CAMH has a forensic mental health program. Here we provide some background about the forensic mental health system in Canada and about the role that CAMH plays within that system.
Forensic Mental Health
The mental health system is the network of people and services that care for people with mental illness. If people who have a mental illness come into contact with the law, they could become involved with the forensic mental health system. In the mental health system, “forensic” means “connected to the law or the courts.”
The criminal justice system includes the courts, the institutions and the professionals that deal with people accused or convicted of crimes.
Under Section 16 of the Criminal Code of Canada, a person is Not Criminally Responsible (NCR) of a crime if a mental disorder prevented them from either understanding what they were doing at the time of the offence or knowing their actions were wrong.
When a court determines a mental illness caused a person to commit an offence, the person is typically ordered to a hospital with a forensic mental health program like CAMH—not prison—to be treated for the causes of their offending behaviour. The forensic mental health system in Canada is separate and apart from the correctional system.
While at a hospital like CAMH, people who have been found NCR are subject to the jurisdiction of provincial Review Boards, not the courts. Review Boards are independent decision-making bodies comprising medical and legal experts. In Ontario, this is the Ontario Review Board (ORB).
Each person found NCR has a hearing before a Review Board. After considering evidence about the individual’s mental condition and risk factors, the Review Board issues a “disposition.” A disposition is a legal order that discharges the individual absolutely without restrictions, or discharges them into the community subject to certain conditions, or orders them to a hospital.
If a Review Board orders a person to a hospital, the disposition will set out a range of privileges potentially available to the individual. This can include supervised passes on hospital grounds or unsupervised passes into the community, once they reach a defined level of stability.
CAMH’s Forensic Program
CAMH’s forensic mental health program carries out the supervision, treatment and recovery of people found NCR. Our management of the individual must be in accordance with the terms of the disposition the ORB has ordered. The process of recovery can be a slow and cautious one.
Society has decided the goal of the forensic mental health system should be to treat people’s mental illness so they can recover and eventually reintegrate into the community. Typically, forensic patients at CAMH are supervised and treated for several years, normally much longer than would be the case in the criminal justice system.
Privileges and Passes
When forensic patients initially come to a hospital like CAMH, they typically stay on secure units while staff work with them to understand their illness, their treatment needs and to develop a unique rehabilitation and recovery plan within the parameters of the disposition issued by the ORB.
Once forensic patients have reached a certain level of stability, which can take several months to years, they may be permitted to access the privileges contained in the disposition ordered by the ORB. This usually starts with staff escorted passes for activities that take place on the CAMH campus.
Passes to leave a forensic mental health unit—either supervised or unsupervised—are only permitted if the individual meets criteria based on a thorough risk assessment performed by specialists. All passes must be reviewed by senior members of the CAMH forensic mental health program.
If a forensic patient leaves the hospital without permission to do so, or does not return to hospital, CAMH has a duty to notify the police as soon as possible.
Following this, police decide whether to issue a public notification. There are many factors that may affect police decisions to notify the public, including how well the person is doing in their recovery.
CAMH takes its duty to protect public safety very seriously. We also have an obligation to fight prejudice and discrimination against people with mental illnesses.
There is a myth that all people with mental illness are dangerous or violent. This is not true. Mental illness is like physical illness—it can affect anybody. Some people with mental illness can be violent. So can people who do not have a mental illness. Some people in the forensic mental health system are there because they have been violent. Non-violent offences also bring people into the forensic mental health system. These offences may include mischief, theft or breaching a court order.
It’s important to remember that because the offence is a product of the illness, and that illness is treatable, the risk that the person poses when they’re receiving care is not the same as it was in their past. Their rate of criminal recidivism is very much reduced compared to people in the criminal justice system, and people found NCR have especially low rates of severe violent recidivism. The result is that the community is much safer for the existence of the disposition and the ORB supervised pathway for secure recovery.
People being treated for mental illness as part of the forensic mental health system can and do recover, and the overwhelming majority are at low risk to reoffend. The recidivism rate for people designated NCR is low compared to other offenders. The recidivism rate for people found NCR in Canada is 17 per cent after three years of rehabilitation in the forensic mental health system. Those who are found NCR for a severe offence have an even lower rate of recidivism at six per cent after three years of rehabilitation . In comparison, the recidivism rates in the correctional system are known to range from 23 per cent to 37 per cent. 
 Charette, Y., Crocker AG., Seto, MC, Salem, BA, Nicholls, TL & Caulet, M. (2015). The National Trajectory Project of Individuals Found Not Criminally Responsible on Account of Mental Disorder in Canada. Part 4: Criminal Recidivism.
The Canadian Journal of Psychiatry, 60(3), 127-134. Retrieved from: https://www.ncbi.nlm.nih.gov/pubmed/25886688