression-Corrections (CGI-C) is an adaptation of the severity scale of the Clinical Global Impression for use in correctional facilities. Although it has been shown to have good inter-rater reliability, there have been no validation studies of this instrument. Method: We analyzed data from 726 initial assessments of persons detained in two correctional facilities and compared clinician's ratings for the CGI-C and modified Brief Psychiatric Rating Scale-Expanded (BPRS-E). We used equipercentile linkage and Spearman correlations to investigate concordance in the total sample, by diagnostic groups, and by gender. Results: We found that the CGI-C scores and BPRS-E scores among persons in remand settings were significantly correlated (ρ = 0.51, p < 0.001) and that correlations were the same for men and women. We found that points of equivalence can be reliably found between the two scales using equipercentile linkage, and that those with psychotic disorders had lower BPRS-E scores than those with mood/anxiety/situational stress for equivalent CGI-C scores. Conclusion: Overall, CGI-C ratings correspond well to BPRS-E ratings for both men and women remand prisoners across diagnoses, and the CGI-C appears to be a valid tool for the assessment of severity of symptoms in this setting.
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Affiliation(s)
- Roland M Jones
- Centre for Addiction and Mental Health (CAMH) and University of Toronto, Toronto, ON, Canada
| | - Cory Gerritsen
- Centre for Addiction and Mental Health (CAMH) and University of Toronto, Toronto, ON, Canada
| | - Margaret Maheandiran
- Centre for Addiction and Mental Health (CAMH) and University of Toronto, Toronto, ON, Canada
| | - Alexander I F Simpson
- Centre for Addiction and Mental Health (CAMH) and University of Toronto, Toronto, ON, Canada
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29
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Paul S, Nakhost A, Stergiopoulos V, Matheson FI, Simpson AIF, Guimond T. Perceptions of key stakeholders on procedural justice in the Consent And Capacity Board of Ontario's hearings. Int J Law Psychiatry 2020; 68:101515. [PMID: 32033692 DOI: 10.1016/j.ijlp.2019.101515] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 09/22/2019] [Accepted: 11/05/2019] [Indexed: 06/10/2023]
Abstract
The Consent and Capacity Board (CCB) of Ontario is an independent administrative tribunal that adjudicates on matters of consent to medical treatment including involuntary admission to a psychiatric facility and findings of incapacity with regard to treatment decisions. This study explores the perspectives of multiple stakeholders on procedural justice in CCB hearings in Ontario. Using purposeful and snowball sampling, participants including CCB panel members and staff, patients, and other professionals (e.g., lawyers, psychiatrists) were recruited from different sites across the city of Toronto. Using focus groups (n = 10) and individual interviews (n = 14), data were collected from 44 participants including 6 patients and 38 other stakeholders who have participated in CCB hearings. Using thematic analysis, we identified five themes - (i) Inclusiveness (ii) Respect (iii) Fairness (iv) Finding and using one's voice, and (v) Balancing interests. Findings revealed that despite efforts by CCB panel members to conduct hearings in an inclusive manner, the legalistic nature of the proceedings, as well as patients' uncertainty regarding the benefits of testifying, may be perceived as barriers to patients' meaningful participation. There was a general belief that patients are respected during CCB hearings by physicians and panel members; however, patients and their lawyers had mixed perceptions about this issue. Almost all stakeholders, excluding CCB panel members, perceived that CCB hearings were not procedurally fair. Our findings indicate that CCB hearings, as currently conducted, are not perceived as procedurally just by many of the relevant stakeholders. This perception may improve by adopting a more informal and less adversarial hearing format as well as enhancing patients' education and understanding of the CCB hearings' processes and potential outcomes.
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Affiliation(s)
- Sayani Paul
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Toronto, Canada..
| | - Arash Nakhost
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Toronto, Canada.; Dept. Of Psychiatry, University of Toronto, Toronto, Canada.; St. Michael's Hospital, Toronto, Canada..
| | - Vicky Stergiopoulos
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Toronto, Canada.; Dept. Of Psychiatry, University of Toronto, Toronto, Canada.; Centre for Addiction and Mental Health (CAMH), Toronto, Canada..
| | - Flora I Matheson
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Toronto, Canada.; Dalla Lana School of Public Health, University of Toronto, Toronto, Canada..
| | - Alexander I F Simpson
- Dept. Of Psychiatry, University of Toronto, Toronto, Canada.; St. Michael's Hospital, Toronto, Canada.; Centre for Addiction and Mental Health (CAMH), Toronto, Canada..
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30
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Skipworth J, Bevin W, McKenna B, Simpson AIF, Brinded P, Pearson J. Comparative outcomes for a national cohort of persons convicted of murder, with and without serious mental illness, and those found not guilty by reason of insanity on a murder charge: A 25-year follow-up study. Crim Behav Ment Health 2019; 29:276-285. [PMID: 31338927 DOI: 10.1002/cbm.2120] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 11/19/2018] [Accepted: 06/14/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Serious mental illness (SMI) is common among persons sentenced to life imprisonment for murder, yet little is known about how this affects rehabilitation, prospects of parole, or risk to the community. AIM The aim of this study is to compare outcomes for a national cohort of offenders charged with murder who were either convicted and sentenced to life in prison or placed on a forensic hospital order. METHODS The 386 cases of murder charges in New Zealand between 1988 and 2000 were divided into three groups: perpetrators without SMI sentenced to life imprisonment (n = 313), perpetrators with SMI but sentenced to life imprisonment (n = 32), or those with such illness and found not guilty by reason of insanity (NGRI) who received a forensic hospital order (n = 41). Access to rehabilitative interventions, time to release, reoffending, and recall to prison or hospital were examined. RESULTS Being in prison but having severe mental illness delayed release on parole but did not increase the risk of criminal recidivism or recall to prison. Hospital order patients were a demographically different group; they were released to the community earlier and had a lower rate of criminal recidivism. CONCLUSIONS This study provides some evidence that incarceration periods for life-sentenced homicide perpetrators with SMI may be reduced without increasing community risk if hospital transfer and/or more targeted interventions are provided in prison. It also provides further evidence that persons found NGRI after a charge of murder have a relatively low risk of criminal recidivism. The stigma that may sometimes attach to such offenders is unwarranted, if it relies on concerns about risk of reoffending.
