Managing Complex Trauma in Women Involved in the Forensic Mental Health System
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Women are a minority in the forensic mental health system, and they have different treatment needs from men. This shows the need for specialized training in trauma-informed care and cultural competency for mental health professionals working with women, including Indigenous women.
Dr. Gillian Munro also discussed the need for improved assessment and treatment of posttraumatic stress disorder (PTSD) in this population. Her presentation for the International Forensic Psychiatry Lecture Series focused on Hummingbird Lodge in North Bay, Ontario, Canada, and the work it does with this population.
Hummingbird Lodge
As part of the Mental Health and the Law Program at the North Bay Regional Health Centre, Hummingbird Lodge is a secure eight-bed provincial forensic inpatient service for adult women. Many patients have a history of trauma.
The lodge is for women who must follow conditions set by the Ontario Review Board after being found not criminally responsible on account of mental disorder. These patients have had difficulty progressing in their recovery due to complex trauma. Despite unsuccessful or negative past clinical experiences, they agree to take part in intensive psychotherapy treatment at Hummingbird Lodge.
The highly supervised and supportive environment provides enhanced relational and procedural security to ensure the psychological, cultural, and physical safety of patients.
The Need for Hummingbird Lodge
Women have higher rates of adverse childhood experiences, other traumatic experiences, and victimization. They may have fewer conditions or circumstances that contribute to criminal behaviour than men. However, women are more likely to have been diagnosed with PTSD, mood disorders, borderline personality disorder, and suicidality (suicidal thoughts or behaviours). They are also more likely to be younger, single, and of Indigenous descent.
After one or more traumatic events, PTSD can lead to unwanted, distressing flashbacks, persistent avoidance, and negative shifts in cognition and mood. It is more common in forensic populations, affecting 21 per cent of females and six per cent of males. However, it is underdiagnosed in the forensic mental health system.
The catchment area for the Mental Health and the Law Program includes more than 30 Indigenous communities. Colonialism, intergenerational trauma from residential schools, cultural suppression, and systemic racism in the health care system mean Indigenous women face even greater challenges than non-Indigenous women. They are also over-represented in the criminal justice system.
Three-Phase Program
The Centre for Addiction and Mental Health collaborated on the development of the program, which is based on Herman’s Triphasic model of recovery. The focus is on individualized care planning using evidence-based treatments, including medications and psychotherapy. It follows a three-phase program.
Phase 1: Safety and Stabilization
The multidisciplinary staff give new patients a series of psychological and psychosocial assessments, which usually takes about three months to complete. With this information, staff create individualized care plans.
Group and individual programming include psychotherapy, building coping skills, learning about safety, and preparing for the intensive trauma therapy in the next phase.
Before progressing to the next phase, patients’ symptoms have stabilized; they can differentiate between environmental threats and fear arising from unwanted, distressing flashbacks; and they have developed self-regulation skills (for example, grounding, self-soothing).
Phase 2: Remembrance and Mourning
Trauma, addiction, and mental health recovery-based individual psychotherapy can include eye movement desensitizing and reprocessing and cognitive behavioural therapy for trauma. Psychoeducational group therapy can include healthy relationships and boundaries, parenting skills, creative therapies (for example, art therapy), and occupational therapy.
Before progressing to the final phase, patients have processed their traumatic memories to the point of reducing their PTSD symptoms and are psychiatrically stable.
Phase 3: Reconnection
In the final stage, patients find closure and discover that their traumatic experiences do not define their identities. Programming includes employment counselling and support, developing leisure activities that benefit others, and discovering meaningful roles and community connections with family, friends, and coworkers. It also includes connecting patients with community resources.
Throughout this three-phase program, staff reassess patients every six to 12 months. While the average length of stay was expected to be one to three years, treatments and durations are individualized, with many patients needing longer stays.
When patients complete the program, they may be discharged to another forensic psychiatry unit or outpatient housing in the North Bay Regional Health Centre or other approved accommodation in their catchment area. They may also be returned to the facility that referred them to Hummingbird Lodge or their home community.
For more details, watch the recording of Dr. Munro’s June 5, 2025, International Forensic Psychiatry Lecture Series presentation, “Hummingbird Lodge: An Approach to the Management of Complex Trauma in Women Involved in the Forensic Mental Health System,” on our website.
Written by Virginia St-Denis and approved by Dr. Gillian Munro.
