Housing trajectories of individuals found not criminally responsible on account of mental disorder

In Canada, Provincial and Territorial Review Boards are mandated to evaluate the risk and custody decisions about individuals found Not Criminally Responsible on Account of Mental Disorder (NCRMD) and render one of three dispositions: (a) custody, (b) conditional discharge, or (c) absolute discharge. To promote community reintegration, conditional discharge can be ordered with the condition to live in supportive housing. Among individuals living with a mental illness, supportive housing in the community has been associated with increased housing stability, reduced number and length of hospitalization and reduced involvement with the criminal justice system. However, NCRMD accused face great barriers to housing access as a result of the stigma associated with the forensic label. To date, there is little information regarding the housing placement for the forensic mentally ill individuals, such as those found NCRMD. In order to address the dearth of literature on supportive housing for the forensic population, the goal of the present thesis is threefold and addressed through two manuscripts: 1) to evaluate of the role of housing placement on rehospitalization and recidivism among individuals found NCRMD; 2) to describe the disposition and housing placement trajectories of individuals found NCRMD, and 3) to explore the factors that predict such trajectories. Data from the Québec sample of the National Trajectory Project of individuals found NCRMD were used. A total of 934 individuals found NCRMD between May 1st 2000 and April 30th 2005 comprise this sample.  In the first paper, survival analyses showed that individuals placed in independent housing following conditional discharge from the Review Board were more likely to be convicted of a new offense and to be readmitted for psychiatric treatment compared with individuals residing in supportive housing. In the second paper, sequential data analysis resulted in four distinct trajectories: 1) conditional discharge in supportive housing (11%), 2) conditional discharge in independent housing (32%), 3) detention in hospital (43%) and 4) absolute discharge (14%). A multinomial logistic regression revealed that the likelihood of a placement in supportive housing compared to being detained significantly decreased for individuals treated in a forensic hospital, as well as those with an increased index offense severity. On the other hand, less restrictive disposition trajectories (i.e. independent housing and absolute discharge) were significantly influenced by clinical factors such as reduced number of prior psychiatric hospitalizations, a diagnosis of mood disorder and an absence of a comorbid personality disorder diagnosis. The findings from this study point to the protective value that supportive housing can have on the community outcomes of forensic patients, and provides solid arguments for the development of a management strategy that incorporates contextual factors such as supportive housing.

Keyphrases: Supportive housing, Not criminally responsible on account of mental disorder, Forensic psychiatry, Community mental Health ressources, Recidivism, Rehospitalization