Forensic Mental Health: Setting the Record Straight

Written by Karim Mamdani on . Posted in Forensic Mental Health

There are more than just a few myths surrounding mental health care in Ontario and the services we provide at Ontario Shores Centre for Mental Health Sciences (Ontario Shores).

When it comes to mental illness and the treatment of it, there is an incredibly long history of silence.

For decades, people struggling with mental illness kept quiet for fear of public shaming, while organizations such as Ontario Shores did not do enough to break down barriers and reduce the stigma through the promotion of available programs and services.

That era is over and mental illness and the importance of mental health is more accepted and recognized in society than ever before. As a hospital, Ontario Shores actively looks to build relationships with partners in mental health care and the community as a whole to ensure people struggling with mental illness and their families know where to turn and understand how we can help.

While we have made tremendous strides in recent years with this commitment to build awareness and remove the stigma associated with mental illness, it is clear both Ontario Shores and the mental health care sector still have substantial work to do in terms of dispelling ageless myths and misconceptions. 

An area that has significant misinformation floating around is the forensic mental health care system.  Whether it is a columnist reporting in the mainstream media or a parent commenting on social media, when a case enters the forensic system and makes headlines, there are great myths which come to the surface and are reported as fact.

It is the myths which I have seen in print which have inspired this blog post.

Forensic Mental Health System
A person who comes into contact with the law and appears to be suffering from mental illness may be ordered by the courts to be placed at a mental health facility like Ontario Shores for an assessment of criminal responsibility or to determine if they are fit to stand trial.

The forensic mental health system consists of specialty designated psychiatric facilities that have been determined by the Ministry of Health and Long-Term Care to have the expertise required to assess and provide treatment and supervision to people struggling with a mental disorder.

Unfit to Stand Trial (Unfit)
A person is declared Unfit if a mental illness prohibits that person from understanding the nature, object or consequences of the events that occur in court, or if that illness prevents the person from being able to communicate with and instruct his or her lawyer. Simply being diagnosed with a mental illness does not make a person Unfit.

Not Criminally Responsible (NCR)
NCR is a court verdict stating that a person has committed an illegal act but, at the time, was suffering from a serious mental illness that rendered them unable to appreciate the nature or quality of the act or of knowing that is was wrong.

If a person living with a mental illness or experiencing mental health issues commits an illegal act, they are not guaranteed to receive a court-ordered assessment or an NCR verdict.

NCR is not a loophole or a get out of jail free card.

Those who are eventually found NCR must first undergo a series of psychiatric assessments and must meet a stringent set of criteria before it is determined that because of their mental illness they were unable to understand or appreciate what they were doing was wrong at the time of the illegal act.

NCR is a verdict that allows those struggling with complex mental illness to receive the help they need. Often times those found NCR have been struggling for months and years in the community without support, access to services and, sometimes, food and shelter.

It is important to remember that NCR verdicts are rare. Only 0.001 per cent of individuals charged with a criminal code violation are declared NCR and just a small percentage of patients in the system have committed serious offences such as murder.

It is also important to know that treating the mentally ill who come in contact with the law is effective. Recidivism rates for people treated in the forensic mental health care system stand between 7.5 and 10.4 per cent and rates for individuals in the criminal justice system are 41 and 44 per cent.

Ontario Shores
We provide a secure inpatient setting for patients in the forensic mental health system. We are not a jail. We are a hospital.
As a service provider within the forensic mental health system, it is our responsibility to provide specialized assessment and treatment services to those in our care while preparing them to eventually re-enter the community.

Forensic patients can require care for months, but more often it is years before they are rehabilitated to the point where they have acquired the necessary skills to manage their illness and live in the community successfully.

Regardless of where patients are on their recovery journey, they are treated and assessed regularly to ensure they are receiving appropriate care and progressing toward a transition back into the community.

Once it is determined that forensic patietns are ready for community living, patients are regularly monitored by specially trained outpatient clinicians, and connected to community organizations and other supports to help them achieve success in the community.

Justice
When an individual is found NCR, essentially the opportunity for victims to find ‘traditional’ justice is gone. The individual is now a patient and our efforts are exerted to make them well, as all other parts of the health care system would.

Once individuals enter the forensic mental health system, the accused becomes a patient and accountable to the Ontario Review Board (ORB), which has jurisdiction over individuals who have been found by a court to be either Unfit or NCR.

The focus of their annual ORB hearing becomes their mental wellness and their progression toward becoming a socially and emotionally healthy person with the ability to one day re-enter the community.

Community Access
In order to prepare patients to successfully re-enter the community, privileges are essential.

Patients earn privileges such as escorted walks around the hospital and community access as they progress in their treatment.
As patients progress in their recovery through a combination of treatment, such as medication and other therapies, and their own effort in learning to manage their illness, they earn the right to a series of standard privileges.

The privileges, which are common throughout specialty mental health hospitals in Ontario, are essential for the patient in preparation for a transition to the community.

These privileges are reviewed frequently by psychiatrists and daily by the patient’s mental health care team. If a patient has earned certain privileges, but is having a rough day managing their illness, their privileges can be revoked until the patient is feeling better.

Without these privileges it would be very difficult to assess whether a patient was ready for discharge. Without the ability for a slow, but consistent expansion of privileges, we could be putting the patient and the community at risk by sending a patient out in the community without the appropriate preparation, care and support.