Forensic Assessment in Canada

Forensic Mental Health in Ontario: An Information Guide

• The mental health system is a network of people and services that care for individuals with mental illnesses.

Why do we have a Forensic Mental Health System?

• It is unfair to punish individuals for criminal acts if they have a mental illness that prevents them from understanding their actions or the consequences of their actions.
• The system aims to help rehabilitate and reintegrate individuals into the community, rather than punish them.

Myths about Mental Illness

• People with mental illnesses are not inherently dangerous or violent.
• Stigma surrounding mental illnesses leads to discrimination, disrespect, and worse.
• Individuals in the forensic mental health system face a "double stigma" due to unfair labeling.

Who Works in the Forensic Mental Health System?

• Police
• Defense and Crown Counsel
• Judges
• Court support workers and diversion programs
• Psychiatrists and psychologists
• Nurses and social workers
• Recreation therapists and occupational therapists
• Patient advocates and rights advisers

The Role of the Judge

• Decides if an individual should be granted bail
• Decides if an individual's mental health should be assessed
• Decides if an individual is fit to stand trial based on the mental health assessment
• Decides if an individual is not criminally responsible due to mental illness
• Decides the sentence if an individual is found guilty

Psychiatrists

• Medical doctors with special training in assessing and treating mental illnesses
• Can prescribe medications to treat symptoms, provide therapy or counseling, and assess individuals who may have a mental illness
• Conduct forensic assessments for the court

Entering the Forensic Mental Health System

• Individuals can enter the system through police charges, hospital assessments, or release without charges
• The Mental Health Act has strict rules for hospitalization against one's will

What Happens After Arrest?

• Individuals can be taken to a hospital for assessment under the Mental Health Act
• Release without charges is possible
• Hospitalization against one's will is only possible under specific conditions outlined in the Mental Health Act

Forensic Assessment

• Can be ordered by a lawyer, Crown, or judge
• Determines fitness to stand trial, criminal responsibility, or sentence
• May include assessment of an individual's mental health, fitness to stand trial, or criminal responsibility

Ontario Review Board (ORB)

• Oversees individuals found not criminally responsible or unfit to stand trial
• Makes decisions regarding an individual's level of security, hospital placement, privileges, and supervision in the community
• Considers an individual's risk to the public, mental health, and integration into society### Fitness to Stand Trial
• A lawyer, Crown, or Judge may request a forensic assessment to determine if an individual is fit to stand trial.
• Fitness is determined by the court, not by the mental illness itself.
• According to the Criminal Code of Canada, an individual is unfit if they cannot:
• Understand the nature, object, or consequences of court proceedings.
• Communicate with and instruct their lawyer.

Treatment Orders

• If found unfit, a judge may order treatment with medication to make the individual fit.
• The individual must take the prescribed medication, which may be administered by injection or orally if refused.
• If still unfit after 60 days, the individual is placed under the authority of the Ontario Review Board (OBR).

Determining Criminal Responsibility

• A forensic assessment may be requested to determine if a mental illness affected the individual's actions at the time of the alleged offence.
• The individual may be found "Not Criminally Responsible" (NCR) if a mental disorder prevents them from:
• Appreciating the nature of their actions.
• Knowing that their actions were wrong.

Forensic Assessment

• A forensic psychiatrist may assess the individual in jail, a courthouse, or a hospital.
• The assessment is presented in court in a report, and the judge makes a decision based on the report.

Ontario Review Board (OBR)

• A panel consisting of a psychiatrist, mental health professional, lawyer, and community member with a background in mental health.
• The panel makes ongoing decisions about the individual, including:
• Level of security required.
• Hospital placement.
• Privileges and supervision in the community.
• Decisions are made by a majority vote, considering:
• Risk to the public.
• Current mental health.
• Past year's mental health.
• Integration into society.
• Potential for successful living outside of a hospital.

Ending the Relationship with the OBR

• An individual is no longer under the OBR's authority when:
• Granted an absolute discharge.
• Fit to stand trial.

Mandatory Treatment in Forensic Settings

• An individual cannot be forced to accept treatment unless:
• A doctor signs a certificate stating they are incapable of consenting or refusing.
• Found unfit to stand trial and a judge orders treatment.

The Ontario Forensic Mental Health System

• A population-based review of the Ontario forensic mental health system.
• Legislative changes and landmark court cases contributed to the growth of the forensic psychiatry population.
• The OBR oversees one of the largest numbers of forensic facilities and forensic patients in Canada.

Canadian Legislation

• An accused is found unfit to stand trial (UST) if they are unable, due to mental disorder, to:
• Understand the nature or object of proceedings.
• Communicate with counsel.
• An NCR verdict is rendered if the court determines that the individual was suffering from a mental disorder at the time of the offence.

Population-Based Review

• A study reviewing the Ontario forensic mental health system.
• Methods: Data collected on 1,240 accused adults under the OBR's jurisdiction between 2014 and 2015.
• Results: The majority of the sample was male, single, unemployed, and had a high school education.
• Most were on a detention order, and almost half were living in the community at the time of the report.
• The majority had prior contact with psychiatric services and/or the criminal justice system.