Frequently Asked Questions - Community Access
What’s involved with outings for patients?
Before patients are considered for outings into the community, they are carefully assessed for risk and clinical well-being by a interdisciplinary treatment team. Assessments are done individually, on a case-by-case basis.
The treatment team uses the patient’s assessment to make an application to the Review Board at a public hearing to see if the patient will be granted the opportunity to start accessing the community. Normally, the Medical Director is granted the discretion of determining how much access to the community the patient is allowed.
Once the Review Board makes a decision on community access how are the individual requests for access approved?
The patient’s clinical treatment team submits an application to the “Program and Privilege Committee” to determine the level of access that patient is allowed. The committee includes the Medical Director, who is advised by a small group of senior clinicians, and considers all factors in approving requests.
The treatment team recommends a level for the patient.
There are 7 levels of access. Patients will progress through Levels 0 to 6 as their individual situation permits. Levels range from accessing different parts of the hospital to accessing the community. Accessing the community can range from outings supervised by staff to unescorted day leaves. Each level has a separate application and review process.
The final step is an assessment done by the nurse in charge of the ward just before the patient is allowed to leave.
At any of these stages mentioned, privileges can be withheld or cancelled if a patient is assessed as being not ready.
What are the levels of access privileges?
Level of privileges are 0-6. The Program and Privilege Committee approves each request. Each level of privilege also has additional graduation within it.
- Level 0 – escorted only off-unit activities that require all patients’ participation (e.g. gym)
- Level 1 – escorted by FPS trained hospital staff to specific treatment programs within the maximum secure areas of the hospital
- Level 2 – escorted by FPS trained hospital staff to specific treatment or vocational programs within the hospital grounds
- Level 3 – within the hospital unescorted attendance at programs, escorted community outings
- Level 4 – unescorted day leave access to community programs
- Level 5 – unescorted day leave access for leisure purposes
- Level 6 – overnight leaves and visit leaves
Who escorts them into the community? Are the staff armed or do they have special training?
Depending on the privilege level assigned to the patient, there may be several staff that go with patients, and this is decided on an individual basis.
Staff are mental health professionals and have training to manage patients who may become disruptive. They are not law enforcement officers and therefore do not carry weapons.
How is the itinerary planned?
The itinerary is set by the hospital staff and is based on psychiatric rehabilitation needs of the patients, including familiarizing the patient with the community, education, self care, or occupational opportunities in addition to recreation, social or cultural activities.
How do we make sure the public is safe?
Formal risk assessments are done every three months and prior to application to the Program and Privilege Committee. Public safety is paramount when assigning privilege levels. Immediately prior to the community outing, the nursing staff will review the risk information on file and complete a pre-outing assessment to determine whether there are any clinical reasons why a patient may not participate in the outing. Also, staff are trained to manage patients who may become disruptive, and every effort is made to ensure public safety is maintained.
What is the purpose of the community access?
The community access provides patients with important rehabilitation-focused goals as part of their treatment. Forensic Psychiatric Hospital is mandated to treat and rehabilitate people deemed unfit to stand trial or not criminally responsible due to mental illness, with a goal of restoring fitness and/or reintegrating them gradually and safely into the community.
Is community access common in BC?
Community access is an important means of examining the progress of a patient in safe circumstances. It is a long standing method and is routinely employed across Canada and in other parts of the world. Having different levels provides a managed, progressive structure to privileges.