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Schizophrenia Society of Ontario Demystifying the Justice and Mental Health System: A Conference for Families May 3, 20

Schizophrenia Society of Ontario Demystifying the Justice and Mental Health System: A Conference for Families May 3, 2008. Forensics vs Corrections: Pathways and Experiences Through Parallel Systems Derek Pallandi, MD, FRCP(C) Centre for Addiction and Mental Health

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Schizophrenia Society of Ontario Demystifying the Justice and Mental Health System: A Conference for Families May 3, 20

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  1. Schizophrenia Society of OntarioDemystifying the Justice and Mental Health System: A Conference for FamiliesMay 3, 2008 Forensics vs Corrections: Pathways and Experiences Through Parallel Systems Derek Pallandi, MD, FRCP(C) Centre for Addiction and Mental Health Mental Health Centre, Penetanguishene University of Toronto

  2. Outline • Who am I? • What is “forensic psychiatry” anyway? • What is the “Forensic System”? • Treatment and rehabilitation • Getting out • Getting back in again • Coercion: myths and realities

  3. Objectives • Give an overview • Clarify misconceptions • Identify opportunities • Interactive discussion

  4. Who are you?

  5. Who am I?

  6. What is a forensic psychiatrist? • MD • Specialist in psychiatry • Particular interest (?peculiar interest) in the area • Dedicated training • Dedicated practice • Eventually…experience

  7. What is the “forensic system”? In Ontario, a system in place to address specific needs for those: • Referred for assessment (fit / NCR) • Detained via the ORB • In diversion programmes

  8. “Forensic system” myth People who are behaving in violent or other problematic ways, have criminal records, or are unmanageable or difficult to place and / or discharge by hospitals can be “sent to the forensic system…”

  9. In Ontario: • Access: via courts / Review Boards • Based on specific circumstances and criteria

  10. Fitness for Trial • Accused, via the court, can be assessed for this specific issue in the following: • Mental Health Courts • Brief Assessment Units • Inpatient Units (min-max; up to 60 days) • Out of custody

  11. Unfit to Stand Trial Being found “Unfit” by the Court after an assessment is another entry point into the system…

  12. Treatment Orders • Once found unfit – typically MMI • Likely to respond (become fit) • Risk not disproportionate to benefit • Specific Court-mandated treatment up to 60 days, in hospital

  13. Treatment Orders • Intrusive? Yes • Effective? Yes • A long-term fix? No

  14. Criminal Responsibility • Historically “Insanity” or “Insanity defence” • People are presumed responsible for their actions, unless shown otherwise

  15. Not Criminally Responsible Being found “NCR” after an assessment, is another entry point into the system, typically via the ORB…

  16. Mental Health Diversion • A short-term entry point into the system • Comprehensive intervention • Largely voluntary • “Treatable” disorders • Minor charges • Goal is to stay charges (no record)

  17. So…what is the “forensic system”? In Ontario: • 1000 patients (and growing) • 10 designated facilities (security spectrum) • 600-700 designated beds (and growing) • Several hundred community detainees

  18. CAMH – Law and Mental Health Programme • 40 medium secure beds • 72 minimum secure beds • 8 SOTU beds • 180 outpatients • Specialty clinics • Consultation Service • Mental Health Courts

  19. ORB population Hopefully… • The mentally ill: • Schizophrenia / Mood • Dementia • MR • “Correctly” identified as NCR or unfit

  20. ORB population • Typical offense types: • Manslaughter / murder • Assaults (simple/ACBH/with weapon) • Sexual offences • Threatening / Harassment • Weapons offences • Other miscellaneous

  21. LAMHP OPS population

  22. Treatment and Rehabilitation • Inpatient (max – medium – minimum) • Outpatient (variable reporting) • “Cascade” notion ORB-governed

  23. Treatment and Rehabilitation • Multidimensional rehabilitation: • Medication • Groups • Recreation • Vocational • Educational • Socialization / social skills

  24. Treatment and Rehabilitation • Multidimensional rehabilitation: • MD • SW • RN • OT • PT • Pharmacist • RT • Dietician

  25. Treatment and Rehabilitation • Goals: • Protect public safety / manage risk • Reintegrate the accused

  26. Treatment and Rehabilitation • Life “inside” • Depends on security level • At minimum – indistinguishable from civil • Groups, outings, recreation, school , work • Families highly involved

  27. Treatment and Rehabilitation • Life “outside” • Various types of housing • Differing reporting frequencies • Work, family, relationships, productivity • Can be minimally intrusive

  28. Getting Out • Do what you are supposed to • Don’t do what you are not

  29. Getting Out • Respond and be amenable to treatment • Participate in groups • Use privileges • Reintegrate • Remain free of aggression / reoffense • Remain free of substances • Structure / skills

  30. Getting Back in Again • It happens…minimizestigma: • Substances • Non-compliance (meds / reporting) • Re-offense • Decompensation • Risk management

  31. “Coercion”: Realities • It is a therapeutic environment • Goal is reintegration • Outcomes are very very good • Failures are rare • Resource-rich

  32. “Coercion”: Myths • Providers benefit from ongoing detention • The system cures all • Once in, always in • It is inhumane

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