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:"# { 'TNai!oni!fJ';~ut!' : ~TROPOLIT AN toRONTO FORENS i C SERVI CE THIRD ANNUAL REPORT - 1979 TABLE OF CONTENTS 1. METFORS Objectives 2. Chairman of the Board - Report to the Attorney General 3. Board of Di rectors of fvETFORS 4. Foreword: Dr. E. Kingstone 5. Report of the Director ••••••• 0 ••••••••••••• 1 I 6. Department Reports: ~ !I Ii 1) Brief Assessment Unit ••••••••••••••••••• 21 Ii METFORS 2) In-Patient Unit ••••••••••••••.•••••• 24 p ~ D " --...... I 3) Psychology •••••••••• ".. •••••••• 27 Ii r1ETROPOLITAN TORONTO FORENSIC SERVICE 4) Social Work ••••••••• ~...... 29 !lI! 1! 5) Nu rs i ng ••••••••••••". • • • • • •• . 31 : ! 999 QUEEN STREET WEST ~ 6) Recreational Therapy •••• 0...... 35 ri 0 7) Consultation: Ministry of Correctional TORONTO} ONTARIO Services •••••.•••••• e...... 39 ru [I ~ 7. Financial Report .•••••••••••••••.•••••.••• 41 r'16J IH4 1 8. Appendices: (416) 535-8501 ~ JO i A. List of Staff ••••••••••••••••••.•. 43 B. METFORS Working Papers in Forensic Psychiatry 45 G' C. Articles published and in press •••••••. 48 1uf D. Scholarly addresses and media involvement 51 I Eo Education and research activities ••••.•• 56 F. Grants •••••••.•.•••••.•.•.•...• 59 ~ G. Honours ••••••••••••••••••••••••• 60 of U H. Vi s ; tors to METFORS ••••••••••••.•••••• 0. 64 9. Research Report \ 67 ~ ,D ...... Ii...... (, 10. Statistical Supplement .: ••••• oJl •••••••••••• 72 " 1 /? l\ ~ !i 0 ,:1. i NCJRS 1 " ~ n 1 NOV 7 1980 ! !I . m n ACQUIStTlO ~ - -"'--=~~=.=--- --=-="-". '-.~-~- rj ~--.. -.-~~~----- fl i ll\l1 E T FOR S metropolitan toronto forensic service METFORS OBJECTIVES II IlwrAri 89 queen street west, toronto, M6J' 1H4 537-2481 ,I \1 I To conduct psych; atric observat i on, exami nat ion, assessment and June 27th, 1980 appropriate treatment of persons who are before the Courts and are r'! Ij M referred to METFORS as a result of charges in the Judicial 11 District of York; also to provide services for other judicial or correctional institutions, '''eporting and advising as appropriate. 100 The Honourable R. Roy McMurtry, Q.C. Attorney General of Ontario 18 King Street East 2. To provide ather psychiatric consultative services for the Courts, Il II 00 Toronto, Ontario government agencies and independent groups in the area of forensic M5C 5Cl psychiatry. This is to include forensic psychiatric consultations to general psychi atric 'facil it i es. u 1\1 ~ l I Dear Mr. McMurtry: 3. To provide the means by which appropriate persons may obtain ~ [ I ~ education in forensic psychiatry, including part~cipation in the In accordance with the prOV1Slon of Section 5 of Order post-graduate training progra/T1l1e in the Department of Psychiat~.Y, in Council 1417/77, I am pleased to submit the Third University of Toronto, and in other profess'jonal and commun1ty ~ In Annual Report of the Metropolitan Toronto Forensic groups and agencies, and to undertake research in the .field of Service (METFORS) for the period April 1st, 1979 to forensic psychiatry. March 31st·, 1980. ~ u Ref.lecting on the past year, METFORS has continued in its obligation to provide the necessary service to the,courts" 4. To encourage the concept of a multi-disciplinary team approach in to pursue through research solutions to new and old problems all of the aforementioned areas. 10 and to communicate these solutions so that public policy decisions can be effected. Because of its striving for excellence, METFORS will continue to fulfil its obligation of being change agent, !~ synthesizer and disseminator of information in the area [ I of Psychiatry and law. Ii ~ !!l' 81 l J \j U J fj ~ l J.P. Rickaby 1 ' Chairman of the Board o ~1 n .. n'~ D n o J j' j l, FORB-lORD METROPOLITAN TORONTO E. KINGSTONE; M.D.) C.M.~ F.R.C,P.(C); F.A.P.A. FORENSIC SERVICE i 1 ~ jl Ii~~ 1) BOARD OF DIRECTORS It is indeed both ah honour and a pleasure to be writing a 1 (~ Foreword for this third annual report of Metfors, the Metropolitan Toronto ! 1 Ii Forensic Service. Although relatively young in age, the unit has fulfilled E !I so many long identified needs that in the perception of the community it Ii MR. J.P. RICKABY) Q.C.) CHAIRMAN) I; appears to have been established for a far longer time. My own informal )1 H)' CROWN ATTORNEY FOR THE JUDICIAL DISTRICT OF YORK j( Ii barometer has been. the repclrting by the press of suicides in detention "H I,J Ii ',0, j! units - I am convinced~ but have no statistics on this, that since the !.[ 'i founding of Metfol"s, these unfortunate events have practically disappeared MR. G.R. THOMPSON MR. W.C. JAPPY ) as would be expected from the implementation of knowledgeable and sophis j DEPUTY MI'NI STER DIRECTOR ! CORRECTIONAL SERVICES PSYCHIATRIC HOSPITALS BRANCH ticated psychiatric practices. '1, MINISTRY OF HEALTH The partnership of the health system, the criminal justice system MR. R.C. HANSEN and the University is clearly an advantageous one and perhaps even a typi EXECUTIVE DIR~CTOR DR. R.E. TURNER cally Canadian one - a complex arrangement that to the outsider appears CLARKE INSTITUTE OF PSYCHIATRY PROFESSOR OF FORENSIC PSYCHIATRY to work without major problems. DIRECTOR AND PSYCHIATRIST MR. M.S. PHILLIPS As might be expected, Metfors has begun to generate not only good IN-CHARGE SECRETARY METFORS service results (as attested to by the statistics concerning referl"'als and DEPUTY DIRECTOR - ADMINISTRATION results and the foreword of Chief Judge Hayes in the second annual report METFORS of Metfors), but also lTIultiple academic pursuits in the fonn of investigative research programmes and publications as even a brief perusal of this report wi 11 attest to. --- ~------.-- K • , ~:':::':;;:::;''':;::-~=--,",,",>,-,"'' \"1 1\ ill f \ THIRD ANNUAL REPORT • c ,I It , \ f ! I 1m i jl METROPOLITAN TORONTO FORENSIC SERVICE " In the current report, the conclusions which followed as a result j J of studies undertaken by Metfors and reported to the Ontario Council of I i l ~~ I I REPORT OF THE DIRECTOR AND PSYCHIATRIST-IN-CHARGE Health in its survey of the mental haalth system of Ontario, contain a number I II ~ of findings which are in total, fascinating, sobering and occasionally dis ! . R.E. TURNER 1 M.D.~ F.A.P.A'J F.R.C.P. (C)I FtR.C. PSYCH. heartening. One of these is the report that there is a lack of interest by 'j 00 f i 'j psychiatrists and/or psychiatric trainees in furthering their experience in I forensic psychiatry. [ 1 l~ This is regrettable for these are excellent educational facilities. It is a pleasure to present the Third Annual Report of the U l~j I Moreover, psychiatrists, by virtue of their involvement, potential or I Metropolitan Toronto Forensic Service for the twelve-month period - !I~ ( actu~l, in the civil liberties and rights of many patients and their IJ \ April 1, 1979 to March 31, 1980. relations are from early on in their training.~xposed to the issues Pt"O U l~ The Order-in-Council (1417/77) that established the Service was duced by the psychiatry-law interface, viz., certificatiqn~ ~ustOdY, etc. I pa·ssed on May 15, 1977. METFORS was designed to provide a new model As the paradoxes and problems of behaviour, illness and crimin n In. 'of a forensic psychiatric service to the criminal justice system. As I ality become the province of more and more professionals and the subject ; METFORS approaches the completion of its third year, it is appropriate of greater public debate the need for well trained professionals in n J~ to review briefly recent developments and implications of such psychiatry and in other disciplines grows as well. The professions and forensic services. II particularly those responsible for training programmes should accept the u ~ Such developments do not occur in isolation. They occur as a challenge to remedy this situation. u II ~ result of major policy decisions arising from determinations of new II I On behalf of the University and as a citizen I congratulate Metfors and increasing needs, and from certain events that occur that prompt a IiI ~. and its staff for its fine accomplishment and its pioneering endeavours. fi I .,: re-examination of current programmes. Some developments have been described in the literature previously by Turner (1) (2) (3). I ) !1 I~ We may also review other developments beginning with 1964. That 110 year saw the first of a series of three publications by the Canadian U Mental Health Association on liThe Law and Mental Disorder", (4) - A Vlce-P vost, ealth Sciences and report on legislation and psychiatric disorder in Canada. The three Septembe~ ~rd, 1980. Professor of Psychiatry. n In University of Toronto o n o-1 [I .~~_~_-~~__ ~-=-.~~~.' .., ~~_d_~_,",,=._.A=U_"==_.~=~"_'·"'''''''''':':-'_·-- , J -""-~.'".~"~.,,~--"--" I ~ ,~~- - 3 - - 2 - /II j ~ 1 the Law Society of Upper Canada wrote that Dr. Gr~y had "unusual volumes consisted of hospitals and patient care, civil rights and f J U irisight into the relationship between mental disorder and legal privileges, and criminal process. (A comprehensive edition was [I responsibil ity as well as deep undel"standi ng of the proper rol e of published in 1973) (5). In the same year, Swadron published psychiatry in the broad field of Cor'rections. The objectivity of his "Detent i on of the Mentally Di sordered" (6), and Moh r, Tu rner & Jerry f 1 approach to medico legal problems caused him to be held in the hiyhest published "Pedophilia and Exhibitionism"(?). The following year regard by the judiciary, by crown counsel and defence counsel. His , I · ; McGrath published "Crime and Its Treatment in Canada" (second edition !I contribution to law and medicine was enormous as a teacher, as an in 1976)(8), and Friedland published "Detention before Tria1"(9). . architect of progressive mental health legislation • •• " (17). The A notable development in Toronto in 1966 was the establishment of ! I ~ 1 ibrary at METFORS is named in. his honour and memory. the Clarke Institute of Psychiatry with a consolidation and i I 0 The Law Refonn Commission of Canada was established in 1971 and enlargement of the forensic In-Patients and Forensic Clinic of the 1 in the folla.'/ing years has published several Working and Study Papers i former Toronto Psychiatric Hospital into one service located on the I : I ' I~ and Reports to Parliament which relate directly to forensic fourth floor of the Institute. The development of forensic psychi atri c work. psychiatric services in Toronto has been described by Turner, l~ 'Chamberlain, Phillips, Aldridge and Coulthard (10) (11) (12) (13') I . IU Reports to Parliament: (14) • Evi dence December 1975 The innovative Mental Health Act, Ontario, 1967, was proclaimed o Our Criminal Law March 1976 in 1968. Judges and magistrates were empowered to order attendance Mental Disorder in the Criminal for examination, to order attendance for treatment, and to order 11 [J Process March 1976 admission for examination. Gigeroff published IIS exua l Deviations in 1 \ Sexual Offences November 1978. the Criminal Law" (15) the same year. The report of the Canadian U Conmittee on Corrections (Mr. Justice Ouimet) which was released in Workiny Papers: ! L~n 1969 (16) included chapters on mentally disordered persons under the The Principles of Sentencing · 1 · :, criminal law, and the dangerous offender. [J · i U I and Dispositions March 1974 :, \ Dr. K.G. Gray, Q.C., the first professor of forensic psychiatry i in Canada, died July 30th, 1970. G. Arthur Martin, then Treasurer of ~ I 1\.1; Ii.'I I! til II ~ !! I IIJ If ------~------~-- :,~~_;::;:::.l..~;,="'::-"""""""'" _,- ,j - 4 - - 5 M It 1m Study Papers: u !m The Kenneth G. Gray Foundation was established in 1973 to embody Medical Treatment and Criminal Law 1980 an'd reflect the ideals which permeated Dr. Gray's career. These ! Consent to Medical Care 1979 ideals contributed greatly to the development of important ties II 1 0 Sanctity of Life or Qual ity of Life 1979 \ between practitioners engaged in psychiatry, criminal law and !ill1 . II I L corrections. The Foundation will promote study for the advancement of Botterell's Report, 1972, (18) "Enquiry into the Health Care ! these professional and scholarly relationships. 11 System in the Ministry of Correctional Services" listed psychiatric \00 1974 marked' the assent to the Forensic Psychiatric Services ! 1 Corrmission Act in British Columbia. The Commission provides (a) services as one of several special areas for concern. In "Conclusions : I ~ and Recorrrnendations" references were made to the governing colleges, forensic psychiatric service to the courts in that province, (b) . . the role of physicians and psychiatrists, affiliation with a 11 n ; n-pat i ent and out-pat; ent treatment for referred persons, (c) p 1 a ns, university health sciences complex, the development of a new system organi zes and conducts research and educat i ona 1 programs, and (d) \ I [J for managing health information, confidentiality, psychiatric services consults with appropriate federal, provincial and municipal for adult inmates, psychiatric staff, and special psychiatric unit~ in departments and agencies. l ! I rl . hospitals for the ~ails. and regional detention centres. The Report Two International Symposia were held at the Clarke Institu,te of recomnended that: (1) an Inter-ministerial study should be promptly U 11 Psychiatry in February 1977 and February 1978 under the joint initiated to establish what health services should be provided by the management of Professor D.N. Weisstub and Dr. R.E. Turner. Professor Ministry of Correctional Services, by the Ministry of Health, by the 11 U Nigel Walker, Wolfson Professor of Criminology and Director of the Ministry of Corrrnunity and Social Serv'ices, and by the Ministry of the il n Institute of Criminology, Cambridge University, gave the first Gray Attorney General; (2) development of policies to produce the closest Lecture on "Dangerous People" (19), and the second was del ivered by possible integration between the Ministry of Health and the Ministry n fJ Professor Joseph Goldstein, Walton Hale Hamilton Professor of Law, of Correctional Services should be undertaken with the object i ves of Science and Social Policy, Yale University (20), on "Psychiatry, the f \ satisfying the legal requirements of custody and of providing the best D Child, and the Law". 1977 saw several judgements handed down by the possible mental health and other medical care. Appeal Division of the Supreme Court of Ontario which related to the It n mentally ill in our crimiFlal law system:- II n l1 H G LJ ~ ~ n • --f, - 7 - - 6 - justified but that the Crown has shown that she should be (a) R. v. Simpson - the administration of the criminal law in detained on primary and secondary grounds. relation to the defence of insanity. II It is obvious to me from the facts and ci rcumstances that Fega n (b) R. v. Sweeney - whether trial judge has jurisdiction to requires a mental assessment and medical treatment while awaiting require accused to submit· to examination by Crown tria1. •• I find support for my view that notwithstanding the psychiatrist, and evidence of refusal by accused. specific sections in the Criminal Code or lack of them, in all ( c) R. v. Deans - whether trial judge empowered to impose a the circumstances I have the power to invoke the provisions of sentence to be served in a provincial mental health centre. The Mental Health Act ••• To do otherwise would not be acting in (d) R. v. Rabey - distinguishing insane and non-insane II the best interests of the accused, whi ch Ubest interests II more automatism. This judgement was upheld by the Supreme Court Ii [I often than not are also in the public interest. I'it" of Canada, 1980. f In the result the accused will be detained in custody until her ( e) R. v. Hi 1t 0 n - dis e as e of the min d due to i nt 0 x i cat ion 0 r I! trial orlJther disposition by a court of competent jurisdiction drugs. and remdP~ed to the Metropolitan Toronto Forensic Service at 1001 and (f) f 1 Fegan v. The Queen - This was a bail review with judgement Queen Street West for up to-60_days for psychiatric by Mr. Justice Lerner. _investigation,' if the full period is necessary, in the discretion of that facility. It is further ordered that at all times she In this last case, the accused was charged with second degree will be in close custody and under constant supervision and murder. The Crown appl i ed for a Detent i on Order and the accused subsequently Similarly supervised in any other custodial facility brought an application for her release on conditions pending pending the disposition of this charge. 