Abstract
Purpose
To quantify the demand for forensic psychiatric services in Ontario over the past 25 years and investigate whether the sociodemographic, clinical and offense-based characteristics of forensic patients have changed over time.
Methods
We investigated all forensic admissions from 1987 to 2012 resulting in a disposition of Not Criminally Responsible on account of Mental Disorder (N = 2533). We present annual proportions of patients with specified sociodemographic, clinical and offense characteristics, and investigate whether the duration of forensic system tenure varies as a function of admission year, psychiatric diagnosis, or index offense.
Results
There has been a steady increase in forensic admissions over this time period, particularly individuals with comorbid substance use disorders and individuals of non-Caucasian ethno-racial background. The proportion of persons committing severe violence has remained low and has decreased over time. Having a comorbid personality, neurological, or substance use disorder significantly increased forensic system tenure, as did committing a violent offense. Individuals who came into the system in earlier years had slower rates of discharge compared to more recent admissions.
Conclusions
Defining the trends characterizing the growth of the forensic population has important policy implications, as forensic services are costly and involve a significant loss of liberty. The current results indicate that young, substance abusing individuals of diverse ethno-racial backgrounds and who commit relatively low-level violence comprise an increasing proportion of Ontario’s forensic population, and suggest that treatment must be optimized to best serve the needs of these individuals.
Similar content being viewed by others
Notes
Some individuals had more than one NCRMD disposition for separate offenses, and so were registered more than once over the study period.
Admittedly, there is some degree of subjectivity when classifying offense severity, particularly whether sexual offenses represent more or less serious offenses as compared to non-sexual violent crimes. We note that just four individuals in the sample had both a sexual and severely violent index offense, and none of these four included homicides. Seventy-two had both sexual and (non-severe) violent offense, with common assault being the most common violent charge accompanying the sexual offense. Results were unchanged whether these individuals were classified as sexual or violent offenders.
References
Shaoling Z, Jun W, Graham M, Chen C, Simei Z, Qiguang L, Qun W, Jiansong Z, Xiaoping W (2017) Attitudes of Chinese community members and psychiatrists towards forensic psychiatric assessments. Psychiatry Res 258:283–288. https://doi.org/10.1016/j.psychres.2017.08.069
Abramowitz MZ, Grinshpoon A, Priebe S, Ponizovsky AM (2008) New institutionalization as a rebound phenomenon? The case of Israel. Isr J Psychiatry Relat Sci 45:272–277
Priebe S, Badesconyi A, Fioritti A, Hansson L, Kilian R, Torres-Gonzales F, Turner T, Wiersma D (2005) Reinstitutionalisation in mental health care: comparison of data on service provision from six European countries. BMJ 330:123–126. https://doi.org/10.1136/bmj.38296.611215.AE
Priebe S, Frottier P, Gaddini A, Kilian R, Lauber C, Martínez-Leal R, Munk-Jørgensen P, Walsh D, Wiersma D, Wright D (2008) Mental health care institutions in nine European countries, 2002 to 2006. Psychiatr Serv 59:570–573. https://doi.org/10.1176/ps.2008.59.5.570
Salize HJ, Dressing H (2007) Admission of mentally disordered offenders to specialized forensic care in fifteen European Union member states. Soc Psychiatry Psychiatr Epidemiol 42:336–342. https://doi.org/10.1007/s00127-007-0159-2
Schanda H, Stompe T, Ortwein-Swoboda G (2009) Dangerous or merely difficult? The new population of forensic mental hospitals. Eur Psychiatry 24:365–372. https://doi.org/10.1016/j.eurpsy.2009.07.006
Jansman-Hart EM, Seto MC, Crocker AG, Nicholls TL, Côté G (2011) International trends in demand for forensic mental health services. Int J Forensic Ment Health 10:326–336. https://doi.org/10.1080/14999013.2011.625591
National Association of State Mental Health Program Directors Research Institute (n.d.). http://www.nri-inc.org. Accessed 25 Sept 2017
Appelbaum PS (1994) Almost a revolution: mental health law and the limits of change. Oxford University Press, Oxford
Jones v United States (1983) 463 U.S. 354
Federal Insanity Defense Reform Act (1984) 18 U.S.C. § 17
Criminal Code of Canada (1985) R.S.C. c. 46. http://laws.justice.gc.ca/en/C-46/. Accessed 25 Sept 2017
Howard H (2003) Reform of the insanity defense: theoretical issues. J Crim Law 67:51–69
Zapf PA, Golding SL, Roesch R (2006) Criminal responsibility and the insanity defense. In: Weiner IB, Hess AK (eds) The handbook of forensic psychology, 3rd edn. Wiley, Hoboken, pp 332–363
R v M’Naghten (1843) 10 Cl. and F. 200, 8 Eng.Rep. 718
Bill C-30 (1992) An act to amend the criminal code and to amend the National Defense Act and the Young Offenders Act in consequence thereof (c. 43, s. 4)
Winko v British Columbia (Forensic Psychiatric Institute) (1999) 135 C.C.C. (3d) 129 (S.C.C.)
