Week 10: Introduction to Forensic Mental Health

Question 1

Disposition

Answer 1

• set of rules, expectations and limitations that will apply to the patient for next year
• may permit patient to independently enter or live in community w/ forensic

Question 2

ORB

Answer 2

• Ontario review board
• authority that detains patients
• determines and issues disposition for the patient
• hospital provides a report and testimony to the ORB & ORB makes a determination for that patient disposition for the next year

Question 3

fitness to stand

Answer 3

• ability to go through trial and communicate what they want to do with their case

Question 4

Index offence

Answer 4

• crime severity (volume and seriousness)
• vicarious trauma, transference and counter transference

Question 5

vicarious trauma

Answer 5

emotional residue of exposure to traumatic stories

Question 6

transference

Answer 6

patient views nurse as similar to an important person in their life (you remind me of my mother)

Question 7

countertransference

Answer 7

nurse unknowingly transfers their unresolved thoughts, feelings, and emotions onto a client (a patient reminds nurse of a family member who disappointed them and transfers that disappointment onto the patient)

Question 8

Absolute discharge

Answer 8

• legal discharge provided by the ORB

Question 9

Compassion-care paradox

Answer 9

• establishing/maintaining therapeutic rapport while upholding legal restrictions
• patients may not believe nurses hold their best interest and may be suspicious of treatment team and view them as representatives of a system that enforces their confinement
• no individual confidentiality between treatment team and court (might not want to share)

Question 10

pre-1992

Answer 10

• only options were acquittal or conviction
• acquitted on the basis of insanity
• mandatory detention at the pleasure of the Lieutenant Governor
• automatic detention for indefinite period

Question 11

post-1992

Answer 11

• inclusion of the Ontario Review Board who must determine if person is a significant threat to the safety of the public
• if not a threat, then must be granted absolute discharge
• if that threshold is met, Review Board must grant disposition that is least restrictive

Question 12

4 factors taken into consideration for process for review

Answer 12

• public safety
• mental status
• reintegration into society
• other needs of the accused that balances with the safety of the public

Question 13

Not criminally responsible (NCR)

Answer 13

no person is criminally responsible for an act committed or an omission made while suffering from a mental disorder that rendered the person incapable of appreciating the nature and quality of the act or omission or of knowing what is wrong

Question 14

Supreme Court of Canada in Winko (1999)

Answer 14

• Winko granted a conditional discharge but appealed requesting an absolute discharge claiming that the criminal code violated his charter rights

Question 15

why did winko loose his appeal?

Answer 15

• didn’t violate charter of rights because:
• didn’t presume danger, nor place an onus on the accused to disprove dangerousness
• restrictions only justified for public protection
• promotes individualized approach to assessment of risk
• goal of treatment rather than punishment
• goal is reintegration of the NCR accused into society and mitigation of risk

Question 16

what does “significant threat” mean?

Answer 16

• a real risk for physical or psychological harm that is serious in the sense of going beyond trivial or annoying
• can’t presume that accused poses a significant threat (onus on board to prove threat)
• harm must be criminal in nature
• risk factors no longer prove harm (substances use, active symptoms, lack of insight)