1I tri al • The issue was whether the accused should be detained, and The Report to Parliament by the Sub-Committee on the Penitentiary if so, whether there is power in the court to remand her to a System in Canada under the chairmanship of Mark McGuigan (21) was psychi atri c facil ity for a menta 1 exami nat i on and asses sment. pubHshed in 1977. Reconmendation 58 stated IIRegional Psychiatric Mr. Justice Lerner was satisfied that not only had she failed to satisfy the burden of proving that her detention was not !1 f ! I\ 0 [1 n '-- -...... ~"""~.-,...... ------.-- - 9 - - 8 - n Service, October 1975, under the chai rmanship of Lord Butler. Centres should be withdrawn from the jurisdiction of the Penitentiary Although the entire Report is of great value to those providing Service and placed under the federal Ministry of Health and Welfare. f I psychiatric services to the criminal justice system, Chapter 20 is Discussions should be held with the provinces to coordinate federal notewt')rthy particularly with stress on the need to develop closer and provincial mental hea1th services ll • Recommendation 59 stated that ! ( relationships among the various services responsible for treating the IIThere should be several separate institutions for the treatment of I mentally disordered offender. "A central feature of fully ! sex offenders, since their therapy needs are distinctive from those of I co-ordinated treatment services would be a network of forensic other irrnates with personality disorders. Admission should be on a psychiatric services based on secure hospital units in each Regional Ii [! 11 voluntary basis. II U 'I Health Authority area", (see Reco'mmendations 69-76). We note too I.' l, The Royal Commission of Inquiry into Confidentiality of Health \1 Recorrrnendati on #140 on research, "We draw attent i on to the need for ri Records, chaired by Mr. Justice Horace Krever, was established in ,I· more research in connection with mentally disordered offe'nders, and ( \ 1978.· All those in the health disciplines look forward to: fhe ~ the importance of planning evaluative studies to be 'built in' to any ~ publication of this Report. Dr. F. Jensen chaired a committee of the h new regime or form of treatment. The initiative in identifying I, II I" Department of Psychiatr:y of the Faculty of Medicine, University of o ,II profitable areas of research should more often come from those tc Toronto, and presented a brief to this Royal CorfV11i~sion. ~ r \ responsible for the operation of the system, including the Government II u 1\ 8i 11 C-21 proposed amendments to the Criminal Code of 'Canada in 11 Departments, the criminal courts and the various services, especially 11 t I' 1979 to enabl e magi strates and judges to order persons before theloJ j u 11 where operational research is concerned". I) directly to health facilities. This matter remains under Ii u The other major Report is that of the Ontario Council of HeaHh - !i consideration by the Department of Justice. IU ti 1979 - Committee on Mental Health Services in Ontario. Legal Task ti 1\ A review of this nature would be incomplete without reference to [j Force, Part I: Civil Rights and the Mentally Part II: The II I·' 11"1. II t\'JO other Reports. p Criminal System and Mental Health Services. The METFORS submission \ The first is the IIReport of the Committee on t1entally Abnormal 1,{ U was one of eighteen received to assist the Legal Task Force with Part lJ Offendersll presented to Parl i amen! in Engl and by the Secretary of 110 11 State for the Home Department and the Secretary of State for Social tl i ~ H;j Ii U u Ii II Ii 1\ fi FI Ii II ifM Ii o Ii ~ f~ --I, - 10 - - 11 - The Summary Recommendations should be quoted in full: 7J That speci a 1 cons i derat i on be gi yen to areas of the provi nce, IJ That the Ministry of Health in consultation with the such as the north, where g'eography and population demand a ~1inistries of the Attorney General, Solicitor General, different service delivery pattern. Correctional Services, COllmunity and Social Services and the 8J That consultation concerning the development of federal Secretariat for Justice clarify the responsibility for mental legislation in criminal law' and procedure be coordinated by health services in relation to the administration of justice. the body responsible for servic~ delivery and that this body That, because of the complexity of leyislation, jurisdiction 2J be also charged with assisting in the development of and administrative procedures, the responsibility be vested U G ~omplementary provincial legislation. in a bOdy, such as a Forensic Psychiatric Services 9J That forensic psychiatric services provide an interphase Commission. n n between criminal justice agencies and general mental hea lth 3J That such a body develop a master plan concerniny the needs 1\ In services with a special empha~sis on prevention through their of the various reyions in Ontario in relation to the criminal cooperation with criminal justice agencies, especially the justice agencies such as the police, the crown and defence, Ii '10 police. the courts, correctional services and comlJlunity a~encies. U Ij-U 10J That there is already a considerable body of knowledge and 4J That such a plan include in addition to provisions for positions in the background materials of this report and that consultation, outpatient and inpatient examination and II 1 U further study is not recommended until the responsibility for treatment, the development of educational and research developments in this area has been consolidated and vested in p rog ramrnes. 1J ~ U a designated government agency. 5J That special consideration be given to the development of secure facilities in the psychiatric hospitals on a reyional r \ 0 basis and that special institutions such as Penetanguishene j j I I U and St. Thomas be reserved for special cases. 6J That a policy be developea concerning the transportation of [! Iu accused persons or offenders to and from mental health facil ities. u )u n 0 G 'I D o u II ,- .. _----_.------.,..-- ',-.-- ~ --1, 1, /f ! ..- 12 - - 13 - Dr~ B. 8ut1er, formerly on the staff of METFORS, undertook a study of Psychiatric Services for the Criminal Justice System in 3J Assessment and treatment should be carried out as close to the Ontario in 1977 for the Ministry of Health ~ Psychiatric Hospitals point of origin of the prisoner as possible to enable contact with : : Branch, and updated this report in 1978 with the assistance of M.F. , u his family and his community. Dunbar, for the Ontario Council on Health. 4J Assessment and treatment are both more efficient if carried out in The conclusions of these two studies are contained in the Report : i u : i the same faci1 ity with cont i nuity of care and staff. of the Ontario Council of Health (1979). U 5] In response to the question, IIIn what way do you find existing f acil iti es and servi ces adequat e and sat i sf act ory?lI, the bas i c CONCLUSION l i response throughout the prov; nce has been -- IIIn no way! II Peop 1e 1J Because of the change in psychiatric hospital policy in Ontario in interviewed felt that secure, reyio~~l psychiatric facilities were about 1959 to unlocked wards from locked facilities, most U necessary and most felt that treatment fadl ities were the first psychiatric hospitals in Ontario do not have the appropriate priority, assessment facilities secondary. physical facilities to manage potentially violent patients. This Il 6J Penetanguishene Mental Health Centre - Oak Ridge Division -- is a 1 so af f e c t s the II for ens i c " pat i e n t. sen t fro m co u rtf 0 t' overcrmvded. Many patients presently housed in Penet~ng could and assessment or transferred from correctional facilities for should be assessed and treated in the local psychiatric hospitals "treatment. serviciny the local communities. Many patients frolll there could 2J It is difficult to predict the actual IIforensic" needs of the -- .... be housed in medium security units. In addition, these units Ontario Criminal Justice System based on the data we have ~ could be used to facilitate movement to an open-ward settin~. obtained. Many courts remain without psychiatric consultation. A 7J A substantial and significant amount of forensic in-patient number of individuals who require psychiatric assessment are not assessment and treatment is presently being done across the being seen. The open i ng of METFORS poi nts out the speed with provi nce. The vast majority of these cases do not require maximum which the courts recognize the usefulness of a psychiatric service security facilities and could be handled in medium security which was previously unavailable. It is also true, however, that facilities. These assessments are beiny done on general many indi vidual s who do not requi re a psychi at ri c assessment are psychJatric wards in the London, Thomas, Brockville, North seen in facilities that provide a IIreadyll assessment service to st. the courts. Bay, Thunder Bay, Hamilton and Kingston Psychiatric Hospitals. These hospitals r2quire separate secure units where forensic -----.- ~ -~--~- ---- - 15 - - 14 - n 10J Because of the size of Ontario, distance from some courts to patients coul'd be assessed. This would consolidate the existing assessment and treatment facilities is enormous. This results in w0 r k, t h us fa c i1 it a tin g a fa s t e r s e r vic e to the co u r t s, th e [I long court delays and enormous expense to the province for correctional system and to the patient. transportation and longer invol vement with the system. There is "Forensic beds" are available at the Hamilton Psychiatric Hospital lJ no secure assessment or treatment facility in Ontario north of and St. Thomas Psychiatric Hospital (female), and Royal Ottawa II Penetang. This results not only in the delays mentioned above, Psychiatric Hospital. Assessments are already being done in forensic but in the removal of the prisoner from his family (creating units in two of these facilities. The need in these facilities is for problems in assessment and treatment). Regional units would " an expansion for treatment cases, particularly for the reduce this problem, not only i~ the north but in all areas of the Lieutenant-Governor Warrant patients presently housed in Penetang. l i province, especially Central-Southern Ontario where the eXisting Brockville is just opening a forensic unit which will in fact have secure facilities are gathered. It some security and is designed to house this type of transitional 11J An additional need that would be met by regional secure patient as well as others. I{ psychiatric facilities is to deal with the cultural and language EIJ Psychiatric assessment and treatment in secure facilities is not problems of various parts of the province. Not only is the entire )J readily available in Ontario. Penetang, the Clarke Institutes the northern portio~ of the province peopled largely by Canadian Brockvi)le Psychiatric Hospital, the St. Thomas Psychiatric .r\ Indians with a separate and distinct culture but the rest of Hospital and METFORS are the only facilities with any kind of Ontario has pockets of ethnic groups from French in the east to security. Large regions of the province, particularly Northern ! ( Slavs in the mining country near Sudbury. A regional centre in Ontario, have no secure facil ity for psychi atri c assessment and these areas should reflect these particular ethnic and language treatment. This results in expensive delays in court proceedings, lJ needs. unnecessary hardship for individuals who are acutely mentally ill 12J Staffing appears to be easier in psychiatric facilities in [1 U and costly transfers to the existing secure facilities. I hospital settings than in correctional settings. Staff is also 9J Each new forensic unit should be closely affiliated with a n II U more likely to stay in a setting with a varied program of university department of psychiatry to ensure high quality service I assessment and treatment and not simply one facet. An additional and research and the recruitment of well-trained and highly III 0 factor to consider in arranging regional secure psychiatric units competent staff. would be the proximity of a university setting so the opportunity n II ~ of teaching and peer interaction would be available. q, l.t.. III U II U ...... " ..~ ., -.--. I ... -.~~"- - r, ,~-,~--,--, , ,u I - 16 - U'jIU - 17 - 13J The establ i shment of new psych i at ri c as sessment and treatment co-operation of new and old forensic facilities and correctional units for indiv'iduals within the criminal justice system should be uII ~ institutions. One proposal was made to have a single card done with the co-operation of the indivi'dual psychiatrists completed on each individual. Such a system would facilitate data actively engaged in forensic psychiatry in the region to be fl n collection. serviced by the new units. /,1 0 18J There are very few psychiatrists with substantial speciali.ty 14J A more complete picture of the present forensic services in the training in forensic psychiatry. In addition, there are very few Brockville-Ottawa area 'is necessary to ensure appropriate I; ! n psychiatric residents presently trained in Ontario, who have shown expansion in this region. I I any interest in forensic psychiatry. This must be considered by 15J The proposed medium security units should provide a treatment II 0 any planni~g group in the staffing of new facilities and in facil ity for the mentally ill withi n thei r regi ona 1 correct i ona 1 Ll providing funds for expanding forensic educational programs. facilities and federal penetentiar¥es. It would be beneficial to n 19J A reasqnable l',"atio of male to female beds for new forensic arrange for a sharing of psychiatric staff with Corrections and to I ! [] assessment units is 9:1, based on the sex ratio of the present transfer part of their existing staff to the new units. caseload. This ratio would be reduced slightly (8:1) if some of 16J There are correctional facilities which do not have psychiatrJc l..i the St. Thomas Psychi atri c Hospita 1 female popu 1 at i on are to be consultation readily available on an ongoing basis. Psych i a't ri c assessed .in the new'medium s~curity units. forensic units could provide regular consultation to local 20J The Thunder Bay region had the highest number of 1977 correctional institutions, expedite the treatment of the mentally charges/populat.ion of the proposed centres for new units. North ill offender, and reduce the inter-institution problems which Bay had the second hi ghest rat i o. Both of these regi ons had more presently exist. (The system in Hamilton with Dr. G. Mercereau Ll than double the ratio for Ottawa-Carleton, which had the lowest. and the Hamilton Psychiatric Hospital forensic unit is an example ['j Th'ese ratios should be considered in establishing forensic of a workable and productive system). n I assessment beds. 17J The establishment of a data base for psychiatric patients within f] I {] 21J The federal penitentiaries should provide data regarding the the criminal justice system is essential to provide complete ! federal parol e popul ati on p,"esently requi ri ng psychi atri c services assessments for courts, and for expanding the behavioural sciences rr '10 in Ontario and, if possible, co-operation obtained in sharing through research. A system could be developed with the III.~ 0 regional secure psychiatric units for treatment and assessment. i I n11 u Diu I ,r D IU 'W_=<=.,,*,=_ ==~-=__ ' J ~~_' __ " • ------~-- ~------ , < '-~~;::;. .. - ~- .