Evidence-Based Practices in Forensic Mental Health Programs and Services: An Annotated Bibliography
Section I - Background, Purposes, Method and Organization
Section II - Definitions of FMHPS in Ontario
Risk Assessment and Management
Treatment and Rehabilitation
Areas Excluded
Forensic programs differ from general mental health programs and services in the following aspect. Part XX.1 of the Criminal
Code of Canada (CCC) and subsequent case law point to forensic mental health patients as posing a threat to the safety of
the public. In this regard, forensic mental health patients are distinguished from non-forensic mental health patients (see
Definitions page). While public safety concerns are present in general mental health services, they are not a central focus. In contrast,
the assessment and management of the risk to public safety posed by forensic patients are defining features of forensic mental
health programs and services (FMHPS). Recidivism, whether it is of a general kind (e.g., theft) or of a more serious nature
(e.g., sexual assault, murder), is of marked concern for those working in the forensic mental health system. There are implicit
as well as explicit expectations that FMHPS will implement safeguards to prevent mentally disordered offenders from continuing
to engage in criminal, especially violent, behaviour. According to Webster, Douglas, Belfrage, and Link (2000), “risk management
is the task of constructing social and physical environments that, in combination with knowledge of the individual’s assets
and liabilities, will likely lead to substantial reduction in violence potential.” (p. 127-128). Risk assessment and risk
management principles will be integral in developing an appropriate accountability framework for FMHPS.
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While risk management is central and critically important, FMHPS are also expected to provide a program of rehabilitation
to the offender and to support their re-integration into the community. Such expectations are codified in the governing legislation. Section
672.54 of the CCC states that the court or board shall make the disposition that is the "least onerous and least restrictive
to the accused" taking into account the four principles enumerated in the section:
- the need to protect the public from dangerous persons;
- the mental condition of the accused;
- the reintegration of the accused into society;
- the other needs of the accused.
In turn, the court or the Ontario Review Board (ORB) passes these expectations and directions on to the designated hospitals
responsible for providing FMHPS. As part of ORB dispositions, the designated hospital is ordered to create a program for the
detention in custody and rehabilitation of the accused person, taking into account the need to protect the public from dangerous
persons, and the need to reintegrate the accused person into society.
Therefore, to be considered effective, FMHPS must balance the need to protect the public from the criminal acts of forensic
patients on the one hand against the needs of the forensic patient for rehabilitation, community reintegration, and liberty
on the other. FMHPS would be considered to be successful if they effectively rehabilitated the mentally disordered offender
allowing for the person to be re-integrated into the community without recidivism or harm to the public. This suggests that
performance indicators of FMHPS will include indicators of failure (criminal recidivism; violent re-offence) and indicators
of success (patient release from in-patient custody to community living; discharges from the forensic mental health system).
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This report was intended to evaluate the evidence-base concerning assessment, management, and treatment of forensic clients
while in a hospital or community setting. Thus, several areas of related interest were excluded. These included:
- Forensic assessments upon entering the system (e.g. fitness to stand trial, or criminal responsibility)
- Criminally-sentenced mentally disordered offenders
- Prevention of criminalization of the mentally ill
- Best practices in non-forensic mental health
- Governance of forensic mental health services
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Section I - Background, Purposes, Method and Organization
Section II - Definitions of FMHPS in Ontario
Centre for Addiction
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