Yanick Charette

The predictive validity of clinical ratings of the Short-Term assessment of risk and treatability (START)

With the increased need to assess and manage risk in inpatient settings, the Short-Term Assessment of Risk and Treatability (START) was implemented on a civil psychiatric unit. The goal of the present study was to examine the tools predictive validity when completed by clinical teams as part of routine practice. Data were collected for 34 patients hospitalized for a minimum of 30 days prior to and after a START evaluation. Several challenging behaviors, such as aggression towards others, self-harm, and substance abuse were assessed using the START Outcomes Scale (Nicholls et al., 2007). Results from multilevel logistic regression and Receiver Operating Characteristics analyses lend partial support for the predictive validity of the START. A limited set of START items combined was significantly better at predicting the challenging behaviors than the original total Strength and Vulnerability scales. Results are discussed in terms of the clinical use of risk assessment.

The National Trajectory Project of Individuals Found Not Criminally Responsible on Account of Mental Disorder in Canada. Part 2: The People Behind the Label

Objective: To examine the psychosocio-criminological characteristics of not criminally responsible on account of mental disorder (NCRMD)–accused people and compare them across the 3 most populous provinces. In Canada, the number of people found NCRMD has risen during the past 20 years. The Criminal Code is federally legislated but provincially administered, and mental health services are provincially governed. Our study offers a rare opportunity to observe the characteristics and trajectories of NCRMD–accused people. Method: The National Trajectory Project examined 1800 men and women found NCRMD in British Columbia (n = 222), Quebec (n = 1094), and Ontario (n = 484) between May 2000 to April 2005, followed until December 2008. Results: The most common primary diagnosis was a psychotic spectrum disorder. One-third of NCRMD–accused people had a severe mental illness and a concomitant substance use disorder, with British Columbia having the highest rate of dually diagnosed NCRMD–accused people. Most accused people (72.4%) had at least 1 prior psychiatric hospitalization. Two-thirds of index NCRMD offences were against the person, with a wide range of severity. Family members, followed by professionals, such as police and mental health care workers, were the most frequent victims. Quebec had the highest proportion of people with a mood disorder and the lowest median offence severity. There were both interprovincial differences and similarities in the characteristics of NCRMD-accused people. Conclusions: Contrary to public perception, severe violent offenses such as murder, attempted murder or sexual offences represent a small proportion of all NCRMD verdict offences. The results reveal a heterogeneous population regarding mental health and criminological characteristics in need of hierarchically organized forensic mental health services and levels of security. NCRMD—accused people were well known to civil psychiatric services prior to being found NCRMD. Risk assessment training and interventions to reduce violence and criminality should be a priority in civil mental health services.

The National Trajectory Project of Individuals Found Not Criminally Responsible on Account of Mental Disorder in Canada. Part 4: Criminal Recidivism

Objective: To examine criminal recidivism rates of a large sample of people found not criminally responsible on account of mental disorder (NCRMD) in Canadas 3 most populous provinces, British Columbia, Ontario, and Quebec. Public concern about the dangerousness of people found NCRMD has been fed by media attention on high-profile cases. However, little research is available on the rate of reoffending among people found NCRMD across Canadian provinces. Method: Using data from the National Trajectory Project, this study examined 1800 men and women in British Columbia (n = 222), Ontario (n = 484), and Quebec (n = 1094) who were found NCRMD between May 2000 and April 2005 and followed until December 2008. Results: Recidivism was relatively low after 3 years (17%). There were interprovincial differences after controlling for number of prior criminal offences, diagnosis, seriousness of the index offence, and supervision by the review boards. British Columbia (10%) and Ontario (9%) were similar, whereas Quebec had almost twice the recidivism (22%). People who had committed severe violent index offences were less likely to reoffend than those who had committed less severe offences. People from the sample were less likely to reoffend when under the purview of review boards, across all 3 provinces. Conclusion: The results of this study, along with other research on processing differences, suggest systemic differences in the trajectories and outcomes of persons found NCRMD need to be better understood to guide national policies and practices.

