Safety & Security
The Forensic Psychiatric Services Commission (FPSC) is mandated to work in partnership with BC’s criminal justice system to provide psychiatric treatment and assessment at Forensic Psychiatric Hospital to individuals who have been referred by the courts. As a specialized facility, it is the job of staff and physicians at the hospital to treat and rehabilitate people deemed unfit to stand trial or not criminally responsible due to mental illnesses, with a goal of restoring fitness and/or reintegrating them gradually and safely into the community.
Before patients are considered for outings into the community and when the request for such access is made, they are thoroughly and carefully assessed for risk and clinical well-being by their multidisciplinary treatment team. On each day that the patient isscheduled to access the community, a nurse on the ward reviews the risk relevant information and assesses the patient to determine if the patient is stable and suitable to access the community.
All patients are reviewed annually by the BC Review Board for a decision as to whether they should remain in hospital or could be discharged with or without conditions.
There are six “privilege levels,” ranging from no access to the hospital grounds to supervised and unsupervised access to different parts of the hospital, to supervised and finally unsupervised access to the community.
Accessing the community always commences with closely supervised assessment outings and progresses gradually and in stepwise manner if appropriate, to unescorted day leaves. Each level has aseparate application and review process.
On each day that the patient is scheduled to access the community, an assessment is made by a nurse on the ward to determine if the patient is stable and suitable to access the community.
At any of these stages, privileges can be withheld or cancelled.
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 enforcement officers and therefore do not carry weapons.
Public safety is a top priority when assigning privilege levels. Staff are trained to manage patients who may become disruptive, and every effort is made to ensure public safety is maintained.
The level of monitoring depends on the level of privilege granted to a patient. Patients with a higher level of privileges may receive day leaves to attend communitybased programs and mechanisms are in place to verify their attendance. Patients who have progressed to the higher levels of privilege may receive day leave for leisure purposes and would not be required to check in with unit staff, but must return at the predetermined time.
Community access provides patients with important rehabilitation-focused goals as partnof their treatment with the ultimate goal of reintegrating the patient back into them community.
If a patient fails to return on time from an authorized leave, even if it is only fifteen minutes late, the RCMP are notified, as part of the hospital’s “Code Yellow” policy.
Staff provide information to the RCMP to assist with determining the level of risk. Alerting the public of the UA, along with when the patient has returned, is the responsibility of the police.
Over the past three years the evaluation process to determine patients’ suitability for community access has been refined.
For example, the Forensic Psychiatric Hospital’s assessment committee, called the Program and Privilege Committee (“P&P”) now requires more risk-relevant information, including a current risk assessment (Short Term Assessment of Risk & Treatability –START) and a clear rationale for the requested privilege level, before making a decision regarding privilege levels and community access.
In the event of an UA, all community access privileges are suspended pending a review and re-application to the assessment committee (P&P). As a result of these improvements, fewer day leaves are granted and the number of UAs has decreased significantly.
A number of corrective actions have been put in place including:
- Enhanced aggression management training for staff
- Implementation of a safety plan for employees changing shifts
- Enhanced communication processes for staff of patient behaviors, risk factors, and triggers for violence e.g., Implementation of SNAP (Structured Nursing Assessment Protocol).
- Enhanced security measures on the grounds and in all areas of the hospital
As with any serious incident, there is a “Critical Incident Review”, which is a qualitydriven standard procedure to review whether our services and procedures adhered to policy, and to identify any areas for improvement. Medical, quality-assurance, clinical and security staff are involved in these reviews.
These reviews as well as the findings of other internal and external reviews are protected under Section 51 of the British Columbia Evidence Act. The purpose of S. 51 and its related confidentiality provisions is to facilitate open and frank discussion among doctors, nurses, support staff, administrators and others to aid quality improvement in the hospital setting.
We appreciate the community’s interest in the hospital and we have met with various community groups and we are listening. We are mindful of public safety as a primary criterion when deciding community access. We know that this is a challenging population and it is in the best interest of patients, staff and the community for our programs to be successful