Lecture 12 - Forensics

Question 1

What is the role of forensic nursing?

Answer 1

Brings together components of traditional nursing care and legal issues to serve victims of violence and individuals who have committed acts that have brought them into contact with the criminal justice system.

Question 2

What is the sequential intercept model?

Answer 2

A model consisting of the 0-5 levels of intercept in the criminal justice system

Question 3

What occurs during intercept 0 of the sequential intercept model?

Answer 3

Community Services
–> Crisis lines and the crisis care continuum

Question 4

What occurs during intercept 1 of the sequential intercept model?

Answer 4

Law Enforcement
–> A 911 call in made and local law enforcement responds
–> May be accompanied by nurse or SW

Question 5

What occurs during intercept 2 of the sequential intercept model?

Answer 5

Initial Detention/Hearings
–> The initial detention is made before a person’s court appearance and a decision is made regarding conviction.

Question 6

What occurs during intercept 3 of the sequential intercept model?

Answer 6

Jails/Courts
–> After being convicted or found NCR, the person is put in jail, a dispositional court, or a specialty court.
–> Person may be diverted to a treatment facility

Question 7

What occurs during intercept 4 of the sequential intercept model?

Answer 7

Reentry
–> Without community support, the person can cause harm to self or others that results in reentry to the system

Question 8

What occurs during intercept 5 of the sequential intercept model?

Answer 8

Community Corrections
–> parole and probation

Question 9

What is the purpose of a treatment order?

Answer 9

To attain fitness to stand trial

Question 10

What does it mean for a person to be unfit to stand trial?

Answer 10

Being unable to conduct a defense on account of mental disorder.

Assessment of fitness relates to assessing the following three factors:
1. Understand the object of the proceeding
2. Understanding the possible consequences of the proceedings
3. Communicate with counsel

Question 11

How long is a person held for an assessment of fitness?

Answer 11

They are assessed on a five day hold
–> Maximum hold is 60 days

Question 12

What is a treatment order?

Answer 12

If a person is unfit to stand trial the court must decide what is necessary to make the person fit to stand trial.
–> Goal is to make fit not treat all issues
–> potential harm must not outweigh anticipated benefits, and treatment must be least restrictive and least intrusive.

Consent is not needed.

Question 13

How long is a criminal responsibility assessment?

Answer 13

30 days

Question 14

In what order must assessments in the mental health court be done?

Answer 14

Fitness trial must be completed firstly and separately from a criminal responsibility assessment

Question 15

According to Canadian law, no person is criminally responsible for an act committed while suffering from a mental health disorder that rendered the person incapable of appreciating the nature and quality of the act.
What situations does this not apply to?

Answer 15

Exclusions include self-induced intoxication and mental disorders that do not alter the appreciation of what is good and bad - such as paraphilias and PDs
–> If a person has drugs in their system but the primary precipitating factor was mental illness, they are still considered for NCR determination (such as a pt with schizophrenia who used cannabis)

Question 16

What disorders are commonly seen in persons who are NCR or UST?

Answer 16

Psychotic spectrum disorders
–> 75%

Manic phase of bipolar

Developmental and cognitive impairments

Comorbid PDs
–> ASPD + Schizophrenia
–> NPD

Comorbid substance use

Question 17

What are possible risks to being held in the forensic psychiatric system?

Answer 17

Long Institutionalization
–> Resulting in loss of social abilities

Risk of violence + risk of being abused

Question 18

What is the purpose of a provincial review board?

Answer 18

To make and or review the disposition orders for persons who are NCRMD or UST

Question 19

Which five members must be present in a provincial review board?

Answer 19

The chair
–> must be a judge, a retired judge, or a person qualitied to a juridical office

two psychiatrists
–> Or one and at least one other member with training and experience in mental health and qualified to practice psychology or medicine

A lawyer

A member of the public

Question 20

What is the purpose of review board hearings?

Answer 20

Every year these parties present evidence to demonstrate if the person poses a significant risk to safety of the public. The goal is to ensure public safety.

Question 21

With what information with a review board hearing use to decide if a person is a risk to public safety?

Answer 21

The hospital (Attendings Psychiatrist) will provide a review to the board before the hearing

The crown will provide a CPIC

Defense attorney will provide evidence for the patient

Patient sits with them

Question 22

How long should there be between an NCR determination and an ORB review?

Answer 22

90 days - in practice this is stretched

Question 23

How do we assess the significance of threat to safety to the public, according to Winko v BC’s decision?

Answer 23

1. The nature of the harm that may be expected
2. The degree of risk that the particular behaviour will occur
3. The period of time over which the behaviour may be expected to manifest itself
4. The number of people who are at risk

Question 24

What is a detention order?

Answer 24

When a person is considered detained by the hospital
–> Allows for involuntary admission of the person to the hospital without having to utilize provisions within provincial MHAs.

Question 25

What is a conditional discharge?

Answer 25

The person is considered discharged under conditions, and therefore if the hospital desires to admit the person, they must utilize provisions of the MHA (forms 1, 3,4)

Question 26

When making a disposition during a review board, which factors play into account?

Answer 26

Primary: The safety of the public

Additionally:
mental health condition of the accused, reintegration of the accused into society, and the other needs of the accused

Question 27

What are the three dispositions that can be made be made by a provincial review board?

Answer 27

Absolute Discharge
Conditional Discharge
Detention Order (Inpatient)

Question 28

Which two documents must be published by the review board after a review hearing?

Answer 28

Disposition
Reasons for disposition
–> Justification for decision being the least onerous and least restrictive

Theses documents are public access

Question 29

With what information is the reasons for disposition report created?

Answer 29

Hospital report, medical and family information obtained by social worker, notes from nurses and psychiatrists.

These reports are often reported verbatim from confidential information into public access Reasons for Disposition Report

Question 30

What did Domingue et al. identify concerning the network of nurse observation and documentation?

Answer 30

Nurses’ practice is vital for persons determined to be UST/NCR. The information collected and documented by nurses is used as justification for dispositions in PRB hearings and is then used to legitimate the application of disciplinary measures against patients.

Question 31

What did Morse determine concerning support for victims of sexual assault within the current system?

Answer 31

Specialized support of victims and advocates is needed for post-sexual assault care. This is especially important when we consider that the system under which this care operates presumed that an uncertain event has occurred and requires a very high standard of evidence that is uncertain to be met.

Question 32

What is Martin et al. identify regarding the role of contemporary forensic mental health nursing?

Answer 32

Mental health nurses need to acknowledge and incorporate a hybrid view of forensic MH nursing as both a legal and healthcare tole. They have responsibilities related to professional nursing requirements, correctional service demands, community expectations, and the needs of forensic service patients. Nursing need to understand that forensic MH nursing is more than simply practicing mental health nursing in a forensic context.