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When MentalWhen Mental
Illness Leads toIllness Leads to
Crime: StigmaCrime: Stigma
and Recovery forand Recovery for
the Fo...
Agenda
What it means to be a forensic client / non
criminally responsible (NCR)
Difference between NCR & antisocial /
psyc...
Integrated Forensic Program (IFP)
Mandate
The IFP provides specialized services
-in assessment, treatment, rehabilitation ...
Forensic Services
• Secure Assessment Inpatient Units: 24 beds
• Secure Rehab & Transition Inpatient Units: 81 beds
• Secu...
Court-Ordered Assessments &
Ontario Review Board (ORB) Clients
• In-custody Fitness Assessments: 37
• Out-of-custody Fitne...
Criminal Code of Canada
Section 16
• Defence of Mental Disorder – no person is
criminally responsible for an act committed...
Criteria for NCR finding
• The person committed a crime
• The person was suffering from a mental
disorder
• The mental dis...
NCR vs Antisocial & Psychopathy
• Antisocial Personality Disorder: a pervasive pattern of
disregard for and violation of t...
THE STIGMATHE STIGMA
OF MENTALOF MENTAL
ILLNESSILLNESS
By Anik Gosselin, Ph.D.,By Anik Gosselin, Ph.D.,
C.Psych.C.Psych.
WHAT IS STIGMA?
Socially discrediting attribute, behaviour or reputation
(Goffman, 1963)
•3 functions:
– Exploitation/domi...
PROGRESSIVE MODEL OF SELF-STIGMA
(Corrigan & Rao, 2012)
AWARENESS
•“The public believes people with mental illness are wea...
THE WHY-TRY EFFECT(Corrigan et al., 2009)
Stereotypes
Blame
Dangerousness
Incompetence
Fewer
behaviours in
pursuit of
goal...
EFFECTS OF STIGMA ON THE TARGETED INDIVIDUALS
• Depression, demoralization, shame (Lucksted et al., 2011)
• Social avoidan...
STIGMA IN FORENSICS– AN ADDITIONAL
CHALLENGE TO RECOVERY
• The forensic label: a double stigma
‘I am violent and mentally ...
HOW TO FIGHT STIGMA?
Policy and law changes
‒ Ex: make discrimination illegal (e.g., refusing a job or housing based on
hi...
GUIDELINES FOR RECOVERY‐ORIENTED PRACTICE:
HOPE, DIGNITY, INCLUSION*
Organized in 6 dimensions of recovery oriented practi...
DISCLOSURE STRATEGIES
for the stigmatized individual (Corrigan & Rao, 2012)
Social Avoidance
Stay away from people so they...
Double Stigma – Forensic Patients and
Their Families
Family Members/Caregiver’s for this presentation includes
mother, fat...
Double Stigma – Family/Caregiver’s Feelings
• Most people with severe mental illness live with family members.
• Ongoing s...
Double Stigma –Family/Caregiver’s
Experiences
• Public and media stigmatization of people with mental illness
• Dealing wi...
Double Stigma – Mental Illness & Crime
How we can help families
• Helping the person with mental health issues:
• Deliver ...
Double Stigma – How can our society reduce the
impact of stigma for families
• Education and Contact with the stigmatized ...
Double Stigma – Mental Illness & Crime
Key Family Information & Support Resources in Ottawa
• L’Apogee
• The Oasis in Kana...
Thank youThank you
to our clientsto our clients
for sharing their storyfor sharing their story
Sean CliftonSean Clifton
Fr...
Q & A
Special thanks to Martin Manseau and
John Espadero for their precious help
with the multimedia
When Mental Illness Leads to Crime: Stigma and Recovery for the Forensic Client
When Mental Illness Leads to Crime: Stigma and Recovery for the Forensic Client
When Mental Illness Leads to Crime: Stigma and Recovery for the Forensic Client
When Mental Illness Leads to Crime: Stigma and Recovery for the Forensic Client
When Mental Illness Leads to Crime: Stigma and Recovery for the Forensic Client
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When Mental Illness Leads to Crime: Stigma and Recovery for the Forensic Client

Not Criminally Responsible. You may have heard this term used in the news or in movies but what does it really mean? At our most recent Conversations at The Royal lecture, we answered this and many other questions about what it means to be a forensic client.

The evening was presented by Dr. Diane Hoffman-Lacombe, Dr. Anik Gosselin, and Raphaela Fleisher, from the Integrated Forensic program at The Royal.

