HCR-20 Historical-Clinical-Risk Management-20 NCRMD not criminally responsible on account of ment... more HCR-20 Historical-Clinical-Risk Management-20 NCRMD not criminally responsible on account of mental disorder NTP National Trajectory Project RB review board SMI serious mental illness UCR2 Uniform Crime Reporting Survey (1988) VRAG Violence Risk Appraisal Guide Highlights • Significant interprovincial differences are observed in the number of people found NCRMD per criminal court verdict annually. • Different trends over time are observed across each province in the number of NCRMD-accused people entering the provincial RB systems.
Objective: To examine the psychosocio-criminological characteristics of not criminally responsibl... more Objective: To examine the psychosocio-criminological characteristics of not criminally responsible on account of mental disorder (NCRMD)-accused people and compare them across the 3 most populous provinces. In Canada, the number of people found NCRMD has risen during the past 20 years. The Criminal Code is federally legislated but provincially administered, and mental health services are provincially governed. Our study offers a rare opportunity to observe the characteristics and trajectories of NCRMD-accused people.
The purpose of this presentation is to explore whether START-AV assessments are indeed dynamic in... more The purpose of this presentation is to explore whether START-AV assessments are indeed dynamic in nature and sensitive to change over time. We compared initial START-AV assessments to follow-up assessments conducted approximately three months later at three juvenile justice residential facilities in a Southern state.
Background Housing First does not, on average, reduce criminal justice involvement. This analysis... more Background Housing First does not, on average, reduce criminal justice involvement. This analysis aims to test whether the overall absence of an impact is due to intervention effect heterogeneity as a function of the pattern of lifetime criminal justice involvement, identified through latent class analysis conducted through earlier work. Methods This analysis relied on data from the Montréal, Toronto and Vancouver sites of the Canadian At Home/Chez Soi randomized controlled trial, merged with administrative records of lifetime criminal charges (N = 1,321). Negative binomial models with interaction terms were used to estimate the impact of Housing First, in comparison to treatment as usual, on violent charges, acquisitive charges (e.g., theft, sex work), and administration of justice charges (e.g., breach of probation), for each pre-identified profile. Results Participants with past criminal justice involvement associated with a chronic history of homelessness or with criminalized substance use experienced a decrease in violent charges as a result of Housing First, whereas those with no or little past criminal justice involvement experienced a marginal increase. Housing First did not affect acquisitive or administration of justice charges, regardless of profile. Conclusions Findings suggest that integrating criminological or forensic mental health tools, knowledge and approaches into the multidisciplinary teams that support Housing First service users may be an effective solution, so that all aspects of their recovery, including potential criminogenic needs, are addressed. Future research should focus on the feasibility and effectiveness of such adjunct interventions.
Background Research findings on the association between outpatient service use and emergency depa... more Background Research findings on the association between outpatient service use and emergency department (ED) visits for mental and substance use disorders (MSUDs) are mixed and may differ by disorder type. Methods We used population-based linked administrative data in British Columbia, Canada to examine associations between outpatient primary care and psychiatry service use and ED visits among people ages 15 and older, comparing across people treated for three disorder categories: common mental disorders (MDs) (depressive, anxiety, and/or post-traumatic stress disorders), serious MDs (schizophrenia spectrum and/or bipolar disorders), and substance use disorders (SUDs) in 2016/7. We used hurdle models to examine the association between outpatient service use and odds of any ED visit for MSUDs as well count of ED visits for MSUDs, stratified by cohort in 2017/8. Results Having had one or more MSUD-related primary care visit was associated with lower odds of any ED visit among people t...
ObjectivesInformation on emergency department (ED) visits for mental and substance use disorders ... more ObjectivesInformation on emergency department (ED) visits for mental and substance use disorders (MSUDs) is important for planning services but has not been explored in British Columbia (BC), Canada. We describe all MSUD ED visits for people ages 15 and older in the province of BC in 2017/2018 and document trends in MSUD ED visits between 2007/2008 and 2017/2018 by disorder group.DesignPopulation-based linked administrative data comprised of ED records and physician billings capturing all MSUD ED visits in BC.SettingBC is Canada’s westernmost province with a population of approximately 5 million. Permanent residents receive first-dollar coverage for all medically necessary services provided by licensed physicians or in hospitals, including ED services.PopulationAll people age >15 with MSUD ED visits during the study period.MeasuresAll claims with a service location in the ED or corresponding to fee items billed only in the ED were examined alongside ED visits reported through a n...