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Affiliation(s)
- Jeremy Skipworth
- Auckland Regional Forensic Psychiatry Service, Specialist Mental Health and Addiction Services, Waitemata District Health Board, Auckland, New Zealand
- New Zealand Parole Board, Wellington, New Zealand
| | - Wendy Bevin
- Auckland Regional Forensic Psychiatry Service, Specialist Mental Health and Addiction Services, Waitemata District Health Board, Auckland, New Zealand
| | - Brian McKenna
- Auckland Regional Forensic Psychiatry Service, Specialist Mental Health and Addiction Services, Waitemata District Health Board, Auckland, New Zealand
- School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand
| | | | - Phil Brinded
- New Zealand Parole Board, Wellington, New Zealand
- Division of Health Sciences, University of Otago, Christchurch, New Zealand
| | - Janet Pearson
- Department of Biostatistics and Epidemiology, School of Public Health and Psychosocial Studies, Auckland University of Technology, Auckland, New Zealand
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31
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Nakhost A, Simpson AIF, Sirotich F. Service Users' Knowledge and Views on Outpatients' Compulsory Community Treatment Orders: A Cross-Sectional Matched Comparison Study. Can J Psychiatry 2019; 64:726-735. [PMID: 30895806 PMCID: PMC6783670 DOI: 10.1177/0706743719828961] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Community treatment orders (CTOs) have been used in the treatment of some individuals with serious mental illness who fail to adhere to their psychiatric treatment, leading to frequent hospitalization. This article examines perceptions and knowledge of CTOs amongst outpatient service users in Toronto, Canada. METHOD Service users under a CTO were matched to a comparison control group of voluntary outpatients (n = 69 in each group). Participants were interviewed using a series of questionnaires aimed at assessing instead of evaluating their knowledge and perceptions of CTOs, as well as understanding their views about the utility and impact of CTOs in the treatment of individuals with mental health issues. RESULTS Participants in the CTO group knew significantly more about CTO processes, restrictions, and procedural protections than the control group. Both groups thought that a CTO could improve certain individuals' mental health. The control group felt more strongly that a CTO could improve a service user's physical health by providing better access to care and closer monitoring (P = 0.019) while a significant proportion of the CTO group thought that being on a CTO was better than being in the hospital (P = 0.001) and that service users should be able to contest their CTO (P = 0.001). In addition, CTO group participants were significantly more optimistic about the potential positive impact of CTOs on other service users' quality of life (P = 0.008) and mental health (P = 0.023) compared to themselves. CONCLUSIONS In general, both groups viewed CTOs as potentially capable of positively affecting treatment and lives of some individuals with mental illness.
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Affiliation(s)
- Arash Nakhost
- Department of Psychiatry University of Toronto, Toronto, Ontario.,Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St Michael Hospital, Toronto, Ontario
| | - Alexander I F Simpson
- Division of Forensic Psychiatry, Department of Psychiatry, University of Toronto, Toronto, Ontario.,Centre for Addiction and Mental Health, Toronto, Ontario
| | - Frank Sirotich
- Canadian Mental Health Association (CMHA), Toronto Branch, Factor-Inwentash Toronto, Ontario.,Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario
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Nakhost A, Simpson AIF, Sirotich F. Community Treatment Orders: A Tool for Treatment of Certain Individuals Who Lack Decisional Capacity with Regards to Their Psychiatric Care. Can J Psychiatry 2019; 64:448. [PMID: 31194590 PMCID: PMC6591748 DOI: 10.1177/0706743719843119] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Arash Nakhost
- Department of Psychiatry, University of Toronto, Toronto, Ontario, and Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St Michael Hospital, Toronto, Ontario
| | - Alexander I F Simpson
- Department of Psychiatry, University of Toronto, Toronto, Ontario, and Centre for Addiction and Mental Health, Toronto, Canada
| | - Frank Sirotich
- Canadian Mental Health Association (CMHA), Toronto Branch, Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario
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Jones RM, Patel K, Simpson AIF. Assessment of need for inpatient treatment for mental disorder among female prisoners: a cross-sectional study of provincially detained women in Ontario. BMC Psychiatry 2019; 19:98. [PMID: 30917798 PMCID: PMC6437954 DOI: 10.1186/s12888-019-2083-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Accepted: 03/18/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND International studies show a consistent finding of women in prisons as having a high prevalence of mental disorder. Most will be treated within the prison however the most severely ill require transfer to a hospital facility. The primary aim of our study was to survey the total provincial female prison population in Ontario, Canada, to determine the proportion that require treatment in a psychiatric hospital, and the security level required. The secondary aim was to investigate the validity and psychometric properties of DUNDRUM-1 and DUNDRUM-2 in making these assessments. METHODS We carried out a cross-sectional study of all remand and sentenced female inmates detained in all 16 provincial jails that hold women in Ontario. The severity of mental health need was categorised by mental health staff on a five-point scale. Two forensic psychiatrists then examined all medical files of prisoners that had been categorised in the highest two categories and a random sample of nearly a quarter of those in the third category. An overall opinion was then made as to whether admission was required, and whether a high intensity bed was needed, and files were rated using DUNDRUM-1 and DUNDRUM-2. RESULTS There were 643 female inmates in provincial prisons in Ontario. We estimated that approximately 43 (6.7%) required admission to a hospital facility, of which 21.6 [prorated] (3.4%) required a high intensity bed such as a psychiatric intensive care bed within a secure hospital. The DUNDRUM-1 and -2 tools showed good internal validity. Total scores on both DUNDRUM-1 and DUNDRUM-2 were significantly different between those assessed as needing admission and those who did not, and distinguished the level of security required. CONCLUSION This is the first study to determine level of need for prison to hospital transfers in Canada and can be used to inform service capacity planning. We also found that the DUNDRUM toolkit is useful in determining the threshold and priorities for hospital transfer of female prisoners.
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Affiliation(s)
- Roland M. Jones
- 0000 0000 8793 5925grid.155956.bCentre for Addiction and Mental Health (CAMH) and University of Toronto, Unit 3, 1001 Queen St West, Toronto, M6J 1H4 Canada
| | - Kiran Patel
- 0000 0000 8793 5925grid.155956.bCentre for Addiction and Mental Health (CAMH) and University of Toronto, Unit 1, 1001 Queen Street West, Toronto, ON M6J 1H4 Canada
| | - Alexander I. F. Simpson
- 0000 0000 8793 5925grid.155956.bCentre for Addiction and Mental Health (CAMH) and University of Toronto, Unit 3, 1001 Queen St West, Toronto, M6J 1H4 Canada
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Abstract
Patients in forensic mental health care have a difficult journey through inpatient rehabilitation and re-integration into the community. Risk assessment guides this progress, usually with clinician-based processes that use structured risk-assessment tools. Patients' understanding of their own risk is important to inform risk assessment and the chances of successful rehabilitation. The emergence of shared decision-making approaches provides an opportunity to consider shared risk assessment and formulation. We reviewed the literature to explore models of patients' involvement in risk assessment and the impact on outcomes in forensic mental health care. We conducted searches of three databases (Medline, PsychINFO, and EMBASE) to identify papers that employed shared risk understanding for violence risk. Additional records were identified through review of citations, with articles being selected using a predetermined set of inclusion and exclusion criteria. We found five studies that met the inclusion criteria for patient involvement in risk assessment with measurement of construct or predictive validity. The studies employed diverse methodologies, but they suggest that patient involvement in assessing risk is feasible when correlated with staff ratings. There is encouraging evidence of the predictive validity of self-rated risk alongside staff-rated risk assessment.