---". R 11 - 19 - - 18 - p tJ ,j 00 REFERENCES 22J As shown in Appendix 16, court-ordered assessments in the j } IJ Turner, R.E., Hutchison, H.C., Williams, L. liThe Forensic Clinic established psychiatric centres and hospitals across Ontario have ~ ll of the Toronto Psychiatric Hospital • Canad. J. Corrections, Vol. 1, NO.1, 1958. -decreased between 1976 and 1977. Even the Penetang Mental Health I ; /' \ 2J Turner, R.E. liThe Development of Forensic Clinics". Manitoba Centre, Oak Ridges, had a reduction in assessments on remand from l~ Medical Review, Vol. 46, No.7, Aug. - Sept. 1966. courts from 226 in 1976 to only 172 in 1977. Explanations given I~ 3J Turner, R.E. "Psychiatry and the Lawll Osgoode Hall Law Journal, Vol. 11, No.1, June 1973. by various officials centered around lack of security in most 4J The Canadian Mental Health ASSOCiation, "The Law and Mental centres and the unwillingness of cour-ts to remand for assessment Di sorder". One: Hospitals and patient care, 1964. to a facility where none exists. The reduction can also be Two: Civil rights and privileges, 1967. " Three: Criminal process, 1969. explained by the opening of r-ETFORS in Toronto. It would appear n 5J The Canadian Mental Health Association, "The Law and Mental that the courts cl early wi 11 not remand to a non-secure sett i ng [j Disorder", 1973. when it is possible to remand to a secure setting and a need has 6J Swadron, 8., "Detention of the Mentally Disordered including our Applicable Criminal Law", Butterworth, Toronto, 1964. ~een proven for such units to be distributed more widely in n 7J Mohr, J.W., Turner, R.E., Jerry, M.B. "Pedophilia and Ontario. The Region #6 figures alone show a fall in assessments in Exhibitionism", University of Toronto Press, Toronto, 1964. the open-setting North Bay hospital from 75 in 1976 to 36 in u 8J McGrath, W'.T. (Ed.), "Crime and Its Treatment in Canada", Macmilla,n, Toronto, 1965. (Second Edition, 1976)0 . 1977·. The evolution and growth of fo~ensic psychiatric services is u 9J Friedland, M., "Detention Before Trial: A Study of Criminal Cases tried in the Toronto Magistrates Courts". University of Toronto apparent from professional literature, reports and one's personal' u Press, TOt'onto, 1965. knowledge and experience. 10J Turner, R.E. "The Forensic Clinic, Toronto". Criminal Law Quarterly, 2, 4, February 1960. Other indications of such growth can be demonstrated by the [] 11J Chamberl ai n, C. "Psychi atric Service to the Juveni 1e Court", establishment of a section on forensic psychiatry in the Ontario Canad. Psychiatr. Assoc. J., 20, 1975. Psychiatric Association in 1973, and in the Canadian Psychiatric [J 12J Turner, R.E. "Servic:es Note. The Development of Forensic Services in Toronto". Canad. J. Crim. 21, 2, April 1979. Association in 1975. The American Academy of Ps.ychiatry and Law, 13J Phillips, M. "HistoY';cal Development of Forensic Psychiatric established in 1969, has grown from 7 original members to over 700. IG Services in Canada II, Personal Manuscri pt, September 1979. 4 We trust that this brief historical review of progress in recent 14J Aldridge, F. and Coulthard, R. "The Forensic Service of the 10 Clark.e Institute of Psychiatry". A publication of the Institute, years demonstrates the many and '"aried influences that affect forensic March 1977. psychiatric programmes. and pOints to possible future policy decisions 15J Gigeroff, A. "Sexual Deviations in the Criminal Law - Homosexual, n Exhibitionistic and Pedophilic Offences in Canada". Clarke and programme development. Institute of Psychiatry Monograph Series, University of Toronto o Press, Toronto, 1968. The remainder of this Report highlights the ways in which METFORS 16J "Report of the Canadian Committee on Corrections. Toward Unity: I'· is providing clinical service to the courts, whilst fulfilling the Criminal Justice and Corrections". Chairman Mr. Justice R. o n Ouimet, Queen's Printer. Ottawa, 1969. educational and research obligations incumbent on both our mandate and l on the responsibility of a forensic psychiatric service. U [l ·--:---_."' ___.... P"""_7;;c;::::====.;;c:;:_~' 1 21 - 20 - n l~ BRIEF ASSESSMENT UNIT :\ ~ l I { 1 I < 17] Martin, G.A. "In Memoriam - Or. Kenneth G. Gray, Q.e.". Gazette, I F.A.S. JENSEN J M.B.B,S'J D.P.H' I D.PSYCH' I M.R.C.PSYCH'I F.R.C.P.CC) Law Society of Upper Canada, IV, 3, September 1970. In 18J Botterell, E.H. IIEnquiry into the Health Care Systel~ ~n the _ t \ ll Mi ni stry of Correctional Servi ces • Report to the Mllil ster, 19/2. DEPUTY DIRECTOR - CLINICAL 19] IlLaw c:nd Psychi atryll. Proceedi ngs of an Internati onacl ~Yldnpos i Uln I.: ID held at the Clarke Institute of psychiatry, Toronto, ana a, February 1977. Ed. David N. Weisstub, Peryamon Press, 1978. The Brief Assessment Unit provides rapid psychiatric assessments for \ \ 10 20] IILaw and Psychiatry IIII. Proceed~nys of an Int~rnational Symposium held at the Clarke Instltute of Psychlatry, Toronto, the Courts. Most of these cases are pending bai1 hearings and are Canada, February 1978. Ed. Davi d N. Wei sstub, Pergamon Press, 1979. tl o carried out within the pennissible 3 day period of detention prior to ll 21] Report to Parl i ament Sub-Col~mittee on th7 IIPenet~nt i ary syst;r~ in the Court Hearing. A few cases may be referred as "outpatients i.e,. Canada". M. MacGuigan, Chalnnan. Standing COllll~l1ttee on JUSwlce [J and Legal Affairs. Minister of Supply and Servlces Canada 1977. U they may ~ave been released to the community on bail and can attend \ ! o our Uni t for pretri al or presentence psychi.atri c as sessments. A11 reports from METFORS are forwarded confi dentially to the Pres i di n9 \ i n Judge, as we are not involved in private, defence assessments. f 1 l\ The assessment process itself is carried out in one day, usually over rl a period of some 6 hours between 9 a.m. and 3 p.m. The patients are I i brought to METFORS from the jail and will then return to jail the same , [ 1 U evening to.gether with the psychiatric r~ports which will be av'ailab1e to the judge when next they appear in Court. The advantages of n U examining the patients here in METFORS instead of the jails are o manifold. Most importantly, we are able to provide a setting in which an intimate interrogation of a troubled person may be carried out. o The validity of such assessments carried out under these conditions is greatly enhanced. \ .I o The assessment is a multidisciplinary one, involving psychiatrist. 1 \ U psychologist, social worker, psychiatric nurse and correctional fj II -.1 n [ J ---- -.....,..------~-- • - 22 - ... 23 - [j i' h; r I officer. It is based mainly on the interview supported by the results !I involved is exercised to a maximum in arriving at a psychodynamic of some brief psychological testing, information from relatives and formulation of the person and his present crisis situation and in others, exploration of any mental health records in the city and lI making recommendations far problem-resolution within the context of behavioural observations during the period of the patient's visit with the court process. us. It should be pointed out that the patients' involvement in the lj process is quite voluntary and, when requisite. we obtain the nece The procedures al so lend themsel ves to fasci!'!~ t i n9 research areas, t ssary Release of Information from the patient. We attempt to contact I such as the prediction of dangerousness. fitness to stand trial, the patient's lawyer and infonn him about our asses.sment. Pri or to {J criminai responsibility and the phenolnenology of crime .. his returning to jail, the patient is informed about the results of our assessment and the main points in our letters to the Court are r '! discussed. li i In the course of these assessments, it is possible to isolate those in need of emergency treatment and whose mental condition precludes their ... ..,."" continued proc~ss through the judicial and correctional systems. These persons may be hospitalized invrlediately under the Mental Health Act. In those cases where we are unsure about the true mental state of the patient and we feel that further investigation is necessary to answer the ques ti ons that we are be i ng asked by the court. we can request that the patie!nt be remanded to our In-patient Unit for a peri od not exceedi ng 30 days. Bri ef assessment under these cond; ti ons provi ~es a uni que teach i ng experience for mental health professionals. The goals of the assess ment are sharply focussed and the expertise of the various disciplines ~-~.------_.~ .,~. ~':-.:"':',-:.'.:::.::;;' ::;:-:: .::::--; ;.,".-::'~':::::;:::::.-:::,'_"7:::': =-_-::-:~::-:::':='~':'::~--::'":::=:::::::-.:.::::...:,:::;.. ..::.:~.,,,-,,~-,,==-..,.;,,_,~-"'-- ""T","' ___ ~ . ~~ ~~" "~"-""~ ~.~-"~"~--- - 24 - - 25 - IN-PATIENT UN·IT d] Therapeutic Programmes Are related to the medical, social, psychological and recreational needs of the patients within the context of R.J. f'1AHABIR the continuing assessment process. 2. Education Objectives: J B.A'J M.B'J CH.B' D.P.M' J C.R.C.P. (C). M.R.e. PSYCH' J F.R.C.P. (e) It is the expectation that all staff at METFORS be actively involved in the on-going Educational Programmes at both the teaching and professional development level. These· programs SENIOR PSYCHIATRIST-IN-CHARGE OF IN-PATIENT UNIT include: ! ! In-Service Training Students and Volunteers under the aegis of METFORS The In-Patient Unit under the direction of Dr. R.J. Mahabir disciplines [ 1 Contacts with Community and Collateral Agencies continues to provide reports to the Courts regarding patients referred 3. Research Objectives: to the unit. [1 u The objectives of the Research Prograrrme are to initiate, develop' During this year 224 patients have been assessed on the and implement projects on the In-Patient Unit through staff participation on an individual or group basis in cooperation with In-Patient Unit. Many have previously been seen on the Brief ! ! u the Research Scientist. Assessment Unit and almost 50% need treatment in addition to being I i r u assessed. The issue of assessment plus or versus treatment continues - The In-Patient Executive Committee will examine problems, evaluate to be a subject of discussion. programmes and make recommendations to the In-Patient staff for II 0 implementation of new and expanded programmes and wi 11 advi se the A significant move was the formation of the In-Patient Executive METFORS Advisory Committee accordingly. /i chaired by Dr. Mahabir with one member from each discipline. This , ) Experience has shown that this committee performs useful functions small corrmittee's first task was to fonnulate objectives surrmarized as including monitoring standards and progress on the unit. [ 1 foll ows: The multi-disciplinary approach to assessment remains the 1. Service Objectives: rl fundamental approach and information gathered from all sources is The objectives of Service on the In-Patient Unit are as follows: incorporated in the final report sent to Court - these sources are aJ ~edical and Nursing Care psychologists, social workers, psychiatrists, recreational therapist, To provide medical and nursing care for all patients in a nursing and correctional officers. safe environment within the policies and procedures of the Clarke Institute of Psychiatry. This is the end point of an assessment and often in Court on the b] Safety witness stand it becomes necessary to explain the process on the To ensure the safety of staff and visitors on the In-Patient Unit. The tourts have expressed appreciation of the amount" In-Patient Unit. of work put into an as·sesment noting especi ally that three times a day c] Assessment , The In-Patient programme is primarily designed to facilitate the assessment process terminating in a comprehens i ve report to the referri ng Court. ------~~=~~=~==~c_-~---'--- fj ==~,~~,". ="'-=====--- 27 - \ - 26 - F on every patient, nursing notes are recorded. Medical staff are III ~ PSYCHOLOGY cognizant of the fact that these notes are extremely valuable and !110 contribute enonnously to ,mistake-free assessments. I . G. TURRALL~ ED,D,~ SENIOR PSYCHOLOGIST One major area of frustration is the lack of follow-up facilities i I I IU During the past year psychology has continued in its specifically selected for METFORS patients by selected METFORS staff. partiCipation and development of METFORS. Several patients can benefit from such a programme especially after liD With our existing staff, the Clinical component of the Service they have established meaningful relationships with members of staff. I i has been the predominant activity. Psychology is involved on both More staff and more space will be needed for such a programme. the Brief Assessment Unit and Inpatient Unit. They function on the Hopefully this can be implemented in the near future providing a I J . 11 Brief Assessment Unit as a team member and resource person. After sorely needed service to a group of people often left in limbo, and as [ 1 the initial team interview when questions regarding differential a spin-off sustaining high morale among disciplines trained to treat U diagnosis or potential for dangerousness remain and immediate answers sick people bearing in mind that a large IlJmber of people referred to II 0 are deemed necessary, psychology's expertise is directed to us (almost 50%) are suffering and also have caused others to suffer. administering and interpreting psychological tests. It has been 0 demonstrated that the unique skills of an experienced psychologist can a·ssist in the 'compl et i on of I-day court ordered assessments. /I 0 \ Without this involvement, a larger percentage of suspected mentally 0 disordered offenders would require protracted and expensive inpatient unit assessments. [ 1 0 Psychology's role and function on the inpatient unit is diverse II n and includes consulting with nursing staff on group dynamics to assuming primary responsiblity for a few patients. Psychology's I i n contribution on this unit is that of a clinician who is also a psychometric test specialist. When clinical impressions and o n interpreted test data are integrated into a psychological report, ~ rl psychologists can offer opinions about fitness to stand tri al , dangerousness and diagnosis. As a result of this involvement, m .., 11 psychologists are asked to attend Significant trials. It is becoming more frequent that psychology is asked to comment upon the [1 I _J feasibility and type of treatment required for individual patients. I o .' - 28 - [I r~- - 29 - j I I Ii SOCIAL WORK ii { 1 ) 0 1\ I' ~ !, M. PENFOLD~ M,S,W,~ CHIEF SOCIAL WORKER I' One psychologist recently appeared to testify on a Dangerous Offender /) n I application and presented testimony about the individuals diagnosis I Social work has continued to provide professional clinical service on and treatment needs. IU the Brief Assessment Unit and Inpatient Unit throughout the year. The Research and Education are areas that psychology hopes to : I I I D involvement of staff on these units is reflected in the social work increase its involvement with this year. Although co-authors in many statistics which appear elsewhere in this report. current research projects, individual psychologists hope to embark on [ : o their own respective research interests. Examples include: Functioning as a team member on the Brief Assessment Unit, social IIcognitive mapping of persons charged Wl. th v,' 01 ent cri mi na 1 acts II and !f U workers bring a unique skill to the assessment process. Where contact IIviolence in the young adultll. 1 : I ~ with the family of the patient or community and health facilities is One psychologist was cross-appointed to the University of Toronto o an important component to the team decision making process, the social at OISE this past year an d efforts are bel'ng made to continue with t l ,0 worker assumes the responsibility of making these con~acts (with the this important affiliatipn with local universities. patient's con-sent) and evaluati'ng the information obta.ined in relation The successful Post-Doctoral Fellowship of Dr. Glasberg has I'D to the patient. The time ptessure of work on the Brief Assessment demonstrated that the conflicting demands for excellence in clincial U~it (information must be obtained within a few hours) dictates that work and our responsibility to train Forensic psychologists need not U the social worker maintain an up-to-date knowledge of community be compromised. In this coming year and within the existing budget, II o facilities, programmes and alternatives to imprisonment. We feel that Psychology will train the second Post-Doctoral Fellow and third ~he social work staff make a valuable contribution on this unit and clinical psychology ,intern. It is hoped that the successful r l o demonstrate daily their importance to this process. experiences of both types of students will lead to accreditation with the Board of Education and Training of the Ontario Psychological o Social work on the Inpatient Unit is an active and integral part of Association. ! j 0 the assessment process. Family' members, friends and community agencies are, with the patient's consent, contacted and/or seen in o [l office interviews. The purpose of these interviews is four-fold: (1) o rl to interpret the METFORS process to the family and/or community, (2) to collect and record relevant historical data, (3) to assess the a I [ support and assistance available to the patient through the family and ' community resources, and (4) to identify the realistic limitations of n .1 u .. I 31 - - 30 - i , : \! j' I' l \ NURSING I! , l these resources in relation to the patient. To adequately work with i " the family and community the social worker must spend considerable L. HERMANSTYNE J B.Sc.N'J HEAD NURSE time with the patient both before and after the outside co'ntacts. , ! , i i ,I \ , INTRODUCTION , I In addition to direct service, social work staff are also involved in " ;very institution captures something of the time and interest of educational and research projects. i ! I its /Tenters and provides something of a world for them; in brief, )! every institution has encompassing tendencies. 