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When Mental Illness Leads to Crime: Stigma and Recovery for the Forensic Client

  1. 1. When MentalWhen Mental Illness Leads toIllness Leads to Crime: StigmaCrime: Stigma and Recovery forand Recovery for the Forensicthe Forensic ClientClient Anik Gosselin, Ph.D., C.Psych. Forensic Neuropsychologist & Clinical Psychologist Raphaela Fleisher, MSW, RSW Social Worker, Outpatient Forensic Service Diane Hoffman-Lacombe, MPs. CPsych Forensic & Clinical Psychologist Integrated Forensic Program
  2. 2. Agenda What it means to be a forensic client / non criminally responsible (NCR) Difference between NCR & antisocial / psychopathy How stigma develops in a society, the double stigma attached to the label “forensic client” The impact for the family What to do to decrease stigma, promote recovery and successful community reintegration 3
  3. 3. Integrated Forensic Program (IFP) Mandate The IFP provides specialized services -in assessment, treatment, rehabilitation and community reintegration -to persons with severe mental illness who have come into conflict with the criminal justice system -within a safe, therapeutic and recovery oriented environment 4
  4. 4. Forensic Services • Secure Assessment Inpatient Units: 24 beds • Secure Rehab & Transition Inpatient Units: 81 beds • Secure Mental Health: 4 beds • Outpatient Services: approx. 1500 clients ORB clients (FIRST, FITT, Transitional Housing) Brief Assessment Unit (BAU) out-of-custody General Forensic Clinic: includes general outpatients and Chrysalis Day Program Mental Health Court, Mental Health Court Clinic, OCDC Specialized Clinics: Sexual Behaviours, Anger Disorders, Family Court Clinic (Child Welfare & Youth) 5
  5. 5. Court-Ordered Assessments & Ontario Review Board (ORB) Clients • In-custody Fitness Assessments: 37 • Out-of-custody Fitness Assessments: 11 • In-custody NCR Assessments: 62 • Out-of-custody NCR Assessments: 18 • 201 ORB clients – 191 NCR – 10 unfit – 81 inpatients – 120 outpatients 6
  6. 6. Criminal Code of Canada Section 16 • Defence of Mental Disorder – no person is criminally responsible for an act committed or an omission made while suffering from a mental disorder that rendered a person incapable of appreciating the nature and quality of the act or omission or of knowing that is was wrong 7
  7. 7. Criteria for NCR finding • The person committed a crime • The person was suffering from a mental disorder • The mental disorder was a factor at the time of the crime – Not able to appreciate the nature and quality – Or not knowing that is was wrong i
  8. 8. NCR vs Antisocial & Psychopathy • Antisocial Personality Disorder: a pervasive pattern of disregard for and violation of the rights of others • Construct of psychopathy is defined by personality traits & behaviours (4 facets: interpersonal, affective, lifestyle, antisocial) • Able to appreciate the nature and quality of the act • Know that it was wrong (legally & morally) • Not psychotic; no loss of contact with reality • Choice of action; actions not driven by illness 9
  9. 9. THE STIGMATHE STIGMA OF MENTALOF MENTAL ILLNESSILLNESS By Anik Gosselin, Ph.D.,By Anik Gosselin, Ph.D., C.Psych.C.Psych.
  10. 10. WHAT IS STIGMA? Socially discrediting attribute, behaviour or reputation (Goffman, 1963) •3 functions: – Exploitation/domination (e.g., racism) – Enforcement of social norms (e.g., smoking, obesity) – Evolutionary purpose (e.g., mental illness, AIDS) •Public Stigma: Negative attitudes held by public about people with devalued characteristics •Self-Stigma: Internalization of these public attitudes
  11. 11. PROGRESSIVE MODEL OF SELF-STIGMA (Corrigan & Rao, 2012) AWARENESS •“The public believes people with mental illness are weak” AGREEMENT •“That’s right. People with mental illness are weak.” APPLICATION •“I am mentally ill so I must be weak.” HARM •“Because I am weak, I am not worthy or able.” WHY TRY… The person gives up trying… (to hold a job, to have friends, to get help) because its not gonna change anything “I am not worthy and beyond help”
  12. 12. THE WHY-TRY EFFECT(Corrigan et al., 2009) Stereotypes Blame Dangerousness Incompetence Fewer behaviours in pursuit of goals! Decreased participation in evidence- based treatments Public Stigma Self-Stigma Awareness Agreement Application Social Mediators Self-esteem Self-efficacy
  13. 13. EFFECTS OF STIGMA ON THE TARGETED INDIVIDUALS • Depression, demoralization, shame (Lucksted et al., 2011) • Social avoidance, distancing (Link et al., 2004) • Increase in symptom intensity (Livingston & Boyd, 2010) • Increase in hospitalization, decrease in engagement (Kvrgic et al., 2013) • Decrease in hope and in quality of life (Mittal et al., 2012) • Decrease in treatment adherence and in help‐seeking (Vogel et al., 2013) • Poor self‐esteem and self‐efficacy
  14. 14. STIGMA IN FORENSICS– AN ADDITIONAL CHALLENGE TO RECOVERY • The forensic label: a double stigma ‘I am violent and mentally ill; I scare people, I am not worthy of love; I have to hide’ • Challenges for health care providers: – Building trust – Impact of learned helplessness → non‐engagement in therapeutic process • Housing difficulties
