Reprinted from "Criminal Justice" issue of Visions Journal, 2005, 2 (8), p. 38
When someone with a mental illness goes on trial for committing a crime, the defence lawyer or judge can call the client’s mental status into question. With the defence lawyer’s consent, the judge can order a psychiatric evaluation to determine if the defendant is able to understand that committing the crime was wrong, or if the defendant is mentally fit to stand trial.
“At that point, court proceedings stop, and the defendant is referred for a psychiatric assessment,” explains Clem Poquiz, clinical services manager at the 190bed inpatient Forensic Psychiatric Hospital (FPH) in Port Coquitlam. “The judge can order an in custody psychiatric assessment at FPH, or an out of custody assessment at one of our six outpatient clinics in the province. The decision depends on the level of concern about the defendant’s mental status and risk management issues.”
FPH serves adults 18 and older who are remanded for assessment and/or treatment in a secure inpatient facility. It’s the only hospital in BC for patients in custody, with people referred from throughout the province.
When an in custody assessment is ordered, the sheriff transfers the patient to FPH. A nurse meets new patients, takes their history, and provides new clothes. Personal belongings are stored until patients are ready to leave the hospital. Staff escort male patients to the 22bed remand unit and show them around. FPH has a separate remand and treatment area for women, who account for 20% of cases. Each patient has a private room. Staff members provide a general orientation of the units and regular routines such as meal times, activities and family visiting hours.
“We try to make patients as comfortable as possible,” says Poquiz. “Some people are quite ill when they arrive and want to be left alone, but we give them a lot of support and supervision. Others may be anxious and not understand why they were sent here.
“The courts give us up to 30 days to complete a psychiatric evaluation, although this period can be extended in complex cases. Psychiatrists, social workers and nurses work together to assess whether a patient was mentally disordered at the time their crime was committed. The most common diagnosis is schizophrenia, and about 75% of our patients have concurrent disorders—a mental illness and substance use problem.”
A psychiatrist then writes an evaluation report for the court, with one of four recommendations:
The person is mentally unfit to stand trial (in other words, not able to understand the impact of the crime)
The person was not criminally responsible due to a mental disorder (NCRMD); for example, someone was delusional
The person understood the crime would cause harm
The person understood the nature of the crime, but has a mental disorder, and follow-up care through a forensic clinic is suggested
This report goes to the court registry, which schedules a court date. The accused may travel between the court and hospital, or participate through videoconference if the courtroom is far away.
For a mentally unfit or not criminally responsible verdict, a judge can order the patient to stay at FPH for treatment. FPH has three levels of security: secured, closed and open. Patients move to the next level as they become more stable, and have greater access to privileges. Eventually, patients live independently in onsite houses, doing their own laundry, budgeting and cooking. The entire facility is surrounded by a monitored fence, but is situated in a parklike setting.
“Our treatment teams develop individual treatment and rehabilitation plans,” says Poquiz. “The BC Mental Health Act gives us the authority to order medication for our patients, and our psychiatrists have access to some of the most up to date psychotropic medications.
“We offer a number of drug and alcohol counselling programs, psychotherapy, anger management groups, occupational therapy, music therapy, and vocational and social skills programs.”
For example, patients can attend school at FPH, take computer training, learn woodworking, work out in the gym, watch TV and read in a quiet room.
The BC Review Board regularly reviews patients found NCRMD or unfit to stand trial. The Board decides whether patients need to stay at the hospital for additional treatment, can reintegrate into the community with supervision, or are ready for an absolute discharge with no limitations, based on their progress and stability. Before release, the Board must be convinced the patient no longer poses a significant risk to public safety.
BC Schizophrenia Society and Forensic Psychiatric Services Commission. (2004). Forensic Psychiatric Services: Information for Families. www.bcss.org/support_ centre/information_ for_families or call 1-888-888-0029
“Our goal is to manage patients’ risk by stabilizing their mental state and behaviour so they can reintegrate into the community,” says Poquiz. “When patients are ready to return to the community, we link them with support staff in our regional forensic clinics and community mental health teams. We also help them find work and volunteer opportunities at agencies in their home communities. And if someone isn’t doing well in the community and requires hospitalization, we have a safe, efficient process for returning them to FPH.”
About the Author
Lisa is a freelance writer working with BC Mental Health and Addiction Services, an agency of the Provincial Health Services Authority, which provides forensic psychiatric services in BC
For more information, visit www.bcmhas.ca