Mental Health and the Law
The Integrated Forensic Program delivers specialized mental health care for individuals with mental illnesses who have come into contact with the criminal justice system or who are at risk of doing so. We provide assessment and treatment services to improve our clients’mental health and reduce their risk of re-offending.
We provide care to adults who:
We also offer a number of specialty services aimed at supporting youth and families, helping clients transition into community living, and addressing problematic behaviours.
The interdisciplinary treatment teams.of the Integrated Forensic Program develop individualized treatment plans to optimize client mental health, well-being, and quality of life while managing and reducing risk for future offending to ensure the safety of the public as well as our clients.
The program includes forensic treatment units at the Royal Ottawa Mental Health Centre, and the Brockville Mental Health Centre, as well as a Secure Treatment Unit at the St. Lawrence Valley Correctional and Treatment Centre (Brockville).
The Integrated Forensic Program provides a number of services to the courts including assessments of individuals subject to Assessment Orders under Section 672.11 of the Criminal Code. These include assessments of fitness to stand trial and assessments of criminal responsibility. The program also conducts pre-sentence assessments and dangerous or long-term offender assessments.
Depending on the needs and custody status of the client, these assessments can be completed through the inpatient or outpatient forensic units. Clients who are in custody may receive a court ordered assessment at the secure Forensic Treatment Units at the Brockville Mental Health Centre or Royal Ottawa Mental Health Centre.
The program also undertakes treatment orders from the courts pursuant to Section 672.58 of the Criminal Code to improve the mental state of individuals before the courts to the point where they are fit to stand trial.
The Integrated Forensic Program provides secure inpatient and outpatient services at the Forensic Treatment Unit in Brockville and Forensic Treatment Unit in Ottawa to individuals under the jurisdiction of the Ontario Review Board (ORB). This includes people found Not Criminally Responsible or not fit to stand trial.
We follow a recovery-focused model of care to help clients with their rehabilitation and to achieve their goals and potential. The treatment team works with each client to create an individualized treatment and reintegration plan within the limits set out by their ORB disposition. As part of the treatment plan, clients may access a variety of individual services and group programming.
Our clinical and administrative teams continually monitor clients’ health and assess their risk for re-offending in order to protect public and client safety while supporting recovery.
To ensure continuity of care throughout our clients’ recovery the Integrated Forensic Program offers comprehensive outpatient support once clients leave the hospital. Our teams serve the Champlain and South East regions of Ontario.
With the assistance of a transitional case manager (Ottawa), clients who require intensive support may access various specialty services including the FIRST (Ottawa) or FITT (Brockville) services. These teams offer interdisciplinary services to clients who have been (or are soon to be) discharged to live in the community.
The Integrated Forensic Program also offers access to Transitional Rehabilitative Housing Programs (see specialty services below) in collaboration with community housing providers to ensure the client has all supports necessary for their reintegration to community,.
The Integrated Forensic Program provides comprehensive mental health and criminogenic needs assessments, treatment and discharge planning services for seriously mentally ill adult male offenders serving a provincial sentence (less than two years) at the St. Lawrence Valley Correctional and Treatment Centre-Secure Treatment Unit.
The St. Lawrence Valley Correctional and Treatment Centre-Secure Treatment Unit is a 100-bed hybrid correctional facility and mental health centre located on the same campus of the Brockville Mental Health Centre. This facility serves 25 other provincial correctional facilities from across Ontario.
The Secure Treatment Unit is the result of a contractual arrangement between the Royal Ottawa Health Care Group and the Ministry of the Solicitor General. Integrated Forensic Program staff are responsible for the assessment, treatment and day to day supervision of residents while the Ministry of the Solicitor General staff are responsible for security and the overall operation of the building. The Secure Treatment Unit is designed to be more like a hospital than prison like and the health care staffing model is similar to that seen in other academic mental health science centres around the province such that the facility is designated as a schedule 1 mental health centre by the Ministry of Health and Long Term Care.
In keeping with The Royal’s multidisciplinary treatment protocol, teams at the Secure Treatment Unit provide specialized evidence-based assessment and treatment, including using the Risk Needs Responsivity Model of rehabilitation. Programs include:
All units include a range of psychosocial rehabilitation modules that address individual mental health and criminogenic needs. Treatment focuses on mental health recovery and targeting criminogenic needs to facilitate successful community reintegration and reduce recidivism (reoffending).
The IFP also offers psychiatric consultations via telemedicine (OTN) in various provincial jails in Ontario.
The Royal’s Sexual Behaviours Clinic serves those who have been or are at risk of being in conflict with the law because of their sexual behaviour. This outpatient clinic provides assessment and treatment to manage the sexual behaviour-related problems, reduce symptom distress, and increase psychosocial skills and coping strategies.