The national trajectory project of individuals found not criminally responsible on account of mental disorder in Canada. Part 1: context and methods.

The National Trajectory Project examined longitudinal data from a large sample of people found not criminally responsible on account of mental disorder (NCRMD) to assess the presence of provincial differences in the application of the law, to examine the characteristics of people with serious mental illness who come into conflict with the law and receive this verdict, and to investigate the trajectories of NCRMD–accused people as they traverse the mental health and criminal justice systems. Our paper describes the rationale for the National Trajectory Project and the methods used to collect data in Quebec, Ontario, and British Columbia, the 3 most populous provinces in Canada and the 3 provinces with the most people found NCRMD.

The national trajectory project of individuals found not criminally responsible on account of mental disorder in Canada. Part 3: trajectories and outcomes through the forensic system.

Objective: To examine the processing and Review Board (RB) disposition outcomes of people found not criminally responsible on account of mental disorder (NCRMD) across the 3 most populous provinces in Canada. Although the Criminal Code is federally legislated, criminal justice is administered by provinces and territories. It follows that a person with mental illness who comes into conflict with the law and subsequently comes under the management of a legally mandated RB may experience different trajectories across jurisdictions. Method: The National Trajectory Project examined 1800 men and women found NCRMD in British Columbia (n = 222), Quebec (n = 1094), and Ontario (n = 484) between May 2000 and April 2005, followed until December 2008. Results: We found significant interprovincial differences in the trajectories of people found NCRMD, including time detained in hospital and time under the supervision of an RB. The odds of being conditionally or absolutely discharged by the RB varied across provinces, even after number of past offences, diagnosis at verdict, and most severe index offence (all covariates decreased likelihood of discharge) were considered. Conclusions: Considerable discrepancies in the application of NCRMD legislation and the processing of NCRMD cases through the forensic system across the provinces suggests that fair and equitable treatment under the law could be enhanced by increased national integration and collaboration.

The National Trajectory Project of Individuals Found Not Criminally Responsible on Account of Mental Disorder. Part 5: How Essential are Gender-Specific Forensic Psychiatric Services?

Objective: To state the sociodemographic characteristics, mental health histories, index offence characteristics, and criminal histories of male and female forensic psychiatric patients. Clinicians and researchers advocate that mental health and criminal justice organizations implement gender-specific services; however, few studies have sampled forensic patients to evaluate the extent to which mens and womens treatment and management needs are different. Method: Data were collected from Review Board files from May 2000 to April 2005 in the 3 largest Canadian provinces. Using official criminal records, participants were followed for 3 to 8 years, until December 2008. The final sample comprised 1800 individuals: 15.6% were women and 84.4% were men. Results: There were few demographic differences, but women had higher psychosocial functioning than men. Both men and women had extensive mental health histories; women were more likely diagnosed with mood disorders and PDs and men were more likely diagnosed with schizophrenia spectrum disorders and SUDs. The nature of the index offence did not differ by gender, except women were more likely to have perpetrated murders and attempted murders. For offences against a person, women were more likely to offend against offspring and partners and less likely to offend against strangers, compared with men. Women had significantly less extensive criminal histories than men. Conclusions: Not criminally responsible on account of mental disorder-accused women have a distinct psychosocial, clinical, and criminological profile from their male counterparts, which may suggest gender-specific assessment, risk management, and treatment in forensic services could benefit patients. The findings are also consistent with traditional models (Risk-Need-Responsivity) and ultimately demonstrate the importance of individual assessment and client-centred services.