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Affiliation(s)
- Ipsita Ray
- Dr. Ray is a Fellow in Forensic Psychiatry in the Division of Forensic Psychiatry at the Centre for Addiction and Mental Health, and in the Forensic Division, Department of Psychiatry, University of Toronto. Dr. Simpson is Chief of Forensic Psychiatry, Centre for Addiction and Mental Health, and head of the Division of Forensic Psychiatry, Department of Psychiatry, University of Toronto
| | - Alexander I F Simpson
- Dr. Ray is a Fellow in Forensic Psychiatry in the Division of Forensic Psychiatry at the Centre for Addiction and Mental Health, and in the Forensic Division, Department of Psychiatry, University of Toronto. Dr. Simpson is Chief of Forensic Psychiatry, Centre for Addiction and Mental Health, and head of the Division of Forensic Psychiatry, Department of Psychiatry, University of Toronto.
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Ray I, Simpson AIF, Jones RM, Shatokhina K, Thakur A, Mulsant BH. Clinical, Demographic, and Criminal Behavior Characteristics of Patients With Intellectual Disabilities in a Canadian Forensic Program. Front Psychiatry 2019; 10:760. [PMID: 31681051 PMCID: PMC6803491 DOI: 10.3389/fpsyt.2019.00760] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Accepted: 09/20/2019] [Indexed: 11/30/2022] Open
Abstract
Background: People with intellectual disability (ID) and forensic issues constitute a challenging clinical group that has been understudied in forensic settings. Methods: We assessed the characteristics of patients with ID under the authority of the Ontario Review Board (ORB) in a large forensic program of a tertiary psychiatric hospital (excluding those with a cognitive disorder) and compared their characteristics with those of a non-ID control group. Results: Among 510 adult ORB patients, 47 had an ID diagnosis. ID patients were of younger age at index offense, with a lower level of education, and were less likely to have been married or employed, more likely to have committed a sexual offense, more likely to have a diagnosis of paraphilia, less likely to be "not criminally responsible," and more likely to be "unfit to stand trial." They were also more likely to have committed their index offenses against care professionals and be treated in a secure unit. Conclusion: Our findings have major implications for clinicians, clinical leaders, and policymakers about the specific needs of patients with ID presenting with forensic issues and differing needs in terms of treatment and risk management.
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Affiliation(s)
- Ipsita Ray
- Complex Care and Recovery Program, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Alexander I F Simpson
- Complex Care and Recovery Program, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Roland M Jones
- Complex Care and Recovery Program, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | | | - Anupam Thakur
- Complex Care and Recovery Program, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Benoit H Mulsant
- Complex Care and Recovery Program, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
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Nakhost A, Sirotich F, Pridham KMF, Stergiopoulos V, Simpson AIF. Coercion in Outpatients under Community Treatment Orders: A Matched Comparison Study. Can J Psychiatry 2018; 63:757-765. [PMID: 29614866 PMCID: PMC6299192 DOI: 10.1177/0706743718766053] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Since the deinstitutionalization of psychiatric services around the world, the scope of outpatient psychiatric care has also increased to better support treatment access and adherence. For those with serious mental illness who may lack insight into their own illness, available interventions include coercive community practices such as mandated community treatment orders (CTOs). This paper examines the perceptions of coercion among service users treated with a CTO. METHOD We used a cross-sectional comparative design where service users treated under a CTO were matched to a comparison group of voluntary psychiatric outpatients. Both groups were receiving intensive community mental health services (n = 69 in each group). Participants were interviewed using a series of questionnaires aimed at evaluating their perceptions of coercion and other aspects of the psychiatric treatment. RESULTS The level of coercion reported by service users treated under a CTO was significantly higher than that in the comparison group. However, in adjusted analyses, service users' perception of coercion, irrespective of their CTO status, was directly correlated with their previous experience with probation and inversely correlated with the sense of procedural justice in their treatment. CONCLUSIONS Evaluation of psychiatric service users' experiences of coercion should consider their past and current involvement with other types of coercive measures, particularly history of probation. Clinicians may be able to minimize these experiences of coercion by incorporating procedural justice principles into their practice.
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Affiliation(s)
- Arash Nakhost
- Department of Psychiatry University of Toronto, Toronto, Ontario, Canada.,Associate Scientist, Li Ka Shing Knowledge Institute, St Michael Hospital, Toronto, Ontario, Canada
| | - Frank Sirotich
- Director of Research and Evaluation, Canadian Mental Health Association (CMHA), Toronto Branch, Toronto, Ontario, Canada.,Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | | | - Vicky Stergiopoulos
- Professor, Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.,Physician-in-Chief and Clinician Scientist at Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Alexander I F Simpson
- Division of Forensic Psychiatry, Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.,Chief of Forensic Psychiatry at the Centre for Addiction and Mental Health, Toronto, Ontario, Canada
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Simpson AIF, Jones RM. Two Challenges Affecting Access to Care for Inmates with Serious Mental Illness: Detecting Illness and Acceptable Services. Can J Psychiatry 2018; 63:648-650. [PMID: 30071756 PMCID: PMC6187441 DOI: 10.1177/0706743718792844] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Alexander I. F. Simpson
- Division of Forensic Psychiatry, Department of Psychiatry, Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario
| | - Roland M. Jones
- Division of Forensic Psychiatry, Department of Psychiatry, Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario
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Simpson AIF, Penney SR. Recovery and forensic care: Recent advances and future directions. Crim Behav Ment Health 2018; 28:383-389. [PMID: 30215871 DOI: 10.1002/cbm.2090] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Accepted: 08/28/2018] [Indexed: 06/08/2023]
Affiliation(s)
- Alexander I F Simpson
- Department of Psychiatry, Centre for Addiction and Mental Health and University of Toronto, Toronto, Ontario, Canada
| | - Stephanie R Penney
- Department of Psychiatry, Centre for Addiction and Mental Health and University of Toronto, Toronto, Ontario, Canada
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Penney SR, Prosser A, Simpson AIF. Age onset of offending and serious mental illness among forensic psychiatric patients: A latent profile analysis. Crim Behav Ment Health 2018; 28:335-349. [PMID: 29336084 DOI: 10.1002/cbm.2069] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 07/05/2017] [Accepted: 12/19/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND Developmental typologies regarding age of onset of violence and offending have not routinely taken account of the role of serious mental illness (SMI), and whether age of onset of offending in relation to onset of illness impacts on the manifestation of offending over the life course. AIMS To test whether forensic psychiatric patients can be classified according to age of onset of SMI and offending, and, if so, whether subtypes differ by sex. METHODS Details of all 511 patients enrolled into a large forensic mental health service in Ontario, Canada, in 2011 or 2012 were collected from records. RESULTS A latent profile analysis supported a 2-class solution in both men and women. External validation of the classes demonstrated that those with a younger age onset of serious mental illness and offending were characterised by higher levels of static risk factors and criminogenic need than those whose involvement in both mental health and criminal justice systems was delayed to later life. CONCLUSIONS Our findings present a new perspective on life course trajectories of offenders with SMI. While analyses identified just two distinct age-of-onset groups, in both the illness preceded the offending. The fact that our sample was entirely drawn from those hospitalised may have introduced a selection bias for those whose illness precedes offending, but findings underscore the complexity and level of need among those with a younger age of onset. Copyright © 2018 John Wiley & Sons, Ltd.
