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.