Understanding Ontario's Forensic Mental Health System

People who have a mental illness and come into contact with the law have special needs. The forensic mental health system is the place where the mental health system and the criminal justice system meet.

It can be difficult to understand at times.  Below are definitions of terms and information on processes to assist in gaining a better understanding of forensic mental health in Ontario.
Entering the Forensic Mental Health System
The forensic mental health system consists of specialty designated mental health 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.
A person suffering from mental illness enters the Forensic Mental Health System through contact with the law. At that time, the person may be ordered by the courts to be placed at a mental health facility for an assessment of criminal responsibility or to determine if they are fit to stand trial.
Unfit to Stand Trial
A person is declared Unfit to Stand Trial (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 him/her incapable of appreciating the nature, quality and consequences of the act. The court’s verdict indicates that the person committed the act, but has determined that he/she is NCR on account of mental illness. A psychiatrist recommends this finding to the court, but it is the judge who makes the final decision.
When a person is found NCR, he/she will be referred to the Ontario Review Board (ORB) and ordered to a forensic unit of a mental health facility.
If the individual does not understand the nature or consequences of court proceedings, is not able to instruct a lawyer before or during court proceedings, and is suffering from a mental illness, the court may find the individual Unfit to Stand Trial. In this case, the individual will be ordered to a mental health facility.
Ontario Review Board (ORB)
A person is placed under the authority of the Ontario Review Board (ORB) after being found Unfit or NCR.  Orders of the ORB must be followed in the same manner in which orders of a judge are.
The ORB is a panel, which typically consists of psychiatrists, lawyers and a person in the community with a background in mental health. The chairperson of an ORB panel is usually a senior lawyer or a retired judge.
The ORB panel makes decisions regarding:

  • Level of security
  • Which hospital a person will be admitted to
  • Access to community privileges
  • Level of support or supervision required if a person is granted community access

Community Access
Forensic patients earn the right to standard privileges such as escorted walks around the hospital and community access as they progress in their treatment.
The level of privileges is based on their treatment, such as medication and other therapies, and ability to manage their illness.
Privileges are common throughout specialty mental health hospitals in Ontario and prepare patients for an eventual safe transition to the community.
These privileges are reviewed frequently by psychiatrists and daily by the patient’s mental health care team. If a person becomes too ill, privileges can be revoked at any time by the patient’s mental health care team.

  • Only 0.001 per cent of individuals charged with a criminal code violation are adjudicated NCR.
  • Only a small percentage of patients in the system have committed serious offences such as murder. 
  • Recidivism rates for people treated in the forensic mental health care system stand between 7.5 and 10.4 per cent and in the criminal justice system rates are 41 and 44 per cent.