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Affiliation(s)
- Stephanie R Penney
- Centre for Addiction and Mental Health, Toronto, Canada
- University of Toronto, Toronto, Canada
| | - Aaron Prosser
- McMaster University, Michael G. DeGroote School of Medicine, Hamilton, Canada
| | - Alexander I F Simpson
- Centre for Addiction and Mental Health, Toronto, Canada
- University of Toronto, Toronto, Canada
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Simpson AIF. Response to Comment Regarding: Medical Assistance in Dying and Mental Health: A Legal, Ethical, and Clinical Analysis. Can J Psychiatry 2018; 63:572. [PMID: 30097001 PMCID: PMC6099751 DOI: 10.1177/0706743718775945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Alexander I F Simpson
- Complex Care and Recovery Program, Forensic Division, Centre for Addiction and Mental Health Head, Division of Forensic Psychiatry, University of Toronto, Toronto, Ontario
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Penney SR, Prosser A, Grimbos T, Darby P, Simpson AIF. Time Trends in Homicide and Mental Illness in Ontario from 1987 to 2012: Examining the Effects of Mental Health Service Provision. Can J Psychiatry 2018; 63:387-394. [PMID: 29056087 PMCID: PMC5971407 DOI: 10.1177/0706743717737034] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE We examine the association between rates of homicide resulting in a mental health disposition (termed mentally abnormal homicide [MAH]) and homicides without such a disposition, as well as to province-wide psychiatric hospitalisation and incarceration rates. METHOD In this population-based study, we investigate all adult homicide perpetrators ( n = 4402) and victims ( n = 3783) in Ontario from 1987 to 2012. We present annual rates of mentally abnormal and non-mentally abnormal homicide and position them against hospitalisation and incarceration rates. RESULTS Among the total sample of homicide accused, 3.7% were mentally abnormal. Most (82.5%) had a psychotic disorder at the time of the offense. Contrasted with declining hospitalisation, incarceration, and population homicide rates, the rate of MAH remained constant at an average of .07 perpetrators per 100,000 population. The rate of MAH was not associated with discharges from or average length of stay in psychiatric hospitals (ρ = 0.10; 0.34, P > 0.10), incarceration rates (ρ = 0.16, P = 0.42), or the total homicide rate (ρ = 0.25, P = 0.22). The proportion of MAH perpetrators with a substance use disorder increased modestly over time (β = 0.35, R2 = 0.12, P = 0.08). CONCLUSIONS The rate of MAH has not changed appreciably over the past 25 years. Declining psychiatric service utilisation was not associated with the rate of homicide committed by people with mental illness and, secondarily, was not linked to increases in the population homicide or incarceration rates. Substance use has become a more prevalent problem for this population.
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Affiliation(s)
- Stephanie R. Penney
- Complex Care and Recovery Program, Forensic Division, Centre for Addiction and Mental Health, Toronto, Ontario
- Department of Psychiatry, University of Toronto, Toronto, Ontario
| | - Aaron Prosser
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario
| | - Teresa Grimbos
- Child, Youth and Family Program, Centre for Addiction and Mental Health, Toronto, Ontario
| | - Padraig Darby
- Complex Care and Recovery Program, Forensic Division, Centre for Addiction and Mental Health, Toronto, Ontario
- Department of Psychiatry, University of Toronto, Toronto, Ontario
| | - Alexander I. F. Simpson
- Complex Care and Recovery Program, Forensic Division, Centre for Addiction and Mental Health, Toronto, Ontario
- Department of Psychiatry, University of Toronto, Toronto, Ontario
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Abstract
Medical assistance in dying (MAiD) legislation is now over a year old in Canada, and consideration is turning to whether MAiD should be extended to include serious mental illness as the sole qualifying condition for being eligible for MAiD. This article considers this question from ethical and clinical perspectives. It argues that extending the eligibility for MAiD to include those with a serious mental illness as the sole eligibility criterion is not ethical, necessary, or supported current psychiatric practice or opinion.
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Affiliation(s)
- Alexander I. F. Simpson
- Complex Care and Recovery Program, Forensic Division, Centre for Addiction and Mental Health, Toronto, Ontario
- Division of Forensic Psychiatry, University of Toronto, Toronto, Ontario
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Abstract
Although electromuscular incapacitation devices (Tasers or ‘stun guns') have been in use for over a decade, concern about potential health effects has not been resolved. Moreover, public policy decisions have expanded the availability of Tasers and require wide consultation with the health sector as well as other stakeholders. In the past 5 years sales of Tasers have grown considerably, with numbers of US law enforcement agencies using the devices growing from 1700 in 2001 to 8700 in 2005 (US Department of Justice, personal communication). Jenkinson et al (2006) recently argued, as have the UK Police Federation, that Tasers should be issued to all front line British police, a move that would see a considerable proliferation of Tasers in the UK. A current trial in four districts may pave the way for Tasers to be used nationwide in New Zealand (New Zealand Police, 2006). These developments make it imperative that health professionals monitor the physical and mental health implications of Tasers, and ensure health considerations are part of the public policy debate on their deployment. In this paper we review the existing literature on the use of Tasers, and note that the psychological effects of Taser use have not been investigated.
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Affiliation(s)
- Roland M Jones
- Complex Care and Recovery Program, Forensic Division, Division of Forensic Psychiatry, Centre for Addiction and Mental Health, University of Toronto, Toronto, ON, Canada
| | - Alexander I F Simpson
- Complex Care and Recovery Program, Forensic Division, Division of Forensic Psychiatry, Centre for Addiction and Mental Health, University of Toronto, Toronto, ON, Canada
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Kaster TS, Martin MS, Simpson AIF. Preventing Prison Suicide With Life-Trajectory-Based Screening. J Am Acad Psychiatry Law 2017; 45:92-98. [PMID: 28270467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
We describe the application of a life-trajectory model of suicide to the prison setting and its implication for suicide risk detection. A model has been developed that describes two distinct trajectories culminating in suicide: one with large amounts of adversity early in life with a young age of suicide and another with chronic, gradually accumulating adversity with a later age of suicide. Support for applying the life-trajectory model to the prison population is found in prison-centric models of suicidal behavior and clinical profiles of individuals at high risk of suicide in prisons. We also describe how the life-trajectory model applies to two recent high-profile suicides within the Canadian prison system. Finally, we propose a screening tool based on the life-trajectory model to quantify an individual's adversity burden at intake and subsequently throughout incarceration. We describe how this proposed tool may improve detection of individuals with increased risk of suicide and describe the steps necessary for the development of this tool.
