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

Abstract

In the Canadian forensic mental health system, a person found Not Criminally Responsible on account of Mental Disorder (NCRMD) and given a conditional discharge returns to the community while remaining under the jurisdiction of a provincial/territorial Review Board. However, the individual can be re-hospitalized while on conditional discharge, for reasons such as substance use, violation of conditions, or violence. We investigated whether being re-hospitalized has an impact on the factors associated with the subsequent Review Board disposition. Persons found NCRMD from the three largest Canadian provinces who were conditionally discharged at least once during the observation period were included in the sample (N = 1,367). These individuals were involved in 2,920 disposition hearings; nearly one-third of patients (30%) were re-hospitalized after having been conditionally discharged by the Review Board. The factors examined included the scales of the Historical Clinical Risk Management-20 and salient behavior that occurred since the previous hearing, such as substance use or violence. The greater presence of clinical items resulted in a greater likelihood of a hospital detention decision at the next hearing. The effect was larger for the re-hospitalized group than for the group who successfully remained in the community since the last hearing. The results suggest that dynamic factors, specifically indicators of mental health, are heavily weighted by the Review Boards, consistent with the literature on imminent risk and in line with the NCRMD legislation. Copyright © 2016 John Wiley & Sons, Ltd.

Persons found not criminally responsible on account of mental disorder (NCRMD) for sexual offences: characteristics, risk factors, and Review Board decision making

“…This was particularly true of clinical and risk management related information of the HCR-20 V3 . These findings are consistent with past research that shows the HCR-20 V3 can predict some forms of Review Board decisions (Côté et al, 2012;Wilson et al, 2015;Wilson et al, 2016). This is encouraging, as it does show the potential for Review Boards to integrate risk information into decisions, and suggests that with further research and outreach to Board members, there is the potential for the use of risk information in decisions to continue and improve.…”

“…HCR-20 V3 risk factors on the other hand were predictive of detention orders, absolute discharges, and community living privileges at the last known disposition during the study period. This is once again consistent with past research which shows that information on the HCR-20 V3 can influence Review Board decisions (Côté et al, 2012;Crocker et al, 2014;Wilson et al, 2015;Wilson et al, 2016). However, one would assume that, due to the dynamic nature of the HCR-20 V3 , the number of risk factors present in persons for NCRMD for sexual offences would change over time.…”

“…For example, the nature and severity of one's index offence, and a diagnosis of a psychotic spectrum disorder reduce the chance of discharge, while a mood disorder diagnosis increases the chance of being discharged (Crocker et al, 2015a). Across this body of work, non-risk related factors related to decisions include clinical factors, attractiveness, psychiatric history, demographic characteristics, and index offense severity (Côté et al, 2012;Crocker et al, 2011;Crocker et al, 2014;McDermott & Thompson, 2006;McDermott et al, 2008;McKee, Harris, & Rice, 2007;Wilson et al, 2015;Wilson, Nicholls, Charette, Seto, & Crocker, 2016). Research on the factors that predict the total length of time persons found NCRMD spend under the purview of the Review Board have a similar pattern of findings, and suggest that time spent under purview is typically related to non-risk related factors (Martin & Martin, 2016, for discussion) What research exists also suggests that Review Board decisions are often related to clinician recommendation (Côté et al, 2012;Crocker et al, 2011;Crocker et al, 2014;Hilton & Simmons, 2001;McKee et al, 2007).…”

Housing Trajectories of Forensic Psychiatric Patients

“…These results do not align with evidence showing that substance use, younger age at index offense and number of prior criminal offenses are important risk factors for violence (Bonta et al, ; Salem et al, ). However, it is possible that, based on the clinical team recommendations, Review Boards rely more heavily on dynamic factors (Crocker et al, ; Wilson et al, ), specifically on changes in the mental condition and evolution of symptom manifestation of the patient when ordering absolute discharges, instead of basing decisions on static/historical factors such as age. Future research should take into account symptom evolution as a predictor of Review Board dispositions.…”

Perspective On Excellence in Forensic Mental Health Services: What We Can Learn From Oncology and Other Medical Services

“…At Level 2, consistency applies only within teams with some consistency through the use of international diagnostic systems and manualized treatment programs. At Level 3, hospital or service-wide governance is applied to essential decision making and processes such as applying admission criteria by admission panels (65–69), to plan care pathways across the service, with evidence-based decision making on matters such as care systems (70–73), leave (74, 75), and reports to mental health review tribunals (76–78). At Level 3, precision medicine can be practiced with diagnosis refined into the staging of progression of illnesses and outcomes (79).…”