Legal proceedings are complex at the best of times. When a court case involves a defendant suffering from mental illness, the law suddenly becomes a lot more complicated.
Psychiatry is the branch of medicine concerned with the diagnosis and treatment of mental disorders, and forensic psychiatry is one of its more demanding disciplines.
“In a nutshell, it’s the treatment of mental illness in people who are in conflict with the law,” says Fred Dawkins, a communications specialist with B.C. Mental Health and Addiction Services.
“In the old days, they would call them the criminally insane, but that’s a term and a concept that’s not used anymore.”
Almost 500 delegates will be in Victoria next week to discuss their profession, during the fourth annual Forensic Psychiatric Conference.
The two-day event is for psychiatrists, psychiatric nurses, counsellors, psychologists and researchers, as well as lawyers and judges who deal with mental illness issues within the criminal justice system.
Every province in Canada has at least one organization or centralized facility focused on the needs of mental health patients who have had run-ins with the law.
In B.C., the main forensic psychiatric hospital is located in Coquitlam and operates under the jurisdiction of the Forensic Psychiatric Services Commission and the Provincial Health Services Authority.
Colony Farm, established in 1905, has beds for 190 patients who fall into several different categories of care.
Some of them have already gone through the court system and have been classified as NCRMD – not criminally responsible on account of a mental disorder.
“The primary mandate for forensic psychiatric agencies is the treatment side of things,” explains Dawkins. “Once someone has been found by the court to be not criminally responsible for the crime they’re accused of – on account of a mental illness of some kind – it’s basically like they’ve been found not guilty.”
At that point, he adds, the patient’s case ceases to be a criminal concern and instead becomes a treatment issue. Once that decision is made, the individual no longer has an option of refusing the court-ordered treatment.
“There are people who have been (at Colony Farm) for years and may never be released,” says Dawkins. “Sometimes people are only there for a few months.”
Forensic psychiatrists provide a variety of services for the legal system, including pre-trial psychiatric evaluations of people involved in cases not yet heard in court. If a person is charged with a crime and there is reason to believe that he or she may have a mental illness, the accused may be sent for a psychiatric assessment (typically a four-week period of testing and observation) to determine if he or she is fit to stand trial.
Another aspect of the job is treating inmates who are already in the penal system and have developed or exhibited signs of a mental illness while in jail. In such a case, a prisoner may be sent to a forensic psychiatric hospital on a temporary basis.
Although the forensic psychiatry profession can be very rewarding, Dawkins acknowledges that it has its own set of challenges that set it apart from a standard psychiatric practice. Many of the underlying mental health issues may be similar (schizophrenia or mood disorders, for example), but forensic psychiatrists often have to deal with “concurrent” treatment problems. That may be a combination of mental illness and one or more other factors, such as drug abuse.
“That’s very common in that field and that might be the one feature that stands out for psychiatrists who (work) in that area,’ notes Dawkins. “They see a very high proportion of clients who have problems with addictions.”
Dawkins feels it’s important for people to understand the long-term goals of the profession and realize that the system is designed to work with the legal system to benefit both the patient and society. Occasionally, high-profile criminal incidents or other problems involving mentally ill people may prompt onlookers to question how well that partnership is working. However, Dawkins believes that provincial authorities are doing a good job in what can be a very difficult area.
“Certainly one of the primary goals of a forensic psychiatric organization in any province, and certainly in B.C., is the protection of the public,” he says. “We have a responsibility to the patient, but also to the community at large. We try to balance those two responsibilities.”
The Fourth Annual Forensic Psychiatric Conference takes place March 28-30 at the Victoria Conference Centre.
By Thomas Winterhoff
News staff
twinterhoff@vicnews.com