International Journal of Forensic Mental Health, 2020
This study identified factors that predicted which of 713 clinically documented incidents of aggr... more This study identified factors that predicted which of 713 clinically documented incidents of aggression-threats to kill, assault, or sexual assault-committed by 404 forensic psychiatric patients were linked to court findings of guilt. Individuals had, on average, 1.7 aggressive incidents and were found guilty of an average of 0.3 offenses against persons during the study period. Aggressive incidents were mostly assaults, followed by uttering death threats, and sexual assaults. The victims of aggressive incidents were mainly other patients or staff, but some incidents involved family members or friends (16%) and strangers (14%). Most of the aggressive incidents (84%) did not lead to findings of guilt. Incidents of aggression linked to court findings were significantly associated with province; personality disorder; fewer prior aggressive incidents; and incidents involving strangers compared to staff or co-patients or to family or friends. These findings have implications for research in terms of understanding how criminal records underestimate histories of aggression. These findings also point to the need for the development of more consistent policies and procedures for responding to patient aggression, including when it is necessary or productive to report to police.
Social Psychiatry and Psychiatric Epidemiology, 2018
Purpose To quantify the demand for forensic psychiatric services in Ontario over the past 25 year... more Purpose To quantify the demand for forensic psychiatric services in Ontario over the past 25 years and investigate whether the sociodemographic, clinical and offense-based characteristics of forensic patients have changed over time. Methods We investigated all forensic admissions from 1987 to 2012 resulting in a disposition of Not Criminally Responsible on account of Mental Disorder (N = 2533). We present annual proportions of patients with specified sociodemographic, clinical and offense characteristics, and investigate whether the duration of forensic system tenure varies as a function of admission year, psychiatric diagnosis, or index offense. Results There has been a steady increase in forensic admissions over this time period, particularly individuals with comorbid substance use disorders and individuals of non-Caucasian ethno-racial background. The proportion of persons committing severe violence has remained low and has decreased over time. Having a comorbid personality, neurological, or substance use disorder significantly increased forensic system tenure, as did committing a violent offense. Individuals who came into the system in earlier years had slower rates of discharge compared to more recent admissions. Conclusions Defining the trends characterizing the growth of the forensic population has important policy implications, as forensic services are costly and involve a significant loss of liberty. The current results indicate that young, substance abusing individuals of diverse ethno-racial backgrounds and who commit relatively low-level violence comprise an increasing proportion of Ontario's forensic population, and suggest that treatment must be optimized to best serve the needs of these individuals.
Objective: To examine the processing and Review Board (RB) disposition outcomes of people found n... more Objective: To examine the processing and Review Board (RB) disposition outcomes of people found not criminally responsible on account of mental disorder (NCRMD) across the 3 most populous provinces in Canada. Although the Criminal Code is federally legislated, criminal justice is administered by provinces and territories. It follows that a person with mental illness who comes into conflict with the law and subsequently comes under the management of a legally mandated RB may experience different trajectories across jurisdictions.
HCR-20 Historical-Clinical-Risk Management-20 NCRMD not criminally responsible on account of ment... more HCR-20 Historical-Clinical-Risk Management-20 NCRMD not criminally responsible on account of mental disorder NTP National Trajectory Project RB review board SMI serious mental illness UCR2 Uniform Crime Reporting Survey (1988) VRAG Violence Risk Appraisal Guide Highlights • Significant interprovincial differences are observed in the number of people found NCRMD per criminal court verdict annually. • Different trends over time are observed across each province in the number of NCRMD-accused people entering the provincial RB systems.
Objective: To examine the psychosocio-criminological characteristics of not criminally responsibl... more Objective: To examine the psychosocio-criminological characteristics of not criminally responsible on account of mental disorder (NCRMD)-accused people and compare them across the 3 most populous provinces. In Canada, the number of people found NCRMD has risen during the past 20 years. The Criminal Code is federally legislated but provincially administered, and mental health services are provincially governed. Our study offers a rare opportunity to observe the characteristics and trajectories of NCRMD-accused people.
The purpose of this presentation is to explore whether START-AV assessments are indeed dynamic in... more The purpose of this presentation is to explore whether START-AV assessments are indeed dynamic in nature and sensitive to change over time. We compared initial START-AV assessments to follow-up assessments conducted approximately three months later at three juvenile justice residential facilities in a Southern state.
Background Housing First does not, on average, reduce criminal justice involvement. This analysis... more Background Housing First does not, on average, reduce criminal justice involvement. This analysis aims to test whether the overall absence of an impact is due to intervention effect heterogeneity as a function of the pattern of lifetime criminal justice involvement, identified through latent class analysis conducted through earlier work. Methods This analysis relied on data from the Montréal, Toronto and Vancouver sites of the Canadian At Home/Chez Soi randomized controlled trial, merged with administrative records of lifetime criminal charges (N = 1,321). Negative binomial models with interaction terms were used to estimate the impact of Housing First, in comparison to treatment as usual, on violent charges, acquisitive charges (e.g., theft, sex work), and administration of justice charges (e.g., breach of probation), for each pre-identified profile. Results Participants with past criminal justice involvement associated with a chronic history of homelessness or with criminalized substance use experienced a decrease in violent charges as a result of Housing First, whereas those with no or little past criminal justice involvement experienced a marginal increase. Housing First did not affect acquisitive or administration of justice charges, regardless of profile. Conclusions Findings suggest that integrating criminological or forensic mental health tools, knowledge and approaches into the multidisciplinary teams that support Housing First service users may be an effective solution, so that all aspects of their recovery, including potential criminogenic needs, are addressed. Future research should focus on the feasibility and effectiveness of such adjunct interventions.