11 By presenting and attending presentations by other social workers, our I! Ii The total institutions of our SOCiety can be listed in three j' staff maintain an active and close relationship with the Department of f rough categories. First there are institutions established to care t Social Work, Clarke Institute of Psychiatry, in the area of education. for persons felt to be both incapable and hanmless. Second, there are ,0ne of the social work staff is a lecturer/consultant on a regular places established to care for persons felt to be both incapable of basis at the Metropolitan Tor~nto Police Colege. In addition, the looking after themselves and a threat to the community, albeit an soci al workers frequently speak or are panel members at a var; ety of publ ic and/or pri vate agency' functi ons. unintended one. A third type of total institution (METFORS) is organized to protect the community against what are felt to be intentional dangers to it, with the welfare o~ the persons thus Social work staff initiated a project on Domestic Violence in 1978. A sequestered being the immediate issue, i.e., fitness to stand trialc second working paper on this study will be available shortly. One of ASSESSMENTS the staff has also been active in a study of homocide in Toronto. The I The Brief Assessment Unit has provided assessments for referrals results of that study should soon, be ready for publication. In addi f1 from within the Judicial District of York and beyond. tion the social workers partiCipate in the wider studies being conduc lD INPATIENT SERVICES ted at METFORS, e.g., the "dangerousness project". We would like very JI 10 The inpatient service has provided assessments for referrals from much to expand our involvement in education and research pursuits. a IlJmber of areas across the province, al so meet; ng the needs of the Unfortunately the clinical demand on staff prohibits this at present. II n 1 Judicial District of York. • 1I [1 , j t' Throughout the year the demand for assessments has increased • t Ig1 This demand has lead to a careful screening of referrals, involving o many discussions and conSUltations with Judges, Crown and Defence U; U Attorneys by telephone. n n \ l - 32 - - 33 - CONTINUING EDUCATION PROGRAMME Ilene Lawson, R.N. Counselling programme for the . The IlJrsing staff· s invol vement in the assessment programme has alcoholic and/or family George Brown College essentially remained the same as it was in 1978-79. Nurses continue Karen Beckett, R.N. Forensics programme to be the primary innovators and operators of the pat i eot mil i eu due Mary Bateman, R.N. George Brown College to their COtlstant twenty-four hour, Monday-to-Sunday presence on the Norma Cohen, R.N. George Brown College unit. Patti White, R.N. George Brown College PROGRAMME ACTIVITIES IN CONJUNCTION WITH ACTIVITY THERAPIST Marnie Ronald, R.N. George Brown College Monday: Patient Ward Meeting 900 - 1000 Robert Russell, C.O. Forensics programme Planning Meeting Team A - Dr. McDonald 1000 - 1130 Dr. Mahabi r Bradley Walker, C.O. George Brown College Patient Coffee & Act i vity 1000 1100 Weights 1330 - 1400 LECTURES AND PRESENTATIONS Music Therapy 1430 - 1530 Gym 1600 - 1700 Kim Levey Forensics programne Tuesda,y: Communication Group 900 1000 Lance Hermanstyne George Brown College Planning Meeting Team B - Dr. Byers 900 1000 Dr. Jensen Lance Hermanstyne Forensic nursing Patient Coffee &Activity 1000 1100 Cen~ennial c?l1ege nursing, students Social Planning Meeting 1100 1130 Weights 1430 - 1500 Lance Hermanstyne Co-ordi nator of i npat i ent forens i c Gym 1600 - 1700 in-service education Wednesday: Communication Group 900 - 1000 Sharon Montgomery Act i ve therapy Nursing Meeting 900 - 1000 (Activity Therapist) Students· Patient Coffee 1000 - 1030 Centennial College Sexual ity Group 1030 - 1130 u Staff Research &Education 1400 - 1530 CROSS EDUCATIONAL APPOINTMENT TO METFORS AND GEORGE BROWN Gym 1600 - 1700 Joan King Clinical Co-ordinator Thursday Dr. Jensen· s Group 915 - 1000 ·n Forensics programme Patient Coffee 1000 - 1030 George Bro~m Dr. Jensen I s Group 1030 - 1115 Weights 1330 - 1400 u u Kim Levey METFORS -George Brown Films 1430 1600 (Recreation Student) Lance Hermanstyne METFORS ~ George Brown Gym 1600 - 1700 o U Friday: . Communication Group 900 - 1000 Coffee &Activity 1000 - 1030 Orientation Group 1030 1130 D fJ Special Event 1400 - 1600 U o , G Ii: a Ii • .-11-1 _~~======"=~--- - 34 - n - 35 - COMMITTEE/PROFESSIONAL ASSOCIATION RECR8\TIONAL THERAPY La~ce Hermanstyne Canadian Association for the Prevention of Crime Karen Beckett Audit committee, ~TFORS s. MONTGOMERY Jane Pepper Audit coounittee, fwETFORS II , Lorraine MacDonald Audit , ,i committee, C. I. P. , i Lance Hermanstyne Industr'ial Safety Committee C.!.P. The needs of the patients seen on the In-Patient Unit at METFORS are RESEARCH in the areas of social, physical and creative skill development. Jane Pepper Dangerousness project Accordingly, programmes have been developed by the recreational l r Alex Rotholc Arson " I therapist to meet these needs: Patti White M.M.P.I. Analysis Common factors in violent crimes I ' WEIGHT TRAINING CLINICAL UPDATE The patients attend this prograrrme three times a week for half-hour= Kim Levey Cardia Pulmonary Rescussitation Ii sessions. This provides the patients with the means o'f developing a Jane Pepper sense of physical awareness, as well as providing staff with an Lynn Keefe assessment tool for observing the patients' ability to work with each David Finlay other, follow a routine and follow instructions. Sharon Montgomery SECURITY AWARENESS PROGRAMME 11 ARTS AND CRAFTS Kim Levey The objectives of this programme are to: Patt i White II !0 Anne Maher 1) Teach the patients new skills I! ~1fj U Lance Hermanstyne 2) Develop an understanding of the patient's capabilities Jane Pepper II j D 3) Provide a meaningful leisure activity j [j-l U It is important that these prograrrmes remain somewhat unstructured, as the needs, capabilities and interests of the patients change with new o U admi ss ions. ~ 0 m n --Of , , 1 - 36 - rJ - 37 - Special Events II Exercise Programme These activities are scheduled for every Friday afternoon at 1430 to This programme is led four times a week by the r~creationa1 therapist. ! 1 1600 hours, and include tournaments (ping pong horseshoes), socials, Because of limited space, this programme is not able to meet the needs t ! ' 1 I sing songs, drama, discussions and table games. L ~ of all of the patients, with their varying ages and backgrounds. There is a serious recognized need for outdoor recreational facilities The purpose of the special events is to provide for interaction between ! i fj to be made available for the patients' use, and solutions to this problem staff and patients, and to involve the patients in planning for their are being discussed. leisure activities. Additionally, this type of event is used for fund r ! fJ Mevi es raising purposes, with the proceeds going towards prizes and for the [( U Patient Ward Fund. These are obtained from the National Film Board once weekly, a~d receive [1 a positive response from the patients. Special events are also scheduled for the holid~y season each year, with U the patients preparing and arranging food for luncheons or dinners, as t: ! U well as organizing entertdinment. Students 1\ (] We have been fortunate to have the services in the past year of one Music TherapY Recreational Therapy student from a community college. This arrangement t l proved to be quite successful -in terms of providing additional input and ~lusic is a mode that can reach all pat'ients at some level. This pro attention for the patients, as well as a learning experience both for gramme is enjoyed by a most diversified group - patients at low and high 11 the student and the recreational therapist/supervisor. A second student levels of mental functioning. The types of music are varied, selected was employed in this capacity during the summer months, and volunteers weekly according to patients' interests. The purpose is to stimulate U and students will continue to participate in the recreational therapy program awareness of mood and rhythm in music and to focus some discussion around fl throughout the coming year. the meaning of lyrics. Some assessment of patients' behaviour is possible by observing reactions and statements and preparing a written record of [l them. Ij Ll fJ !..:. [] [} ! 1 - 39 - - 38 - ,~ CONSULTATION TO THE MINISTRY OF CORRECTIONAL SERVICES Conclusion Ll The objectives of the Recreational Therapy programme are to provide CONSULTANT PSYCHIATRIST meaningful, stimulating activity opportunities for patients, as well " as to facilitate staff interaction with and observation of the patients Dr. A.J. Dacre continued to 'serve as a link between the three during these activities. Th';s in turn allows staff to make significant Toronto jails and detention centres and METFORS, especially in contributions to the overall assessment process. relaying specific information about medication of patients seen at METFORS and returned to detention centres, thus ensuring continued cate. There was a real increase in the numbers of mentally pi sordered individuals in detention, and an increase in referrals from all centres in'Toronto, necess i tat i ng extended consu ltat i on with other psychiatrists. The Parole Board has continued to ask for psychiatric reports on ['1 n certain inmates before deciding upon plans for the inmates' future. On II n occasion, this has included consultation with the Parole Board Regional Chairmen. o n There has been an increase in consultation with Canada Employment o and Immigration Commission in Toronto, advising on suitability of n individuals to attend Adjudication Hearings for immigration purposes, fl n for deportation by air and in medical escorts for repatriation. 1 Dr. Dacre has accompanied patients with seri ous mental ill ness 1'1 IU who have been incarcerated to ,p1 aces as di verse as New Del hi, Hong Kong, London, England, Damascus, Haiti. U.S~A. and Portugal. He has Ll [l taken advantage of this to discuss the workings of METFORS and the n, R Ministry of Correctional Services with officials of other jurisdictions and to visit their institutions, for example Siu Lam o Ll Psychiatric Centre in Hong Kong. Arising out of his work, Dr. Dacre u o _ ~,_~~~-=-~.l.:b ...... ,--.__ ~. _~ ____ .. ----.··1 - _~~,~,_r==~ =''o-:::=:::::---=--::o.::::;::::,,-.-=--====- I~l·~-'·'~~-~· ,,', - 41 - - 40 - was asked to speak at the XXVII International Conference of Aviation [ 1] ;1' ~ and Space" Medicine in Montreal in Septerrter, 1980 on "The Carriage by METROPOLITAN TORONTO FORENSIC SERVICE Air of the Mentally Disordered". I: II ~ FUND OF THE BOARD , ' Dr. Dacre has been involved in discussions within METFORS and the 'I ~ STATEMENT OF iNCOME AND EXPENDITURE , , 1 Ministry of Correctional Services over the increase in need for I APRIL 1, 1979 - MARCH 31, 1980 obtaining psychiatric placements for mentally unwell inmates in J I ~ REVISED JUNE, 1980 I prison. innI BALANCE ON HAND, APRIL 1, 1979: (C) $ 12,215.68 The Statistical Tables CI-C13 provided show the wide range of ,~ ~ RECEIPTS: CA) 13,064.00 DISBURSEMENTS: (B) 9,682.68 cases met within this special facet of Correctional Service. Over 20% _ I~ BALANCE ON HAND, MARCH 31,1980: (D) 15,597.00 of the patients seen for the first time were diagnosed as suffering ,] ill (A) RECEIPTS: from a psychosis. Inmates seen on subsequent occas ions, 01" who had I[!J From governments, institutions and others for been seen before by Dr. Dacre in the previous three years were not services performed by METFORS: 11,982.25 ,!l~ !! recorded aga in. ,I From interest received on deposit receipts 1m (C.I.B.C.) 1 ,081.75 It is interesting that 27% of inmates seen in Toronto were not I : I ~U $ 13,064.00 Canadian, with over 7"f, being. from the U;S.A. and 4"f, from Jamaica; the j (B) DISBURSEMENT~: next countries being represented were Italy and Scotland in the 1~ Conferences, conventions, seminars: 4,794.74 Educational courses - fees, textbooks, etc. 2,316.65 population distribution. Luncheons, retreats, receptions 1,616.29 ! i METFORS/CIP Lectures _-,"l~t0,;;..;0,0.00 With a slight attempt to decrease medication within the prison ! II~ $ 9,682.68 system generally, it should be noted that recommendations made and tn treatment given include a figure of about 30% for specific (C) BALANCE HELD AS: medications. On the whole this medication recommended consisted of [1 Funds in bank 4,215.68 u Deposit receipts - C.l.B.C. 8,000.00 "antidepressant/antianxiolytic medicine", and of two or three major [l $ 12,215.68 tranquil i zers. (D) BALANCE HELD AS: A close relationship with the Chief Provincial Bailiff's Office o Funds in bank 1,666.27 was of benefit to individual inmates, as relocation was often speedily Deposit receipts - C.I.B.C. 13,930.73 obtained after a telephone conversation, resulting in lessening of U o $ 15,597.00 tension both in the patient and in the holding institution, and in improved circumstances for the rehabilitation of the individual. It fl is felt that this liaison is one of th~ roost important aspects of the 1- 1 . [1 Consultant Psych; atr; st' s funct; on. ..J I· .1 _._ =-=...... "'==-1f" ~._._ ...... ,;~~=.