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Affiliation(s)
- Tyler S Kaster
- Dr. Kaster is a Psychiatry Resident, Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada. Mr. Martin is a PhD Candidate, School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Ontario, Canada. Dr. Simpson is Chief of Forensic Psychiatry, Centre for Addiction and Mental Health, Toronto, Ontario, Canada. No funding was provided for this research. T.S.K. was awarded the Isaac Sakinofsky Essay Prize in Suicidology from the Centre for Addiction and Mental Health for this work. M.S.M. is currently on unpaid educational leave from the Correctional Service of Canada
| | - Michael S Martin
- Dr. Kaster is a Psychiatry Resident, Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada. Mr. Martin is a PhD Candidate, School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Ontario, Canada. Dr. Simpson is Chief of Forensic Psychiatry, Centre for Addiction and Mental Health, Toronto, Ontario, Canada. No funding was provided for this research. T.S.K. was awarded the Isaac Sakinofsky Essay Prize in Suicidology from the Centre for Addiction and Mental Health for this work. M.S.M. is currently on unpaid educational leave from the Correctional Service of Canada
| | - Alexander I F Simpson
- Dr. Kaster is a Psychiatry Resident, Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada. Mr. Martin is a PhD Candidate, School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Ontario, Canada. Dr. Simpson is Chief of Forensic Psychiatry, Centre for Addiction and Mental Health, Toronto, Ontario, Canada. No funding was provided for this research. T.S.K. was awarded the Isaac Sakinofsky Essay Prize in Suicidology from the Centre for Addiction and Mental Health for this work. M.S.M. is currently on unpaid educational leave from the Correctional Service of Canada.
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Friedman SH, Appel JM, Ash P, Frierson RL, Giorgi-Guarnieri D, Martinez R, Newman AW, Pinals DA, Resnick PJ, Simpson AIF. Unsolicited E-mails to Forensic Psychiatrists. J Am Acad Psychiatry Law 2016; 44:470-478. [PMID: 28003391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
E-mail communication is pervasive. Since many forensic psychiatrists have their e-mail addresses available online (either on personal websites, university websites, or articles they have authored), they are likely to receive unsolicited e-mails. Although there is an emerging body of literature about exchanging e-mail with patients, there is little guidance about how to respond to e-mails from nonpatients. Therefore, we used a Delphi technique to develop a consensus about salient points for the forensic psychiatrist to consider regarding responding to e-mails from nonpatients and the risks entailed. Four scenarios are described, including e-mails from nonpatients and unknown others requesting advice or help. The potential ethics-related, legal, moral, and practical concerns for forensic psychiatrists are discussed. Finally, potential pitfalls for forensic psychiatrists are described.
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Affiliation(s)
- Susan Hatters Friedman
- Dr. Friedman is Associate Professor, University of Auckland, New Zealand, and Case Western Reserve, Cleveland, OH. Dr. Appel is Assistant Professor of Psychiatry, Icahn Mount Sinai School of Medicine, New York, NY. Dr. Ash is Professor, Emory University Department of Psychiatry and Behavioral Sciences, Atlanta, GA. Dr. Frierson is Professor, Department of Neuropsychiatry and Behavioral Science, University of South Carolina School of Medicine, Columbia, SC. Dr. Giorgi-Guarnieri is in Private Practice, Williamsburg, VA. Dr. Martinez is Professor of Psychiatry and the Law, University of Colorado, Denver, School of Medicine, Denver CO. Dr. Newman is Chair of Psychiatry, California Pacific Medical Center, San Francisco, CA. Dr. Pinals is Clinical Professor of Psychiatry, University of Michigan, Ann Arbor, MI. Dr. Resnick is Professor of Psychiatry, Case Western Reserve University, Cleveland, OH. Dr. Simpson is Associate Professor of Psychiatry, University of Toronto, Toronto, Ontario, Canada; Authors represented the Committee on Psychiatry and Law for the Group for the Advancement of Psychiatry.
| | - Jacob M Appel
- Dr. Friedman is Associate Professor, University of Auckland, New Zealand, and Case Western Reserve, Cleveland, OH. Dr. Appel is Assistant Professor of Psychiatry, Icahn Mount Sinai School of Medicine, New York, NY. Dr. Ash is Professor, Emory University Department of Psychiatry and Behavioral Sciences, Atlanta, GA. Dr. Frierson is Professor, Department of Neuropsychiatry and Behavioral Science, University of South Carolina School of Medicine, Columbia, SC. Dr. Giorgi-Guarnieri is in Private Practice, Williamsburg, VA. Dr. Martinez is Professor of Psychiatry and the Law, University of Colorado, Denver, School of Medicine, Denver CO. Dr. Newman is Chair of Psychiatry, California Pacific Medical Center, San Francisco, CA. Dr. Pinals is Clinical Professor of Psychiatry, University of Michigan, Ann Arbor, MI. Dr. Resnick is Professor of Psychiatry, Case Western Reserve University, Cleveland, OH. Dr. Simpson is Associate Professor of Psychiatry, University of Toronto, Toronto, Ontario, Canada; Authors represented the Committee on Psychiatry and Law for the Group for the Advancement of Psychiatry
| | - Peter Ash
- Dr. Friedman is Associate Professor, University of Auckland, New Zealand, and Case Western Reserve, Cleveland, OH. Dr. Appel is Assistant Professor of Psychiatry, Icahn Mount Sinai School of Medicine, New York, NY. Dr. Ash is Professor, Emory University Department of Psychiatry and Behavioral Sciences, Atlanta, GA. Dr. Frierson is Professor, Department of Neuropsychiatry and Behavioral Science, University of South Carolina School of Medicine, Columbia, SC. Dr. Giorgi-Guarnieri is in Private Practice, Williamsburg, VA. Dr. Martinez is Professor of Psychiatry and the Law, University of Colorado, Denver, School of Medicine, Denver CO. Dr. Newman is Chair of Psychiatry, California Pacific Medical Center, San Francisco, CA. Dr. Pinals is Clinical Professor of Psychiatry, University of Michigan, Ann Arbor, MI. Dr. Resnick is Professor of Psychiatry, Case Western Reserve University, Cleveland, OH. Dr. Simpson is Associate Professor of Psychiatry, University of Toronto, Toronto, Ontario, Canada; Authors represented the Committee on Psychiatry and Law for the Group for the Advancement of Psychiatry
| | - Richard L Frierson
- Dr. Friedman is Associate Professor, University of Auckland, New Zealand, and Case Western Reserve, Cleveland, OH. Dr. Appel is Assistant Professor of Psychiatry, Icahn Mount Sinai School of Medicine, New York, NY. Dr. Ash is Professor, Emory University Department of Psychiatry and Behavioral Sciences, Atlanta, GA. Dr. Frierson is Professor, Department of Neuropsychiatry and Behavioral Science, University of South Carolina School of Medicine, Columbia, SC. Dr. Giorgi-Guarnieri is in Private Practice, Williamsburg, VA. Dr. Martinez is Professor of Psychiatry and the Law, University of Colorado, Denver, School of Medicine, Denver CO. Dr. Newman is Chair of Psychiatry, California Pacific Medical Center, San Francisco, CA. Dr. Pinals is Clinical Professor of Psychiatry, University of Michigan, Ann Arbor, MI. Dr. Resnick is Professor of Psychiatry, Case Western Reserve University, Cleveland, OH. Dr. Simpson is Associate Professor of Psychiatry, University of Toronto, Toronto, Ontario, Canada; Authors represented the Committee on Psychiatry and Law for the Group for the Advancement of Psychiatry
