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FORUM on Corrections Research
How Are Forensic Patients Managed by the Mental Health and Justice Systems?
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What happens to mentally disordered offenders after they have been assessed by mental health
professionals? Forensic patients frequently disappear into the mental health or criminal justice systems
after the assessment period and are not heard from again. Many offenders are remanded for multiple
psychiatric assessments within short periods of time. Unfortunately follow-up on these individuals is
rarely conducted. Often clinicians who prepare assessment reports for the courts never receive feedback
indicating the extent to which their recommendations were incorporated into the judicial decisions. As a response to this lack of follow-up, a study of the Brief Assessment Unit (BAU) of the Metropolitan Toronto Forensic Service was conducted by Menzies and Webster (1987). Data were collected on all patients that were assessed during the first 12 months of operation of the BAU in 1978. The researchers tracked the career patterns of the 571 offenders over the two year period following their initial BAU assessments. Over the two year period following initial assessment, one quarter of the offenders received at least one further court-ordered assessment. Other results showed that 49% of the 571 patients received a total of 592 in-patient admissions for psychiatric hospitalization; 61 % received a total of 663 terms of imprisonment; 25% of the patients spent time in both prison and hospital following their assessment. In addition, one third of the subjects showed assaultive behaviour during the follow-up period and 56% of offenders who spent some time in the community were charged with at least one criminal offence over the two year period. Menzies and Webster's results raise many important issues regarding the relationship between the mental health and criminal justice systems. They reveal the extraordinary costs involved in what they refer to as "bus therapy": the passing of the patient back and forth between the mental health and criminal justice systems. Moreover they reveal large amounts of replicated paperwork generated by both systems for the same individuals. The researchers argue that much of the problem resides in the system itself rather than the person. The implications that flow from this study call for the tailoring of a coordinated administrative structure to serve mentally disordered offenders; a reduction in the number of psychiatric remands by providing the judiciary with yearly accounts of the outcomes of their clinical referrals and the utilization of case managers to link patients with appropriate facilities in an effort to reduce needless court proceedings. In short, the authors are advancing various strategies and mechanisms aimed at keeping the circulation of individuals between the health and justice systems to a minimum. Menzies and Webster are calling for a centralized organization that will address the pertinent medical and legal needs of mentally disordered offenders in our society. Menzies, R.J., Webster, C.D. (1987). Where They Go and What They Do: The Longitudinal Careers of Forensic Patients in the Medicolegal Complex. Canadian Journal of Criminology, 29, 275-293. |
