The Use of Risk and Need Factors in Forensic Mental Health Decision‐Making and the Role of Gender and Index Offense Severity

Abstract

Canadian legislation makes Review Boards (RBs) responsible for rendering dispositions for individuals found Not Criminally Responsible on account of Mental Disorder (NCRMD) after considering public safety, the mental condition of the accused, and his/her potential for community reintegration. We reviewed 6,743 RB hearings for 1,794 individuals found NCRMD in the three largest Canadian provinces to investigate whether items from two empirically supported risk assessment measures, the Historical Clinical Risk Management-20 and the Violence Risk Appraisal Guide, were considered. Less than half the items were included in expert reports or in RBs' reasons for dispositions, and consideration of these items differed according to gender and index offense severity of the accused. These items included evidence-based risk factors and/or legally specified criteria: mental health, treatment, and criminal history. These results illustrate the gap between research on risk factors and the integration of this evidence into practice. In particular, we recommend the implementation of structured measures to reduce the potential for clinicians to be unduly influenced by gender and offense severity.

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

“…The NTP (https://ntp-ptn.org, ) was an archival, longitudinal study examining a cohort of Canadian individuals found NCRMD in British Columbia (BC), Ontario (ON), and Québec (QC). The full methodology is described in detail by Crocker and colleagues (Crocker et al, ; see also Charette et al, ; Crocker et al, ; Crocker et al, 2015a–c; Nicholls et al, ; Salem et al, ; Wilson et al, ). Details relevant to the current analyses are presented here.…”

“…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, ).…”

“…However, research from this same project has demonstrated that Review Boards do discuss empirically valid and/or legally relevant criteria [i.e., variables that are often items on recognized risk assessment tools such as the Violence Risk Appraisal Guide (VRAG; Quinsey, Harris, Rice, & Cormier, , ; Historical Clinical Risk Management‐20 (HCR‐20, Webster, Douglas, Eaves, & Hart, ) (Crocker et al, ; Wilson et al, ). Wilson et al () found the Review Boards considered factors that fell into three broad categories: mental health (e.g., major mental illness, substance use, personality disorder, active symptoms), treatment (e.g., supervision failure, unresponsive to treatment), and criminal history (e.g., previous violence, sex of victim). Crocker et al () found that historical items from the HCR‐20, as well as compliance with medication since the previous hearing, were associated with conditional discharge decisions.…”

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

“…This study was carried out in the three largest provinces of Canada (British Columbia, Ontario and Quebec) and followed 1,800 individuals through the provincial Review Board systems Crocker et al, 2015a;Crocker et al, 2015b;Crocker et al 2015c;Crocker et al, 2015d;Nicholls et al, 2015; see also Salem et al, 2015;Wilson et al, 2015). The NTP results provided several essential insights into the population served by forensic psychiatric services:…”