This document discusses stigma faced by forensic clients with mental illness who commit crimes. It begins by defining forensic clients as those found not criminally responsible due to mental illness. It describes how stigma develops in society and is especially strong for forensic clients due to a double stigma of mental illness and criminality. The document outlines how stigma impacts recovery and community reintegration for forensic clients and their families by decreasing treatment adherence and social engagement. It recommends promoting recovery-oriented practices, education to decrease ignorance, and support for families to help reduce this stigma.

1. When MentalWhen Mental
Illness Leads toIllness Leads to
Crime: StigmaCrime: Stigma
and Recovery forand Recovery for
the Forensicthe Forensic
ClientClient
Anik Gosselin, Ph.D., C.Psych.
Forensic Neuropsychologist & Clinical
Psychologist
Raphaela Fleisher, MSW, RSW
Social Worker, Outpatient Forensic
Service
Diane Hoffman-Lacombe, MPs. CPsych
Forensic & Clinical Psychologist
Integrated Forensic Program

3. Agenda
What it means to be a forensic client / non
criminally responsible (NCR)
Difference between NCR & antisocial /
psychopathy
How stigma develops in a society, the double
stigma attached to the label “forensic client”
The impact for the family
What to do to decrease stigma, promote recovery
and successful community reintegration
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4. Integrated Forensic Program (IFP)
Mandate
The IFP provides specialized services
-in assessment, treatment, rehabilitation and
community reintegration
-to persons with severe mental illness who have
come into conflict with the criminal justice
system
-within a safe, therapeutic and recovery oriented
environment
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5. Forensic Services
• Secure Assessment Inpatient Units: 24 beds
• Secure Rehab & Transition Inpatient Units: 81 beds
• Secure Mental Health: 4 beds
• Outpatient Services: approx. 1500 clients
ORB clients (FIRST, FITT, Transitional Housing)
Brief Assessment Unit (BAU) out-of-custody
General Forensic Clinic: includes general outpatients
and Chrysalis Day Program
Mental Health Court, Mental Health Court Clinic, OCDC
Specialized Clinics: Sexual Behaviours, Anger Disorders,
Family Court Clinic (Child Welfare & Youth)
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6. Court-Ordered Assessments &
Ontario Review Board (ORB) Clients
• In-custody Fitness Assessments: 37
• Out-of-custody Fitness Assessments: 11
• In-custody NCR Assessments: 62
• Out-of-custody NCR Assessments: 18
• 201 ORB clients
– 191 NCR – 10 unfit
– 81 inpatients – 120 outpatients
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7. Criminal Code of Canada
Section 16
• Defence of Mental Disorder – no person is
criminally responsible for an act committed
or an omission made while suffering from a
mental disorder that rendered a person
incapable of appreciating the nature and
quality of the act or omission or of knowing
that is was wrong
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8. Criteria for NCR finding
• The person committed a crime
• The person was suffering from a mental
disorder
• The mental disorder was a factor at the
time of the crime
– Not able to appreciate the nature and quality
– Or not knowing that is was wrong
i

9. NCR vs Antisocial & Psychopathy
• Antisocial Personality Disorder: a pervasive pattern of
disregard for and violation of the rights of others
• Construct of psychopathy is defined by personality
traits & behaviours (4 facets: interpersonal, affective,
lifestyle, antisocial)
• Able to appreciate the nature and quality of the act
• Know that it was wrong (legally & morally)
• Not psychotic; no loss of contact with reality
• Choice of action; actions not driven by illness
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13. THE STIGMATHE STIGMA
OF MENTALOF MENTAL
ILLNESSILLNESS
By Anik Gosselin, Ph.D.,By Anik Gosselin, Ph.D.,
C.Psych.C.Psych.

14. WHAT IS STIGMA?
Socially discrediting attribute, behaviour or reputation
(Goffman, 1963)
•3 functions:
– Exploitation/domination (e.g., racism)
– Enforcement of social norms (e.g., smoking, obesity)
– Evolutionary purpose (e.g., mental illness, AIDS)
•Public Stigma: Negative attitudes held by public about
people with devalued characteristics
•Self-Stigma: Internalization of these public attitudes

15. PROGRESSIVE MODEL OF SELF-STIGMA
(Corrigan & Rao, 2012)
AWARENESS
•“The public believes people with mental illness are weak”
AGREEMENT
•“That’s right. People with mental illness are weak.”
APPLICATION
•“I am mentally ill so I must be weak.”
HARM
•“Because I am weak, I am not worthy or able.”
WHY TRY…
The person gives up trying… (to hold a job, to have friends, to
get help) because its not gonna change anything “I am not
worthy and beyond help”

16. THE WHY-TRY EFFECT(Corrigan et al., 2009)
Stereotypes
Blame
Dangerousness
Incompetence
Fewer
behaviours in
pursuit of
goals!
Decreased
participation in
evidence-
based
treatments
Public
Stigma
Self-Stigma
Awareness
Agreement
Application
Social
Mediators
Self-esteem
Self-efficacy

