Forensic patients are people who, because they are unwell, have committed an offence. Because their mental illness caused the offence they are sent to a hospital – not prison – to get treatment and rehabilitation for the causes of their offending. This process of recovery is a slow and careful one, overseen by the Ontario Review Board.
Initially, most patients are confined to secure hospital wards while staff work with them to understand their illness, their treatment needs and to develop a rehabilitation and recovery plan in accordance with their Review Board disposition. During this time, staff members also determine the potential risk the patient has to others, as well as to themselves. Once this is achieved, a gradual plan for increasing privileges is put in place so the person may attend treatment opportunities available off the ward. This may also include passes for recreation and socialization opportunities.
Off-ward passes are only granted if several conditions are met: the Review Board has provided authorization; the patient understands the purpose of the pass; and the patient agrees to the conditions and responsibilities inherent in being given the pass.
Public safety is always a prominent concern.
Excursions initially take the form of brief visits on the grounds of the hospital with two or more staff escorts. If successful, the passes increase in duration and decrease in escort levels until the person can gradually gain unescorted passes into the community.
This system of gradually increasing passes is essential to prepare the person for being able to safely re-engage with the community. This is an important component of the rehabilitation mandate of the forensic mental health system.
Occasionally, a patient may abscond from an escort or not return in a timely manner as stated by the terms of their passes. Under the Review Board system, such patients are declared AWOL and police are informed. Almost all return within a few hours. However, out of concern for them, we and the police may at times feel it is necessary to inform the public that the person is at large.
CAMH has looked hard at why patients abscond and we have done much to improve our decision making to reduce AWOL incidents. We continue to examine these events to further improve our decision making, and we know that the public has not been harmed by patients who have been AWOL, indicating that our risk assessment processes are solid.
The safety of our patients and members of the surrounding community is of utmost concern. Maintaining clear communication and ensuring that public risk is minimized is an important function of our role at CAMH. We also recognize the importance these privileges have in the treatment and rehabilitation of our patients in the forensic system.
For more information on the field of Forensic Mental Health please see The Forensic Mental Health System in Ontario: An Information Guide (PDF)