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.
CAMH called for an external review into its system of passes and privileges for forensic patients. You can read the report, its recommendations and the CAMH Action Plan here.
Forensic Mental Health
The mental health system is the network of people and services that care for people with mental illness.
The criminal justice system includes the courts, the institutions and the professionals that deal with people accused or convicted of crimes.
If people who have a mental illness come into contact with the law, they could become involved with the forensic mental health system. Here, “forensic” means “connected to the law or the courts.” Forensic mental health is still one of the most misunderstood and stigmatized aspects of the health care system.
When a court determines a mental illness caused a person to commit an offence (i.e. they have been found Not Criminally Responsible (NCR) or unfit to stand trial), the person is typically ordered to a hospital with a forensic mental health program like CAMH—not prison—to receive mental health care. The forensic mental health system in Canada is separate and apart from the correctional system.
While receiving mental health care at CAMH, forensic patients are subject to the jurisdiction of the Ontario Review Board (ORB) - an independent decision-making body comprising medical and legal experts. The Review Board issues a legal order called a “disposition” that sets out a range of privileges potentially available to the individual. This can include supervised passes on hospital grounds or unsupervised passes into the community, depending on their recovery.
CAMH’s Forensic Program
CAMH’s forensic mental health program provides mental health care to patients found NCR or unfit to stand trial.
The goal of the program is to treat patients’ mental illness so they can recover and eventually reintegrate into the community. Typically, forensic patients at CAMH receive treatment over several years.
Privileges and Passes
Each forensic patient at CAMH has a unique rehabilitation and recovery plan that is guided by the terms set out in their disposition from 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 certain privileges that the ORB has granted them. This ladder of privileges starts with staff escorted passes for therapeutic activities that take place on the CAMH campus with the goal of reintegrating into the community.
Authorized passes are a critical element of the treatment and recovery process for forensic mental health patients.
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.
Unauthorized Leaves of Absence (ULOA)
If a forensic patient leaves the hospital without permission to do so, or does not return to CAMH from a pass, CAMH has a duty to notify the police as soon as possible.
CAMH must adhere to legislation that governs the personal health information of our patients. Law enforcement determines whether or not to enlist the public’s assistance to locate patients that are required to return to hospital to continue mental health treatment.
There are many factors that may affect police decisions to notify the public, including how well the person is doing in their recovery.
1 in 3,000 passes issued by CAMH results in a forensic ULOA. Of that 1 in 3,000 – one third are late returning from a pass.
In the summer of 2019, CAMH called for an external review into its system of passes and privileges for forensic patients. You can read the report, its recommendations and the CAMH Action Plan here.
CAMH takes its duty to protect public safety very seriously.
Forensic mental health is one of the most misunderstood parts of the health care system, and we 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. For some people with mental illness, violence is directly related to the acute symptoms they are experiencing. Illnesses and symptoms respond to health care treatment, so the risk that the person poses when they’re receiving health care is not the same as it was in their past, or at the time of an offence.
Some people in the forensic mental health system are there because they have been violent, but non-violent offences also bring people into the forensic mental health system. These offences may include mischief, theft or breaching a court order.
The rate of criminal recidivism in the forensic system 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
This page was last updated December 2019.