The Journey from “Risk” to “Recovery"

A topic that is often in the news and one that generates much discussion was the focus at this week’s Grand Rounds presentation.  Dr. Wood Hill, a Psychiatrist at Ontario Shores Centre for Mental Health Sciences (Ontario Shores) gave the packed room some insight into forensic psychiatry, the forensic mental health system, and the Ontario Review Board.  He also discussed the paradigms of risk and recovery and how a patient might move through these.

Dr. Wood Hill explained that when a person with a mental illness comes in contact with the law and has been designated as Not Criminally Responsible (NCR) for the crime committed, they enter the forensic mental health system.

At this time, these persons are generally considered a risk to the public and are in need of mental health care.

They would then fall under the supervision of the Ontario Review Board (ORB).  This board made up of judges, lawyers, doctors and lay persons examine the reports of both the hospital and the patients to make a determination about the degree of liberty or constraints that the person designated NCR may face.

At all times, the ORB assesses the risk that the person may pose to others.  The Board carefully considers the need to protect the public from danger, the NCR’s mental condition and their reintegration into society, as well as any other need they may have before making an assessment.

It is aim of the ORB to manage the risk by reviewing the persons closely to determine if they understand their role in the crime, show an understanding of how they lived in the past and how they hope to live in the future, their attitudes and awareness.  The ORB also examines their family and peer support network, their vocational skills and their housing needs.

“The aim of the forensic psychiatrist is always to get persons to play an active role in their own recovery,” says Dr. Wood Hill, adding that “the person must show some insight”.

The ORB, every year examines whether NCRs are a physical or psychological threat and if they are no longer a risk, they may be considered in recovery and then the NCR designation will be removed.

Recovery for persons in the mental health system includes a demonstration of growth.  Ontario Shores works with outpatients as partners in their care to maintain their recovery. The hospital also works closely with agencies in the community to create a viable risk management program, so that risk will continue to decrease and recovery will increase.