While it’s unlikely for a person with mental illness to be involved in a serious or violent crime, Dr. Stephanie Penney believes it is possible to prevent these rare incidents.
“Such serious offences occur at a critical time point in the person’s life,” says Dr. Penney, Independent Scientist and forensic psychologist at CAMH. “In many cases, it will be the first and only offence for the person.”
Through an ongoing study, she aims to understand what leads to this critical point by establishing a detailed chronology of the hours and days preceding an offence. The study will involve at least 75 individuals currently in the forensic service at CAMH – that is, individuals with mental illness who are involved with the criminal justice system. The information will be used to identify symptom profiles and patterns of behaviour among these patients. And ultimately, the results can serve to educate family or caregivers and identify warning signals in advance of a potentially more serious event.
Already, it’s well established that certain conditions or circumstances increase the risk of a person committing a serious offence, such as a lack of support, not taking medication, or having a substance use problem. But, she notes, “risk factors can change day by day, so you often can’t point to one specific factor that led to the offence. Our approach will show how the risk factors materialize in real time.”
After an offence, as a person works through the justice system, they may be deemed Not Criminally Responsible on account of Mental Disorder (NCRMD) and diverted into the forensic mental health system under the authority of the Ontario Review Board.
As soon as possible after this point, Dr. Penney and her team are stepping in to interview these patients. This approach is what makes this study unique, as typically such research interviews occur long after an event, when details are forgotten.
“We’re assessing their motivation for offending and violence. We ask simple questions about the offence, such as ‘Why do you think you did this? Were you taking medications? Were you seeing a mental health professional?’” For those who’ve had previous contact with a mental health professional, issues such as follow-up or time between health-care visits will be further probed.
Initial study results suggest there are three profiles of forensic patients with distinct motivations, circumstances and behaviours, each of which could be identified and targeted in different ways. One group, the minority, engages in criminal activity for conventional reasons, such as stress, anger or financial distress, says Dr. Penney. For another group, substance abuse is the primary factor. And for a third group, the offence is directly related to symptoms of their illness, such as psychosis.
Dr. Penney anticipates the research will have the most benefit for those close to patients. “Forensic patients offend most often not against strangers, but against their families or caregivers.”
Once a forensic patient has been discharged by the Ontario Review Board, 97 per cent do not re-offend in a violent manner, notes Dr. Penney.
She has also investigated the idea of capturing risk factors at multiple time points in her past research, on a study of forensic patients ready to move back into the community. In such cases, experts systematically address the risks to both the patient and the community before discharge. This study, published in Law & Human Behavior, also reinforced the importance of assessing risks at different points in time.