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Risk and Recovery

Forensic Psychiatry Division | CAMH Research

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Risk and Recovery

Forensic psychiatric patients are among the most complex and stigmatized users of mental health services, and there are still many questions about best practices for recovery and rehabilitation. The Risk and Recovery pillar aims to advance knowledge of risk factors associated with violence, offending and other adverse outcomes among forensic patients, as well as factors that promote recovery, resilience and successful community outcomes. Our overarching research objectives are to understand the causes of violence and offending in individuals with major forms of mental illness, to enhance the science and clinical practice of violence risk assessment, and ultimately, improve service delivery and mental health outcomes. We also undertake research into the broader health system in which forensic patients receive care. Here, we seek to understand the causes of the rapid growth in demand for forensic mental health services in Ontario— and indeed, most of Canada — over the last two decades, as well the patterns of healthcare utilization and re-offending after patients are discharged from the system.


Grants

 


1) CIHR Operating Grant: National Women’s Health Research Initiative

Stephanie Penney, Tonia Nicholls (PIs), Co-Investigators: Ipsita Ray, Smita Vir Tyagi, Adeyo Alabi, Lucy Barker, Liam Dodge, Juliette Dupre, Cory Gerritsen, Roland Jones, Alexander Simpson, Treena Wilkie, Lisa Monchalin, Martha Kahnapace: What are the unique mental health needs of women in correctional and forensic mental health settings? A virtual community of practice model;
($583,022; 3 yrs)

The Problem:  Justice-involved women present with unique mental health needs and carry a greater burden of illness when compared to men; they suffer higher rates of childhood adversities, intimate partner violence and sexual victimization.

Our Goal: Bring together a hub of experts from academia, clinical practice, community partners, and persons with lived and living expertise to co-produce, disseminate and translate research evidence into improved health policies and best practice guidelines for justice-involved women.

2) American Academy of Psychiatry and Law – Institute for Education and Research

Treena Wilkie (PI); Co-Investigators: Sumeeta Chatterjee, Roland Jones, Sandy Simpson, Lisa Ramshaw, Gary Chaimowitz: Factors impacting Recruitment and Retention of Forensic Psychiatrists in Ontario;
($12,320.52 USD; 1 year)

The Problem: The expertise of forensic psychiatrists is highly specialized, and is based on training, clinical experience, and scholarship. In Ontario, there is an increasing demand for forensic psychiatrists in secure hospitals and correctional settings.

Our Goal: We will gather perspectives through surveys and interviews from Forensic Psychiatrists and psychiatry residents to understand factors important for job selection and satisfaction.  Data from this project will help to model future need for forensic psychiatrists and make recommendations to the provincial forensic system. 

3) American Academy of Psychiatry and Law – Institute for Education and Research

Treena Wilkie, Stephanie Penney (PIs); Co-Investigators: Maryana Kravtsenyuk, Ipsita Ray, Sumeeta Chatterjee: Factors Contributing to Absconding from Forensic Mental Health Care;
($23,059 USD; 1 year)

The Problem: Absconding events or unauthorized leave from the hospital can pose significant risks to patient safety, and often delay recovery efforts.  This is particularly concerning in forensic mental health services where patients are mandated to be in a secure therapeutic setting.  Absconding events that gain media or government attention can significantly erode public confidence in the system and contribute to stigmatizing and restrictive practices.

Our Goal:  We will gather perceptions of both patients, staff and forensic division leadership on an every absconding event over the next two years as well as examine impact of risk and behavioural factors measured within days to weeks of an absconding event. Our findings will inform institution and systems-level policies and interventions to better manage the risk of absconding behaviour, and ultimately, improve patient care and public trust.   


Current Studies

 

The impact of cannabis legalization on the forensic mental health patient population in Ontario  
The purpose of this study is to better understand the potential harms and health-related impacts of cannabis legalization on users of forensic mental health services in Ontario. In particular, we would like to better understand the views of forensic patients and forensic mental health clinicians, as well as decision-makers in the forensic mental health system, about the risks and/or benefits associated with cannabis use among individuals with mental illness. It is hoped that this study will provide new information on the impact of cannabis legalization on forensic service users and help inform policy in a timely manner.

Factors impacting recruitment and retention of forensic psychiatrists in Ontario
The recruitment and retention of forensic psychiatrists is crucial to the future needs and development of the provincial forensic system. In recent years, there have been increasing challenges recruiting forensic psychiatrists to hospital-based forensic programs. This study surveys both forensic psychiatrists and psychiatry residents to understand what is important for them when choosing a career. The results will inform improvements to forensic psychiatry programs that increase job satisfaction. 

Motivational influences and trajectories to violence in the context of major mental illness 
Despite growing evidence that certain forms of mental illness are statistically correlated with violence, surprisingly little is known about if, how and how often specific illness symptoms actually motivate incidents of violence. This study will advance knowledge in this area by assessing motivations for violence among offenders with serious forms of mental illness, identifying the primary illness and non-illness related variables connected to acts of violence. It is hoped that studying these factors will lead to better prevention of offenses, and better identification of early warning signs and unmet treatment needs. 

Culture is protection: A gathering on cultural connectedness as a protective factor in youth violence prevention
 Indigenous youth are grossly overrepresented at all stages of the criminal justice system. Current risk assessments have been criticized for being biased and insensitive to the cultural and historical factors experienced by these youth. This study will bring together Indigenous and non-Indigenous researchers, knowledge users, and Indigenous youth with lived experience to build consensus on the meaning and role of cultural connectedness in Indigenous youth violence prevention. The group will also capture research priorities and build partnerships and plans for an Indigenous-led research agenda to explore the identified priorities.

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