The Forensic Mental Health Care System and “Not Criminally Responsible" Designation

8:06 AM

As some of you may know, I work at the South West Centre for Forensic Mental Health Care, in the Food and Nutrition Services department. I used to split my time between multiple sites, whereas now I am here 100% of the time, unless one of our buildings at Parkwood Institute in London is really in need. In this short time of being more devoted to this facility, my passion for it has grown so much. I am excited to write more about the forensic mental health care system today, and try to explain what the ‘not criminally responsible’ designation means. (Catch my post about the public opinion, especially sparked by Vincent Li, here.)

I really apologize if this is more boring or less relevant than my usual posts. I am well aware that my blog has NO perceivable theme or subject-continuity - haha. I could talk about this subject ALL DAY and I think it's something the average person doesn't know a lot about, so if you'll bear with me, it's a really interesting topic and I hope you enjoy.

What does “Not Criminally Responsible” mean?

All over Ontario we have hospitals that offer support for people suffering with mental illness. Occasionally one of these people will come in contact with the law (we don’t use the term “break the law” in our line of work). When a person is in a situation of standing trial for a crime it is possible to use a defence of being not criminally responsible due to mental illness (NCR).

Often, before standing trial, a person will be held on “form”. This can mean a few things. Form 1 means that a physician has deemed it mandatory for a person to be held for a psychiatric assessment, involuntarily for up to 72 hours. If the person is still meeting the conditions for involuntary admission, they are given a Form 3, a “Certificate of Involuntary Admission” and can’t leave for up to two weeks. Beyond that time frame requires a Form 4 which is a “Certificate of Renewal”.

A court deciding someone is NCR does not simply mean that the person suffers from mental illness and will be pardoned from the crime. A person can suffer from mental illness and still be responsible for a crime. What this defence means is that their mental illness rendered them incapable of appreciating the nature and quality of their act or omission, or of knowing it was wrong. This comes straight from the Criminal Code of Canada. You cannot say “Well, I was very depressed so I set fire to my ex-girlfriend’s house.” In this case, the depression did not stop them from knowing the destruction it would cause, or that arson is against the law.
They must prove two things: that they were in fact suffering from a disease of the mind at the time, and that it was the cause of their inability to understand the nature or wrongness of the act or omission. I say omission because sometimes not doing something can be criminally wrong, like feeding your child or paying your taxes. (Wrong can mean legally, or morally, wrong.) This is similar to the ‘pleading insanity’ that you see in movies. Much of the time this situation involves delusions, and often ones of a schizophrenic nature.

In the famous case of Luka Magnotta, we saw that he was found in a dire psychiatric state (out of touch with reality) at the time of killing a woman, but had promised he would commit murder months earlier which negated his defense of NCR.

Another case in which NCR did not apply is Christopher Husbands who committing a mass shooting in Toronto’s Eaton Centre a few years ago. Though it was argued that he suffers from Post-Traumatic Stress Disorder, the courts found that the shooting itself was a deliberate act of retaliation.

The assessment is done by a forensic psychiatrist who spends time talking with the individual, and possibly their family and friends.

There is also the case of being “Unfit to Stand Trial”. This means they cannot properly represent themselves or be represented. The conditions of this are chosen by ORB (the Ontario Review Board). It is possible to be considered “permanently unfit to stand trial” but also “non-dangerous to the public”. To be considered unfit to stand trial it must be proven that the person cannot understand the nature, object or consequences of what happens in court or that they are unable to communicate with or instruct their lawyer. Sometimes a judge will call for a Treatment Order which requires the person to take a medication, and if they refuse they are given an injection of it. This is to assist them in being considered fit to stand trial.

How they end up at the South West Centre for Forensic Mental Health Care

If the court finds the person NCR or Unfit they are seen by ORB (the Ontario Review Board) which is made up of three people, most often a judge, psychiatrist and psychologist. They determine how dangerous the person is to the public, and how restrictive their next moves should be; ultimately they want to keep the most amount of freedom for the person while still keeping the public safe. Think of this example, if a person is charged with not paying $500 worth of parking fines but it is found that they ignored these bills because of a period of psychosis, it is not necessarily essential to have them spend time in a forensic mental health care facility. In all likelihood, the public is perfectly safe having a person who did not pay parking fines in their vicinity. They would do best receiving mental assistance at a non-forensic facility. However, if someone has committed a violent crime, it is not safe to discharge them to the public without further rehabilitation. The possible outcomes are: absolute discharge (continue living in their home, some restrictions or supports may be offered), conditional discharge (with continuous overseeing from a forensic team), or being detained in a hospital. That’s where we come in. The decision doesn’t specify how “sick” or “cured” the person is, simply how much of a risk they pose. Keep in mind, proper psychiatric medications can aid a person greatly in making better moral and lawful decision. This has been well proven over time. In fact, recidivism rates (how often a person re-commits an offense) of individuals found not criminally responsible on account of a mental disorder are much lower than rates among individuals found guilty of a crime.

What happens in the South West Centre?

It is much like a hospital you’d be used to seeing, only we are treating the mind not the physical body. There are 5 “wards” (living areas of the hospital) that have individual bedrooms for clients, as well as common areas. Nursing staff work around the clock. Each person is also assigned to a physician. We have recreational therapists, occupational therapists, spiritual advisory, and more. Medications often offer a lot of improvement. Our food and nutrition team works to support the client through meals and snacks, and also help them achieve dietary-related goals like losing weight or increasing energy levels. We plan special themes like brownies with pink and red icing for Valentine’s Day. There are floor hockey tournaments and band nights, we watch hockey games and play cards. Clients can take classes. They spend time in the garden. We have a “corner store” as well as a cafeteria and a small library (which gets all the latest magazines much to my amusement.)

Our facility is not maximum-security: there is only one in Ontario which is located in Penetanguishene. Our clients range in age, and we have males and females. We also have varying levels of security within the building, but those with the lowest level (in other words the highest level of privileges) can be granted day passes or even Leaves of Absence.
Staff are outfitted with personal alarms in case they ever feel at risk, and security are quick to respond if a personal alarm is activated. All doors are locked by sensors and can be opened by a FOB card. Clients wear a bracelet which governs where they can and cannot go (by locking and unlocking doors). If a client is particularly aggressive we have “seclusion rooms” available to make sure they do not harm anyone. Depending on privileges, most clients can have visitors but they must sign in and go through security before entering, much like at an airport.

When can they leave?

Clients are reviewed by ORB every 12 months at which time they can decide again: detainment, conditional discharge, or absolute discharge. At one time they tried to pass a change which would maximize the length of time in the forensic mental health system to the length of time they would have served if convicted of the crime, but it didn’t go through.

ORB’s four main questions are:
Are they a risk to members of the public? How is their mental health now and how has it been over the past year? How well integrated into society are they (could they hold a job)? Do they have any other needs that should be considered?
ORB decisions can be appealed.

Why it works

This system is built entirely for the mutual benefit of patients and the public. It helps EVERYONE if these people get better. If we can transition a person from a life that is riddled with mental illness and unlawful behaviour, to our secure admissions department, to another unit where they have more independence, to a personal apartment within the facility, to a group home for people with mental illness, and then to an independent apartment building (with check-ins from forensic staff) - we are happy campers. But everything must be done in the right time. It's a great, and gradual, transition that has impressive effects.



Thanks for taking the time to read about Forensic Mental Health. I don't promise it'll be the last time I write about it, but I do promise that most of the time I will stop myself from posting a 10,000 word rant that is better served as a personal journal entry.

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