The St. Joseph’s Healthcare, Hamilton Forensic Psychiatry Service/Forensic Division, McMaster University, Department of Psychiatry and Behavioural Neurosciences, is a provincial program dealing with mentally ill offenders who run into difficulty with the criminal justice system. The Forensic Psychiatry Program in Hamilton is one of eight forensic programs in the province and provides court-ordered assessments of Fitness to Stand Trial, Criminal Responsibility and Risk Assessments. In addition, the Program provides ongoing care and risk management for patients who fall under the jurisdiction of the Ontario Review Board. These are patients who have primarily been found Not Criminally Responsible by virtue of their Mental Disorder, or Unfit to Stand Trial and who remain a significant risk to the safety of the public.
The range of specialized services that forensic programs offer also includes risk assessment, assessment of anger and impulsivity, sexual offenders, correctional psychiatry, neurolaw, forensic neurosciences and civil medicolegal assessments.
The Academic Forensic Psychiatry Division is an integral part of the Program with the Division Head part of the Program’s leadership team.
The Forensic Psychiatry Program in Hamilton consists of two Secure, two General and one Assessment unit for a total of 114 beds. The Assessment Unit contains patients who are being assessed for Criminal Responsibility, Fitness to Stand Trial and risk assessments. The Secure Units are for patients under the jurisdiction of the Ontario Review Board who require a more secure inpatient setting. The General Forensic Units contain patients who have more of a rehabilitation focus and who require a less secure inpatient setting.
In addition there are outpatient services including a Transitional Outreach Rehabilitation Treatment team, a team that essentially conducts enhanced case management for Ontario Review Board patients currently residing in the community. The outpatient service also provides a number of clinics including an Aggression and Impulsivity Assessment Clinic, Civil Forensic Psychiatry assessments, telehealth assessments and a Fitness to Stand Trial assessment clinic that operates in local detention centres and by videoconference.
The Forensic Psychiatry Research Group conducts research in the area of risk assessment. As a consequence we have developed two risk assessment tools, the Aggressive Incidents Scale (AIS) and the Hamilton Anatomy of Risk Management (HARM). These tools are state-of-the-art risk assessment processes that have been developed and are currently being studied. We were recognized by Accreditation Canada as being a Best Practice in 2009. The AIS HARM manual is now in its second edition (2015). The initial results from these two tools have been presented internationally and multi-site collaboration field testing is underway. The forensic version of the HARM, the eHARM-FV, has built in analytics and an aggregator to allow for the use of analytics/data to better evaluate risk and quality indicators. Additional research projects and activities include studies in Parricide, Stress in Review Boards, Sexual Offenders within the Ontario Review Board, Fitness to Stand Trial and associated Treatment Orders as well as a general analysis of cases under the Ontario Review Board. The Forensic Division includes external faculty Dr. Robin Wilson, an international expert on sexual offenders and Dr. Peter Collins, an international expert on risk prediction. Other notable faculty include Dr. Hy Bloom, Dr. Graham Glancy, Dr. Brian Jones, Jeff Manishen and Janice Blackburn.
The Forensic Psychiatry Program has a very active education program with students from all disciplines. Residents are regularly assigned to the forensic programs, as are clinical clerks. We have had continuous Fellows in Forensic Psychiatry for the last decade, including several international fellows. The Forensic Program has successfully run the Risk and Recovery Conference, now in its tenth year, attracting presenters and attendees from across the country. It is one of the premier Canadian forensic conferences.
Several staff members of the Forensic Program are Order-in-Council appointees to the Ontario Review Board tribunal and one is Vice-Chair of the Consent and Capacity Board. These provide additional learning experiences for trainees.
In addition to the research and training opportunities within our specialized clinics we have developed a relationship with Syl Apps, the Secure Forensic facility dealing with children and adolescents.
Forensic Psychiatry has Subspecialty status from the Royal College of Physicians and Surgeons of Canada with a formal PGY6 program.
We offer training in all disciplines, with high quality teaching and training in the areas of psychology, social work, nursing, occupational therapy, therapeutic recreation and vocational rehabilitation.
The Risk and Recovery Conference
The Forensic Service hosts an internationally-recognized Risk and Recovery Conference, now in its tenth year. This two-day conference held in April features keynote speakers from around the world as well as profiling local research and speakers. This conference has grown in stature and currently attracts approximately 200 registrants. It is seen as one of the premier forensic conference offerings in Canada and serves as another platform to highlight the Academic Division of Forensic Psychiatry at McMaster University.
The Forensic Psychiatry Program
The Forensic Psychiatry Program is located at St. Joseph’s Healthcare, West 5th Campus. This is an active, multidisciplinary group, led by Dr. Gary Chaimowitz, Academic Head of the Forensic Division. Members provide state-of-the-art training in forensic psychiatry at all levels of medical, psychiatric, and allied health professionals in a variety of clinical settings. Their strength lies in a broad wealth of expertise found among its members which includes psychiatrists, psychologists, lawyers, and judges. The Division has been successful in attracting trainees to its Fellowship Program and has consistently had fellows for the last decade. The Fellowship Program provides a comprehensive training experience in a wide range of forensic settings and services, combined with a formal academic core component. The fellowship can be completed in one or two years, depending on the trainee’s needs. A RCPSC PGY6 training year is anticipated.
Faculty and staff are involved in Postgraduate Psychiatry Education and provide residents with broad elective training opportunities in forensic psychiatry as well as experience working on the inpatient programs to meet part of their required training in chronic care.
In addition to experience with inpatients and outpatients, residents can participate in a number of forensic clinical opportunities including Fitness to Stand Trial Assessments, Review Boards, both Consent and Capacity and Ontario Review Boards, as well as Correctional Psychiatric Assessments. There are also opportunities to do Sexual Behaviours Assessments and Management, assess Dangerous Offenders/Long-Term Offenders, Violence Risk assessments, as well working at the Aggression and Impulsivity clinic. There are also opportunities for videoconferencing with video clinics to assess patients in correctional facilities as well as northern native communities in Ontario.
Residents and fellows are encouraged to participate in tribunals, criminal and civil courtroom cases and testify.
The Forensic Program also has a long-established relationship with key stakeholders and has monthly meetings with senior representatives from the Attorney General’s office, the correction system, probation and parole and police services. This is designed to ensure coordination of services for this population. The group has been very successful in developing processes and programs that enhance quality of services for populations served by the Forensic Program.
The Forensic Service has an active research group with a number of postgraduate and other students in the group. At this point in time research activities include not only risk assessment tools but also parricide, risk assessment and management, stress in review boards, sexual offenders within the Ontario Review Board, Fitness to Stand Trial and analysis of cases under the Ontario Review Board.
We believe we are well-situated to offer premier training experiences in Forensic Psychiatry.