Background Research findings on the association between outpatient service use and emergency depa... more Background Research findings on the association between outpatient service use and emergency department (ED) visits for mental and substance use disorders (MSUDs) are mixed and may differ by disorder type. Methods We used population-based linked administrative data in British Columbia, Canada to examine associations between outpatient primary care and psychiatry service use and ED visits among people ages 15 and older, comparing across people treated for three disorder categories: common mental disorders (MDs) (depressive, anxiety, and/or post-traumatic stress disorders), serious MDs (schizophrenia spectrum and/or bipolar disorders), and substance use disorders (SUDs) in 2016/7. We used hurdle models to examine the association between outpatient service use and odds of any ED visit for MSUDs as well count of ED visits for MSUDs, stratified by cohort in 2017/8. Results Having had one or more MSUD-related primary care visit was associated with lower odds of any ED visit among people t...
ObjectivesInformation on emergency department (ED) visits for mental and substance use disorders ... more ObjectivesInformation on emergency department (ED) visits for mental and substance use disorders (MSUDs) is important for planning services but has not been explored in British Columbia (BC), Canada. We describe all MSUD ED visits for people ages 15 and older in the province of BC in 2017/2018 and document trends in MSUD ED visits between 2007/2008 and 2017/2018 by disorder group.DesignPopulation-based linked administrative data comprised of ED records and physician billings capturing all MSUD ED visits in BC.SettingBC is Canada’s westernmost province with a population of approximately 5 million. Permanent residents receive first-dollar coverage for all medically necessary services provided by licensed physicians or in hospitals, including ED services.PopulationAll people age >15 with MSUD ED visits during the study period.MeasuresAll claims with a service location in the ED or corresponding to fee items billed only in the ED were examined alongside ED visits reported through a n...
International Journal of Forensic Mental Health, 2020
This study identified factors that predicted which of 713 clinically documented incidents of aggr... more This study identified factors that predicted which of 713 clinically documented incidents of aggression-threats to kill, assault, or sexual assault-committed by 404 forensic psychiatric patients were linked to court findings of guilt. Individuals had, on average, 1.7 aggressive incidents and were found guilty of an average of 0.3 offenses against persons during the study period. Aggressive incidents were mostly assaults, followed by uttering death threats, and sexual assaults. The victims of aggressive incidents were mainly other patients or staff, but some incidents involved family members or friends (16%) and strangers (14%). Most of the aggressive incidents (84%) did not lead to findings of guilt. Incidents of aggression linked to court findings were significantly associated with province; personality disorder; fewer prior aggressive incidents; and incidents involving strangers compared to staff or co-patients or to family or friends. These findings have implications for research in terms of understanding how criminal records underestimate histories of aggression. These findings also point to the need for the development of more consistent policies and procedures for responding to patient aggression, including when it is necessary or productive to report to police.
Social Psychiatry and Psychiatric Epidemiology, 2018
Purpose To quantify the demand for forensic psychiatric services in Ontario over the past 25 year... more Purpose To quantify the demand for forensic psychiatric services in Ontario over the past 25 years and investigate whether the sociodemographic, clinical and offense-based characteristics of forensic patients have changed over time. Methods We investigated all forensic admissions from 1987 to 2012 resulting in a disposition of Not Criminally Responsible on account of Mental Disorder (N = 2533). We present annual proportions of patients with specified sociodemographic, clinical and offense characteristics, and investigate whether the duration of forensic system tenure varies as a function of admission year, psychiatric diagnosis, or index offense. Results There has been a steady increase in forensic admissions over this time period, particularly individuals with comorbid substance use disorders and individuals of non-Caucasian ethno-racial background. The proportion of persons committing severe violence has remained low and has decreased over time. Having a comorbid personality, neurological, or substance use disorder significantly increased forensic system tenure, as did committing a violent offense. Individuals who came into the system in earlier years had slower rates of discharge compared to more recent admissions. Conclusions Defining the trends characterizing the growth of the forensic population has important policy implications, as forensic services are costly and involve a significant loss of liberty. The current results indicate that young, substance abusing individuals of diverse ethno-racial backgrounds and who commit relatively low-level violence comprise an increasing proportion of Ontario's forensic population, and suggest that treatment must be optimized to best serve the needs of these individuals.
Objective: To examine the processing and Review Board (RB) disposition outcomes of people found n... more Objective: To examine the processing and Review Board (RB) disposition outcomes of people found not criminally responsible on account of mental disorder (NCRMD) across the 3 most populous provinces in Canada. Although the Criminal Code is federally legislated, criminal justice is administered by provinces and territories. It follows that a person with mental illness who comes into conflict with the law and subsequently comes under the management of a legally mandated RB may experience different trajectories across jurisdictions.
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Papers by Tonia Nicholls