Safety & Security
The Forensic Psychiatric Hospital cares for the most complex, severely mentally ill patients in B.C. We are required by law to treat patients found not criminally responsible or unfit to stand trial, and help them integrate safely and gradually back into their communities when and if possible. Our mandate to work toward community integration when possible comes from the B.C. Review Board
, an independent tribunal under the Criminal Code of Canada.
Before patients are considered for a community outing, a multidisciplinary treatment team thoroughly and carefully assesses the risk of such an outing as well as the patient's clinical well-being. The impact of the patient's presence in the community is also considered—we notify community and family members as appropriate.
Then, on the day that the patient is scheduled to access the community, a nurse on the ward reviews the relevant information and assesses the patient to determine whether he or she is stable and suitable to visit the community.
All patients are reviewed annually by the B.C. Review Board for a decision about whether they should remain in hospital, and whether they may be eligible for community access.
It's important to note that the Review Board's decision relates only to eligibility for community access—not to whether a patient will actually be granted day leaves. Community visits take place at the discretion of the Director-in-Charge of the hospital, and only after a careful safety assessment.
Many patients who are eligible for community access do not receive day passes for reasons including their illness, readiness for community access, and public safety.
There are six “levels” for patients at the hospital, 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 begins with closely supervised assessment outings and progresses gradually to unescorted day leaves. Each level has aseparate application and review process. Not all patients progress through all levels for safety reasons.
Depending on the patient, several staff may escort him or her on a community visit. This is decided on an individual basis.
Our escorting staff are mental-health professionals who are trained to manage patients who may become disruptive. They are not enforcement officers and therefore do not carry weapons.
Public safety is paramount when determining whether a patient may access the community. Staff are trained to manage patients who may become disruptive, and make effort to ensure public safety is maintained.
The level of monitoring depends on the patient. Some patients are escorted by staff. Very low-risk patients may receive day leaves to attend community-based programs on their own, and mechanisms are in place to verify their attendance. They must return at a predetermined time.
We are mandated by the B.C. Review Board to integrate patients into the community safely and gradually when possible. This needs to happen in a graduated matter.
Community access is part of this process, providing patients with opportunities to apply the self-management skills they learn during their treatment and experiment with coping outside the hospital. It also provides staff and physicians an opportunity to further assess patients for treatment.
It's important to note that community outings are not a "treat" or "time off for good behaviour." They are an important part of patients' mandated treatment processes.
If a patient fails to return on time from an authorized leave, even if it is only 15 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 absence, and when the patient has returned, is the responsibility of the police.
We have robust safety and security protocols in place at the hospital to ensure patient, staff and public safety.
If a patient does not return at the expected time, or absconds while on a staff-escorted outing, we take immediate measures to address the situation.
In the event of an unauthorized absence, all community access privileges are suspended pending a review and re-application to the assessment committee.
We have made a number of improvements in recent years, and as a result, fewer day leaves are granted and the number of UAs has decreased significantly. Out of nearly 1,300 visit and day leaves in 2018/2019, 99.7 percent of patients returned as scheduled. Those who did not returned in short order.
A number of improvements designed to improve safety for everyone at the Forensic Psychiatric Hospital are in progress. Read more here.
As with any serious incident, there is a critical incident review, which is a quality-driven 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, we have met with various community groups, and we are listening. We are mindful of public safety as a top priority when making decisions about community access.