Nussbaum D, Malcolmson S, Dosis O (2000) Summary of research on Bill C-30 implementation in Ontario during 1993 and 1994. In: Eaves D, Ogloff JRP, Roesch R (eds) Mental disorders and the criminal code: Legal background and contemporary perspectives. Mental Health, Law, and Policy Institute, Burnaby, pp 104–118
Ohayon M, Crocker A (2000) Impact of Bill C-30 in the province of Quebec. In: Eaves D, Ogloff JRP, Roesch R (eds) Mental disorders and the criminal code: legal background and contemporary perspectives. Mental Health, Law, and Policy Institute, Burnaby, pp 119–128
Roesch R, Ogloff JRP, Hart SD, Dempster RJ, Zapf PA, Whittemore KE (1997) The impact of Canadian criminal code changes on remands and assessments of fitness to stand trial and criminal responsibility in British Columbia. Can J Psychiatry 42:509–514. https://doi.org/10.1177/070674379704200508
Department of Justice Canada (2006) The Review Board systems in Canada: an overview of results from the mentally disordered accused data collection study. Author, Ottawa
Crocker AG, Nicholls TL, Côté G, Latimer EA, Seto MC (2011) Individuals found not criminally responsible on account of mental disorder: are we providing equal protection and equivalent access to mental health services across Canada? Can J Community Ment Health 29:47–54
Livingston JD, Wilson D, Tien G, Bond L (2003) A follow-up study of persons found not criminally responsible on account of mental disorder in British Columbia. Can J Psychiatry 48:408–415
Schneider RD, Forestell M, MacGarvie S (2002) Statistical survey of provincial and territorial review boards. Department of Justice Canada, Ottawa
Balachandra K, Swaminath S, Litman LC (2004) Impact of Winko on absolute discharges. J Am Acad Psychiatry Law 32:173–177
Ontario Review Board (2015) Annual report. Author, Toronto
Crocker AG, Nicholls TL, Seto MC, Côté G, Charette Y, Caulet M (2015) The national trajectory project of individuals found not criminally responsible on account of mental disorder in Canada. Part 1: context and methods. Can J Psychiatry 60:98–105. https://doi.org/10.1177/070674371506000304
Nicholls TL, Crocker AG, Seto MC, Wilson CM, Charette Y, Côté G (2015) The national trajectory project of individuals found not criminally responsible on account of mental disorder. Part 5: how essential are gender-specific forensic psychiatric services? Can J Psychiatry 60:135–145. https://doi.org/10.1177/070674371506000308
Charette Y, Crocker AG, Seto MC, Salem L, Nicholls TL, Caulet M (2015) The national trajectory project of individuals found not criminally responsible on account of mental disorder in Canada. Part 4: criminal recidivism. Can J Psychiatry 60:127–134. https://doi.org/10.1177/070674371506000307
Statistics Canada (2011) National Household Survey. http://www12.statcan.gc.ca/nhs-enm/2011/dp-pd/prof/index.cfm?Lang=E. Accessed 16 May 2018
Jacobs P, Moffatt J, Dewa CS, Nguyen T, Zhang T, Lesage A (2014) Criminal justice and forensic psychiatry costs in Alberta. Institute of Health Economics, Edmonton
Vigod SN, Kurdyak PA, Seitz D, Herrmann N, Fung K, Lin E, Perlman C, Taylor VH, Rochon PA, Gruneir A (2015) READMIT: a clinical risk index to predict 30-day readmission after discharge from acute psychiatric units. J Psychiatr Res 61:205–213. https://doi.org/10.1016/j.jpsychires.2014.12.003
Lebenbaum M, Chiu M, Vigod S, Kurdyak P (2018) Prevalence and predictors of involuntary psychiatric hospital admissions in Ontario, Canada: a population-based linked administrative database study. BJPsych Open 4:31–38. https://doi.org/10.1192/bjo.2017.4
Centre for Addiction and Mental Health v Ontario (2012) 342 O.N.C.A.
