The Ontario Forensic Mental Health System: A Population-based Review

Chaimowitz, Gary; Moulden, Heather M.; Upfold, Casey; Mullally, Katelyn; Mамак, Мини

doi:10.1177/07067437211023103

Cited by 10 publications

(6 citation statements)

References 25 publications

(44 reference statements)

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“…This reflects that one of our data collection sites was a male-only facility, but is also consistent with the finding that the most serious forms of violence still tend to be dominated by men. Individuals in this sample otherwise showed rates of personality and substance use disorders, as well as rates of prior criminal justice involvement, comparable to those for the larger and more heterogeneous population of forensic service users in Canada [39][40][41] (see Supplementary Table 1, available at https://doi. org/10.1192/bjo.2023.567).…”

Section: Patient and Victim Typesmentioning

confidence: 66%

Homicide in the context of psychosis: analysis of prior service utilisation and age at onset of illness and violence

Penney,

Lam,

Kolla

et al. 2023

BJPsych open

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Background Public stigma and fear are heightened in cases of extreme violence perpetrated by persons with serious mental illness (SMI). Prevention efforts require understanding of illness patterns and treatment needs prior to these events unfolding. Aims To examine mental health service utilisation by persons who committed homicide and entered into forensic care, to investigate the adequacy of mental healthcare preceding these offences. Method Forensic patients across two mental health hospitals in Ontario with an admitting offence of homicide between 2011 and 2021 were identified (n = 112). Sociodemographic, clinical and offence-related variables were coded from the health record and reports prepared for the forensic tribunal. Results Most patients (75.7%) had mental health contacts preceding the homicide, with 28.4% having a psychiatric in-patient admission in the year prior. For those with service contacts in the year preceding, 50.9% had had only sporadic contact and 70.7% were non-adherent with prescribed medications. Victims were commonly known to the individual (35.7%) and were often family members in care-providing roles (55.4%). Examination of age at onset of illness and offending patterns suggested that most persons admitted to forensic care for homicide act in the context of illness and exhibit a low frequency of pre-homicide offending. Conclusions Many individuals admitted to forensic care for homicide have had inadequate mental healthcare leading up to this point. Effective responses to reduce and manage risk should encompass services that proactively address illness-related (e.g. earlier access and better maintenance in care) and criminogenic (e.g. substance use treatment, employment and psychosocial supports) domains.

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Section: Patient and Victim Typesmentioning

confidence: 66%

Homicide in the context of psychosis: analysis of prior service utilisation and age at onset of illness and violence

Penney,

Lam,

Kolla

et al. 2023

BJPsych open

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“…The present study aims to fill this gap by examining the role of psychopathy in the link between ACEs and self-harming behaviours among forensic patients. The study utilized data from individuals under the Ontario Review Board Database (ORB) in 2014 and 2015 [ 23 ]. The database was created to capture information from ORB reports for a defined period on study-specific items, including measures of ACEs, psychopathy, and self-harm [ 23 , 24 ].…”

Section: Introductionmentioning

confidence: 99%

“…The study utilized data from individuals under the Ontario Review Board Database (ORB) in 2014 and 2015 [ 23 ]. The database was created to capture information from ORB reports for a defined period on study-specific items, including measures of ACEs, psychopathy, and self-harm [ 23 , 24 ]. The study will test the hypothesis that psychopathy mediates the effect of ACEs on self-harm.…”

Section: Introductionmentioning

confidence: 99%

Adverse childhood events and self-harming behaviours among individuals in Ontario forensic system: the mediating role of psychopathy