17. EFFECTS OF STIGMA ON THE TARGETED INDIVIDUALS
• Depression, demoralization, shame (Lucksted et al., 2011)
• Social avoidance, distancing (Link et al., 2004)
• Increase in symptom intensity (Livingston & Boyd, 2010)
• Increase in hospitalization, decrease in engagement (Kvrgic
et al., 2013)
• Decrease in hope and in quality of life (Mittal et al., 2012)
• Decrease in treatment adherence and in help‐seeking
(Vogel et al., 2013)
• Poor self‐esteem and self‐efficacy

18. STIGMA IN FORENSICS– AN ADDITIONAL
CHALLENGE TO RECOVERY
• The forensic label: a double stigma
‘I am violent and mentally ill; I scare people, I am not
worthy of love; I have to hide’
• Challenges for health care providers:
– Building trust
– Impact of learned helplessness → non‐engagement in
therapeutic process
• Housing difficulties

19. HOW TO FIGHT STIGMA?
Policy and law changes
‒ Ex: make discrimination illegal (e.g., refusing a job or housing based on
history of mental illness)
Decrease ignorance and preconceived ideas through education
Shift from medical model to recovery model
•Recovery Model: System that provides hope, treat people with dignity and
respect and support everyone in finding their path to better mental health
and well‐being
–Living a satisfying, hopeful and contributing life, even when there are limitations
caused by mental illness (as opposed to finding a cure)
•Include Peer Support Workers in multidisciplinary teams
Change societal attitudes at the national level

20. GUIDELINES FOR RECOVERY‐ORIENTED PRACTICE:
HOPE, DIGNITY, INCLUSION*
Organized in 6 dimensions of recovery oriented practice:
1)Creating a culture and language of hope
2)Recovery is personal
3)Recovery occurs in the context of one’s life
4)Responding to the diverse needs of everyone living in Canada
5)Working with First Nations, Inuit and Metis
6)Recovery is about transforming services and systems
*http://www.mentalhealthcommission.ca/English/initiatives/RecoveryGuidelines

21. DISCLOSURE STRATEGIES
for the stigmatized individual (Corrigan & Rao, 2012)
Social Avoidance
Stay away from people so they don’t have a chance to stigmatize me
Secrecy
Go out into the world – work and go to church, but tell no one about my
illness
Selective Disclosure
Tell people about my illness who seem like they will understand
Indiscriminant Disclosure
Hide it from no one
Broadcast
Be proud - Let people know

22. Double Stigma – Forensic Patients and
Their Families
Family Members/Caregiver’s for this presentation includes
mother, father, brother, sister, husband, wife, and a close
friend or relative.
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23. Double Stigma – Family/Caregiver’s Feelings
• Most people with severe mental illness live with family members.
• Ongoing stress can be detrimental to caregiver’s mental and physical
wellbeing
• Carries significant emotional turmoil
• Question their coping abilities
• Feelings of being trapped
• Protective of their sick family member in spite of clear signs of personal
danger.
• Desensitized to violence and associated fears
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24. Double Stigma –Family/Caregiver’s
Experiences
• Public and media stigmatization of people with mental illness
• Dealing with media and legal proceedings difficult and not in most people’s skill repertoire
• Adverse publicity and hostility often directed toward offenders’ family members
• Guilt by association, ostracism, general abuse, and physical violence
• Feelings of shame and suffering common due to media exposure
• Result in losing friends and becoming isolated in their community. Lack support network
• Unaware of social and medical services offered to either patient or family
• Feeling stigmatized key challenge facing forensic caregivers
• Causes ambivalence among family members towards the perpetrator
• Change of the family unit
• Negative reporting adversely affects the recovery process and community reintegration of
both the individual with mental illness as well as their family
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25. Double Stigma – Mental Illness & Crime
How we can help families
• Helping the person with mental health issues:
• Deliver co-ordinated and integrated care for the
person with mental health and forensic issues
• Helping the families and caregivers:
• Provide counselling referrals to the caregivers
• Develop support groups for forensic families
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26. Double Stigma – How can our society reduce the
impact of stigma for families
• Education and Contact with the stigmatized groups
• Use Media to decrease public stigma
• Reducing the stigma leads to early identification and early treatment
of mental illness
• Research needed to determine impact of providing education through
media and other outlets on early detection and treatment efforts.
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27. Double Stigma – Mental Illness & Crime
Key Family Information & Support Resources in Ottawa
• L’Apogee
• The Oasis in Kanata
• Canadian Mental Health Association
• Mental Health Crisis Line
• Montfort Renaissance
• National Alliance on Mental Illness
(NAMI) Family to Family Programs
• Parent’s lifeline of Eastern
Ontario (PLEO)
• Psychiatric Survivors Ottawa
(PSO)
• The Royal - Education Series
and Coping with Mental Illness
Group
• Schizophrenia Society of
Ontario, