Department of Psychiatry
School of Medicine Queen's University
 

Clinical Services

At Risk Program

The At-Risk Program is a multi-disciplinary forensic program that provides community mental health services for mentally ill offenders who have had or currently have contact with the criminal justice system and who are residing in the community.  We provide outpatient assessments, follow-up intervention and psychological services predominantly for individuals with severe mental illness who are at risk of criminal behaviour.  Our service acts in partnership with local probation and court diversion services as well as receiving referrals internally through the Forensic Division.

Inpatient Forensic Services:

Inpatient Forensic Services is a 30-bed unit located at Providence Care Mental Health Services.  The unit accepts patients from all over Ontario almost exclusively through either judicial order (Judge's Order) or via a decision of the Ontario Review Board (ORB).  The unit provides services to both men and women who have come into conflict with the criminal justice system.  Patients admitted on a Judge's Order (Section 672 of the Canadian Criminal Code), are shorter-stay patients, typically admitted for 30-day inpatient psychiatric asssessments.  These assessments serve to provide recommendations to the court concerning the legal issues of Fitness to Stand Trial and/or Criminal Responsibility related to pending criminal charges.  Judicial orders may also be for psychiatric treatment, for patients who have been found unfit to stand trial.  The unit typically provides services to 5-8 patients under Judge's Order at a given time.

Patients admitted under an ORB detention are longer-stay patients.  Treatment and rehabilitation services are provided with the mandate of ensuring public safety within the least onerous and least restrictive conditions, using a Recovery Model of care.  Clinical services are provided by a full multidisciplinary team including psychiatry, nursing, social work, psychology, occupational therapy, and recreation therapy.  As a teaching hospital, students and residents from various disciplines are also active members of the clinical team.  The unit typically provides services to 22-25 patients who are under an ORB detention order.

Outpatient Forensic Services:

Patients whose Ontario Review Board disposition allows for community living are provided ongoing clinical services and supervision in the community.  These services are provided both in the home and community and through appointments in hospital.  Outpatient Forensic Services are provided primarily by a psychiatric nurse and/or social worker and all patients are followed by a psychiatrist.  The outpatient team also includes a Frontenac Community Mental Health Services Transitional Case Manager.  Outpatients may also receive psychological intervention services on an as-needed basis.  As with Inpatient Services, the mandate of Outpatient Services is to ensure the safety of the public with the least onerous and least restrictive approach.  Forensic Outpatients are empowered to develop the necessary skills needed to be productive members of society, following a Recovery Model of Care.

Other Forensic Psychiatry Services:

Faculty with the Department of Psychiatry, Forensic Division also have ties with the Correctional Service of Canada (CSC), and with provincial correctional and detention facilities (e.g. Quinte Detention Centre).  In addition, the division has links with the Family Law Clinic.  Residents completing rotations with the Forensic Division have the opportunity to gain additional experience with these other services.

There are opportunities to visit Corrections Canada and be supervised in psychiatric assessments and management of patients there.  There are also opportunities to do clinics under supervision at the Family Law clinics.

Tele-Psychiatry:

The Forensic Division actively utilizes tele-psychiatry in its operations.  Mentally ill offenders awaiting trial at Quinte Detention Centre are assessed via video conference and triaged as to whether they require an inpatient forensic admission for further assessment and/or treatment.  We also use tele-psychiatry to provide outpatient psychiatric services to 'the Metis Nation of Ontario'.