Reprinted from "Criminal Justice" issue of Visions Journal, 2005, 2 (8), p. 31
staff at six Forensic Psychiatric Services (FPS) outpatient clinics across BC and at the inpatient Forensic Psychiatric Hospital (FPH) assess the mental status of people on trial, when the court orders a psychiatric assessment. They determine whether people are mentally fit or unfit to stand trial, or are not criminally responsible due to a mental disorder. The FPH provides in-custody assessments and treatment, and the FPS clinics provide out-of-custody assessments. Clinic staff also offer outpatient support for adults with mental illness who are granted a conditional discharge.
“We supervise people found not criminally responsible or unfit to stand trial, who are living in the community,” explains Sheila Dankwerth, a registered nurse and clinical case manager at the Victoria Forensic Psychiatric Services (FPS) clinic.
The other clinics are located in Vancouver, Nanaimo, Prince George, Kamloops and Surrey. Their multidisciplinary teams include nurses, psychologists, psychiatrists, and court liaison and jail liaison workers.
The Victoria clinic serves an urban area, where clients have fairly ready access to the clinic and community resources. In contrast, the forensic clinics in rural areas, such as the Kamloops and Prince George clinics, cover vast distances and clients may reside in remote communities. Here, staff support clients on an outreach basis and through acting as a liaison with community service providers.
Under the Criminal Code of Canada, the BC Review Board must regularly review the cases of people, both in and out of custody, found not criminally responsible or unfit to stand trial. For those living in the community, the case manager and psychiatrist produce a report outlining a client’s response to treatment, substance use management and integration into community living to help the Board make a decision about future conditions. The Board can order clients who need hospitalization to FPH, or can extend the conditional discharge, which clinic staff continue to oversee.
“We monitor clients’ progress in treatment and adherence to the Review Board conditions,” says Dankwerth. “We also assess and treat offenders on bail, probation and parole.”
A day in the life at the Victoria FPS clinic
“My morning usually begins with a few appointments at the clinic,” says Dankwerth. “When new clients come in, we do an intake assessment to determine their mental health status, substance use patterns and support needs. With regular clients, we discuss how they’re doing and what’s been happening in their lives to assess whether their mental status and situation are stable. We check on their housing and relationships with friends and family
“Over the day, I work with my colleagues to provide support services like medication, anger and substance use management.
We also update each other on new developments. For example, I might talk to the court liaison worker about a client’s experience in court, or with a physician about treatment plans.
“We talk to probation officers as well. Some clients are concerned that what they tell us at the clinic is shared with their probation officer, but it’s not. We simply touch base to ensure clients are attending appointments. And I may attend Review Board hearings with a client and psychiatrist, where the living conditions for the next year are set.
“Some days I take new clients for their first visit to Laurel House, a dropin centre for adults with mental illness, or to pools in the region that offer discounted rates for people on low incomes. We help clients access Vancouver Island Health community mental health services, like life skills, work readiness, job coaching and drug and alcohol programs. And we link people with the Cool Aid Society’s REES Network (Research, Education, Evaluation and Support), which offers training, peer support, education and a casual labour pool that matches people looking for work with employers.”
About 75% of clients have concurrent disorders—a mental illness and substance use problem. Dankwerth is one of many FPS staff who have taken drug and alcohol counselling training in the last year and a half. Now more clients can get counselling quicker, as a result. FPS conducted three phases of training for clinic and hospital staff across BC: Nearly 300 staff across BC participated in a two-day training session to learn the basics about substance use 22 specially trained staff delivered a oneweek course to FPS colleagues, so all treatment team members have substance use treatment skills 20 staff completed a Substance Misuse Counselling Diploma program and a 200-hour practicum; they provide one-on-one and group counselling for clients
“I worked with several other community agencies as part of my practicum,” notes Dankwerth. “Most communities are grappling with the social consequences of mental health and addictions, and health authorities are working to coordinate services. Fortunately, the forensic service has done a good job of combining these services.
“Clients often face a range of problems: they may be homeless, poor and have a mental illness and addiction. We try to address the spectrum. We help clients maintain as healthy a situation as possible, recognizing that people often relapse with addictions. Safe shelter is vital, because it’s tough to be stable if you don’t have anywhere to live.
“Our goal is to help clients get stabilized on the right meds, obtain housing, reduce drug or alcohol use, maintain stable mental and physical health, reconnect with their peers and/ or family, build life skills and find work opportunities. Ultimately, we want clients to be able to live independently with support and take better care of themselves. Our job is to support clients to live safely, and help keep the community safe as well.”
About the author
Lisa is a freelance writer working with BC Mental Health and Addiction Services, an agency of the Provincial Health Services Authority that provide forensic psychiatric services in BC