| | - Deborah Giorgi-Guarnieri
- Dr. Friedman is Associate Professor, University of Auckland, New Zealand, and Case Western Reserve, Cleveland, OH. Dr. Appel is Assistant Professor of Psychiatry, Icahn Mount Sinai School of Medicine, New York, NY. Dr. Ash is Professor, Emory University Department of Psychiatry and Behavioral Sciences, Atlanta, GA. Dr. Frierson is Professor, Department of Neuropsychiatry and Behavioral Science, University of South Carolina School of Medicine, Columbia, SC. Dr. Giorgi-Guarnieri is in Private Practice, Williamsburg, VA. Dr. Martinez is Professor of Psychiatry and the Law, University of Colorado, Denver, School of Medicine, Denver CO. Dr. Newman is Chair of Psychiatry, California Pacific Medical Center, San Francisco, CA. Dr. Pinals is Clinical Professor of Psychiatry, University of Michigan, Ann Arbor, MI. Dr. Resnick is Professor of Psychiatry, Case Western Reserve University, Cleveland, OH. Dr. Simpson is Associate Professor of Psychiatry, University of Toronto, Toronto, Ontario, Canada; Authors represented the Committee on Psychiatry and Law for the Group for the Advancement of Psychiatry
| | - Richard Martinez
- Dr. Friedman is Associate Professor, University of Auckland, New Zealand, and Case Western Reserve, Cleveland, OH. Dr. Appel is Assistant Professor of Psychiatry, Icahn Mount Sinai School of Medicine, New York, NY. Dr. Ash is Professor, Emory University Department of Psychiatry and Behavioral Sciences, Atlanta, GA. Dr. Frierson is Professor, Department of Neuropsychiatry and Behavioral Science, University of South Carolina School of Medicine, Columbia, SC. Dr. Giorgi-Guarnieri is in Private Practice, Williamsburg, VA. Dr. Martinez is Professor of Psychiatry and the Law, University of Colorado, Denver, School of Medicine, Denver CO. Dr. Newman is Chair of Psychiatry, California Pacific Medical Center, San Francisco, CA. Dr. Pinals is Clinical Professor of Psychiatry, University of Michigan, Ann Arbor, MI. Dr. Resnick is Professor of Psychiatry, Case Western Reserve University, Cleveland, OH. Dr. Simpson is Associate Professor of Psychiatry, University of Toronto, Toronto, Ontario, Canada; Authors represented the Committee on Psychiatry and Law for the Group for the Advancement of Psychiatry
| | - Alan W Newman
- Dr. Friedman is Associate Professor, University of Auckland, New Zealand, and Case Western Reserve, Cleveland, OH. Dr. Appel is Assistant Professor of Psychiatry, Icahn Mount Sinai School of Medicine, New York, NY. Dr. Ash is Professor, Emory University Department of Psychiatry and Behavioral Sciences, Atlanta, GA. Dr. Frierson is Professor, Department of Neuropsychiatry and Behavioral Science, University of South Carolina School of Medicine, Columbia, SC. Dr. Giorgi-Guarnieri is in Private Practice, Williamsburg, VA. Dr. Martinez is Professor of Psychiatry and the Law, University of Colorado, Denver, School of Medicine, Denver CO. Dr. Newman is Chair of Psychiatry, California Pacific Medical Center, San Francisco, CA. Dr. Pinals is Clinical Professor of Psychiatry, University of Michigan, Ann Arbor, MI. Dr. Resnick is Professor of Psychiatry, Case Western Reserve University, Cleveland, OH. Dr. Simpson is Associate Professor of Psychiatry, University of Toronto, Toronto, Ontario, Canada; Authors represented the Committee on Psychiatry and Law for the Group for the Advancement of Psychiatry
| | - Debra A Pinals
- Dr. Friedman is Associate Professor, University of Auckland, New Zealand, and Case Western Reserve, Cleveland, OH. Dr. Appel is Assistant Professor of Psychiatry, Icahn Mount Sinai School of Medicine, New York, NY. Dr. Ash is Professor, Emory University Department of Psychiatry and Behavioral Sciences, Atlanta, GA. Dr. Frierson is Professor, Department of Neuropsychiatry and Behavioral Science, University of South Carolina School of Medicine, Columbia, SC. Dr. Giorgi-Guarnieri is in Private Practice, Williamsburg, VA. Dr. Martinez is Professor of Psychiatry and the Law, University of Colorado, Denver, School of Medicine, Denver CO. Dr. Newman is Chair of Psychiatry, California Pacific Medical Center, San Francisco, CA. Dr. Pinals is Clinical Professor of Psychiatry, University of Michigan, Ann Arbor, MI. Dr. Resnick is Professor of Psychiatry, Case Western Reserve University, Cleveland, OH. Dr. Simpson is Associate Professor of Psychiatry, University of Toronto, Toronto, Ontario, Canada; Authors represented the Committee on Psychiatry and Law for the Group for the Advancement of Psychiatry
| | - Phillip J Resnick
- Dr. Friedman is Associate Professor, University of Auckland, New Zealand, and Case Western Reserve, Cleveland, OH. Dr. Appel is Assistant Professor of Psychiatry, Icahn Mount Sinai School of Medicine, New York, NY. Dr. Ash is Professor, Emory University Department of Psychiatry and Behavioral Sciences, Atlanta, GA. Dr. Frierson is Professor, Department of Neuropsychiatry and Behavioral Science, University of South Carolina School of Medicine, Columbia, SC. Dr. Giorgi-Guarnieri is in Private Practice, Williamsburg, VA. Dr. Martinez is Professor of Psychiatry and the Law, University of Colorado, Denver, School of Medicine, Denver CO. Dr. Newman is Chair of Psychiatry, California Pacific Medical Center, San Francisco, CA. Dr. Pinals is Clinical Professor of Psychiatry, University of Michigan, Ann Arbor, MI. Dr. Resnick is Professor of Psychiatry, Case Western Reserve University, Cleveland, OH. Dr. Simpson is Associate Professor of Psychiatry, University of Toronto, Toronto, Ontario, Canada; Authors represented the Committee on Psychiatry and Law for the Group for the Advancement of Psychiatry
| | - Alexander I F Simpson
- Dr. Friedman is Associate Professor, University of Auckland, New Zealand, and Case Western Reserve, Cleveland, OH. Dr. Appel is Assistant Professor of Psychiatry, Icahn Mount Sinai School of Medicine, New York, NY. Dr. Ash is Professor, Emory University Department of Psychiatry and Behavioral Sciences, Atlanta, GA. Dr. Frierson is Professor, Department of Neuropsychiatry and Behavioral Science, University of South Carolina School of Medicine, Columbia, SC. Dr. Giorgi-Guarnieri is in Private Practice, Williamsburg, VA. Dr. Martinez is Professor of Psychiatry and the Law, University of Colorado, Denver, School of Medicine, Denver CO. Dr. Newman is Chair of Psychiatry, California Pacific Medical Center, San Francisco, CA. Dr. Pinals is Clinical Professor of Psychiatry, University of Michigan, Ann Arbor, MI. Dr. Resnick is Professor of Psychiatry, Case Western Reserve University, Cleveland, OH. Dr. Simpson is Associate Professor of Psychiatry, University of Toronto, Toronto, Ontario, Canada; Authors represented the Committee on Psychiatry and Law for the Group for the Advancement of Psychiatry
