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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.

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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.

Roland Jones, Cory Gerritsen, Margaret Maheandiran, Stephanie Penney, Sandy Simpson
The Canadian Journal of Psychiatry. 2023;68(6):418-425.

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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. 

Jack Tomlin, Sarah Markham, Ciska Wittouck, and Alexander Simpson, p.00258024231206865.
Medicine, Science and the Law, 2023

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Due to the involuntary nature of their treatment, patients in the forensic system often have decisions made for them. Procedural justice relates to the fairness of processes used by those in positions of authority in the forensic system. This article advocates for forensic mental health services to be provided under a procedural justice framework. This would include shared decision-making where patients are involved in developing their own treatment plans. Such autonomy and “ownership” of treatment has been shown to improve trust in the system and increase compliance — and thus promote recovery. 

Frank Sirotich, Samuel F. Law, Alexander I. F. Simpson, and Arash Nakhost 
Community Mental Health Journal volume 59, pages1352–1363 (2023)

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This study is the first in Canada to examine the relationship between forms of leveraged treatment pressures and personal recovery in outpatient community mental systems. Leverage involves suggesting access to desired resources (e.g. social welfare entitlements and money) or avoidance of some undesired outcome (e.g. criminal sanctions) to encourage adherence to recommended treatment. Leverage is widespread in mental health settings. The authors found that financial leverage was associated with feelings of coercion and negatively related to personal recovery. This suggests the need for further studies to better understand the relationship between different types of leverage and recovery. 

Stephanie Penney, Suraya Faziluddin, Sandy Simpson, Patti Socha and Treena Wilkie
Behavioral Sciences & the Law. 2023 Mar 10. doi: 10.1002/bsl.2615. Epub ahead of print. PMID: 36898979. 

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In this paper we describe a novel, integrated conceptual model that assesses risk for future violence, protective factors and progress in treatment and recovery in forensic mental health settings. We propose that the value of such a model lies in its ability to improve clinical efficiencies and streamline assessment protocols, facilitate meaningful participation of patients in assessment and treatment, and increase the accessibility of clinical assessments to principal users of this information.

Stephanie Penney, Roy Ulrich, Margaret Maheandiran
Journal of the American Academy of Psychiatry and Law. July 2023 doi: 10.29158/JAAPL.220110-22

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This study investigates whether two stalking-specific risk instruments— the Guidelines for Stalking Assessment and Management (SAM) and the Stalking Risk Profile (SRP) — can more accurately predict stalking in forensic patients compared to a well-validated violence risk assessment measure (Historical, Clinical, Risk Management-20, Version 3 (HCR-20V3)). Dynamic risk factors were rated once a year over three years and revealed significant change over time. Results supported the value of stalking-specific risk factors on the SAM and SRP in terms of risk prediction, as well as tailoring risk-management and treatment plans for patients with a history of stalking-related behaviors. The paper also highlights the value of monitoring changing patterns in dynamic risk factors over time.