= ~_[]1 . [I . ~ - --I ~ - 43 - 42 - APPENDIX A u METROPOLITAN TORONTO FORENSIC SERVICE STAFF LIST STATEMENT OF !NCOME AND EXPENSES u u APRIL 1st, 1979 - MARCH 31st, 1980 AMENDED o AMARAL, Ms. Maria Dietary Helper BALANCE AS AT To'ARCH 31st, 1979:' $ 38,912.30 II o ASTAPRAN, Mr. Dwyer Psychiatric Assistant BATEMAN, Ms. Mary Registered Nurse INCor~E : ,BECKETT, Mrs. Karen Registered Nurse [ j [J BYERS, Dr. D. Psychiatrist Mi ni s try of the Attorney Genera 1: $ 1,527,500.00 CHIARAMIDA, Ms. Mary Clerk Typist CORLEY, Gaye Registered Nurse Retained by Ministry for f ; CRAWLEY, Elsie Cleaner-Part Time transfer to Correctional Services: 68,149.73 Ii DACRE, Dr. John Consultant Psychiatrist DILLON, Mrs. Barbara Registered Nurse Less amount returned March, 1980: (50,000.00) $ 1,545.649.73 DOLMAN, Eileen Registered Nurse ! U EBBITl', Mr: Barry Correctional Officer SUB TOTAL: $ 1,584,562.03 FERGUSON, Ms Michelle Correctional Officer I ; FINLEY, Mr. David Psychiatric Assistant I, ' U GLASBERG, Dr. Rhoda Psychologist EXPENSES: HERMANSTYNE, Mr. Lance Head Nurse HWOSDECKYJ J Mr. Wal ter Psychiatric Assistant: Medical Salaries & Benefits $ '346,200.83 [ 1 o JACKSON, Ms Hargare t Research ASsistant JENSEN, Dr. F.A.S. Deputy Director-Clinica1 Non Medical Salaries & Benefits 831,816.00 KEEFE, Ms Lynn Registered Nurse ( KOPPEN, Miss Inge Secretary to Director Correctional Officers' Salaries o KORNELSON, Ms Yvonne Secretary~Im-patient Unit & Benefits 107,167.92 LaCROIX, Ms Janet Dietary Helper LEVEY, Ms Kimber ley Registered Nurse-Team Leader Queen Street Mental Health Centre 109,563.72 o LEWIS, Lystra Clerk Typist/Reception U MacDONALD, John Correctional Officer Clarke Institute of Psychiatry 25,989.82 McCLEARY, Dr. H. Consultant- Obstetrics and Gynecology [J McDONALD, Dr. Angus Psychiatrist Supplies, Expenses & Equipment 85,021.09 rJ McDONALD, Mr. Daniel Housekeeper McRAE, Ms Catherine Registered Nurse SUB TOTAL: $ 1,505,759.38 MAHABIR, Dr. R.J. Psychiatrist-in-charge of In-patient Unit fl U MAHER, Ms Anne Registered Nurse MARTIN-SMITH, Dr. Paul Consultant-General Practice BALANCE AS AT MARCH 31st,1980: $ 78,802.65 MENZIES, Mr. Robert Research Assistant )i1" LJ MONTGOMERY, Ms Sharon Recreational Therapist MORROW, Ms Suzanne Social Worker MYLLYNEN, Mr. John Correctional Officer NEUMAN, Ms Suzanne Administrative Secretary rl NOONE, Dr. J. Psychiatric Resident OLLEY, Ms Vanessa Intake/Medical Records Librarian/Librarian PAVLIN, Dr. C. Consultant-ophthamology [J PENFOLD, Mrs. Mary Chief Social Worker u PEPPER, Mrs. Jane Registered Nurse-Team Leader o U u "I D ~--~~_..... ~==<=""''''-'=_''-7' ,.,. ~-===,:w____ _ ._/ , - 44 - - 45 - APPENDIX B 00 METFORS n WORKING PAPERS PHILLIPS, Mr. Michael Deputy Director-Administration IN PURINS, Mr. John Psychology Intern n FORENSIC PSYCHIATRY PUSZKARSKI, Dr. Walter Consultant-General Practice QUANCE, Ms Donna Social Worker (part-time) RONALD, Ms Margaret Registered Nurse !'J ROSE, Mr. Robert Psychiatric Assistant RUSSELL, Mr. Robert Correctional Officer RYAN, Mr. Arthur (Art) Psychiatric Assistant II 1/ Penfold, M., Morrow, S., and Webster, C.D. A Semi-Structured SAYE, Ms Erin Clerk Typist Interview Approach to the Analysis of Severe Marital SCIORTINO, Mr. Santo Housekeeper Discord (23 pgs). SEPEJAK, Ms Diana Research Assistant 11 SHAUGHNESSY, Mr. Michael Psychiatric Assistant 2/ Webster, C.D., Turrall, G.T., and White, P. Health-Corrections STA IN TON , Mr. Daniel. Psychiatric Assistant-Part Time Workers and Police Officers look at One Another: A Note SULLIVAN, Mr. Basil Psychiatric Assistant on Role Conceptions (18 pgs). TECSON, Ms Virginia Dietary Helper U THOMAS, Mrs. Janice Secretary-Brief Assessment Unit 3/ Webster, C.D., Butler, B.T., Jensen, F.A.S., and Turrall, G.M. TURNER, Dr. R.E. Psychiatrist-in-charge and Director Constructing Interview-Based Models for the Assessment 'l11RRALL, Dr. Graham Senior Psychologist U and Prediction of Dangerous Behaviour: I, Notes an the WALLACE, Ms Morag Correctional Officer Dimensions of the Prablem and Some Suggested Criteria i~ WALKER, Mr. Bradley Correctional Officer :" a,gainst which New Systems might be Evaluated (16 pgs). J WEBER, Dr. M.B. Consultant-Neurology , [1 (Supported by the Ontario Ministry af Health and the 1; WEBSTER, Dr,'Chris Research Bcientist lJ Depal~tment of Justice, Canada). I: WHITE, Mr. James Psychiatric Assistant WHITE, Miss Patricia Registered Nurse 4/ Webster, C.D' n Slomen, D., Butler, B.T., Jensen, F.A.S., and [] Turrall, G.M. Canstruct i ng I ntervi ew-Based Madel s for the Assessment and Prediction of Dangerous Behaviaur: 2, Notes an Recarding Interviews and a Discussion of [1 Methodological Possibilities (41 pgs). II (Supparted by the OntariO' Ministry af Health and the Department af Justice, Canada). LI 5/ Dacre, J., and Webster, C.D. Constructing Interview-Based Madels for the Assessment and Predictian af Dangeraus Behaviaur: 3, Preliminary Attempt to Define and Test Categories of ! ! i Dangerous Behaviour (10 pgs). II (Supparted by the OntariO' Ministry of Health and the f • Department of Justice~ Canada). [ ! ; I 6/ Webster, C.D. (Ed.) Problems in the Prediction of Dangerousness: Notes from the 1978 'Vialence and the Violent Individual Conference' (13 pgs). [ 1 (S~pparted by the Department of Justice, Canada). 7/ Menz;'es, R.J., Webster, C.D., Butler, B.T., Jensen, F.A.S., and U [ 1 Turner, R.E. An Analysis of the Development and Process af the METFORS BriEf A~sessment Unit (132 pgs). n rl (Supparted by the Department of Justice, Canada). n ![I I - 46- - 47 - u i 8. 'Jackson, M.A., Webster, C.D., Butler, B.T., Jensen, F.A.S., , , Mahabir, R.J., and Turner, R.E. [J 15. Sepejak, D.S., Webster, C.D •. The Effects of Psychiatric Recommendations upon Court . The Relationship Between Predictions of Dangerous Decisions: A Study of 188 Court-Remanded Assessments in Metropolitan Behaviour at Brief ASfiessment and Actual Incidents During Extended Toronto (105 pgs). - [J Inpatient Evaluations. (Supported by the Department of Justice, Canada). [J 16. Sepejak, 0.5. I Webster, C.D. 9. Allgood, R., Butler, B.T., Byers, D., Chapeskie, T., Colling, T., The Relationship Between Predictions of Dangerous Dacre, J., Hartman, 1., Jensen, F.A.S., Keeling, K.,_ Behaviour Made During a Brief Assessment and the Presence of Mahabir, R.J., Menzies, R.J., Penfold, M., Pepper, J., U Dangerousness in Further Criminal Charges. Slornen, D., Spirling, J., Turner, R.E., Turrall, G., Watkins, A., Webster, C.D. 17. Sepejak, 0.5. Predicting Dangerous Behaviour: A Review of the The Assessment and Predi cti on of Dangerous Behaviour: !n Literature. Factors Affecting Decision Making in an Interdisciplinary Team (10 pgs). 0 18. Slomen, D., Webster, C.D., Dacre, J. t Sepejak, 0., Butler, B.T., (Supported by the Ontario Ministry of Health). 1 Jensen, F.A.S., and Turrall, G. [: o Assessing Dangerous Behaviour by Means of Videotaped 10. Webster, C.D., Butler, B.T., Turner, R.E., Jackson, M.A., and Interviews: Data on Inter-Rater Reliability Based on a New Comprehensive Menz1es, R.J. Scale .. Psychi atri c Assessment of Mentally Disordered Offenders I \ o 19. Butler, B.T., Menzies, R.J., Turner, R.E., Webster, C.D. in Canada. Vol. 1 (104 pgs). The Outcome of Forensic Assessment: A Study of Remands I : i (Supported by the Department of-Justice, Canada). i[1 in Six Canadian Cities. 20. Jackson, M.A. and Webster, C.D. 11. Webster, C.D., Butler, B.T., Turner, R.E., Jackson, M.A., and [l Menzies, R.J. U What the Judges Want: Outcome of METFORS Judicial Questionnaire Psychiatric Assessment of Mentally Disordered Offenders [ j in Canada. Vol. 2 ( ) ~ 21. Dacre, A.J.I. (Supported by the Department of Justice, Canada). III u The Carriage of the Mentally Disordered 12. MacDonald, L. Anxiety in Front Line Staff in a New Forensic Psychiatric Inpatient Unit. n n 13. Turrall, G. The MMPI Profile and its Relation to Mental Disorder: [ I ['1 .. Preliminary Study of Inter-Clinician Agreement . 14. Slomen, D., Webster, C.D., Butler, B.T., et al. [ , t : The Assessment of Dangerous Behaviour: Two New Scales. U [ , n~ [j ---I " - 48 - [1 49 - APPENDIX C [! Turner, R.E. Services Note THE DEVELOPMENT OF FORENSIC SERVICES IN ARTICLES PUBLISHED AND IN PRESS TORONTO, Can. Journal of Criminology, 1979. [ j Turner, R.E. THE ETHICS OF PRE-ARRAIGNMENT PSYCHIATRIC EXAMINATION: ONE CANADIAN VIEWPOINT (with Butler, B.T.), Bulletin of the PUBLICATIONS AAPL, Vol. VI, No. 4. II .Turner, R.E. Legal Task Force. Part I: Civil Rights and the Mentally Ill. Part II: The Criminal Just'ice System and Mental Health Services. A Report to the Ontario Council of Health, 1979 (joint authorship). J a c k son ,M. A. , Osborne, J. A • and Wi 1 d e t K • Revenge or fl Rehabilitation? Punishment in a Rational Society. Canadian Turner, R.E. COrmJents on The Limits of Ps~chiatric Authority by J. Criminology Forum, 1979, 1 (Spring): 58-60. Robitscher, "LAW & PSYCHIATRY II'~ Proceedings of the Second U International Symposium held at the Clarke Institute of Jackson, M.A. Review of Mental Disorder and the Criminal Trial Psychiatry, Toronto, February 1978, edited by D.N. Weisstub. Process by Marc Schiffer." Canadian Criminology Forum, 1979, 1 (Spring): 57. II Pergamon Press, 1979. Konstantareas i M.M., Webster, C.D. and Oxman, J. Manual language Menzies, R.J. Ps:z:chiatry and the Judicial Process: A Bibliography. aCquisition and its influence on other areas of functioning Universlty of Toronto, Centre of Criminology. Toronto: in autistic and autistic-like children. Journal of Child 1979. I! Psychology and Psychiatry. 1979, 20, 1-14. Menzies, O.J. "Book Review - Web s t e r , C. D ., Men z i e s, R. J. and S 10m en, D. J • Com m,e n ton Social Construction of u Dangerousness. American Journal of Psychiatry, 1980, 137, Canadian Criminology Forum 261-262. , ' \ IN PRESS Webster, C.D., Menzies, R.J. and Slomen, D.J. More on Predicting n Dan erousness, American Journal of Psychiatry, 139, 2 Glasberg, R. and Aboud, F. Children's Evaluative Reactions to February, 1980): 261-262. rl Sadness: Implications for the Study of Emotional UJ Experience, 1980. Phillips, M.S. The Medical Administrator, A Publication of METFORS, Toronto, 1980.- Glasberg, R. and Aboud, F. Multi-Dimensional Scaling Approach to r 1 Children's Cognitive Drganization of Emotional Constructs, PhillJps, M.S. Disaster Plans and Emergenc~ Procedures for 1980. Psychiatric Hospitals, A Publication of METFORS, Toronto, 1980. l J Glasberg, R. and Aboud, F. Keep; n* One's "Di stance" from Sadness: Children's Self-Reports 0 Emotlonal Experience, 1980. Phillips, M.S~ Historical Development of Forensic Psychiatric Services in Canada, A Publication of METFORS, Toronto, 1979. Webster, C.D., Jackson, M.A., Menzies, R.J., Butler, B.T. and Turner, R.E. "Forensic Psychiatric Assessment of the Mentally Phillips, M.S. A Collection of Undergraduate Papers on West Indian Disordered Offender: An Anal sis of S stems, Procedures and Culture, A Publication of METFORS, Toronto, 1979. utcomes • Phillips, M.S, A Forensic Psychiatric Program for Nurses, Dimensions Jackson, M.A., Webster, C.D., Jensen, F.A.S~ and Turner, R.E. in Health Care, May, 1980. ' "Judicial uestionnaire Survey." Toronto: Metropolitan Toronto Forensic Service. METFORS Working Paper), 1980. Phillips, N.S. Hospital Security: A Joint Endeavour:. International Association for Hospital Security Newsletter, March/April, McDonald, A. Mushrooms and Madness: The Hallucinogenic Mushrooms. 1980. Canadian Psychiatric Association Journal, November, 1980. Turner, R.E. Chapter 39: LEGAL ISSUES in "Method of Psychiatry", University of Toronto, Lea 1& f.'ebiger, 1978. Turner, R.E. THE CRIMINAL JUSTICE SYSTEM AND MENTAL HEALTH SERVICES, 1978, for the Committee on Mental Health Services of Ontario for ,the Ontario Council of Health, co-author with Prof. J .W. Mohr. "~"',C"_====,"'~~~''"=c.,,..~_~~~,~~,'=,,~~~,.'" I - 50 - rll ,- 51 - APPENDIX D [ i McDonald, A. and Paitich, D. A Stud The of Predictive Test Factors. n lna reV1Slon lan SCHOLARLY ADDRESSES AND MEDIA INVOLVEMENT Psychiatric Association Journal. u Menzies, R.J., Webster, C.D., Butler, B.T. and Turner, R.E. The Outcome of Forensic Ps chiatric Assessment: A Stud -or Remands in Six Canadian Cities. Crimina Justice and [ 1 Behaviour. . Phillips, M.S. The Medical Man as Administrator - Another D. BYERS: Viewpoint , Canadian Doctor. !1 - L€cture: George Brown School of Nurs i ng - "Psychophannacology and Phillips, M.S. Educating the MBA Executive: An Approach to Meeting I ; Drug Use", 1979-80. the Needs. Canadian Business Magazine. \ B..! ..}JlASBERG: Turrall, G.M. Police and Mental Health Workers Take a Look at One Another, Journal of Police Science and Administration, Menzies, R.J. and Glasberg, R. Variables Affecting the Referral of July, 1980. ME~FORS Brief Assessment Unit Patient to HETFORS Inpatient Unlt. To be given at Conference on Research in Forensic Turrall, G.M. Prediction of Dangerousness, requested by the Psychiatry, Vancouver, 1980. Criminal Lawyers' Association - Newsletter. The Use of Sodium Amy tal in Forensic Psychiatry Paper presented as Oxman, J., Webster, C.D. and Konstantareas, ·M.M. The representational part of METFORS Educational Series 1980. and information-processing found~tions of linguistic function;n in autistic children. In: Language and ognltlve ty es, aQd R. St. Clair. M. JACKSON: Webster, C.D., Konstantareas, M.M., Oxman, J., and Fruchter, D. 1979 "Assessments of Assessments: Evaluatin9 the Impact of Forensic Autism: A Review of the literature with particular emphasis Psychiatric Opinion on Decisions of the Court" Canadian on current treatment approaches. Child and Youth Services. Psychological Association Annual Meeting, Quebec City, June \ ; 13-15. Hebster, C.D., Turrall. G.M. and White, P. Health-Corrections workers and police officers look at one another: A note on role 1980 "Inpatient Assessment of Metropolitan Toronto Forensic Patients: conceptions. Journal of Police Science and Administration. o A St~dy of Mentally Disordered Offenders Discharged From Four Servl~es.Over a Six-Mon~h Period," Ontario Psychiatric Webster, C.D. Book Review: Caring for Troubled Children by James K. ASsoclatlon Annual Meetlng, January 24-26, Toronto. Whittaker._ In: Child Care Quarterly, 1980. Webster, C.D. Literature Note (Gorky). Journal of Autism and 1980 "Psych~atric O~inion and Consequences," Workshop on Research in Developmental Disorders, 1980. Forens1c Psychlatry, Vancouver, May 12-14. Webster. C.D. Experimental-clinical psychology. Canadian 1980 "Prob~tion Success: Is It Necessary to Fulfill the Conditions?" Canadlan Psychological Association Annual Meeting Calgary June Psychological Review, 1980. 18-20. ' , Webster, C.D., Konstantareas, M.M., Oxman, J. and Mack, J. Autism: F.A.S. JENSEN New directions in research and education. Pergamon: New York. April, 1979 - 9th - ~lth - Metro Police Emergency Task Force Webster, C.D. Abnormal psychology. Chapter for Introductory I Seminar - Guest Speaker 24th - Medical Jurisprudence lecture PS~ChOl09{ Textbook. Edited b1 J.E. Grusec, G.C. Walters an R.S. ockhard. St. Martin s Press. St. Michael's Hospital I May, 1979 22nd - Forensic Nursing Course - George Brown College - Confidentiality/Criminal I I! Respons i bi 1i ty I ~ , U _'~~ .... .<;",~.,_c --[ I " - 52 - n 1~ - 53 - j f I F.A.S. JENSEN: (cont'd) j 1I~ ' j M. PENFOLD: (cont'd) Appeared as a guest on the television prograll1T1e, "Attack", to discuss July, 1979 27th "Street Talk" T.V. prograll1T1e. "Powers [-I l~ Domestic Violence. i of the Pol ice" '''; i R. Eo TURNER: September, 1979 12th Woodsworth Course Comenced - Mental II in i Abnormality and the Treatment of 1 I! Offenders - weekly lectures 13th - METFORS Retreat - Seminar "Intent" :1 U aJ Q.S.M.H.C. - Presentation of Forensic Work of Joseph Workman II I October, 1979 1st - Forensic Nursing Course - George Brown bJ C.I.P./METFORS - COll1T1entary on Paper by Dr. A. Weston - The Butler College - Confidentiality/Criminal Report. Responsibility [ i IU 19th - Osgoode Hall Students (2nd & 3rd year) cJ Psychiatry Legal Issues "Psychiatric Assessments for Courts" I certification third year undergraduate incompetence j 1 medical students. February; 1980 12th Medical Jurisprudence Lecture II 1 n confi dent i a 1 ity ) St. Michael's Hospital j ! dJ Lectures in Forensic Psychiatry March, 1980 3rd - Jarvis Collegiate - 11 1 U Introduction: Historical Review: Law Reform; "The Career of Psychiatrist" 1 f Current Issues - second year postgraduate students I ' in psychiatry. 12th - 14th Metro Pol ice Emergency Task Force I J I Guest Lecturer - "Classification of I JU Mental Disorders" eJ Law & Psychiatry - Ethics first year residents in psychiatry. : fJ George Brown College Lectures in Forensics Course A. McDONALD: ' . I[I "Section 16; Criminal Code" Course: University of Toronto, School of Continuing Studies, Modern fitness J Mental Health Legislation Clinical Psychiatry, September-May, 1980. I : I, U t I R.J. MENZIES: gJ Durham District Health Council - Mental Health Legislation and Forensic Psychiatric Services September, 1979 "An Analysis of the D~v~lopf!1ent ~nd Process of the U METFORS Brief Assessment Umt' Umvers,ty of Toronto, n hJ Ontario Police College, Aylmer - Psychiatry & Law Department of Psychi atr,r Research Day. iJ Visiting Lecturer - B.C. Forensic Psychiatric Services Commission ,.;n LJ September, 1979 "The Outcome of Forensic PS'ychiatr~c As~e~sm~nt: ~ Epidemiological Data from Selected Canad,an C,t,es. Annual jJ Paper on "The Depressions" to Annual Meeting of the Justices of Meeting of the Canadian Psychiatric Association. Vancouver, the Supreme Court of Ontario, Kempenfeldt Bay. British Columbia. [] kJ Paper on Mental Health Legislation - Process of Change, at Annual Meeting, Section on Psychiatry, B.C. Medical Association, May, 1980 "Psychiatric and Legal Det,enninal'lts of Fitness Assessments Vancouver. by Forensic Psychiatrists". Works~o~ on Resea~ch in Forens ic Psychi atry. Vancouver, Br-, t, sh Col umb, a. ~ n 1J Panel on Mental Health Legislation, and ~ In Panel on Mental Health Problems - Charles O. Sick Police College M. PENFOLD: mJ Witness at a Discipline Committee Hearing Spoke to the staff of the Oakville Family Service Bureau on Domestic [J nJ Member of a Board of Inquiry - College Of PhysiCians & Surgeons of Violence. Ontari o. Addressed the 2nd year students, University of Toronto, Faculty of Social Work on Psychopathology, Forensic Issues. n [l 1 r I J n 'J ! '.