Castle DJ, Sham P, Murray RM (1998) Differences in distribution of ages of onset in males and females with schizophrenia. Schizophr Res 33:179–183. https://doi.org/10.1016/S0920-9964(98)00070-X
Häfner H (2003) Gender differences in schizophrenia. Psychoneuroendocrinology 28:17–54. https://doi.org/10.1016/S0306-4530(02)00125-7
Nicholls TL, Brink J, Greaves C, Lussier P, Verdun-Jones S (2009) Forensic psychiatric inpatients and aggression: an exploration of incidence, prevalence, severity, and interventions by gender. Int J Law Psychiatry 32:23–30. https://doi.org/10.1016/j.ijlp.2008.11.007
Robbins PC, Monahan J, Silver E (2003) Mental disorder, violence, and gender. Law Hum Behav 27:561–571. https://doi.org/10.1023/B:LAHU.0000004886.13268.f2
Hiday VA, Swartz M, Swanson JW (1998) Male–female differences in the setting and construction of violence among people with severe mental illness. Soc Psychiatry Psychiatr Epidemiol 33:568–574. https://doi.org/10.1007/s001270050212
Social and Aboriginal Statistics Division (2011) Aboriginal peoples: fact sheet for Canada. Statistics Canada, Ottawa
Penney SR, Prosser A, Grimbos T, Darby P, Simpson AI (2018) Time trends in homicide and mental illness in Ontario from 1987 to 2012: examining the effects of mental health service provision. Can J Psychiatry 63:387–394. https://doi.org/10.1177/0706743717737034
Koskinen J, Löhönen J, Koponen H, Isohanni M, Miettunen J (2010) Rate of cannabis use disorders in clinical samples of patients with schizophrenia: a meta-analysis. Schizophr Bull 36:1115–1130. https://doi.org/10.1093/schbul/sbp031
Simpson AIF, Penney SR, Seto M, Crocker AG, Nicholls TN, Darby PL (2014) Changing characteristics of the Review Board population in Ontario: a population-based study from 1987 to 2012. Report commissioned by the Ontario Ministry of Health and Long-term Care
Penney SR, Marshall L, Simpson AI (2018) A prospective study of pathways to hospital readmission in Canadian forensic psychiatric patients. J Forensic Psychiatry Psychol 29:368–386. https://doi.org/10.1080/14789949.2017.1395061
Minkoff K (2001) Developing standards of care for individuals with co-occurring psychiatric and substance use disorders. Psychiatr Serv 52:597–599. https://doi.org/10.1176/appi.ps.52.5.597
Cannabis A (2017) S.O. c. 26, Sched. 1
Acknowledgements
We would like to thank the Honorable Justice Richard Schneider, Angie Baggetta, Sheila McDermott, Chloe Vice and other staff at the Ontario Review Board office for their generous support of this project. In addition, we wish to thank the research analysts who collected the data: Stephanie Fernane, Bronwyn Mackenzie, Crystal Li and Daphne Vrantsidis. This study was funded by the Ontario Mental Health Foundation and Ministry of Health and Long Term Care. Dr. Nicholls would like to acknowledge the consecutive salary support of the Canadian Institutes of Health Research New Investigator Award and Michael Smith Foundation for Health Research Scholar Award.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Rights and permissions
About this article
Cite this article
Penney, S.R., Seto, M.C., Crocker, A.G. et al. Changing characteristics of forensic psychiatric patients in Ontario: a population-based study from 1987 to 2012. Soc Psychiatry Psychiatr Epidemiol 54, 627–638 (2019). https://doi.org/10.1007/s00127-018-1619-6
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00127-018-1619-6