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Forensic psychiatric patients are among the most complex and stigmatized users of mental health services, and there are still many questions about best practices for recovery and rehabilitation. The Risk and Recovery pillar aims to advance knowledge of risk factors associated with violence, offending and other adverse outcomes among forensic patients, as well as factors that promote recovery, resilience and successful community outcomes. Our overarching research objectives are to understand the causes of violence and offending in individuals with major forms of mental illness, to enhance the science and clinical practice of violence risk assessment, and ultimately, improve service delivery and mental health outcomes. We also undertake research into the broader health system in which forensic patients receive care. Here, we seek to understand the causes of the rapid growth in demand for forensic mental health services in Ontario— and indeed, most of Canada — over the last two decades, as well the patterns of healthcare utilization and re-offending after patients are discharged from the system.
Stephanie Penney, Suraya Faziluddin, Sandy Simpson, Patti Socha and Treena Wilkie
Behavioral Sciences & the Law. 2023 Mar 10. doi: 10.1002/bsl.2615. Epub ahead of print. PMID: 36898979.
Link to Publication
In this paper we describe a novel, integrated conceptual model that assesses risk for future violence, protective factors and progress in treatment and recovery in forensic mental health settings. We propose that the value of such a model lies in its ability to improve clinical efficiencies and streamline assessment protocols, facilitate meaningful participation of patients in assessment and treatment, and increase the accessibility of clinical assessments to principal users of this information.
Stephanie Penney, Roy Ulrich, Margaret Maheandiran
Journal of the American Academy of Psychiatry and Law. July 2023 doi: 10.29158/JAAPL.220110-22
Link to Publication
This study investigates whether two stalking-specific risk instruments— the Guidelines for Stalking Assessment and Management (SAM) and the Stalking Risk Profile (SRP) — can more accurately predict stalking in forensic patients compared to a well-validated violence risk assessment measure (Historical, Clinical, Risk Management-20, Version 3 (HCR-20V3)). Dynamic risk factors were rated once a year over three years and revealed significant change over time. Results supported the value of stalking-specific risk factors on the SAM and SRP in terms of risk prediction, as well as tailoring risk-management and treatment plans for patients with a history of stalking-related behaviors. The paper also highlights the value of monitoring changing patterns in dynamic risk factors over time.
Sumeeta Chatterjee, Alexander I. F. Simpson and Treena Wilkie
Journal of the American Academy of Psychiatry and the Law Online September 2023
Link to Publication
Over the last 30 years, the ethnic diversity among forensic patients has increased, with Indigenous and other minority populations being overrepresented. This article summarizes the framework used by the forensic service to implement a culturally safe environment for patients and staff. Our team is developing analyses to assess the impact of these initiatives on patient and staff experiences, as well as long-term recovery.
The impact of cannabis legalization on the forensic mental health patient population in Ontario
The purpose of this study is to better understand the potential harms and health-related impacts of cannabis legalization on users of forensic mental health services in Ontario. In particular, we would like to better understand the views of forensic patients and forensic mental health clinicians, as well as decision-makers in the forensic mental health system, about the risks and/or benefits associated with cannabis use among individuals with mental illness. It is hoped that this study will provide new information on the impact of cannabis legalization on forensic service users and help inform policy in a timely manner.
Factors impacting recruitment and retention of forensic psychiatrists in Ontario
The recruitment and retention of forensic psychiatrists is crucial to the future needs and development of the provincial forensic system. In recent years, there have been increasing challenges recruiting forensic psychiatrists to hospital-based forensic programs. This study surveys both forensic psychiatrists and psychiatry residents to understand what is important for them when choosing a career. The results will inform improvements to forensic psychiatry programs that increase job satisfaction.
Motivational influences and trajectories to violence in the context of major mental illness
Despite growing evidence that certain forms of mental illness are statistically correlated with violence, surprisingly little is known about if, how and how often specific illness symptoms actually motivate incidents of violence. This study will advance knowledge in this area by assessing motivations for violence among offenders with serious forms of mental illness, identifying the primary illness and non-illness related variables connected to acts of violence. It is hoped that studying these factors will lead to better prevention of offenses, and better identification of early warning signs and unmet treatment needs.
Culture is protection: A gathering on cultural connectedness as a protective factor in youth violence prevention
Indigenous youth are grossly overrepresented at all stages of the criminal justice system. Current risk assessments have been criticized for being biased and insensitive to the cultural and historical factors experienced by these youth. This study will bring together Indigenous and non-Indigenous researchers, knowledge users, and Indigenous youth with lived experience to build consensus on the meaning and role of cultural connectedness in Indigenous youth violence prevention. The group will also capture research priorities and build partnerships and plans for an Indigenous-led research agenda to explore the identified priorities.
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