Myths about Forensic Mental Health

5:53 AM

Just yesterday a local news station covered a story about Vincent Li (the Canadian man who beheaded another passenger while riding a Greyhound in 2008) and the fact that he is being released to a group home. People were shocked to discover that someone who had taken another life so recently could be given such freedoms. Many comments were made, most of which were not based on fact. So I’m here to set the record straight! From someone who is passionate about forensic mental health, who works with the population 30+ hours a week and who spends countless hours keeping up to date on new information, here is the truth about forensic mental health (FMH).
Note: I have a lengthy post written up about all the details of the FMH system, but I’ve been reluctant to post it because it’s … uh, boring. Ha ha. It’s still a possibility for the future, but this is a quick version.

The system

People enter the FMH system for 2 reasons: they’re not fit to stand trial (their mental state makes it so that they cannot understand the weight of what’s going on in court) or they’re found not criminally responsible due to mental illness (the act or omission that they’ve been charged with was committed when their mental state was the reason for what they did, or why they didn’t understand the gravity of it). Once they are placed in a facility – my place of work being one of them – they meet with the Ontario Review Board on an annual basis to discuss their progress and future. They can either stay in the facility for further rehabilitation, be granted a conditional discharge (ability to go into the community, with stipulations) or an absolute discharge (extremely rare, and done very conservatively). Their decision attempts to balance the individual’s liberties with the risk to the public.

What people don’t understand

The first comment, or myth, to address is “these people are getting away with murder.” No human being can inflict schizophrenia or any other psychotic disorder on themselves in order to avoid prison time. The assessment teams are very thorough with their analysis. In many cases, the length of time a person stays in our system is actually longer than the prison sentence they would have served if found criminally responsible. That is the interesting thing about FMH: while the traditional justice system is mostly based on fitting the sentence to the crime (likening it to more of a punishment), a stay in a mental health facility is entirely based on recovery needs (likening it to more of a personalized rehabilitation). For every “Vincent Li” case where a horrific crime seems to be linked to a shorter recovery period, there are dozens of people who enter the system for much pettier thing and stay for decades. I understand that the families who mourn the loss of their loved ones (who seem to be most vocal about the issue) are desperate for justice, however ensuring that the reason for the altercation (which is mental illness) is eradicated, is the most important thing.

“They are just going to go attack someone else.” This myth can be easily dispelled by simple statistics. The recidivism rate (percentage of times they re-committed an offence) is under 10% here, upon absolute discharge from FMH, and the rate drops even further when looking at only violent crimes. Comparatively, the Canadian average within the traditional criminal justice system is over 33%. Also, the likelihood of someone discharged from the FMH system attacking a stranger on the street is almost non-existent. The victims of these acts is by and large family members, other individuals close to the person, as well as enforcement officers and mental health staff. In the majority of cases they do not pose a risk to the general public.

“These people are monsters/animals/psychos/evil…” I take personal offence to these statements because of the time I’ve spent with my clients. I liken it to hearing people make jokes about seizures being that my dad has epilepsy, or even knowing that people think gluten-free diets are ridiculous, when my four immediate family members have Celiac disease. If you don’t understand something, it’s not okay to use ignorant words to express your distaste. People with mental illness are suffering with a disease the same way that a cancer-suffer is. In fact, it can be more socially challenging because of the stigma around it. Many people struggle with their mental illness alone because it is not widely accepted as a true illness the way physical ailments are, in our society. Everyone needs to educate themselves in this way.

“They did the act so they need to pay for it.” Please consider the following example and then decide if you agree. You are driving down the road carefully when suddenly a very-low blood sugar attack hits you, from Diabetes you have not yet been diagnosed with, and it causes you a great deal of impairment. Through your struggle, your vision is clouded and your vehicle strikes a woman on a bike. She is disabled for life. In the next weeks you see a doctor about your blood sugar issues, describe some events that have happened in the past that help the doctor come to a diagnosis, blood work confirms the concerns, you get on a treatment plan, and so long as you take your insulin at regular intervals you are very unlikely to have this ever happen again. Naturally if you ever forgot to take your insulin, and happened to be driving at the time with a bike on the street near you, the event could potentially happen again. You are embarrassed about, and regretful of, what happened, but everyone assures you it wasn’t your fault. You play the events over in your head daily, and you deeply wish the cyclist could have the use of her legs back. This is the story of a person whose physical illness allowed them a chance at wellness and going on with their life after tragedy. The plan that “they need to pay”-folks are suggesting, takes mental illness and says ‘you did what you did, now do the time’. Should a diabetic be jailed for an unforeseen blood sugar attack? Should a schizophrenic be jailed for an unforeseen delusion?

“The Ontario Review Board should be accountable for all of the violence that occurs after a person is discharged.” Just to set the record straight, the ORB is extremely conservative in the liberties that they extend to clients in the FMH. Their utmost concern is public safety: after all, they are members of the community in which clients are discharged. Their job is a difficult one because they need to balance everyone’s rights. Our clients have basic human rights too: the right to seek rehabilitation and the right to enter the community once they are rehabilitated. The same way that any person has the capacity for an act of aggression, discharged clients do too. We cannot hold a person in a mental health facility simply for their capacity to re-commit, only for their likelihood to do so. The process is complex, lengthy and very successful.

“They should not be walking the streets alone.” Cases of a person committing a violent act and then being discharged without supervision or continuing care are extremely rare. When clients leave our facility they most often enter a staffed group home. And this is after they’ve gone through all of the stages of privileges here. They begin in our admissions unit where they are unable to leave the ward for any reason. In time, when they have proven self-control, stability and responsibility, they’ll be transferred to a secondary unit where they are able to have free access to the entire hospital. They can eat in our staff cafeteria, shop at the corner store, watch tv in the main room, explore outside in our gated courtyard, play some floor hockey, and then book a haircut. We have a mini “downtown” to ease the transition back to the community. At a certain point they can be transferred to a readiness unit which allows them to leave the facility in controlled ways. Perhaps it’s just to the road for a cigarette, sometime it’s going into town with a few staff members to grab a coffee at Timmy’s. As they advance in their treatment they can receive day passes. If there is any concern, they are supervised. The final step is making plans to join a group home. Once they leave our facility they are linked up with a forensic treatment unit in the community who see them regularly and also ensure that their medication is taken exactly as scheduled. Vincent Li will not have an opportunity to “go off his meds” like people are suggesting. Mental health staff spend hours of their day making rounds to dispense medication and most of the time the act is followed by asking for an open mouth to inspect that the capsules are swallowed, like you do with a child. There isn’t an honour system here.

“But Vincent Li took two lives: the man he killed, and the officer who reported to the scene who later committed suicide over the events.” Isn’t this a perfect testament to why we need stronger mental health care in Canada (and everywhere)?

“Imagine if that was your kid who was killed.” As much as I wouldn’t like to, I will say this: if my child or anyone close to me is ever the victim of a mental illness-related crime, it would be of utmost importance to me that the person who committed the offense is treated in a way that the act does not occur again. If you have any doubt that healing and support is possible between family members of mental illness-related homicides, and the client being treated, look no further than the documentary Out of Mind, Out of Sight, which tells the story of a man whose mother’s life was taken at his hands while in a schizophrenic episode. His own father, sister, and two brothers are unwaveringly supportive of him, despite having lost their loved one. When asked how they found it in themselves to forgive him, one brother answered (and I’m paraphrasing): “To even suggest forgiveness is necessary is to blame the victim. When schizophrenia killed my mother that day, there were two victims, and one survived, and lives to suffer from it.”  

Edited to add: here is a virtual tour of my FMH facility.

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