The primary treatment goal of this clinic is to improve the patient’s overall well-being so they can live successfully in their communities. Over the longer term, desired outcomes include reduced recidivism, prevention of hospital admissions, and eventual discharge from the forensic program. This clinic also provides support to the spouses and partners of individuals who have been or are at risk of being in conflict with the law because of their sexual behaviour.
The Sexual Behaviours Clinic sees clients that have been charged with sexual offences as well as those who have never acted on their problematic sexual interests (i.e. sexual interest in children), and want help to ensure that they do not offend.
To access this service, please ask your doctor for a referral. If you do not have a doctor, you can ask a doctor at a walk-in clinic.
For more information visit www.sexualbehavioursclinic.ca to learn more about the clinic and its research.
The Family Court Clinic (FCC), through The Royal's Integrated Forensic Program, provides court-ordered assessments of families, children and youth in matters that pertain to the Child, Youth and Family Services Act (CYFSA), as well as the Youth Criminal Justice Act (YCJA). The goal is to provide the Court with an understanding of prevailing problems and recommendations based on the child/youth's best interest.
All FCC assessments are conducted by a multidisciplinary team comprised of a psychiatrist, psychologist/ psychological associate and social worker, and include, but are not limited to, recommendations for interventions and treatment options that address the best interests and specific needs of the child/youth. The final reports are authored by the psychiatrist, with professional contributions from the social worker and psychologist/psychological associate.
The Family Court Clinic conducts court-ordered assessments of families in circumstances where the local child protection agencies cite concerns about the protection and well-being of the children within the family that are below the age of majority and petition the Court for an Order for Assessment of the family pursuant to section 98 CYFSA.
In the course of the FCC assessment of the family, a psychiatric assessment of each family member, cited for assessment by the Court, is conducted by the psychiatrist and a psychological evaluation of each parent/parent-figure is conducted by the FCC psychologist/psychological associate. The FCC Social Worker conducts home visits with the identified caregivers in the family and observes parent-child interactions within the family home, and gathers inform the child protection agencies involved with the family.
In the preparation of the final report, consideration is given to supporting the autonomy and integrity of the family unit, especially in cases where the parents may need help in caring for their children, as well as to making recommendations that are in keeping with the least disruptive course of action available and that are appropriate to help the child(ren), including the provision of prevention services, early intervention services and community support services.
For youth between the ages of 12 and 18, the Family Court Clinic provides assessments ordered by the Youth Court, pursuant to section 141 YCJA, for the assessment of criminal responsibility and fitness to stand trial under Part XX.1 of the Criminal Code, and pursuant to section 34 YCJA to assist with making a disposition and to advise the Court about the influence of underlying mental health, behavioural, psychosocial and family-related problems upon the youth's decision to engage in activities that resulted in the conflict(s) with the law and the laying of charges against the youth.
The assessment process includes both psychiatric and psychological assessments of the youth, as well as other specific assessments or investigations deemed relevant to the youth's situation, as well as collateral information from prior assessors or treatment providers of the youth, provided with the informed consent of the parties involved.
The parent(s), guardian (s) and/or parent-figure(s) of the youth are invited to participate in the assessment process by way of an interview with the psychiatrist or other member of the team. In addition, recommendations are made for treatment interventions that are specific to the identified needs of the youth arising from the findings of the assessment, and that will best facilitate the rehabilitation process and reduce the recidivism risk of the youth.
The final report is released to the Court and is subject to confidentiality and disclosure stipulations.
The Integrated Forensic Program provides assessment and treatment services for youth under the age of 18 at the time of their charge. Services include court ordered assessments for criminal responsibility and fitness to stand trial under Part XX.1 of the Criminal Code. We also provide services for court ordered treatment and stabilization. These multidisciplinary services are available to any Youth Court within the Champlain region.
These services are provided in the least restrictive manner consistent with the client’s clinical need and the safety of themselves and others. The services are delivered in a manner to expedite the court process and minimize disruption to the lives of the youth.
The Royal’s Anger Disorders Clinic provides specialized and comprehensive assessment and treatment for individuals with anger related problems. Anger is a normal emotion but, like anxiety and depression, it can be dysfunctional. The goal at this clinic is to assist individuals to successfully manage dysfunctional anger and thereby prevent its detrimental effects.
The clinic serves individuals over the age of 18 with recurrent aggressive behaviour, impulsivity, angry rumination, or emotional regulation. Clients must have motivation to be assessed and treated. While conflict with the law is not a requirement to be seen in this clinic, those without involvement in the criminal justice system will be recommended for community-based treatment for anger management following their assessment.
The Anger Disorders Clinic does not treat individuals with an acute major mental disorder or an uncontrolled substance related disorder, however it will provide consultations on such individuals.
The Anger Disorders Clinic is based at the Royal Ottawa Mental Health Centre and referrals are accepted through The Royal’s centralized intake.
