Research Priorities in Mental Health, Justice, and Safety: A Multidisciplinary Stakeholder Report

This paper is based on the report following the National Research Agenda Meeting on Mental Health, Justice, and Safety held in Montreal on November 19, 2014, which convened academics; health, social, and legal professionals; and people with lived experience of mental illness from across Canada. The goal was to identify research priorities addressing relevant knowledge gaps and research strategies that can translate into public policy action and improvements in evidence-based services.

Participants identified key challenges: (1) inadequate identification and response to needs by civil mental health services and frontline law enforcement, (2) limited specialized resources in forensic and correctional settings, (3) fragmented care and gaps between systems, (4) limited resources for adequate community reintegration, and (5) poor knowledge transfer strategies as obstacles to evidence-based policies. Knowledge gaps were identified in epidemiology and risk reduction, frontline training and programs, forensic and correctional practices, organizations and institutions, knowledge transfer, and rehabilitation. Finally, participants identified potential sources of support to conduct real time research with regard to data collection and sharing. The findings represent a roadmap for how forensic mental health systems can best proceed to address current challenges through research and practice initiatives, drawing from lived, clinical and research experiences of a multidisciplinary group of experts.

Key Principles

There was a general consensus among participants that the following key principles guided the discussion regarding key knowledge gaps, research priorities, and opportunities.

1. Prevention: Taking forensic experience upstream (e.g., bring knowledge of assessment and management of risk into civil psychiatric and community mental health organizations and services; target risk factors for early intervention efforts).
2. Recovery Orientation: Incorporating recovery orientation at all levels of clinical care, research, police, and knowledge transfer and exchange.
3. Public Safety: Emphasizing the potentially positive relationship between recovery/rehabilitation and public safety.
   • Break the dualism opposing rehabilitation and “tough on crime”, or rehabilitation and public safety, or victim and perpetrator;
   • Seek societally optimal policy;
   • Change the conversation/language around severe mental illness and crime.
4. Holistic Individualized Approach: Following the person across systems (i.e., sharing information between civil psychiatry, forensic psychiatry, and correctional and social services agencies); seeking to fill the gaps when patients/clients are transitioning between systems of care / moving through an individual agency's continuum of care (e.g., it is often when persons are discharged from institutional settings that there is insufficient planning and resources in place to ensure that transportation, medication, housing, etc. are in place to facilitate community integration).
5. Intersectoral Collaborations: Creating more opportunities for cross-ministerial panels in order to promote data consistency, information sharing, transparency, and communication.
6. Inclusion of People with Lived Experience:
   • Including persons with lived experience of homelessness, criminal justice involvement, and/or mental illness as partners in research from inception to dissemination and as collaborators in KTE efforts;
   • Involving families and victims in the production, exchange and translation of knowledge.

Information Sharing and Data Consistency (e.g., through research-friendly administrations).
Knowledge Transfer and Exchange Agenda

A common theme across the discussions was the importance of knowledge transfer and exchange between researchers and practitioners, across sectors, etc. The following principles and considerations were identified.

What?

1. Evidence-based policy making
2. Paradigm of risk reduction, rehabilitation services, and recovery orientation
3. Holistic perspective that includes social determinants of health
4. Thread of recovery message
5. Cost-effectiveness
6. Data access

How?

1. Promote tailored, confident, concise and consistent communication to the public
2. Make use of personal stories, success stories; become positive and proactive rather than reactive and defensive
3. Target media, swing voters, and political leaders to position optimal policy solutions

Top Research Priorities

Following the presentations from the small groups formed for Part Two of the one-day agenda meeting, all participants discussed research priorities in Part Three and agreed that the following were key priorities for an agenda on mental health, criminal justice, and public safety research.

First Contact

1. Evaluation of diversion programs and community supports (e.g., Mental Health Courts in Canada)
2. Examination of contexts and factors related to police-driven fatalities of people living with mental illness
3. Initiation of multi-site cohort studies of early interactions with criminal justice personnel
4. Evaluation of training for frontline service providers on criminal justice, and recovery outcomes
5. Evaluation of longitudinal impacts of legislation or policy change, including on families and suicide rates

Assessment

1. Examination of factors associated with crime and recidivism among people living with mental illness
2. Risk assessment and communication, including shared risk understanding between service user and provider
3. Risk assessment and management: Research on closing the gap between research and practice
   1. Improving the relevance of research and knowledge transfer strategies on risk management and assessment beyond psychometric properties of tools
   2. The role of management and treatment efforts in the moderation of the relationship between risk factors and adverse outcomes

Treatment and Rehabilitation

1. The 3 Rs (Recovery, Recidivism, Research): Evaluation of recovery approaches and recovery-oriented care on recidivism and other outcomes, including future mental health service use, housing, employment, and quality of life
2. Cost-benefit analysis of forensic interventions and legislative practices from a health economics perspective
3. Research transitions and success/failure outcomes to develop best practices
4. Exploratory and pilot research on alternatives to segregation in correctional settings
5. Studies that deconstruct and identify active ingredients of successful programs in terms of lower recidivism

Systems

1. Creation of a national data sharing coalition among researchers in the field
2. Creation of a national database with common indicators (e.g., national scorecard)
3. Edition of a scoping review on international legislation and approaches at the intersection of mental health, justice, and safety
4. Evaluation of best knowledge transfer and exchange strategies to support evidence-based practices and practice-based evidence. Answering the questions and addressing the problems of direct care providers and of those with lived experience
5. Creation of a national research network on mental health, justice, and safety with a strong focus on knowledge transfer and public communication.

Full article at:   http://goo.gl/j6zUk0

By:   Anne G. Crocker, a , * Tonia L. Nicholls, b Michael C. Seto, c Laurence Roy, d Marichelle C. Leclair, e Johann Brink, gAlexander I. F. Simpson, f and Gilles Côté h

^aDepartment of Psychiatry, McGill University and Douglas Mental Health University Institute Research Center, Montreal, Quebec, Canada

^bDepartment of Psychiatry, University of British Columbia and BC Mental Health and Substance Use Services, Coquitlam, British Columbia, Canada

^cRoyal Ottawa Health Care Group, Brockville, Ontario, Canada

^dSchool of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada; Douglas Mental Health University Institute Research Center, Montreal, Quebec, Canada

^eDouglas Mental Health University Institute Research Center, Montreal, Quebec, Canada

^fCentre for Addiction and Mental Health, Complex Mental Illness, Forensic Division, Toronto, Quebec, Canada; Department of Psychiatry, University of Toronto, Quebec, Canada

^gForensic Psychiatric Services Commission, BC Mental Health and Substance Use Services, Coquitlam, British Columbia, Canada

^hDepartment of Psychology, Université du Québec à Trois-Rivières, Trois-Rivières Québec, Canada; Philippe-Pinel Institute, Research Center, Montreal, Quebec, Canada

Address correspondence to Anne G. Crocker, Douglas Mental Health University Institute Research Center, 6875 LaSalle Blvd., Montreal,Quebec, H4H 1R3Canada. E-mail: ac.lligcm@rekcorc.enna

 

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