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Corrections
Forensic Psychiatry Division | CAMH Research
Corrections
The Corrections group focuses on understanding why certain groups of individuals with severe mental illness are overrepresented in, and often first diagnosed within, the criminal justice system. They are often incarcerated for relatively minor offenses, offenses related to substance use, and minor offenses against judicial orders. This may result in repeated periods of brief incarceration, which can cause fracturing of community ties such as housing, income support and access to psychiatric care. Using the Screening, Triage, Assessment, Intervention and Re-integration (STAIR) care pathway as a framework, researchers work to understand cognition, course of illness, and interventions to promote reintegration into the community and reduce re-offending. Our researchers also design education and mental health interventions to ensure individuals working in the corrections system are well-supported.
Grants
1) American Academy of Psychiatry and Law – Institute for Education and Research
Roland Jones (PI); Co-Investigators: Sandy Simpson, Cory Gerritsen, Stephanie Penney, Margaret Maheandiran: Change in Severity of Mental Disorder for Individuals in Custody in Segregation/Separate Confinement;
($15,647.66 USD; 1 year)
The Problem: Confinement is used for various reasons in correctional settings including safety and discipline. This practice may have negative impact on inmates’ mental health.
Our goal: We will conduct time series analyses to understand the impact of confinement practices on the mental health of persons in custody using data from over 4000 men and women in British Columbia Correctional Institutions. Our findings will help inform confinement policies and support inmate wellbeing.
2) PSI Foundation Clinical Research Competition
Sandy Simpson, Roland Jones (PIs); Co-Investigators: Cory Gerritsen, Mark Sinyor, Clement Ma: A Population Study of Completed Suicide in Ontario Provincial Corrections: 2007-2023;
($163,500; 2 yrs)
The problem: Compared to the general population suicide rates are several times higher among persons in custody even those awaiting trial. A thorough understanding of these risk groups is crucial for developing effective interventions for addressing the needs of individuals in crisis, and preventing the occurrence of tragic incidents.
Our goal: We will analyze data from Coroner’s reports and jail health records to identify potential risk factors. The Ministry of the Solicitor General (SOLGEN) has progressively implemented a range of policies aimed at suicide reduction during the period of study. We will investigate whether these policies have impacted suicide rates.
Paper Summaries
Reintegration after incarceration for people with mental illness: A pilot Community Mental Health Bridging Service
What: There are high rates of reincarceration among people with mental illness released from correctional facilities. A community mental health service was designed to provide continuity of care and immediate access to community mental health support and psychiatric care.
So What: Community reintegration mental health services following incarceration can prevent return to custody, by helping to address continuity of clinical care including prescribing of medication, and support in obtaining housing and other social support.
Now What: Evaluation of patient outcomes and service effectiveness at 6 and 12 months is being carried out to report on effectiveness and lessons learned from the first year of the service.
Recent Publications
Change in severity of mental disorder of remand prisoners: An observational group-based trajectory study
Roland Jones, Cory Gerritsen, Margaret Maheandiran, Stephanie Penney, Sandy Simpson
The Canadian Journal of Psychiatry. 2023;68(6):418-425.
Link to Publication
This study looks at the course of mental health symptoms during an individual’s care in the Forensic Early Intervention Service (FEIS) in two Toronto jails. We were able to identify three separate trajectories of change using group-based modelling separated by their level of illness at admission. Although all groups showed some improvement, a significant number of individuals continue to have moderately severe symptoms. There is a need for adequate detection of mental disorders and appropriate treatment within jails, but also the need for timely transfer to hospital for those with severe symptoms. Our group is further researching the effectiveness of hospital care for these severely ill individuals.
A systematic review of reviews of correctional mental health services using the STAIR Framework
Sandy Simpson, Cory Gerritsen, Margaret Maheandiran, Vito Adamo, Tobias Vogel, Lindsay Fulham, Tamsen Kitt, Andrew Forrester and Roland Jones
Frontiers in Psychiatry, 2022, 12, 747202.
The STAIR (Screening, Triage, Assessment, Intervention, and Re-integration) model is an evidence-based framework that defines and measures correctional mental health services as a clinical pathway. Our team reviewed the data on all measures and programs that align with the STAIR pathway. We found that there is a large body of studies on correctional mental health services. However, more research is needed on care pathways as a whole and in particular on interventions for severe mental illness and community reintegration programs.
Current Studies
Criminal justice involvement in first episode psychosis
This study aims to understand demographic, historical, personality, social and cognitive differences in people that receive care for early psychosis in jail compared with those who access care through civil routes. A better understanding of the variables which differentiate these two groups can help plan interventions to get people care before they enter the jail system.
Reintegration programs for people with SMI released from correctional institutions: A systematic review
The STAIR review identified gaps in care, particularly with reintegrating people being released from prison into the community. This systematic review will assess all available studies on the effectiveness of such programs that provide support during this transition.
Impact of segregation on mental health
The Clinical Global Impression Scale for Corrections (CGI-C) was developed by our team to both measure overall mental health symptom severity of individuals in correctional settings, and be used by clinicians of different disciplines. This study looks at how segregation, or solitary confinement, impacts mental health symptom severity (CGI-C scores) in a sample of 4,700 individuals in the British Columbia Corrections system.
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