Note to referring physicians and nurse practitioners: Referrals to The Royal’s Forensic Mental Health Program can be submitted electronically directly from your EMR if you have been set up with Ocean eReferral. Ocean eReferral is a regional program that offers an integrated solution at no cost for all primary care providers in Champlain with compatible EMRs (Telus PSS, QHR Accuro, and certain versions of OSCAR). Once set up, referrals can be initiated directly from the patient's chart in your EMR, launching the appropriate electronic referral form and automatically populating it with much of the appropriate information for the patient and referring clinician. For more information about eReferral, please email: Champlain_eReferral_Team@lhins.on.ca
The Integrated Forensic Program offers assessment services for the court at the request of the Crown Attorney and defence councils. If the individual is in custody, they will be visited by a Forensic Psychiatrist the courthouse or by video link. The purpose of this assessment will be to determine if a formal assessment order should be made regarding Fitness to Stand Trial or criminal responsibility.
The team offers recommendations on whether a client is an appropriate fit for Mental Health Court and provides recommendations for additional assessment and/or treatment. Individuals out of custody may be referred to the Mental Health Court Clinic. This team works in collaboration with other court supports such Canadian Mental Health Association court service or John Howard Society.
The FIRST and FITT provide intensive outpatient services to outpatient under the jurisdiction of the Ontario Review Board (people found Not Criminally Responsible or not fit to stand trial). FIRST is based in Ottawa and serves the Champlain region. FITT is based in Brockville and serves the South East regions.
These teams provide enhanced outpatient services and community links for clients. In collaboration with the client, the team builds and implements a comprehensive rehabilitation plan using the Recovery model and the conditions of their ORB disposition orders as a framework. Much of the support is provided to the client in the community to facilitate the reintegration. FIRST and FITT will support clients for up to one year after they receive an absolute discharge or a stay of proceedings.
The FITT Home provides 24 hour supervised accommodation for clients in the forensic mental health system. It provides services and housing to support the client with their transition from an inpatient unit to independent living.
The FITT-DD program is a collaborative transitional rehabilitation housing program initiative between the Integrated Forensic Program and Developmental Services of Leeds and Grenville (DSLG). This program supports the transition of individuals with developmental disabilities and/or dual diagnosis from forensic hospitals into the community.
With a focus on recovery, the FITT-DD service provides psychosocial assessment and rehabilitation programming, in tandem with community supports. FITT-DD has an ongoing focus on supporting the person to transition into generic community services and suitable alternative accommodation as permitted by the Ontario Review Board.
Each FITT-DD client will have an individualized Community Placement Support Plan identifying their behavioural and developmental needs, a risk management plan, monitoring requirements, and individualized programming and services.
FITT-DD serves clients who:
The purpose of Lebreton Transitional Rehabilitation Program is to provide short to medium term assistance with housing, along with enhanced supports directed at maintaining housing in the long term, for selected clients who are under the jurisdiction of the Ontario Review Board. This program is focused on offering supportive housing to assist in the transition from the Rehabilitation Unit to independent living.
The clients in this program should have some needs that can be monitored and supported over the course of their year stay at the house. The Lebreton program offers the monitoring of medication and substance use services and vocational opportunities, while addressing Instrumental Activities of Daily Living through the care of the outpatient team (FIRST) and/or the Canadian Mental Health Association caseworker as well as through programming from The Royal and the John Howard Society.
The Grove Transitional Rehabilitation program is a transitional housing and psychosocial rehabilitation program. Grove provides the opportunity for 10 adults (4 Grove residents and 6 clients living in satellite apartments) who live with persistent mental illness to continue on their recovery pathway. The program focuses on helping people acquire the skills and supports to live actively and interdependently with the outcome of a satisfying life in the community. The Grove Transitional Rehabilitation program involves partnership between Salus, Canadian Mental Health Association and The Royal. The length of stay depends on the person’s treatment/rehabilitation goals and progress (usually one year).
The Ontario Review Board (ORB) conducts annual reviews of the status of every person who has been found to be not criminally responsible or who is unfit to stand trial for criminal offences due to a mental disorder. Information on the ORB can be found on its website at: www.orb.on.ca
The support from family and friends is important for the recovery of our clients. We encourage visits while the client is staying at the Forensic Treatment Units in Ottawa or Brockville, or at the Secure Treatment Unit.
For the safety and security of our clients and our staff, and to ensure space is available, all visitors to the Forensic Treatment Units (Ottawa and Brockville) must contact the unit 24 hours prior to the visit. Visiting Times vary by unit, so please discuss timing with staff.
Visits to Secure Treatment Unit may be open in a visiting room or closed through glass with use of a telephone. All visits to the Secure Treatment Unit must be arranged and approved through Ministry of the Solicitor General (+1 (613) 341.2870, ext. 1100).