Kaggwa,

Chaimowitz,

Erb

et al. 2024

BMC Psychiatry

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Background Adverse childhood events (ACEs), psychopathy, and self-harming behaviours are prevalent among individuals in the forensic psychiatry system. While existing literature suggests that ACEs, self-harm, and psychopathy are interrelated, little is known about the interplay of psychopathic traits in this relationship. The present study aimed to determine the mediating role of psychopathy in the relationship between ACEs and self-harming behaviours in forensic patients. Methods This was a retrospective study of patients under the Ontario Review Board (ORB) between 2014 and 2015. In the analysis, we included patients with complete data on ACEs, self-harming behaviours, and a Psychopathy Checklist-Revised (PCL-R) score - a measure of psychopathic traits and their severity conducted during the reporting period. Mediation analysis was based on the Baron and Kenny approach, and sensitivity analysis was performed based on the types of ACEs. Results The sample population (n = 593) was made up of adults, with a mean age of 41.21 (± 12.35) years and were predominantly males (92.37%). While there was a partial mediating effect of psychopathy on the relationship between ACEs and incidents of self-harming behaviours in the past year, the mediation was complete in the relationship between ACEs and a lifetime history of self-harming behaviours. Following sensitivity analysis based on the types of ACE, the mediating effects were more attributed to specific ACEs, especially having experienced child abuse or having an incarcerated household member before 18 years. Conclusion Among forensic patients in Ontario, psychopathy mediates the relationship between experiencing ACEs and engaging in self-harming behaviours. Effective intervention to mitigate self-harming behaviours in this population should consider the potential role of psychopathy, especially among individuals who have experienced ACEs involving a history of child abuse and a family who was incarcerated.

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“…Deinstitutionalization and an overburdened health care system have contributed to the steadily increasing rates of mental illness in prisons and community corrections, Abracen et al (2014 , 2016) . Previously those individuals diagnosed with major mental illness (MMI) were thought to belong strictly to the forensic psychiatric realm, but research shows that in fact, many individuals who are found not criminally responsible or unfit to stand trial have previous criminal charges and convictions, with a significant proportion having served custodial sentences ( Moulden et al, 2014 ; Skeem et al, 2014 ; Moulden and Myers, 2017 ; Chaimowitz et al, 2021 ). The fluidity between systems suggests that some knowledge can be shared about individuals with mental illness, regardless of how their behavior is adjudicated.…”

Section: Introductionmentioning

confidence: 99%

The Relationship Between and Correlates of Problematic Sexual Behavior and Major Mental Illness

et al. 2022

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While research has consistently found that general distress and psychopathology are not predictive of sexual recidivism, examination of specific syndromes and their relationship to offending has revealed a potentially more complicated relationship. One proposed mechanism for the mixed findings with respect to major mental illness and sexual offending may be the confound of neurological injury. As identified in Mann et al. (2010) work on psychologically meaningful risk factors, mental illness represents an area in need of more study given the indirect influence it may exert on risk. To this end, the current paper summarizes the study of the relationship between neurological injury, psychosis and problematic sexual behavior among two Canadian samples of forensic and civil psychiatric patients. In the first study we observed higher than expected rates of sexually-themed psychotic symptoms (45%) and problematic sexual behavior (PSB; 40%) among a combined group of forensic and civil psychiatric patients (n = 109). Indeed 70 percent of those individuals who engaged in PSB endorsed sexually-themed psychotic symptoms. While comorbidity is common amongst this group, brain injury appeared to represent a specific liability. Compared to those who did not engage in PSB, those who did were almost 4x (OR = 3.83) more likely to have a documented history of brain injury (e.g., traumatic and acquired brain injury, including fetal alcohol syndrome). In the second study we sought to replicate this finding in a larger forensic sample of 1,240. However, the recorded rates of brain injury were significantly less, such that no relationship to PSB was observed. Based on the mixed findings to date, including our own data, questions remain about the nature of a potential shared vulnerability for psychosis and PSB previously postulated. Among psychiatrically complex individuals who engage in PSB, understanding etiology and links to risk are helpful, but perhaps more importantly is attention to the mechanisms through which symptoms confer risk (e.g., problem solving, sexual disinhibition, social/intimacy deficits) and how best to treat and manage them.

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The Ontario Forensic Mental Health System: A Population-based Review

Cited by 10 publications

References 25 publications

Homicide in the context of psychosis: analysis of prior service utilisation and age at onset of illness and violence

Homicide in the context of psychosis: analysis of prior service utilisation and age at onset of illness and violence

Adverse childhood events and self-harming behaviours among individuals in Ontario forensic system: the mediating role of psychopathy

The Relationship Between and Correlates of Problematic Sexual Behavior and Major Mental Illness

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