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Penney SR, Marshall LA, Simpson AIF. The assessment of dynamic risk among forensic psychiatric patients transitioning to the community. Law Hum Behav 2016; 40:374-386. [PMID: 26914860 DOI: 10.1037/lhb0000183] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Individuals with serious mental illness (SMI; i.e., psychotic or major mood disorders) are vulnerable to experiencing multiple forms of adverse safety events in community settings, including violence perpetration and victimization. This study investigates the predictive validity and clinical utility of modifiable risk factors for violence in a sample of 87 forensic psychiatric patients found Not Criminally Responsible on Account of Mental Disorder (NCRMD) transitioning to the community. Using a repeated-measures prospective design, we assessed theoretically based dynamic risk factors (e.g., insight, psychiatric symptoms, negative affect, treatment compliance) before hospital discharge, and at 1 and 6 months postdischarge. Adverse outcomes relevant to this population (e.g., violence, victimization, hospital readmission) were measured at each community follow-up, and at 12 months postdischarge. The base rate of violence (23%) was similar to prior studies of discharged psychiatric patients, but results also highlighted elevated rates of victimization (29%) and hospital readmission (28%) characterizing this sample. Many of the dynamic risk indicators exhibited significant change across time and this change was related to clinically relevant outcomes. Specifically, while controlling for baseline level of risk, fluctuations in dynamic risk factors predicted the likelihood of violence and hospital readmission most consistently (hazard ratios [HR] = 1.35-1.84). Results provide direct support for the utility of dynamic factors in the assessment of violence risk and other adverse community outcomes, and emphasize the importance of incorporating time-sensitive methodologies into predictive models examining dynamic risk. (PsycINFO Database Record
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Khan S, Chiu M, Simpson AIF, Guttmann A, Jembere N, Kurdyak P. Use of Mental Health Services by Youths and Young Adults Before and During Correctional Custody: A Population-Based Study. Psychiatr Serv 2016; 67:790-3. [PMID: 26828398 DOI: 10.1176/appi.ps.201500085] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The authors measured use of mental health services among young people before and during incarceration. METHODS Administrative data were used to describe mental health services received by 13,919 youths and young adults (ages 12-24) while incarcerated in Ontario, Canada, correctional centers (physician visits, April 1, 2010-March 31, 2012) and, for a subset of the population, during the five years prior to incarceration. RESULTS Forty-two percent had a mental health-related visit during incarceration. Thirty-five percent had no mental health contact for five years before the beginning of the correctional episode. Forty percent of individuals with schizophrenia had a psychiatric hospitalization in the year before entering custody. CONCLUSIONS For one-third of young people with a mental health visit while incarcerated, the visit was the first mental health contact in at least five years. Yet high use of psychiatric services before entering custody among individuals with schizophrenia may indicate gaps in continuity of mental health care.
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Affiliation(s)
- Saba Khan
- Ms. Khan, Dr. Chiu, Dr. Guttmann, Mr. Jembere, and Dr. Kurdyak are with the Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada (e-mail: ). Dr. Guttmann is also with the Division of Paediatric Medicine, Hospital for Sick Children, Toronto, Ontario. Dr. Kurdyak is also with the Centre for Addiction and Mental Health, Toronto, Ontario, where Dr. Simpson is affiliated
| | - Maria Chiu
- Ms. Khan, Dr. Chiu, Dr. Guttmann, Mr. Jembere, and Dr. Kurdyak are with the Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada (e-mail: ). Dr. Guttmann is also with the Division of Paediatric Medicine, Hospital for Sick Children, Toronto, Ontario. Dr. Kurdyak is also with the Centre for Addiction and Mental Health, Toronto, Ontario, where Dr. Simpson is affiliated
| | - Alexander I F Simpson
- Ms. Khan, Dr. Chiu, Dr. Guttmann, Mr. Jembere, and Dr. Kurdyak are with the Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada (e-mail: ). Dr. Guttmann is also with the Division of Paediatric Medicine, Hospital for Sick Children, Toronto, Ontario. Dr. Kurdyak is also with the Centre for Addiction and Mental Health, Toronto, Ontario, where Dr. Simpson is affiliated
| | - Astrid Guttmann
- Ms. Khan, Dr. Chiu, Dr. Guttmann, Mr. Jembere, and Dr. Kurdyak are with the Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada (e-mail: ). Dr. Guttmann is also with the Division of Paediatric Medicine, Hospital for Sick Children, Toronto, Ontario. Dr. Kurdyak is also with the Centre for Addiction and Mental Health, Toronto, Ontario, where Dr. Simpson is affiliated
| | - Nathaniel Jembere
- Ms. Khan, Dr. Chiu, Dr. Guttmann, Mr. Jembere, and Dr. Kurdyak are with the Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada (e-mail: ). Dr. Guttmann is also with the Division of Paediatric Medicine, Hospital for Sick Children, Toronto, Ontario. Dr. Kurdyak is also with the Centre for Addiction and Mental Health, Toronto, Ontario, where Dr. Simpson is affiliated
| | - Paul Kurdyak
- Ms. Khan, Dr. Chiu, Dr. Guttmann, Mr. Jembere, and Dr. Kurdyak are with the Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada (e-mail: ). Dr. Guttmann is also with the Division of Paediatric Medicine, Hospital for Sick Children, Toronto, Ontario. Dr. Kurdyak is also with the Centre for Addiction and Mental Health, Toronto, Ontario, where Dr. Simpson is affiliated
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Penney SR, Morgan A, Simpson AIF. Assessing illness- and non-illness-based motivations for violence in persons with major mental illness. Law Hum Behav 2016; 40:42-49. [PMID: 26322953 DOI: 10.1037/lhb0000155] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Research on violence perpetrated by individuals with major mental illness (MMI) typically focuses on the presence of specific psychotic symptoms near the time of the violent act. This approach does not distinguish whether symptoms actually motivate the violence or were merely present at the material time. It also does not consider the possibility that non-illness-related factors (e.g., anger, substance use), or multiple motivations, may have been operative in driving violence. The failure to make these distinctions clouds our ability to understand the origins of violence in people with MMI, to accurately assess risk and criminal responsibility, and to appropriately target interventions to reduce and manage risk. This study describes the development of a new coding instrument designed to assess motivations for violence and offending among individuals with MMI, and reports on the scheme's interrater reliability. Using 72 psychiatric reports which had been submitted to the court to assist in determining criminal responsibility, we found that independent raters were able to assess different motivational influences for violence with a satisfactory degree of consistency. More than three-quarters (79.2%) of the sample were judged to have committed an act of violence as a primary result of illness, whereas 20.8% were deemed to have offended as a result of illness in conjunction with other non-illness-based motivating influences. Current findings have relevance for clarifying the rate of illness-driven violence among psychiatric patients, as well as legal and clinical issues related to violence risk and criminal responsibility more broadly.