Police Encounters Involving Citizens With Mental Illness: Use of Resources and Outcomes

OBJECTIVE Few studies have addressed use of resources in police interventions involving individuals with mental illness. The time police officers spend on interventions is a straightforward measure with significant administrative weight, given that it addresses human resource allocation. This study compared the characteristics of police interventions involving individuals with mental illness and a control sample of individuals without mental illness. METHODS A total of 6,128 police interventions in Montreal, Québec, were analyzed by using a retrospective analysis of police intervention logs from three days in 2006. Interventions involving citizens with (N=272) and without (N=5,856) mental illness were compared by reason for the intervention, the use of arrest, and the use of police resources. RESULTS Police interventions involving individuals with mental illness were less likely than those involving individuals without mental illness to be related to more severe offenses. However, interventions for minor offenses were more likely to lead to arrest when they involved citizens with mental illness. Interventions for reasons of equal severity were twice as likely to lead to arrest if the citizen involved had a mental illness. After controlling for the use of arrest and the severity of the situation, the analysis showed that police interventions involving individuals with mental illness used 87% more resources than interventions involving individuals without mental illness. CONCLUSIONS Future studies using administrative police data sets could investigate the use of resources and division of costs involved in new programs or partnerships to better address the interface of criminal justice and mental health care.

Supportive housing and forensic patient outcomes.

In Canada, Review Boards are mandated to evaluate individuals found Not Criminally Responsible on Account of Mental Disorder (NCRMD) on an annual basis and render 1 of 3 dispositions: (a) custody, (b) conditional discharge, or (c) absolute discharge. To promote social reintegration, conditional discharge can be ordered with the condition to live in supportive housing. However, NCRMD accused face great barriers to housing access as a result of the stigma associated with the forensic label. The goal of this study was to evaluate the role of housing in the clinical and criminal trajectories of forensic patients as they reintegrate into the community. Data for this study were extracted from a national study of individuals found NCRMD in Canada (Crocker, Nicholls, Seto, Côté, et al., in press). The present study focuses on a random sample of NCRMD accused in the province of Québec, who were under a conditional discharge disposition during the study period (n = 837). Controlling for sociodemographic, clinical, and criminal variables, survival analysis showed that individuals placed in independent housing following a conditional discharge from the Review Board were 2.5 times more likely to commit a new offense, nearly 3 times more likely to commit an offense against a person, and 1.4 times more likely to be readmitted for psychiatric treatment compared with individuals residing in supportive housing. These results point to the influence housing can have on the trajectories of forensic patients, above and beyond a range of clinical, criminological, and sociodemographic factors.

The judicious judicial dispositions juggle : characteristics of police Interventions involving people with a mental illness

Objective: The number of police interventions with people presenting a mental health problem has been increasing during the past 30 years, and police services are becoming increasingly aware of the human resources and skills these interventions require. Our study addresses the characteristics explaining police time used and outcomes of interventions as police officers interact with people with mental illness. Method: Using a police service administrative database from a large Canadian city, and an identification algorithm method, police interventions with people with mental illness were identified on 3 randomly selected days in 1 year. A content analysis of intervention logs was carried out to identify characteristics of those interventions: the call initiator, the location, and the final outcome of the intervention. Results: Interventions with people with mental illness represent a small proportion (3%; n = 272) of all police interventions (n = 8485). General linear models show that the type of outcome is the most important factor in estimating the time required by police interventions. Arrests and hospitalizations are the least time-efficient outcomes, consuming 2.0 and 3.2 times, respectively, more time than informal dispositions. A multiple correspondence analysis shows that police interventions can be depicted in 2 dimensions, representing their main roles concerning people with mental illness, namely, to ensure the public safety and to protect the most vulnerable citizens. The more these services are required, the more police time will be required. Conclusion: Education and partnerships between police services and mental health services are essential to a proper management of outcomes.

The network dynamics of co-offending careers

Abstract Despite the long-standing acknowledgement that crime is a group phenomenon, little research treats co-offending as a dynamic network process. This study analyses the individual and network processes responsible for long-lasting criminal relationships using co-offending dyads from eight years of arrest records in Chicago. Results from proportional hazard models suggest that homophily with respect to age, race, gender, geographic proximity, and gang identity lead to sustained partnerships. Victimization increases the probability of continued co-offending, while the victimization of one’s associates dissuade continued collaboration. Supra-dyadic processes (centrality, transitivity) influence the likelihood of continued co-offending. Results are discussed regarding opportunities and turning points.