- ---I " - 54 - - 55 - G.M. TURRALl: f1 C.D. WEBSTER: (cant/d) (Canadian Psychiatric Association) Ontario Psychiatric Association, January, 1980, "Assessing Dangerous Behaviour by Means of Videotaped Interviews: Data on Inter-Rater [II September 28th. R.J. Menzies, C.D. Webster, B.T. Butler, F.A.S. Reliability Based on a New Comprehensive Scale" Jensen, and R.E. Turner. The Outcome of Forensic Psychiatric (w'ith D. Slomen, C. Webster and others). Assessment: Epidemiological Data from the Brief Assessment Unit at I METFORS and from Selected Major Cities in Canada. Vancouver, B.C • [.J Peel Memorial Hospital, June 1979: "Reorganization of Psychological Services in Comnunity Hospitals". (Presentations within the Clarke Institute of Psychiatry) l METFORS - Correctional Officers Training Seminars: Psychological [J December 5th, 1979. C.D. Webster. IMeasuring Dangerous Behaviour • Assessment. Juvenile and Family Court Clinic. Employment and In:rnigration Canada: "Psychological Assessment of February 22nd, 1979. C.D. Webster. Child Care as an Emerging Individuals Unable to Maintain and Secure Employment", May, 1979. fJ Discipline. Child and Family Study Centre. Ontario Provincial Police - Ministry of Solicitor General: "Proposal March 21st, 1979. M. Penfold, S. Morrow, and C.D. Webster. The to Incorporate Psychological Assessment and Screening of New Police I.J Assessment of Dangerous Behaviour in the Family Unit. Child and Rec ru its II, J u1 y, 1979 • Family Study Centre. [I CeO. WEBSTER: (Department of Psychiatry, University of Toronto) September 7th, 1979 (Research Day). C.D. Webster, B.T. Butler, R.E. Turner, R.J. Menzies. The Outcome of Forensic Psychiatric Assessment: Epidemiological Data from Selected Major Cities in Canada • . September 7th, 1979 '(Research Day). R.J. Menzies, C.D. Webste r $ B.T. Butler, F.A.S. Jensen, R.E. Turner. The Analysis of the Deve'Ic:{)ment and Process of the METFORS Brief Assessment Unit, Toronto. U ·1 ' March 20th, 1980 (Research Day in Chil d psychi atry). C. D. Webstep-. The Nature of Child Care Work: Semi-Structured Interviews with Sixty ![] Randomly Selected Workers~ (Ontario Psychiatric Association) n 1 D January 25th, 1980. D. Slomen, C.D. Webster, J. Dacre, B.T. Butler, F.A.S. Jensen and G. Turrall. Assessing Dangerous Behaviour by Means of Videotaped Interviews: Data on Inter-Rater Reliability based on a New Comprehensive Scale. Toronto. 11 IU January 25th, 1980. M.A. Jackson, C.D. Webster, R. Glasberg, B.T. Butler, R.E. Turne'r and R.J. Mahabir. Inpatient Assessment of 11'/0 Metropolitan Toronto Forensic Psychiatric Patients: A Study of Mentally Disordered Offenders Discharged from Four Services over a Six Month Period. Toronto. II ' i [] (Canadian Psychological Association) rl June 15th, 1979. M.A. Jackson, C.D. Webster, B.T. Butler, F.A.S. Jensen, R.J. Mahabir and R.E. Turner. Assessment of Assessments: Evaluating the impact of forensic psychiatric opinion on decisions. of the court. [] r1 u~ {I = • ---I c-_, __.~~,~~==--'~--'=·=~, I,] .",,~~-=--... , - 56 - [JIm - 57 - APPENDIX E. [I , : ~ ~ I EDUCATION AND RESEARCH ACTIVITIES Ll, ~ and J. Dacre) " ~ 1. "Psychiatry and Justic:e - Chimera or Reality?" 1 by Dr. Jacques Quen, New York. U 1 ~ Commentator: Professor B. Dickens, September 19, 1979, 6:30 p.m. Paper fJ I ~. 2. "Criminal Responsibilit,V in Canada", 1 I by Mr. Justice G.A. Martin. , I Jackson M.A., Webster, C.D., Glasberg, R., Butler, B.T., Turner, Commentators: Judge E. Houston and Mr. Justice J.M. Ducros, ii R.E., M~habir, R.J.: Inpatient Assessment of Metropo~itan Toronto [J I Law Reform Commission of Canada, " Forensic Psychiatric Patients: A S~udy of Menta~ly Dlsturbe~ 10 October 24, 1979, 6:30 p.m. Offenders Discharged from Four Servlces over a S1X Month Perlod. i ! 3. "Criminal Responsibility in the United Kingdom and the Butler Ongoing Research Projects U 10 Report on the Mentally Abnormal Offender", 1 by Dr. W.A. Weston, Saskatchewan. The Treatment Process for Patients on Lieutenant Governor's Warrants Commentator: Professor R.E. Turner, (In collaboration with Dr. I. Wayne, Queen Street Mental Health !1 1U November 7, 1979, 7:00 p.m. Centre). l 4. "The Psychodynamics of Homicide and Criminal Responsibi 1ity" Psychotherapy Process Research - Measuring the Core ~onf1~ctual by Dr. E. Tanay, Detroit. Relationship Theme in Psychotherapy. (In collaboratlon wlth Dr. E. I. i jU Commentator: Dr. Basil Orchard, Marziali, Clarke Institute of Psych~atry). December 5, 1919, 7:00 p.m. r -I Courses Given 0 5. "I ntoxi cat i on and the Capac; ty to Form I ntent II Undergraduate: by Mr. Alan Gold. Commentator: Dr. R.W. Hill, F.A.S. Jensen. WDW213Y - Mental Abnormality and the Treatment of III January 16, 1980, 7:00 p.m. Offenders U 6. "Automatism: Clinical Entity and Psychiatric Defence" C.D. Webster. Psychology 240S, Abnormal Psychology (half course) by Dr. R. Coulthard. U n Commentator: Professor Edwards, Graduate: [] February 13, 1980, 7:00 p.m. C.D. Webster. Criminology 3170F, Psychological Theory and n 7. liThe Disposition of the Criminally Insane" Practical Implications (half course). by Dr. Vernon Quinsey, Penetanguishene. Commentator: Professor Cyril Greenland, Special Classes in Forensic Psychiatric Research f : D March 19, 1980, 7:00 p.m. September 11th, 1979. C.D. Webster. Seminar for M.A. Students in Social Work Criminology, University of Toronto (given at METFORS). L U (Ms. S. Morrow) September 13th, 1979. C.D. Webster. Lecture to Queen Street Mental 1J Organized and chaired the Sophie Boyd Memorial Lecture, sponsored Health Centre. 'METFORS after Two Years: Assessing Assessors from a by the Alumni ·Assoc-Faculty of Social Work, University of Toronto. Research Perspective'. U 0 2] Attended a two week training programme at Smith College North January 16th, 1980. C.D. Webster. Seminar for Residents in Psychiatry (given at the Clarke Institute of Psychiatry). 0 n Hampton, Mass., on family assessment July 1980. February 1, 1980. C.D. Webster. Seminar for Second Year Law , Students Osgoode Hall (given at METFORS). s 0 fl [] U " .-"-".. ~.-'-.-. "=:~ --~=~--'---- , I ," I - 58 - f! - 59 - (Mrs. M. Penfold) ! ! I APPENDIX F 1] Attended a Law & Psychology Conference, University of Chicago in' October- 1979. ! ! GRANTS I 2] I~as on the organizing cOlTJ11ittee for a meeting of social workers in o[ the forensic field in Ontario. I j 3] Organized and conducted a series of 8 seminars at 14 Division, Metropolitan Toronto Police from January to March 1980. II 4] Has been acting as consultant and lecturer at the C.O. Sick Police G.M. TURRALL , j College, Metropolitan Toronto Police since January 1980. 1J "Assessment and Prediction of Dangerousness" - Ontario Mental 5] Was involved with a METFORS psychiatrist in a specialized training 11 Health Project - Refunded - 1980-1981, $38,000. programme for the Metropolitan Toronto Police. ! I I 2] In Process: "Adolescent Murder in Canada: Legal and (The Social Work Staff) l j Psychological Consequences". 1] Hosted a number of visits from forensic social workers from 3] In Process! International Development Research Centre, Canada, United States and Sweden. f j "Investigation of Sri Lanka's Legislative Policies and its Effects upon the Delivery of Mental Health Services, Including the ":1 2] Have provided consultation to a number of social workers and i Mentally Di;sordered Offender". I( policing agencies on a variety of topics. " [ ]"! l~ 4] In Process: ilLegal Awareness of Individuals Psychiatrically 1!Ul 11" Assessed through Brief Assessment at f.£TFORS". I! 3J Continue to be involved in a, number of research pr-ojects at I METFORS, incl~ding the topics of domestic violence, homicide, and Ii fitness to stand trial. C. D. WEBSTER, "I: f t j U Ii ;;" I' n J! 1J Ontario Ministry of Health. The Assessment of Dangerolls f; Behaviour: A Scheme, for Classification and Obtaining Inter-Judge Ii f ,I , U Reliability (with B.T. Butler, F.A.S. Jensen, and G. Turrall) :1 ~ $36,654.00. ~ i ! l InI ' 2] Law Foundation of Ontario. The Mentally Disordered Offender in Canada. 1979, $5,000.00 (with B.T. Butler and R.E. Turner). f 1 3] Laidlaw Foundation. A Chronographic Analysis of Conversations o with Autistic Persons. July 1st, 1979. $4,000.00 (with S. Feldstein and M.M. Konstantareas). f ' f ' I, U 4J Clarke Institute of Psychiatry Research Fund. Problem Children Grow Up: A Foliow-up Study Five to Ten Years After Discharge from Group Treatment. $3,262.00 (with M.M. Konstantareas, L. Sloman f 1 fl and D. Hunter). 'I n ! U iD I ~ iU , U U o ---~---,."" , • " - 60 - [1 ~ - 61 - APPENDIX G u l~ HONOURS :\I~ . lJ R.E. TURNER D.S. BYERS U (Comnittees) Clinical lectures, University of Toronto a] Clarke Institute - i) Medical Advisory Committee member of Psychiatry ii) Chairman, Committee on Ethics of Human LJ " Experimentation Passed part I exams of American Board of Psychiatry and Neurology in b] METFORS i) Member of Board M.A. JACKSON t [I !J [] Book Review Editor, Canadian Criminology Forum, 1979 to present. c] Clinical Institute i) Member of Board of Addiction Research Foundation Reviewer for the Journal of CriminoloSl. rl.1 : fJ F.A.S. JENSEN d] University of i) Chairman, Office of Research {Honours) . Toronto Administration Committee on Ethics of Human Experimentation for Department of rI IU Psychi atrYi Promoted to Associate Professor of Psychiatry effective July 1st, 1980. ! President of Medical Staff, Clarke Institute of Psychiatry 1979-1980. ~ ii) Chairman, Division of Forensic (Comnittees) r I U PsychiatrYe Department of Psychiatry, Faculty 'of Medicine; Chainman, Credentials Committee, C.I.P. Member~ Medical Records and Audit Committee, C.I.P. 'U [j iii) Subject Supervisor - Medical. Member, Bye-l aws Corrmittee, C. I.P. Jurisprudence III Year Undergraduates Medici ne Nember of Associates E'xective, C. I.P~ Chairman, Expectations Committee ["I1 Alternate Chairman, Committee on Ethics of Human Experimentation, U. of T. n i v) Depa rtment of Psych i at ry Execut i ve Chairman, METFORS Advisory Committee v) Department of Psychiatry Promotions Chairman, METFORS Medical Records and Audit Committee u n Comittee RaJ. MENZIES vi) Course Organizer - Psychiatric Legal Associate Editor, Canadian Criminology Forum. n f1 Issues, Family Practice Residents (with (Centre of Criminology, University of Toronto). Dr. S. Hucker) S. MORROW e] Queen Street Consultant Psychiatrist [I [J Mental Health Centre Elected Vice President of the Alumrii-Faculty of Social Work, University of Toronto for 1979-80. f] Ontario - i) Ontario Council of Health (to November II n 1979) Legal Task Force. Committee on M.S. PHILLIPS.- Mental Health Services in Ontario Chairman, Planning and Advisory Committee, course in Forensics II ii) Membe~, Advisory Review Board George Brown College fl g] Canada Consultant in Psychiatry, Law Reform Commission of Canada. Lecturer, Department of Psychiatry, University of Toronto [J fl R.E. TURNER h] Other i) President - Kenneth G. Gray Foundation (Academic) 0 [J ii) Canadian Psychiatric Association Member, Professor of Forensic Psychiatry, University of Toronto. Constitution Committee 0 n ... ~:- _""'"~~.v '~ -- - 62 - - 63 - !! i] Provincial i) Ontario Psychiatric Association, Chairman, Constitution Committee AppOintments, Centre of Criminology, Unive~sity of Toronto i1) ~'ember, Council of Medico-Legal S\'Jciety C.D. Webster., Speci al Lecturer (and Mermer of the Graduate of Toronto. Faculty) (July 1st. 1979). j] International Chief of Ontario Team for World Health (Committee AppOintments:) Organi zat i on Research 1'roject on Statutory Mana~ement of DanQerousness. Department of Psyc:hiatry, University of Toronto C.D. Webster. Member. Research Committee (elected). C.D. Webster. Member, Executive Committee of Research Committee G.M. TURRALL (apPointed). (Academic Promotions) C.. D. Webster. Member, Human ~eview Committee (apPointed). C.D. Webster. Member, Academlc Lectures Committee (appointed). University of Toronto at Ontario Institute For Studies in Education, Department of Applied Psychology, Instructor. (Appointments to Funding Agencies) - (OthElT' Academi c and Profess'i ona 1 Awards) { j Provincial Ontario Psychological Association, Section on Psychology i~ the C.D. Webster. Member, Research Grants Committee, Ontario Mental Health Foundation (new appOintment). Justice System, President Elect, February, 1980. IJ Arneri can Board of Professi onal Psychology - Candidate for Diplomate - Canadian Government Clinical Psychology. [J. C.D. Webster. Member, Sub-committee 47, Health and Welfare (Ccmnittees) (continuing). "Classification Ministry of Community and Social Services Task Force: [ 1 ...... of Juvenile Offenders", July, 1978 - Decerrner, 1979. .-- Clarke Institute of Psychiatry - Psychology Executive COI11T1ittee. Lr .-1 Clarke Institute of Psychiatry - Education and Training Corrmittee for Psychology. (Consultantships) o Employment and Immigration Canada - Diagnostic Consultant. o C.D. WEBSTER (Academic Promotions and Appointments:) Promotions, Department of Psychiatry, University of Torqnto n C.D. Webster. From Assistant to Associate Professor (July 1st, 1979) • II D Appointments, Department of Psychology, University of Toronto 11 [J C.D. Webster. Instructor (July 1st, 1979 - August 31st, 1979) C.D. Webste-r~ Professor (October 1st, 1979). ['I rl _.J ---J, - 64 - - 65 - APPENDIX H VISITORS LOCATION John Forester Deputy Minister, Alberta VISITORS TO r~TFORS i Richard Davif~s Director pf Public Health, , I Prince Edward Island. VISITORS LOCATION Dr. Paul Roach Director of Psychology, James s. Pavlin Health Commission of N.S.W. Centracare, Saint John, N.B. Dr. Harold Kalant Dept. of Pharmacology, Jeanne-Marie Hill North Bay Psychiatric University of Toronto Hospital Professor W.J. Curran Harvard f1edical School Helene Eade North Bay Psychiatr.ic Hospital Dr. Lane Porter Harvard Medical School/Public Health L.H. McMahon R.P.C.CO). Kingston, Ontario Sheila Latimer Director of Nursing QSMHC Inspector John Reid Metropolitan Toronto Police Force Dwight Whitson Dept. of Justice, Ottawa Dr. J. Jeffri es President, Associates in E. Ewachuck Dept. of Justice, Ottawa Psychiatry, Clarke Institute of Psychi atry Dr. Sheckley Solicitor General, Alberta Mrs. M. Sagansld . Executive Secretary, Mr. Ni rza Hamcedul1-ah Former Chief Justice of India Associates - Psychiatry, 'Clarke Institute of Merlies Regenbrecht Regional Psychiatric Center Psychiatry Saskatoon Mr. J. St. Pierre Department of Health, Graham Zellick University of London, England Frederiction, New Brunswick Karen L. Scott Forensic Services - Nora J. Earle, R.N. Senior Nursing Consultant, Vancouver, Brit~sh Columbia Ministry of Correctional Services, Ontario Judge E.J. Houston Law Reform Commission Edward Myers law Reform Commission of Robert W. Beckman Metro Toronto Police Canada William Dunlop Mental Health Services, Dr. S.K. Littmann Clinical Director, Clarke Al berta Institute of Psychiatry Lee Spencer Canadian Penetentiary Service Dr. W.A. Weston Medical Director, Regional Psychiatric Centre, Professor.W.J. Curran Harvard Medical School, WHO Saskatoon Study . Mrs. G. Weston Saskatoon N. Bercusson Harvard School of Public Health Sydney Ba i rd Education Co-ordinator, Forensic Psychiatric Dr. Lane porter Harvard School of Public Services Commission, B.C. Health Mr. D.M. Robertson Director of Administration, Mr. Gilbert Sharpe Ministry of Health Forensic Psychiatric Services Commission, B.C. J. Dayton H & W/Canada, Montreal Division ---1 ~l -,~~.~--- .' ==- ----=----. , f I : iItIJ il. - 66 - 0 j - 67 - \ [I 1!lJlriJl METFORS RESEARCH LOCATION I VISITORS l~ [1 .'1 It.l C.D. WEBSTER .. PH.D . Mr. Ben Jowett Director of Finance, Ross Memorial Hospital ! Mr. Jack Griffin Canadian Mental Health [1 II ~ RESEARCH SCIENTIST Associa~ion I . ! Ms. Linda Tod Forensic Psychiatric Services Commission. Vancouver. B.C. fl I~ (~ ! Major Projects Mr. W. McKerrow Mental Health Center Penetangui shene II !