Dynamic and Static Factors Associated with Discharge Dispositions: The National Trajectory Project of Individuals Found Not Criminally Responsible on Account of Mental Disorder (NCRMD) in Canada

Abstract

The majority of individuals found not criminally responsible on account of mental disorder (NCRMD) in Canada spend some time in hospital before they are conditionally or absolutely (no conditions) discharged to the community by a legally mandated review board. By law, the decision to conditionally discharge an individual found NCRMD should be guided by the need to protect the public, the mental condition of the accused, and the other needs of the accused, especially regarding his/her community reintegration. At the time of this study, Canadian legislation and case law required that the review board disposition should be the "least onerous and least restrictive" possible for the accused. This means that, if there is no evidence that the person poses a significant risk to public safety, he/she must be released. However, the Canadian Criminal Code does not specify the criteria that must be considered when making this risk assessment. This leads to two questions. (1) What predicts review board dispositions? (2) To what extent do disposition determinations reflect evidence-based practices? The present study examined dynamic and static predictors of detention in custody, conditional discharge (CD), and absolute discharge (AD) dispositions among persons found NCRMD across the three largest provinces in Canada. The National Trajectory Project (NTP) examined men and women found NCRMD in British Columbia (BC), Québec (QC), and Ontario (ON) between May 2000 and April 2005, followed until December 2008. For the purposes of this study, individuals who had at least one hearing with a review board were extracted from the NTP dataset (N = 1794: QC = 1089, ON = 483, BC = 222). Over the course of the study, 6743 review board hearings were examined (QC = 3505, ON = 2185, BC = 1053). Despite advances in the risk assessment field, presentation of a comprehensive structured risk assessment to the review board was not the norm. Yet our findings suggest that review boards were taking into account a combination of empirically validated static and dynamic risk factors, as represented by the items of the HCR-20 risk assessment scheme. Particular attention was being paid to the behavior of the patient between hearings (e.g., violent acts, compliance with conditions). Severity of index offense was associated with review board decisions; though index severity is not related to recidivism, it is an important consideration in terms of public perceptions of the justice system and can be related to better established risk factors (i.e., criminal history and prior violence). Historical factors had more influence on the decision to detain someone, while clinical factors were more influential on an AD decision. Disposition stability was the most common trajectory, meaning that a patient with a prior CD disposition was most likely to receive another CD disposition at the next hearing. Static and dynamic risk factors found in the HCR-20 influenced review board determinations, although presentation of a complete structured risk assessment is the except...

Factors Associated with Review Board Dispositions following Re‐hospitalization among Discharged Persons found Not Criminally Responsible

“…Under a conditional discharge, the person returns to the community, but remains under the jurisdiction of the Review Board and is subject to specific conditions set by the Review Board. Examples of such conditions include residing in a specified place (e.g., supervised group home), refraining from using drugs and/or alcohol, following treatment recommendations, and travel restrictions (for more information, see Crocker, Nicholls, Charette, & Seto, ; Wilson et al, ).…”

“…To determine the appropriate disposition, the Review Board must rely on information that is presented for the hearing and conduct an individual assessment (s. 672.51, Criminal Code, ). Generally, the reports and the expert evidence provided to the Review Board offer information pertaining to the individual's mental and physical health, behavior, adherence to treatment/medication, and any notable events or behavior that occurred since the previous hearing (see Crocker et al, ; Wilson et al, ).…”

Methodological development of the Hoeven Outcome Monitor (HOM): A first step towards a more evidence based medicine in forensic mental health

“…For example, it was shown that the historical HCR-20 scale , living arrangement (Marshall et al, 2014;Novosad et al, 2014), financial resources, personality disorder, substance use disorder and number of incidents in the CR programme, were related to revocation of CR (Manguno-Mire et al, 2014). As highlighted by several scholars (Crocker et al, 2014;Gowensmith et al, 2014;Green et al, 2014;Manguno-Mire et al, 2014), more research into empirically validated CR related risk and protective factors is needed to provide the clinical and legal practice with an empirical basis to standardize the decision-making process into CR and to develop successful CR programmes. The HOM meso-measurements can provide for this much needed evidence based working model to research empirically validated factors to augment our empirical understanding of CR patients as to enhance CR risk assessment and management programmes.…”

“…This need to research different types of discharge by means of empirically supported methods to provide for a more efficient and effective treatment, is more readily stressed in a recent special issue of Behavioral Sciences and Law (32 (5), 2014) into the practices and outcomes of conditional release (CR) of criminal offenders with mental illness (Vitacco, Green & Felthous, 2014). To complement the lack of consensus in the clinical and legal practice of CR readiness risk assessment and management, these studies focused on (1) assessing risk and improving methodologies for evaluating CR readiness (Crocker, Nicholls, Charette & Seto, 2014;Douglas, 2014;Gowensmith, Bryant & Vitacco, 2014;Green et al, 2014) and (2) success and failure of CR (Manguno-Mire, Coffman, DeLand, Thompson & Myers, 2014;Marshall, Vitacco, Read & Harway, 2014;Novosad, Follansbee, Banfe & Bloom, 2014), to explore and validate empirically based CR related risk and protective factors for the development of standardized assessment protocols. Overall, these studies showed that a number of static and dynamic risk and protective factors were associated with failure and success of CR.…”

Research Priorities in Mental Health, Justice, and Safety: A Multidisciplinary Stakeholder Report

“…A major spark for this meeting was the reaction of the scientific community and of mental health and legal stakeholders when the Canadian federal government introduced the Not Criminally Responsible Reform Act (formerly introduced as Bill C-14 and C-54, 2013). Some elements of the Act, particularly the "high-risk" designation and dispositions, run counter to the scientific evidence on the trajectories of Canadian individuals found NCRMD (see papers from the National Trajectory Project, which are available at https://ntp-ptn.org in open access, as part of a special issue of Canadian Journal of Psychiatry: Charette et al, 2015;Crocker, Nicholls, Seto, Charette et al, 2015a;Crocker, Nicholls, Seto, Charette et al, 2015b;Nicholls et al, 2015; see also Crocker, Nicholls, Charette, & Seto, 2014;Salem et al, 2015;.…”