  15. 15. HOW TO FIGHT STIGMA? Policy and law changes ‒ Ex: make discrimination illegal (e.g., refusing a job or housing based on history of mental illness) Decrease ignorance and preconceived ideas through education Shift from medical model to recovery model •Recovery Model: System that provides hope, treat people with dignity and respect and support everyone in finding their path to better mental health and well‐being –Living a satisfying, hopeful and contributing life, even when there are limitations caused by mental illness (as opposed to finding a cure) •Include Peer Support Workers in multidisciplinary teams Change societal attitudes at the national level
  16. 16. GUIDELINES FOR RECOVERY‐ORIENTED PRACTICE: HOPE, DIGNITY, INCLUSION* Organized in 6 dimensions of recovery oriented practice: 1)Creating a culture and language of hope 2)Recovery is personal 3)Recovery occurs in the context of one’s life 4)Responding to the diverse needs of everyone living in Canada 5)Working with First Nations, Inuit and Metis 6)Recovery is about transforming services and systems *http://www.mentalhealthcommission.ca/English/initiatives/RecoveryGuidelines
  17. 17. DISCLOSURE STRATEGIES for the stigmatized individual (Corrigan & Rao, 2012) Social Avoidance Stay away from people so they don’t have a chance to stigmatize me Secrecy Go out into the world – work and go to church, but tell no one about my illness Selective Disclosure Tell people about my illness who seem like they will understand Indiscriminant Disclosure Hide it from no one Broadcast Be proud - Let people know
  18. 18. Double Stigma – Forensic Patients and Their Families Family Members/Caregiver’s for this presentation includes mother, father, brother, sister, husband, wife, and a close friend or relative. 22
  19. 19. Double Stigma – Family/Caregiver’s Feelings • Most people with severe mental illness live with family members. • Ongoing stress can be detrimental to caregiver’s mental and physical wellbeing • Carries significant emotional turmoil • Question their coping abilities • Feelings of being trapped • Protective of their sick family member in spite of clear signs of personal danger. • Desensitized to violence and associated fears 23
  20. 20. Double Stigma –Family/Caregiver’s Experiences • Public and media stigmatization of people with mental illness • Dealing with media and legal proceedings difficult and not in most people’s skill repertoire • Adverse publicity and hostility often directed toward offenders’ family members • Guilt by association, ostracism, general abuse, and physical violence • Feelings of shame and suffering common due to media exposure • Result in losing friends and becoming isolated in their community. Lack support network • Unaware of social and medical services offered to either patient or family • Feeling stigmatized key challenge facing forensic caregivers • Causes ambivalence among family members towards the perpetrator • Change of the family unit • Negative reporting adversely affects the recovery process and community reintegration of both the individual with mental illness as well as their family 24
  21. 21. Double Stigma – Mental Illness & Crime How we can help families • Helping the person with mental health issues: • Deliver co-ordinated and integrated care for the person with mental health and forensic issues • Helping the families and caregivers: • Provide counselling referrals to the caregivers • Develop support groups for forensic families 25
  22. 22. Double Stigma – How can our society reduce the impact of stigma for families • Education and Contact with the stigmatized groups • Use Media to decrease public stigma • Reducing the stigma leads to early identification and early treatment of mental illness • Research needed to determine impact of providing education through media and other outlets on early detection and treatment efforts. 26
  23. 23. Double Stigma – Mental Illness & Crime Key Family Information & Support Resources in Ottawa • L’Apogee • The Oasis in Kanata • Canadian Mental Health Association • Mental Health Crisis Line • Montfort Renaissance • National Alliance on Mental Illness (NAMI) Family to Family Programs • Parent’s lifeline of Eastern Ontario (PLEO) • Psychiatric Survivors Ottawa (PSO) • The Royal - Education Series and Coping with Mental Illness Group • Schizophrenia Society of Ontario, Ottawa Chapter • Youth Services Bureau (YSB) 27
  24. 24. Thank youThank you to our clientsto our clients for sharing their storyfor sharing their story Sean CliftonSean Clifton Francis LaveauxFrancis Laveaux Michael StewartMichael Stewart
  25. 25. Q & A Special thanks to Martin Manseau and John Espadero for their precious help with the multimedia

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  • BrianDanzyger

    Feb. 17, 2018
  • ChiaHerng

    Jul. 1, 2020

Not Criminally Responsible. You may have heard this term used in the news or in movies but what does it really mean? At our most recent Conversations at The Royal lecture, we answered this and many other questions about what it means to be a forensic client. The evening was presented by Dr. Diane Hoffman-Lacombe, Dr. Anik Gosselin, and Raphaela Fleisher, from the Integrated Forensic program at The Royal.

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