~ 1. Forensic Psychiatric Assessment of the Mentally Disordered Dr. E. Tanay Clinical Professor of Psychiatry. Wayne State University. Detroit, Michigan fl 10 Offender: An Analysis of Systems, Procedures and Outcomes. Superintendent R. Fleming Metropolitan Toronto Police - li1/ 14 Division [I /U j Investigators: C.D. Webster, B.T. Butler, R.E. Turner, M.A. JacKson, !.J IU and R.J. Menzies. D We have now collected data from forensi c psychi atri sts concerni ng the -l outcome of Court-ordered evaluations. Some studies deal in detail .. - ..... r. I with one foren~ic psychiatric assessment unit (METFORS) over an exten U ded period (one year), others consider several psychiatric services (Penetanguishene, Clarke Institute of Psychiatry, and others), and one u such study is based on information gained from several Canadian cities (Halifax, Cal gary t Montreal, and others) over a short peri od (one month). Of particular interest ere the kinds of opinions reached by , psychiatrists and the extent to which those opinions are adopted by the Court. These data are now being reanalyzed and a monograph is being prepared. The monograph will provide a statistical description of the population remanded bv i:~,~ Courts for psychiatric evaluation and it will also describe the results of those assessments. Our , general aim has been to employ epidemiological techniques in the ===_... _==_._--_. 1 - 68 - fJ n - 69 - U 1 expectation that we might be able to improve the communi.cation link between Court and clinic. n Ie 3. The Prediction of Dangerous Behaviour: Analysis of Videotaped Psychiatric Assessments. 2. The Prediction of Dangerous Behaviour: Development of an Interview [J III ~ Based Scale. [] I ~ Investigators: C.D. Webster, D. Slomen. D. Sepejak. J. Dacre. B.T. I ! . Butler. F.A.S. Jensen and G.M. Turrall. l ~ Investigators: C.D. Webster. D. Slomen. D. Sepejak. B.T. Butler, O ,j Uti I 1i F.A.S. Jensen, and G.M. Turrall. 1 Nine videotapes were being made of interviews between a forensic [] \ j~ psychiatrist and an individual who, pending Court, was being assessed ! As a result of extended discussions with clinician colleagues, we have U as an inpatient at METFORS. These tapes were then yiewed by devised with them a 23-item scale for the evaluation of future I~ non-involved raters using the scale mentioned in the previous project dangerous behaviour. Non-involved raters have used this scale in r.l H ~ (as well as additional scales). Three pairs of raters were employed. observi ng some 200 i'n"tervi ews. Adequate reliability between coders I10 One pair both saw and heard the tape, one pair saw but did not hear has been obtained with 17 items. Similar ratings were also made by I it. and the remaining pair heard but did not see it. The aim was to clinical staff. These data are now being analysed. Predictions will confirm previous findings regarding the measurement of inter-rater u 10j be tested against actual outcome in a follow-up study completed two rel i abil ity and al so to find out how much information coders requi re years after assessment. The follow-up, both for the sample mentioned u In in order to be able to offer reliable judgments. These data, and for an additional 500 patients (for whom predictions were made but presented in preliminary form at the Annual Meeting of the Ontario on a less specific basis), is being completed by means of a search of n n Psychiatric Association, are now being analysed in detail. semi-public records (correctional, police. and health). The main JI1i 18l} object is to determine whether or not particular clinicians can 1 Mi nor Projects I identify readily individuals especially prone to engage in dangerous 110 acts. Alternatively we would hope to find out whether or not t 4. Mental Disorder and Criminal Responsibility. clinicians as a group are better able to predict the future dangerous D behaviour of some types of individuals than others. U Edftors: S. Hucker. C.D. Webster. J. Dacre and M. Ben-Aron. 1"1 I : I -----~~-- -.-. --:-:- --- ~-I 1 ; ._" .... -~-.,. -·"·"·"-~--·I if ,; " II 11 'i It ii rJ : - 71 - I - 70 - i i I: Ii U' ), During the 1979-80 academic year we organized a series of lectures which were sponsored by the Clarke Institute of Psychiatry and U Investigators: C.D. Webster, M.M. Konstantareas, L. Slomen, and D. METFORS. These lectures deal largely wi th the present state of the o Hunter. insanity defense in Canada, the United States and Great Britain. These lectures will 'eventually be edited for publication. o We have isolated from our records some fifty former child patients who received therapy within a day-treatment programme at the Clarke Insti 5. Serious Domestic Conflict: An attempt to Isolate Distinct D tute of Psychiatry. These children and their families will now be Patterns of Engagement followed and, wherever possible, interviewed according ·to a semi U structured format. The investigators are particularly interested to determine the extent to which fonner patients have had contact with Investigators: M. Penfold, S. Morrow, and C.D. Webster. D the police, courts and mental hospitals. According to the, hypothesis of the senior investigator there exist at ·n 7. Characteristi'cs of Mentally Disordered Offenders: Homicide ver:-sus least three di.stinct patterns of fighting within the family. Between n Assault versus NonViolence. some spouses there is a high sustained level of conflict usually with ~ little or no physical hannensuing. Between others there is a gener [ I Investigators: N. Ladha, C.D. Webster and P. White. ally very low level but with occasional high peaks. These peaks, hard to predict, may leave serious consequences. Yet other couples begin u Records of former METFORS patients are being examined to determine their relationship with a relatively low level of fighting activity U whether or not three types of patients differ in terms of background but gradually escalate the conflict over days, weeks or months. In an characteristics, psychiatric classification, and general prognosis. attempt to determine whether or not there is any general support for t : ! Twenty subjects in each group will be matched according to age, sex, these notions, the investigators have used a semi-structured fonnat to and other variables. The main aim is to determine whether or not conduct separate interviews with 25 patients and their spouses. Data iJ' particular profiles can be established for each of the three groups. are now being analysed. [] 6. Problem Children Grow Older: A Follow-Up Study of BS'h.aviourally o and Emotionally Disordered Children After Seven Years. In IJ ---'I, - 72 - - 73 - In 1980 \'/e very much hope to attain funding for a research STATISTICAL SUPPLEMENT project on 'fitness to stand trial". If we are successful in this venture it shoul d lrean that we shall be abl e to improve somewhat the kind of routine statistics reported here. The data provided in these tables follow the format used in the Supplement to the 1977 and 1978 Reports. We give information about patient characteristics from those programmes: the Brief Assessment Unit; the In-patient Unit; and the Prison Psychiatric Consultation f ::..: Service. In the 1978 Report we noted that the burden of produci ng annual figures would be eased in the present year through use of the record-keeping system established through the Hospital Medical Records P,I d Institute. Although in 1979 we did in fact employ this service for It tl i! use with our Brief Assessment Unit as well as with our In-patient n }! ;: Unit, it did in the end prove easier to extract by hand the data II contained in the following tables. What we now hope is that we can, I! H U !' during 1980, arrange for the establishment of a more orderly and r Ii comprehensi ve data base through the enl a rged computer facil it i es at jI t j i' fl rl I) the Clarke Institute of Psychiatry. L A::. was the case in the previous annual report, some explanation I: [J j\ I.HI such as that given above is needed to account for the fact that we l I'd offer here only a one-month sample of the Brief Assessment Unit !! P.1 II Ii information. But, as is indicated in the 1978 Supplement, the actual ! j II qi) data vary little month by month. In all, we saw"in the Brief H 1i [ J ,I: , Assessment Unit 672 cases duri ng 1979 J a fi gure very close to that H,1 {' J!I. r found in 1978 (734). Similarly we discharged from the In-patient Unit I) II n II exactly the same number of cases in 1979 (224) as in 1978. II it 1'1 dI" n II ---- ~-- • ,.~,,-,::!~.:;::-;::::'.!l l t ) ! " I - 74 - [Ii ~ - 75 - SAMPLE DATA (APRIL, 1979) ON PERSONS ASSESSED WITHIN BAU AT METFORS ,;; TABLE A3 , , [J 'I ~ i' i i Distribution of Population , TABLE Al IJ II Referred to METFORS during April, 1979 by Age and Sex Courts Refe.rri ny to METFORS for Bri ef Assessment during April, 19791 o j ~ Court Males Females Males and Females N Percent [] II ~ Age J Bracket IJ : 0 N Percent N Percent N Percent Old City Hall (Toronto) 26 42.27 I I East Mall (Etobicoke) 9 16.36 U; 1n 2222 Eglinton Ave. East (Scarborough) 3 5.45 q 16 - 19 6 13.33 1 10.00 7 12.13 5290 Yonge Street (Willowdale) 1 1.82 Other 2 3.64 II 10 22.22 2 20~00 12 21.82 Mi ss i ng Oat, ... 14 25.45 n D 20 - 24 I] II D 25 - 29 9 20.00 2 20.00 11 20.00 I TOTAL 55 100.00 o !n 30'- 34 7 15.56 2 20.00 9 16.36 35 - 39· 6 13.33 2 20.00 8 14.55 TABLE A2 I] - , In 40 - 44 7 15.56 7 12.73 Marital Status of 45 - 49 1 .10.00 1 1.82 Persons Referred to METFORS Din during April, 1979 o [] 50 - 54 55 - 59 State N Percent n '\ n 60+ I Si n91 e 39 70.91 liD Married 3 5.45 Separated 5 9.09 ,: I U TOTAL 45 100.00 10 100.00 55 100.00 Divorced· 6 10.91 Widowed Common law 1 1.82 j Missing Data 1 1.82 I U [1 0 TOTAL 55 100.00 [1 n ~------.-.- ...... :~;--=1";"w '1 ! - 76 - [J ~I. - 77 ... TABLE A4 I TA~LE AS Population Referred By Courts For u Psychiatric Assessment During April, 1979 11 Occupational Status of Persons By Count ry of Ot"; g; n1 ~ Referred to B.A. U. ·at MfTFORS LI iii1~ ] During Apr;l, 1979 vI ~{ji ;J ~ ~1 .' ~ Country N Percent U Occupation Given N Percent I i~ Canada 32 58.18 U I i Student / Unemployed 1 1.82 U.S.A. 1 1.82 II Unemployed 17 u l'O 30.91 l: Iraq 1 1.82 Labourer / Unemployed 4 7.27 I: i,I Labourer ( \1 1 1.82 I, England 1 1.82 U tl U Driver 1 1.82 t (/ Metal Paint Stripper 1 1.82 Germany 2 3.64 [J Mechanic 1 1•. ~2 Welder '1 1.82 Greece 2 3.64 ~ U El ectr; ci an 1 1.82 , Yugosl avia 1 1.82 Ll Butcher 1 1.82 1U Painter 1 1.82 Palestine' 1 1.82 Stu'dent 1 1.82 n n Car Wash Attendant 1 1.82 Hall and 2 3.64 Small Machine Operator 1 1.82 [] Painter / Unemployed 1 1.82 Sweden 1 1082 II Chair Assembler 1 1.82 Welfare / Unemployed 6 10.91 Austri a 1 1.82 Salvage / Unemployed 1 1.132 U rl 1.H2 Jamaica 1 1.82 Gas Attendant 1 [i Part time (Manpower) 1 1.82 Hungary 2 3.64 l.1 Photographer 1 1.82 Roofer 1 1.82 Macedon'j a 1 1.82 ! i Carpet Cl eaner 1 1.8,2 0 Farmhand / Unempl~y-ed 1 1.8;~ No Data 6 10.91 Disabil ity Pensioll 1 1. 8,~ Registered Uurs;ng Assistant '1 1~82 u Don't Know 5 9.09 TOTAL 55 100.00 I] TOTAL 55 100.00 fl • ,------======------,, - 78 - - 79 - l- ' TACLE A7 TABLE A6 Summary of Impressions formed by Social Work Staff Nature of Charges faced by population recelvlng u I~ During Brief Assessments at HETFORS Brief Psychiatric Assessment at HETFORS April, 19791 during Apri1, 19791 U I D N Percent Charge N Percent Work - General Level of Functioning Assault and Bodily Harm 5 9.09 DID Unemployable 5 11.63 Weapons Dangerous 5 9.09 Unskill ed 28 65.12 Arson 2 3.64 Semi Skilled / Skilled 4 9.30 Mi.schief 7 12.73 Managerial/Professional 1 2.33 o 10 Uncertain Break and Enter 8 14.55 5 11.63 43 100.00 Assault Police 1 1.82 OliO Theft Under 8 14.55 Stability and Directedness of Work Patterns Indecent Assault 2 3.64 Very Unstable 22 51.16 A~tempted Murder 2 3.64 n iD Quite Unstable 4 9.30 Wilful Non-Compliance 1 1.82 Fairly Stabl e 8 18.60 Wounding 2 3.64 II I U Very Stabl e 3 6.98 Failur~ to Comply 1 L82 . Uncertain 6 13.95 Intimidati,on 1 1.82 43 100.00 Family / Social Relationships Possession of Stolen Credit Cards 1 1.82 [l Previous Family Background' Failure to Appear 1 1.82 ,0 Poor 9 20.93 Attempted Theft Over 1 1.82 Fairly Poor 10 23.26 Theft Over 1 1.82 I[ l U Fairly Good 4 9.30 Uttering 1 1.82 Very Good o Rape 1 1.82 Uncertain 20 46.51 Fraud Accommodation 1 1.82 Ll U 43 100.00 .2nd Degree Murder 1 1.82 Indecent Exposure 1 1.82 Present Family / Social Situations [] i u Poor 18 41.86 Unknown 1 1.8'2 1 Fairly Poor 15 34.88 I: 0 Fairly Good 2 4.65 Very Good 1 2.33 Uncertain 7 16.28 TOTAL 55 100.00 U 43 100.00 Quality of Social Contacts Outside Family 1. Based on the most serious charge in cases where a person was facing Poor 17 '39.53 multiple charges. D Fairly Poor 7 16.28 Fairly Good 2 4.65 Very Good o Uncertai n 17 39.53 43 100.00 .~. f,i Not all BAU patients at METFO~S can be assessed by a social worker. No data for 1~ cases. ~l {j ".~.L~··'1_·_ ...... -.-' _* '-',e' .-""--'--'---="',' , ." ·1 ____ ...... - 81 - - 80 - Tl'.CL E A8 Relationship between Smoking and Drinking Educational Level of Persons Referred to according to Reports Given to Nursing Staff B.A.U. at METFORS during April, 19791 at METFORS (B.A.U.) during April, 1979 (N = 43)1 DRINKING Level n Percent Less than Grade 8 14 25.45 NON LIGHT MODERATE HEAVY Grades 9 - 10 21 38.18 Grades 11 - 12 12 21.82 N Some University 0 1 (1.82) 1 (1.82) Community College N University Graduation Not Recorded 8 14.55 L S I TOTAL. 55 M G 3 (5.45) 1 (1.82) 100.00 0 H K T I N G M 6 0 E 1 (1.82) 4 (7.27) 9 (16.36) 16 (29.09) R [j 0 A T [1 fl E H ["1I E 1 (1.82) 4 (7.27) n A V f 1 Y I: n [J fl *1. Data incomplete on 12 cases. II f] 2. Figures in brackets represent percentages. n 11 ~,/ [J ID1 [1 . "'''''' :, "". ,-...... ,.,- ~-=.~-...,; ~--- -=------~------~--~ ~,..,.·.t) __ ~~...... -, l - 83 - TABLE All - 82 - u II METFORS Psychiatric Recommendations Regarding Persons Assesse~ TABLE Ala for Fitness to Receive Bail, Stand Trial or Receive Sentence u II during April, 1979 (N = 55) Estimate of Dangerousness of Persons N Percent Total Referred to METFORS for Psychiatric Assessment [j i ~ duri ng Apr; 1, l:?J9 Fit to be Granted Bail Not Menta lly Disof'der~d o [] Mentally Disordered a Potential Object N Percent Not Fit to be Granted Bail Not Mentally III Mentally III a THIS IND I VIDUAL: Fit to Stand Trial Not Mentally Disordered 24 43.64 8 14.55 Not Mentally Ill: Further Analysis Needed 1 1.82 Is Dangerous Mentally Disordered 8 14.55 Mentally Ill: Further Analysis Needed 2 3.64 Mental Status Questionable 1 1.82 May Be Dangerous 44 80.00 Mental Status Questionable: Further Analysis Needed a Mentally Defective a 66.47 Is Not Dangerous 3 5.45 Not Fit to Stand Trial Not Mentally III a Not Mentally Ill: Further Analysis Needed a Mentally III 1 1.82 . TOTAL 55 100.00 . Mentally Ill: Further Analysis Needed 5 9a09 Mental Status Questionable a Mental Status Questionable: Further Analysis Needed 0 Mentally Defective 0 10.91 Fitness to Stand Trial Questionable Not Mentally III a Not Mentally Ill: Further Analysis Needed a Mentally III 1 1.82 Mentally Ill: Further Analysis Needed 5 9.09 Mental Status Questionable a Mental Status Questionable: Further Analysis Needed 4 7.27 18,,18 Fit to Receive Sentence Not Mentally III 2 3.64 1 [ Mentally III 1 1.82 .1 Mentally Ill: Further Analysis Needed 0 5.46 VI II Co-operation Refused o [f TOTAL Ii 55 100.00 1., It is not always cl ear whether the judge wi shes an Opl n1 on about a [j D person's suitability for bail or his fitness to stand tr'~al or recommendations on both issues. When in doubt we have considered the assessment to be mainly for fitness to stand trial. U ~ n -- -- I " - 84 - TABLE A17 - 85 - SUMMARY DATA ON INPATIENTS DISCHARGED FROM METFORS Diagnostic Classifications Employed by METFORS Psychiatrists DURING APRIL 1, 1979 TO MARCH 31, 1980 following Brief Assessments at Toronto Jail during April, 1979 [J TABLE Bl Classification n Percent U I. PSYCHOSES Mode of Referral 291.9 Chronic Alcoholism 3 5.45 295.0 Simpl e 'yple 3 5.45 295.3 Paranoid Type 7 12.73 Method of Referral N Percent 295.8 Chronic 4 7.27 295.9 Unspecified (Schizophrenia) 1 1.82 .' . ------296.1 Mani c DeprE~SS i ve Psychos is, Man; c Type 2 3.64 ~ Warrant of Remand, Criminal Code 135 95.07 Form 1 (Mental Health Act) 2 1. 41 II. NEUROSES, PERSONALITY DISORDERS AND OTHER NON-PSYCHOTIC MENTAL Form 8 (Mental Health Act) 1'.. 2 1. 41 DISORDERS ~ , J ; ; [. Warrant of Remand and Form 8 0 300.4 Reactive Depression 1 1.82 Other 3 2'1.11 301.2 Schizoid Personality Disorder 1 1.82 [ No Data 69 301.6 Passive-Aggressive Personality Disorder 1 1.82 ,._- .. ,-_._------301.7 Anti-Social Personality Disorder 5 9.09 301. 