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Penney S.R.,Center for Addiction and Mental Health | Morgan A.,Ontario Shores Center for Mental Health science
Law and Human Behavior | Year: 2016

Research on violence perpetrated by individuals with major mental illness (MMI) typically focuses on the presence of specific psychotic symptoms near the time of the violent act. This approach does not distinguish whether symptoms actually motivate the violence or were merely present at the material time. It also does not consider the possibility that non-illness-related factors (e.g., anger, substance use), or multiple motivations, may have been operative in driving violence. The failure to make these distinctions clouds our ability to understand the origins of violence in people with MMI, to accurately assess risk and criminal responsibility, and to appropriately target interventions to reduce and manage risk. This study describes the development of a new coding instrument designed to assess motivations for violence and offending among individuals with MMI, and reports on the scheme's interrater reliability. Using 72 psychiatric reports which had been submitted to the court to assist in determining criminal responsibility, we found that independent raters were able to assess different motivational influences for violence with a satisfactory degree of consistency. More than three-quarters (79.2%) of the sample were judged to have committed an act of violence as a primary result of illness, whereas 20.8% were deemed to have offended as a result of illness in conjunction with other non-illness-based motivating influences. Current findings have relevance for clarifying the rate of illness-driven violence among psychiatric patients, as well as legal and clinical issues related to violence risk and criminal responsibility more broadly. Source

Gabe K.,The Hincks Dellcrest Center and North York General Hospital | Pinhas L.,Ontario Shores Center for Mental Health science | Eisler I.,Kings College London | Katzman D.,Hospital for Sick Children | Heinmaa M.,Hospital for Sick Children
Journal of the Canadian Academy of Child and Adolescent Psychiatry | Year: 2014

Objective: Preliminary research suggests that multiple family therapy (MFT) may be an effective intervention for adolescent anorexia nervosa (AN). This study compared the extent of weight restoration for patients enrolled in one year of MFT compared to a matched control group receiving treatment as usual (TAU). Method: A retrospective chart review was performed using data from 25 MFT cases matched to 25 controls on age, diagnosis and year of entry to the eating disorder program. Results: Both cases and controls experienced significant weight restoration, however patients enrolled in MFT were restored to a higher mean percent ideal body weight than the TAU group (99.6% (±7.27%) vs. 95.4 (±6.88); p<0.05). Conclusions: MFT may be more effective than TAU in restoring weight in adolescents with AN. © 2014, Canadian Academy of Child and Adolescent Psychiatry. All Rights Reserved. Source

Cyr J.J.,Center for Mental Health science | Paradis J.,Ontario Shores Center for Mental Health science
Journal of Forensic Nursing | Year: 2012

A major challenge faced by Forensic Program management teams is to balance their budgets due to the unpredictability of the forensic patient population, particularly the context of managing staffing costs where the hospital is not the "gatekeeper" and does not have control over who is admitted and when. forensic mental health, the justice system, either via the courts, or review boards, determines who is ordered for admission to hospital for assessment or treatment and rehabilitation. Hospitals have little, if any, recourse but to admit these mentally disordered offenders. This typically results increased levels of staffing with concomitant overtime costs. The literature suggests that clustered float pool nurses develop enhanced relationships with staff and patients, thereby enabling them to attaspecialized clinical expertise to treat specific patient populations, promoting safer, high quality care, and overall are more cost effective. Forensic nursing is recognized as a mental health subspecialty. The "Forensic Float Nurse" concept was piloted to provide readily available, highly adaptable, skilled forensic nurses to assist times of unpredictably heavy workloads and/or unplanned staffing shortages. A significant reduction approaching 50% overtime was achieved. Heuristic implications of this finding are presented. © 2012 International Association of Forensic Nurses. Source

Penney S.R.,Center for Addiction and Mental Health | Marshall L.A.,Ontario Shores Center for Mental Health science | Simpson A.I.F.,Center for Addiction and Mental Health
Law and Human Behavior | Year: 2016

Individuals with serious mental illness (SMI; i.e., psychotic or major mood disorders) are vulnerable to experiencing multiple forms of adverse safety events in community settings, including violence perpetration and victimization. This study investigates the predictive validity and clinical utility of modifiable risk factors for violence in a sample of 87 forensic psychiatric patients found Not Criminally Responsible on Account of Mental Disorder (NCRMD) transitioning to the community. Using a repeated-measures prospective design, we assessed theoretically based dynamic risk factors (e.g., insight, psychiatric symptoms, negative affect, treatment compliance) before hospital discharge, and at 1 and 6 months postdischarge. Adverse outcomes relevant to this population (e.g., violence, victimization, hospital readmission) were measured at each community follow-up, and at 12 months postdischarge. The base rate of violence (23%) was similar to prior studies of discharged psychiatric patients, but results also highlighted elevated rates of victimization (29%) and hospital readmission (28%) characterizing this sample. Many of the dynamic risk indicators exhibited significant change across time and this change was related to clinically relevant outcomes. Specifically, while controlling for baseline level of risk, fluctuations in dynamic risk factors predicted the likelihood of violence and hospital readmission most consistently (hazard ratios [HR] = 1.35-1.84). Results provide direct support for the utility of dynamic factors in the assessment of violence risk and other adverse community outcomes, and emphasize the importance of incorporating time-sensitive methodologies into predictive models examining dynamic risk. © 2016 American Psychological Association. Source

Raymond G.,Ontario Shores Center for Mental Health science
Healthcare quarterly (Toronto, Ont.) | Year: 2011

This case study outlines key considerations for healthcare organizations experiencing significant transformational change, based on the experience of Ontario Shores Centre for Mental Health Sciences (Ontario Shores), formerly Whitby Mental Health Centre. Significant systemic change requires specific and intentional efforts from the leaders tasked with carrying out transformational activities. This article presents the perspectives of leaders involved in the transformation of Ontario Shores as it moved from a government-based agency to a stand-alone specialty psychiatric hospital in 2006. During this time, several conventional strategies were employed to manage the transition, but various critical approaches also emerged that assisted the organization to effect significant change and achieve marked improvements over key evaluation metrics. These critical strategies included maximizing the distinct and collective roles of governance and leadership; balancing strategy and action through a culture of accountability; leveraging strategic communication opportunities; and shifting the organizational mindset. Source

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