Changing characteristics of forensic psychiatric patients in Ontario: a population-based study from 1987 to 2012

Penney, Stephanie R.; Seto, Michael C.; Crocker, Anne G.; Nicholls, Tonia L.; Grimbos, Teresa; Darby, Padraig L.; Simpson, Alexander I. F.

doi:10.1007/s00127-018-1619-6

Cited by 44 publications

(31 citation statements)

References 25 publications

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“…We limited the included populations by excluding studies where we expected considerable differences during the inpatient stay or unique discharge situations (e.g., long inpatient stays in forensic settings (23,50) or discharge into homelessness). Nevertheless, the comparability of the included studies was limited by a broad range of interventions and a high number of diverse outcomes and outcome measurements.…”

Section: Strengths and Limitationsmentioning

confidence: 99%

Effectiveness of Transitional Interventions in Improving Patient Outcomes and Service Use After Discharge From Psychiatric Inpatient Care: A Systematic Review and Meta-Analysis

et al. 2020

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Background: The transition from psychiatric hospital to community is often hindered by challenges that influence community adjustment and continuity of care. Transitional interventions with bridging components are provided prior to discharge and continue beyond inpatient care. They provide continuity of care and may be effective in preventing readmission. We aimed to assess the effectiveness of transitional interventions with predischarge and postdischarge components in reducing readmissions and improving health-related or social outcomes of patients discharged from psychiatric hospitals. Methods:We conducted a systematic review by searching electronic databases (MEDLINE, Embase, Cochrane Library, CINAHL, PsycINFO, and Psyndex) and included randomized, nonrandomized, and one-group study designs. A random effects metaanalysis was conducted with randomized controlled trials (RCTs) reporting data on readmission rates. Other study designs were synthesized qualitatively.Results: After screening 2,673 publications, 16 studies (10 RCTs, three quasiexperimental, and three cohort studies) were included and nine RCTs were included in the meta-analysis. The tested interventions included components from case management, psychoeducation, cognitive behavioral therapy, and peer support. All studies with significant improvements in at least one outcome provided elements of case management, most frequently in combination with cognitive behavioral therapy and psychoeducation. Readmission rates during follow-up ranged between 13% and 63% in intervention groups and 19% and 69% in control groups. Overall, we found an odds ratio of 0.76 (95% confidence interval = 0.55-1.05) for readmission due to transitional Frontiers in Psychiatry | www.frontiersin.org January 2020 | Volume 10 | Article 969 1

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Section: Strengths and Limitationsmentioning

confidence: 99%

Effectiveness of Transitional Interventions in Improving Patient Outcomes and Service Use After Discharge From Psychiatric Inpatient Care: A Systematic Review and Meta-Analysis

et al. 2020

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“…Adverse consequences include a reported rise in transinstitutionalization, homelessness, and criminalization of persons with mental illness (96)(97)(98)(99). While there is debate about the extent to which deinstitutionalization has resulted in negative outcomes (100,101), contact with the criminal justice system is now a common experience for persons with mental illness.…”

Section: Trans-institutionalization and The Criminal Justice Systemmentioning

confidence: 99%

The interRAI Suite of Mental Health Assessment Instruments: An Integrated System for the Continuum of Care

et al. 2020

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The lives of persons living with mental illness are affected by psychological, biological, social, economic, and environmental factors over the life course. It is therefore unlikely that simple preventive strategies, clinical treatments, therapeutic interventions, or policy options will succeed as singular solutions for the challenges of mental illness. Persons living with mental illness receive services and supports in multiple settings across the health care continuum that are often fragmented, uncoordinated, and inadequately responsive. Appropriate assessment is an important tool that health systems must deploy to respond to the strengths, preferences, and needs of persons with mental illness. However, standard approaches are often focused on measurement of psychiatric symptoms without taking a broader perspective to address issues like growth, development, and aging; physical health and disability; social relationships; economic resources; housing; substance use; involvement with criminal justice; stigma; and recovery. Using conglomerations of instruments to cover more domains is impractical, inconsistent, and incomplete while posing considerable assessment burden. interRAI mental health instruments were developed by a network of over 100 researchers, clinicians, and policy experts from over 35 nations. This includes assessment systems for adults in inpatient psychiatry, community mental health, emergency departments, mobile crisis teams, and long-term care settings, as well as a screening system for police officers. A similar set of instruments is available for child/youth mental health. The instruments form an integrated mental health information system because they share a common assessment language, conceptual basis, clinical emphasis, data collection

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“…Quota sampling will be used to select a sample of inpatients (n = 60) and outpatients (n = 60) who have had their annual review by the ORB within the last 3 months. Given our prior work detailing the sociodemographic and clinical characteristics of all forensic patients in Ontario ( [35]; described below), we will be able to ascertain whether the current sample is representative of the larger patient population in the province.…”

Section: Setting and Participantsmentioning

confidence: 99%

“…Anticipated sample characteristics may be gleaned from our prior population-based study of all Ontario forensic admissions from 1987 to 2012 resulting in a disposition of NCRMD (N = 2533 [35];). The majority were male (86%), had less than a high school education (48%), and were never married (58%).…”

Section: Setting and Participantsmentioning

confidence: 99%

Perceptions of procedural justice and coercion among forensic psychiatric patients: a study protocol for a prospective, mixed-methods investigation

et al. 2020

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Background: The risk and recovery paradigms are the dominant frameworks informing forensic mental health services and have been the focus of increasing research interest. Despite this, there are significant gaps in our understanding of the nature of mental health recovery in forensic settings (i.e., 'secure recovery'), and specifically, the key elements of recovery as perceived by forensic patients and their treatment providers. Importantly, we know little about how patients perceive the forensic mental health system, to what extent they see it as fair and legitimate, and how these perceptions impact upon treatment engagement, risk for adversity, and progress in recovery. Methods: In this prospective, mixed-methods study, we investigate patient perceptions of procedural justice and coercion within the context of the forensic mental health system in Ontario, Canada (final N = 120 forensic patients and their primary care providers). We elicit patient self-assessments of risk and progress in recovery, and assess the degree of concordance with clinician-rated estimates of these constructs. Both qualitative and quantitative methods are used to assess the degree to which patient perceptions of coercion, fairness and legitimacy impact upon their level of treatment engagement, risk for adversity and progress in recovery. A prospective, two-year follow-up will investigate the impact of patient and clinician perspectives on outcomes in the domains of forensic hospital readmission, criminal reoffending, and rate of progress through the forensic system. Discussion: Results from this mixed-methods study will yield a rich and detailed account of patient perceptions of the forensic mental health system, and specifically whether perceptions of procedural fairness, justice and legitimacy, as well as perceived coercion, systematically influence patients' risk for adversity, their ability to progress in their recovery, and ultimately, advance through the forensic system towards successful community living. Findings will provide conceptual clarity to the key elements of secure recovery, and

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Changing characteristics of forensic psychiatric patients in Ontario: a population-based study from 1987 to 2012

Cited by 44 publications

References 25 publications

Effectiveness of Transitional Interventions in Improving Patient Outcomes and Service Use After Discharge From Psychiatric Inpatient Care: A Systematic Review and Meta-Analysis

Effectiveness of Transitional Interventions in Improving Patient Outcomes and Service Use After Discharge From Psychiatric Inpatient Care: A Systematic Review and Meta-Analysis

The interRAI Suite of Mental Health Assessment Instruments: An Integrated System for the Continuum of Care

Perceptions of procedural justice and coercion among forensic psychiatric patients: a study protocol for a prospective, mixed-methods investigation

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