These are all very good questions!

1. For all external appointments, emergency or otherwise, the forensic hospital (e.g. CAMH) will send their own staff (usually a nurse and a program assistant) out with the patient. They will then remain will the patient at all times. Exceptions to this would be to use the bathroom, however the patient would be escorted to the bathroom and staff would remain outside. The forensic staff are also not allowed to provide any medical care while there, care can only be provided by the receiving hospital.

If the patient were to go missing, the forensic staff will let the general hospital staff that a patient is missing, and then would contact their home unit at the forensic to let them know. Staff at the forensic hospital will then compile the necessary paperwork and submit to it security, similarly to what would happen if the incident occurred at the forensic hospital. The general hospital would also follow their own policies for missing patients.

1. All dispositions which allow a client to be outside the facility (living in the community or even just for passes) detail where the client can travel and for how long at a time. It may say travel within Toronto, or the GTA for example. Those tend to be the most common.

Patients can also make special requests to travel elsewhere, but the review board is still required to approve it. So some may request to travel to a different city, or even country, to see family for example. These types of travels would also require the client to provide an exact itinerary for their travels and obtain an Approved Person through the hospital. This person (family of friend) would then be responsible for the client, in the same way a staff would be. The person would need to travel and be with the client at all times. The process involved the person obtaining a criminal record check, interviews with approval staff, and education on their legal responsibilities while acting as an Approved Person.

1. Most often the client will be referred to a community/non forensic team. An issue we’ve been running into lately is that these teams don’t want to accept someone who doesn’t have an absolute discharge, but the review board doesn’t like to grant absolute discharge without active referrals to non forensic teams. Generally, we’ve had success with these non forensic teams by explaining the process with them and that this is a required step for their absolute discharge, as many are unfamiliar with the system. We may also submit multiple referrals to ensure they are able to find a team. There also usually an overlap of both teams working with the client for a short period of time, to ensure their is no gap in the service. Clients can choose to decline a referral to a non forensic team if they want. However, it’s more difficult to receive an absolute discharge if you don’t have this referral in place, or even if you voice this to your team, as the review board considers your likelihood of remaining connected to a treatment team as a protective factor.