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Pridham KMF, Berntson A, Simpson AIF, Law SF, Stergiopoulos V, Nakhost A. Perception of Coercion Among Patients With a Psychiatric Community Treatment Order: A Literature Review. Psychiatr Serv 2016; 67:16-28. [PMID: 26423101 DOI: 10.1176/appi.ps.201400538] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Various forms of compulsory psychiatric community treatment orders (CTOs) are commonly utilized internationally. CTOs remain contentious because of the ethical implications of coercing patients to receive treatment. Understanding patients' experience of CTOs can assist in the development of more patient-centered and recovery-focused community care. This review examined the relationship between CTOs and patients' perceptions of coercion in the literature. METHODS A search of key terms relating to CTOs and patients' perceptions of coercion was conducted of relevant databases from their inception to March 31, 2014. Publications were included if they were peer reviewed, reported on original research, surveyed or interviewed patients who were or had been subject to a CTO, and were written in English. Factors influencing patients' perceptions of coercion, including the regional context of the studies, were identified. RESULTS Twenty-three primary research articles, reporting on 14 studies from seven countries, were included. Evidence indicated that CTOs may contribute to a patient's sense of coercion, with marked variations among studies in the levels of coercion. Contextual factors, including perceptions of alternatives to CTOs, the presence of additional forms of leverage in patients' lives, and the process of CTO initiation and enforcement, may mitigate or enhance perceptions of coercion. CONCLUSIONS Coercive elements of CTOs may be reduced through increased patient access to information, better working relationships with service providers, and accessible, fair processes. The coercive aspects of CTOs should be seen as part of a broader understanding of the daily pressures and leverage applied in outpatient psychiatric treatment.
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Affiliation(s)
- Katherine M Francombe Pridham
- Ms. Francombe Pridham, Dr. Law, Dr. Stergiopoulos, and Dr. Nakhost are with the Department of Psychiatry, St. Michael's Hospital, Toronto, Ontario, Canada, and Dr. Law, Dr. Stergiopoulos, and Dr. Nakhost are also with the Department of Psychiatry, University of Toronto, also in Toronto, where Dr. Berntson and Dr. Simpson are affiliated (e-mail: ). Dr. Berntson is also with the Department of Psychiatry, Mount Sinai Hospital, and Dr. Simpson is also with the Centre for Addiction and Mental Health, both in Toronto
| | - Andrea Berntson
- Ms. Francombe Pridham, Dr. Law, Dr. Stergiopoulos, and Dr. Nakhost are with the Department of Psychiatry, St. Michael's Hospital, Toronto, Ontario, Canada, and Dr. Law, Dr. Stergiopoulos, and Dr. Nakhost are also with the Department of Psychiatry, University of Toronto, also in Toronto, where Dr. Berntson and Dr. Simpson are affiliated (e-mail: ). Dr. Berntson is also with the Department of Psychiatry, Mount Sinai Hospital, and Dr. Simpson is also with the Centre for Addiction and Mental Health, both in Toronto
| | - Alexander I F Simpson
- Ms. Francombe Pridham, Dr. Law, Dr. Stergiopoulos, and Dr. Nakhost are with the Department of Psychiatry, St. Michael's Hospital, Toronto, Ontario, Canada, and Dr. Law, Dr. Stergiopoulos, and Dr. Nakhost are also with the Department of Psychiatry, University of Toronto, also in Toronto, where Dr. Berntson and Dr. Simpson are affiliated (e-mail: ). Dr. Berntson is also with the Department of Psychiatry, Mount Sinai Hospital, and Dr. Simpson is also with the Centre for Addiction and Mental Health, both in Toronto
| | - Samuel F Law
- Ms. Francombe Pridham, Dr. Law, Dr. Stergiopoulos, and Dr. Nakhost are with the Department of Psychiatry, St. Michael's Hospital, Toronto, Ontario, Canada, and Dr. Law, Dr. Stergiopoulos, and Dr. Nakhost are also with the Department of Psychiatry, University of Toronto, also in Toronto, where Dr. Berntson and Dr. Simpson are affiliated (e-mail: ). Dr. Berntson is also with the Department of Psychiatry, Mount Sinai Hospital, and Dr. Simpson is also with the Centre for Addiction and Mental Health, both in Toronto
| | - Vicky Stergiopoulos
- Ms. Francombe Pridham, Dr. Law, Dr. Stergiopoulos, and Dr. Nakhost are with the Department of Psychiatry, St. Michael's Hospital, Toronto, Ontario, Canada, and Dr. Law, Dr. Stergiopoulos, and Dr. Nakhost are also with the Department of Psychiatry, University of Toronto, also in Toronto, where Dr. Berntson and Dr. Simpson are affiliated (e-mail: ). Dr. Berntson is also with the Department of Psychiatry, Mount Sinai Hospital, and Dr. Simpson is also with the Centre for Addiction and Mental Health, both in Toronto
| | - Arash Nakhost
- Ms. Francombe Pridham, Dr. Law, Dr. Stergiopoulos, and Dr. Nakhost are with the Department of Psychiatry, St. Michael's Hospital, Toronto, Ontario, Canada, and Dr. Law, Dr. Stergiopoulos, and Dr. Nakhost are also with the Department of Psychiatry, University of Toronto, also in Toronto, where Dr. Berntson and Dr. Simpson are affiliated (e-mail: ). Dr. Berntson is also with the Department of Psychiatry, Mount Sinai Hospital, and Dr. Simpson is also with the Centre for Addiction and Mental Health, both in Toronto
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