Participation as an Expert in Cases Involving the Production of Mental Health Records in Canadian Courts

In Canada, s. 278 of the Criminal Code sets out a two-stage procedure for the disclosure of records to the defence when there is a reasonable expectation of privacy. In this article, we summarize the nature of this legislation and the cases that directly led to its formation. We then review the implications for practice for mental health professionals. The main purpose of this article is to review a relatively new role for forensic mental health professionals: acting as experts in informing the court whether the disclosure is in the interests of justice.

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Forensic Psychiatry in Pakistan: An Update

Pakistan is a lower-middle income country in South Asia where forensic psychiatry is often not recognized as a distinct subspecialty of psychiatry. Although evolution toward this direction has begun, more development in this field is needed. Before Pakistan’s Mental Health Ordinance of 2001, much of the mental health legislation and institutional infrastructure pertaining to the mentally ill offender can be traced back to the Indian Lunacy Act of 1912. The past two decades have witnessed important legal developments in the role of psychiatry in Pakistan’s criminal justice system. This has been seen through the devolution of health-care provision and by an extension of psychiatric service provision from the federation (federal government) to the four provinces. Despite the sparse resources allocated to psychiatry, competent yet scarce psychiatry residents are graduating from Pakistan’s accredited residency programs with an interest in forensic psychiatry. The objective of this article is to reflect on the past, while examining the current state of existing forensic mental health in Pakistan. This article will also address the future trajectory of forensic psychiatry in Pakistan and supports the establishment of forensic psychiatry as a subspecialty in Pakistan.

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A Review on the Effectiveness of Canadian and American Mental Health Courts

Objective: This systematic review synthesizes mental health court (MHC) research across the United States and Canada. This study reviews and compares the operations and practices of MHCs across both countries, as well as their recidivism rates.

Methods: We gathered from existing literature to present common MHC practices used across the United States. However, in response to the lack of literature about Canadian day-to-day practices, we developed a questionnaire and contacted every Canadian MHC. In total, we contacted 36 Canadian MHCs, and 19 courts filled out a questionnaire. With respect to recidivism rates, we conducted a comprehensive literature search in February and March 2019 in PsycINFO, Google Scholar, Web of Science, and National Criminal Justice Reference Service Abstracts using the keywords mental health court, therapeutic justice, serious mental illness, mentally ill offenders, mental health diversion and problem-solving courts.

Results: Canadian and American MHCs have similar practices. However, American MHC’s have more robust screening measures and typically admit more participants with schizophrenia, bipolar disorder, and major depressive disorder into their programs compared to Canadian MHCs. MHC participants in both countries typically had lower recidivism rates compared to regular docket court participants.

Conclusions: MHC research should inform public policy. Additional research should move in the direction of discovering the predictors for why MHCs reduce recidivism.

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Absconsion from forensic psychiatric institutions: A review of the literature

Absconding from mental health units is referred to as a patient leaving without permission and can have significant consequences for the patient, family, community, and institution. The varying definitions of absconsion involve breaching security of an inpatient unit, accessing grounds or community without permission, gaining liberty during escorted leave or being absent for longer than permitted from authorized or trial leave. While considerable literature exists on absconsion from acute psychiatric units, there is a paucity of literature specific to forensic absconsions, despite inherent differences between patients and systems. Forensic patients are offenders who are found unfit to stand trial, or not criminally responsible on account of mental disorder. The literature indicates the absconding rate within the forensic population is expected to be low, based on the fact that the level of security in forensic units is higher than general psychiatric units. Despite the rates being considered low, the outcomes of absconding in this population can potentially be serious, thus the exploration of factors surrounding these incidents is essential. Purpose: To review the literature regarding absconsion from forensic psychiatric institutions. This review will identify potential risk factors and motivations of forensic patients that have absconded. Methods: Electronic database and hand searches were conducted to locate articles pertaining to absconding specific to forensic psychiatric institutions published from 1969-present. Search terms included “abscond”, “escape”, “AWOL”, “runaway”, “psychiatric inpatient”, “forensic institution”, & variants. All full-text articles meeting inclusion & exclusion criteria were appraised for qualitative themes, limitations, and assessed for risk of bias using appropriate CASP Checklists. The review is structured following the PRISMA checklist and framework. Results: A total of 19 articles meeting literature review criteria were identified. The majority of the articles were of retrospective case-control design (n=12). Three systematic reviews were found on absconsion that included analyses from both forensic and general psychiatric populations. Definitions for absconding were omitted or varied making comparisons between studies difficult. Much research compared demographic, static and dynamic factors. History of previous absconsion, scores on validated risk-of-violence assessment tools, substance-use disorder, acute mental state, and socio-environmental factors were consistently noted as risk-factors. Four distinct motivations for absconding emerged: goal- directed, frustration/boredom, symptomatic, and accidental. Overall, the literature suggested forensic absconsion was a rare event of short duration with low risk to the public and few re- offending incidents. Conclusions: There is a paucity of literature on forensic absconsions. A consistent definition of absconsion and use of standardized reporting protocols across forensic programs would be beneficial in order to be able to compare data on absconding events. Also, prospective studies should be undertaken to better understand the motivations and dynamic risk factors of forensic patients who have absconded and would help inform a forensic absconsion risk assessment protocol.

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