9 Unspecified Personality Disorder 3 ·5.45 Total 211* 100.00 303.0 Episodic Excessive Drinking 7 12.73 I 303.1 Habitual 'Excessive Drinking 5 9.09 *Data Missing 13 304.0 Drug Dependence (Opium and Opium alkaloids) 1 1.82 304.9 Drug Dependence (Unspecified) 3 3.64 [ [J 307.0 Transient Situational Disturbances 3 3.64 TABLE B2 309.0 Organic Brain Syndrome 1 1.82 ~ n III. MENTAL RETARDATION Marital Status of Persons Referred to METFORS 311.0 Mild Mental Retardation 3 5.45 ~ Ll during April 1, 1979 to March 31, 1980 Not Menta 'Ily Di sordered 1 1.82 ~( U TOTAL 55 100.00 State N Percent n ,0 ~ 1 36.36 I ~ i SUMMARY: PSYCHOSES 20 \ } NEUROSES etc. 31 56.36 Single 117 1 i 66.48 i! MENTAL RETARDATION 3 5.45 . 1 101 I. Married 24 . I P 13.64 i NOT MENTALLY DISORDERED 1 1.82 1 Common Law 6 3.41 ------[ I IU Separated 18 10.23 55 100.00 .. , Divorced 9 5.11 Widowed 2 1.14 ["l fJ Unclear or No Data 35 f '\i I 1'-1 I ' I TOTAL 211 100.00 I r.i r 1 ! ' '.-~~-"~.--o_~.-----" • - 86 - rJ ~ - 87 - II/ TABLE B4 , ' TABLE B3 ~ I I " j Population Discharged from Inpatient Unit Distribution of Population Discharged LI 'I ~ at METFORS between April, 1979 and March, 1980 from Inpatient Unit at METFORS By Country of Origin between April, 1979 to March, 1980 U' In Country N Percent - ---- .-.-- U I n ------_... Males Females Males and Females Canada 134 63.51 Age ------:------U II U Jamaica 10 4.74 Bracket England 10 4.74 N Percent N Percent N Percent fj- II USA 6 2.84 •. q D Italy 6 2.84 Greece 4 1.90 Trinidad 3 1.42 16 - 19 27 14.?9 4 15.38 31 14;69 T [.J [] China 3 1.42 3 1.42 20 - 24 46 24.86 Poland 8 30.77 54 25.95 Czechoslovakia 2 0.95 U [1 Yugoslavia 2 0.95 25 - 29 29 15.68 5 19.23 34 16~ 11 India 2 0.95 Barbados 2 0.95 30 - 34 25 13.51 1 3.85 26 12.32 rJ o Portugal 2 0.95 Germany 2 0.95 St. Kitts 1 0.47 35 - 39 25 13.51 4 15.38 29 13.74 . { : 0 Israel 1 0.47 40 - 44 8 4.32 Lebanon 1 0.47 2 7.69 10 4.74 Scotland 1 0.47 II [l Switzerl and 1 0.47 45 - 49 6 3.24 1 3.85 7 3.32 Hall and 1 0.47 Grenada 1 0.47 50 - 54 7 3.78 1 3.85 8 3.79 II [J Phil ippines '1 0.47 Finland 1 0.47 55 - 59 6 3.24 0 I ! Hungary 1 0.47 6 1 2.84 r :~ i 1 [] Denmark 1 0.47 60+ No Data 9 4.27 6 3.24 0 6 2.84 No Data 0 U 0 0 0 0 Total 100.00 U 0 ------.. -.--.-~,------TOTAL 185 100.00 26 100.00 211 *100.00 ------_..•. _. ~ rl Ii m:1 ! : 0 II i . ~,'.'~~---, L ... '~G>--- r • ~l \. - 88 - TABLE B5 - 89 - Nature of Charges Faced by Popul at ion Di scharged TABLE 85 con1t from Inpatient Unit of METFORS between April, 1979 and March, 1980 Nature of Charges Faced by Population Dischar'ged (Based on the Most Serious Charge) from Inpatient Unit of METFORS between April, 1979 and March, 1980 Charge N Percent Charge N Percent Murder, 2nd Degree 4 1.90 Indecent Assault 11 5.21 Common Assault 8 3.79 Breach of Undertaking 2 0.95 Rape 5 2.37 Attempt to Escape Custody 1 0.47 Attempted Rape 1 0.47 False Message 1 0.47 Mischief 14 6.64 Attempted Murder 8 3.79 Petty Trespassing 2 0.95 Dangerous Driving 3 1.42 Criminal Negligence 5 2.37 Assault Police Officer 2 0.95 Robbery 7 3.32 Indecent Exposure 1 0.47 Incest 1 0.47 Threatening 3 1.42 Theft Over 4 1.90 Sex With a Minor 1 0.47 Theft Under 5 2.37 Fraud 4 1. 90 Concealed Weapon 2 0.95 0 In Attempted Fraud 1 0.47 Pointing a Firearm 2 0.95 Forgery 2 0.95 Failure to Comply 3 1.42 0 1U False Statement 1 0.47 Use of Stolen Credit Ca:'ds 2 0.95 Possession of a Prohibited Weapon 1 0.47 " 1 Possession Over 2 0.95 LOitering 1 0.47 Cause Disturbance 5 2.37 0 U Wounding 4 L90 Weapons Dangerous 18 8.53 Intimidation 1 0.47 False Pretences 1 0.47 0 Cruelty to Animals 1 0.47 Watch and Beset 1 0.47 10 Illegal Possession of Drugs 2 0.95 Assault Causing Bodily Harm 15 7.12 Carnal Knowledge 1 0.47 Arson 12 5.68 n 10t - Assault with Intent 1 0.47 Break and Enter Attempt 1 0.47 ! 1 No Data 3 1. 42 Indecent Act 2 0.95 [j '~l 0 Break and Enter 21 9.95 ----.------Breach of Recognizance 1 0.A7 Attempted Theft Over 2 0.95 0 n Total 211* 100.00 Attempted Theft Under 2 0.95 Contributing to Juvenile Delinquency I 1 0.47 a 0 *Note: Data missing for 13 cases. Failure to Appear 2 0.95 Making Explosives 1 0.47 Auto Theft 3 1.42 0 f'l 0 Ii - 91 - - 90 - 0 TABLE B7 TABLE 8'6 [II METFORS Psychiatric Recommendations Regarding Perso~s ---- Discharged from the Inpatient Unit at METFORS j) between April. 1979 and March, 1980 Procedures Employed and Treatments Gi ven to Pat; ents Discharged from the Inpatient Unit at METFORS 0 between Apr;l, 1979 and March, 1980 N Percent fJ Fit to Stand Trial Procedure/Treatment N Percent Not Mentally 111 85 40.28 Mentally III 86 40.76 . 0 Mentally III Unclear 2 0.95 Drugs Prescribed 148 70.14 Not Fit to Stand Trial Eo Eo G. Gi ven 120 56.87 Not mentally III o 0 Mentally III 22 10.43 Special Consultation Regarding .Current Assessment (e.g. Neurology) 36 17.06 Fitness to Stand Trial Questionable Special Consultation Unrelated to Current Assessment 27 12.08 0 Not Mentally III o Psychological Consultation 166 78.67 Mentally III 2 0.95 Mentally III Unclear 1 Social Work Interviews with or on Behalf of Patients 1500 0 Fit to Receive Sentence Not Mentally III 9 4.27 TOTAL PATIENTS 211 0 Mentally III 4 1. 90 Mentally III - No Further Information o 0 [J TOTAL 211* 100.00 U TABLE B8 Estimate of Dangerousness of Persons Discharged from Inpatient Unit at METFORS [1 between April, 1979 and March, 1980 ! i Potential Object N Percent Self Only 11 5.21 l j Others Only 63 29.85 Both Self and Others 22 10.43 Uncertain to Self, 0 Dangerous to Others 0 Uncertain to Others 1 0.47 Uncertain to r [] Self and Others (3 1.42 Not Dangerous 10i3 51.18 , No Data 3 1.42 ~ TOTAL 211* 100.00 'I ~'I ::;:;:e:::::::~ .•..: .."' ... __ .... #"'~::;l: - 92 - n u - 93 - TABLE B9 TABLE Bll Excessive Use of Alcohol and Drugs by Persons u Discharged from Inpatient Unit at METFORS u between April, 1979 and March, 1980 Diagnostic Classifications Employed by METFORS Psychiatrists at Discharge from Inpatient Unit at METFORS u n between April, 1979 and March, 1980 Substance N Percent U U Opinion Certain Classification N Percent Alcohol 49 23.22 [] 10I Drugs 10 4.74 1 Psychoses 97 45.97 Alcohol and Drugs 39 18.48 0 Neuroses, Personality Disorder and 1D Other Non-Psychotic Disorders 101 47.87 Opinion Uncertain 0 110 Alcohol 5 2.37 f I Mental Retardation 7 3.32 Drugs 4 1.90 0 10 Mental Retardation + Neuroses 1 0.47 Alcohol and Drugs 24 11.37 I Other 0 Apparent Normal Use 80 37.91 U f [J No Mental III ness - 2 0.95 TOTAL 211 100.00 0 0 No Data 3 1.42 [J I t 0 TABLE BID TOTAL 211 100.00 Prognosis for Persons Discharged from METFORS Inpatient Unit 0 0 between, April, 1979 and March, 1980 0 Rating N Percent 0 Excellent 3 1.42 n D Good 44 20.85 Fair 98 46.45 Poor 65 30.81 l! Not Given 1 0.47 n LI TOTAL 211* 100.00 0 II r1. J ~ [jl I 0 W ~.-] ~,,~_ ... __-;t"rt7:;"r >, ,. >'." •. ~ ~-,-::.::.-=..:;..~:.:~';;;.i...:~"-.:..:::::::-.:-.-:x.~:;::..c'':;'',r.;:.:;:>,¢tCo:.o'''''''''''''2.!-!:-_ _v.,.. ~:;r-..::.=.~"""",,~--.,-...... ~~. ~"'''''',.,,~,,~.~ . - '-.. ~----==~~~...... ~.- - ::tJt=~r;r-n::::'~ ~~~-"-L"_iz,"~" , p/ - 95 - - 94 - 0 ~D TABLE C3 SUMMAR Y DATA ON II U n Distribution of Population PSYCHIATRIC ASSESSMENTS COMPLETED 1\ AT REQUEST OF METROPOLITAN TORONTO JAILS Referred by Jail s for'Psychi atri c Assessment il '!\ , DURING APRIL, 1979 TO MARCH, 1980 during April J 1979 to March, 1980 ! I ~ U ! I by Age and Sex if TABLE CP1 II If Number of Cases ·Seen ~ n Males Females Males and Females If >, Age - --- i I Bracket Centre Number PercEmt of Tota 1 U jU N N N Percent I -- ''!;.- []~ - f fl U > Toronto Jai 1 21 7.27 I· ~ East Detention 100 :34.60 16 - 19 45 7 52 17.99 ~Iest Detention 168 !58.13 Un ~ J I ~IETFORS 0 0.00 20 - 24 64 16 80 27.68 (t r[J 25 - 29 59 4 63 21.80 T,otal 289 lQO.OO ~ I 30 - 34 36 4 40 13.84 ~I. U III 35 - 39 18 4 22 7.61 11 11 D 0 Ii TABLE CP2 40 -44 13 .2 15 5.19 II 'I ~ fii,~rital Status of jl 0 45 - 1~9 3 1 4 1.38 Ij Persons Referred by Jail for Psychiatric n li Assessment during April, 1975 to March, 19801 50 - 54 5. 1 6 2.08 I) D L1 I I State N Percent 55 - 59 2 3 5 1. 73 .1 f i 0 60+ 2 0 2 .69 II Single 69.90 202 !lII Married 26 9.00 No Data a 0 0 0 ,I COITVnon Law 18 6.23 01 LI II,I Separated 24 8.30 Ii Divorced 14 4.84 II.J rl rl TOTAL 247 42 289 100.00 'I h Wido\'I'ed 4 1.38 11 Don't Know 1 .35 C' I· f"'lL: U· II ~~r~' TOTAl 289 100.00 II'I I .;.~ [1 [i i I I n II, 1 it II ' " 0 .. Ll .,_.- .., -, . '"~-''-''' =-- .... -~ ... == -- - '-"---'-'~'-~- '''.0-.-_--- .. --f '-~=~~-l , -96 - - 97 - \\ o u TAULE C4 -~~- Population Referred By Jails For o 10 Psychiatric Assessment During April, 1979 to March, 1980 By Countr-y of Origin Previous History of Persons 0 n Referred By Jail For Psychiatric Assessment Duri ng Apri 1 j 1979 to March, 1.980 Country N Perc;ent U u Type of Experience Canada 212 73.36 N Percent England 1 .35 0 IU U.S.A. 22 7.61 China 1 .35 No Previous Psychiat. Exper., Charges, Probate , Jamaica 12 4.15 G U~ or Tim~ in Prison 25 8.65 St~ Kitts 1 .35 Outpatient Psychiatric Experience 3 1.04 .69 Guyana 2 Inpatient Psychiatric Experience 5 1.73 5 1.73 Scotland e o Outpatien1~ and Inp 11 [l TOTAL \' ..... 289 100.00 TOTAL 289 100.00 I t n !'l 1. Includ~s one where inpatient and outpatient psychiatric is unclear. I I [1 0 [l 0 n [l --.- { I i! il '" 1/ - 99 - r ~ I I TABLE C8 - 98 - '1 ~ I Estimate of Dangerousness According to TABLE C7 Specific Characteristics {After Megargee, 1976)1 ",1J~ ' Estimate of Dangerousness of Persons ! Month Characteristics Referred for Psychiatric Evaluation at and ------Metropolitan Toronto Jails ~ Person AA IA HO TA II CA CD AH SE PO Du~ing April, 1979 to March, 1930 ~~ April M UC UC UC UC UC UC UC UC UC M M M L L M M M M L L M Potential Object N Pe,rcent M M M M M M M M M M M ~ M M L L M M M L M M M Low to Self, Unclear to Others 13 4.50 ,U M L L L M UC NA NA L L M I May Low to Self and Others 164 56.75 i M M L M M M NA NA M M M Low to Self, Medium to Others 41 14.19 M M L M L M M M L L M Low to Self, High to Others 10 3.46 jD M H M H M UC UC UC M M UC Medium to Self, Low to Others 36 12.46 ~ M H H M H M L M M L H Medium to Self, Medium to Others 7 2.42 M M M M H UC UC UC M M L High to Self, Low to Others 5 1.73 lU ------~~~------Unclear to Self and Others 3 1.04 I June M M M M. L L M 'M" M M M High to Self, Medium to Others 1 0.35 Medium to Self, High to Others 4 1.38 tU Medium to Self, Unclear to Otbers 2 0.69 July M M M H H M L L M M M Hi~h to Self, High to Others 1 0.35 [l M H M H H UC UC UC H L H High to Self, Unclear to Others 1 0.35 M M L H M UC UC UC UC UC H Unclear to Self, Medium to Others 1 0.35 M M M M M H UC UC M M UC [l M M M UC M UC M M M M M ------TOTAL 289 100.00 rj August M L L L H L UC UC UC UC H M H M H H M UC UC H M H M M L M M M M i~ M M M Ll M L L L L M M NA L L L M M L M M M M L L L H M L L L UC UC H UC UC UCM [J M L M L M L M NA L L H M M M L M M M M M M M M L L L M UC M M UC UC H [1 ------.. Sept. M UC UC UC UC UC UC UC UC UC H n M M L M H L M M M L H M M L M M UC UC UC UC UC M [-1 M M L M M M M M M M M ------~------r''', I : :-1 , . .., 101 - - 100 - n 10 ______•• ______~ _____ b ______~ ___ _ ,. TABLE C8 can't f j In M M L M M M M L M M M M L L M M UC UC UC L L UC M L L L M M M UC L M H [] F M L L M M M M M L M Month Characteristics Lli F M L M H M NA NA M M H and ------F M M L M M M L L L H Person AP. IA HO TA II CA CD AH SE PO F L L . L L L L L L L H F L M L M M M NA L L M II n F L L L H M M M L M M October M L L L L UC UC UC UC UC H F M M M H M UC UC M M L M L L L L M M L L L H l I F L M L M M M UC L L H M UC UC UC UC UC UC UC UC UC H iJ F M M M M L M M M M H M M M M M M M NA M M H F L L L M L UC UC L L H M M M M M M L L M M M F lie UC UC M M UC UC UC UC M M L M L M L UC UC L L L n II i F M M L M M M M M M H ------F L L L M L NA NA L L M f! F UC UC UC UC UC UC UC UC UC H November M L L L M M M M L L H M L L L L M M L L L L M L M L L L NA NA L L H ------_._------No. of Females = 14 f No. of Males = 58 Total = 72 D~cember M M L L M M NA M M L r~ M M M M M M H H M L H ~ It 1. AA - Angry Aggression AH - Aggressive Habits --~------IA - Instrumental Aggression SE - Socio-cultural January M L L L L M NA UC UC L M 1'10 - Hostile Enhancement . : M M L L M M M M, L· L M II TA - Transitory Rage PD ~ Dangerousness M M L L M M M L1C L L L n II - Internal Inhibitions rel ated to ------.. _------CA - Controls Reduced under Alcohol Psychiatric Disorder [1 CO - Controls Reduced under Drugs F - Female February M L M L M M M l~ L M M n M - Male M L N M M L L IL M L M UC - Unclear M L L L M M MA IUC l M l [1 NA - Not Applicable M M L L M M M I~ L L M u M M L L M M M Ii L M H M L M L M M NA L L M M I I . M UC UC UC UC UC UC lJC UC UC H n, I. M H H L M M H ~, L M H ------,------I I I March M L M L L L L l. L L H r I.. M H H H M M M Itl H H H M L L L L L L L L L L : . I . I f ------I I f f u .1! o l 'l m lJ I ------.----:;;.'" ------~--- - 102 - TABLE C9 [) In - 103 - Pattern of Alcohol and Drug Use TABLE e1l Among Persons ,Referred for Psychiatri c Eva1 uat ion by the Metropolitan Jails LJ 10 Ouri ng April, 1979 to March, 1980 General Categ0.ries of Psychiatric Disturbance Applied to Prisoners seen by Psychiatric Consultant U tu 1 Substance N' Percentage During April, 1979 to March, 198J U i Alcohol IU Chronic Use 44 15.22 Episodic Use 17 5.88 Classification Number of Cases Percentage Unclear 2 0.69 o o Drugs Chronic Use 23 7.96 U o 'Psychoses Only 58 20.07 Episodic Use 8 2.77 Neuroses Only 45 15.57 Alcohol and Drugs U [l Personality Disorder Only 84 29.07 Chronic Alcohol/Episodic Drugs 5 1.73 Retardation Only 3 1.04 Chronic Alcohol/Chronic Drugs 34 11.76 Episodic Alcohol/Episodic Drugs 10 3.46 Psychoses and Personality Disorder 2 0.69 Episodic Alcohol/Chronic Drugs 7 2.42 D L! Neuroses and Personality Disorder 20 6.92 Neuroses and Retardation 2 0.69 No Apparent Misuse 107 37.02 Unclear 31 10.73 U [1 Personality Disorder and Retardation 4 1.38 No Data 1 0.35 Psychoses and Neuroses and Personality Di sorder' 0 a l".t'- Neuroses and Psychoses 0 a TOTAL 289 100.00 o U Neuroses and Personality Disorder and Retardation 1 0.35 TABLE CI0 o rJ None of the Above 66 22.84 Unclear 4 1.38 I Drugs Requested by and Prescribed for ,I~ Ii Persons Assessed by Psychiatrist at [I l' Metropolitan Toronto Jails n jl, During April, 1979 to March, 1980 TOTAL' 289 100.00 11 [ : fII u 1\ H Drugs N Percent 11 [I [I 1. I n many instances, persons will be c1 ass i fi ed as abusers of a1 coho 1 Not Requested / Not Prescribed 173 59.86 or drugs. (Table C12) ~ Not Requested / Prescribed 44 15.22 ~l Requested / Not Prescribed 16 5.54 fJ U P~escribed 50 17.30 I Requested / Unknown / Uncertain / No Data 6 2.08 [] '" 1 TOTAL 289 100.00 fl [-1 , [1 -' ----~'-- ~--'---~------~----~--=----~~~~-~----~------1~~"'~--.--~.- - 104 - - 105 - fl n TABLE Cll TABLE C12 Recommenda~ions Made and Treatments Given [j '0 By Consulting Psychiatrist Diagnostic Classification Employed By During April, .1979 to March, 1980 1 Consu~:tant Psych i at ri st Fo 11 owi ng Assessments ; n Metropol itan Toronto Jai·l s U ~ During April, 1979 to March, 1930 Recommendation N Percent {] n Classification Number of Cases Percent Counselled 76 26.30 Observation 56 19.38 0 n Medication 39 13.49 Relocate 20 6.92 21.80 Psychoses 63 Observation and Counselled 6 2.• 08 Medication and Observation 9 3.11 . Neuroses, Personality Disorder and Other u 10 Observation and Deportation 4 1.38 Non-Psychotic Mental Disorders 177 61.25 ) Deportation 10 3.46 u InI . Observation and Segregation 3 1.04 Mental Retardation 3 1.04 Observation and Relocate 4 1.38 Observation and Report to OBP 1 0.35 46 15.92 n Counselled and Report to OBP 2 0.69 Other U Counselled and Medication 14 4.84 I Medicat~on and Deportation 1 0.35 .0 U Parole 2 0.69 TOTAL 289 100.00 t Counselled and Parole 1 0.35 Sent to Court 3 1.04 0 0 Report to OBP 4 1.38 Strict Supervision 1 0.35 r-j METFORS 7 2.42 L D Certified, Relocate or Deport 1 0.35 Observe and Send to Court 1 0.35 Medication and Relocate 1 0.35 0 0 Medication and Segregation 1 0.35 Medication, Counselled and Relocate 1 0.35 Medication ~nd Placement 5 1.73 0 U Placement 12 4.15 Counsell ~~ and Pl acement 3 1.04 [1 0 Assessment by Mixed Team for Court 1 0.35 TOTAL '\ 289 100.00 [1"I \' J 0 1. In many cases the~e were more than one recommendation made or U D treatment given (e.g., medication and counselling). We have listed [} 0 here only the major procedure. 0 0 I~ a 0 r r ...--.. . " \ .'1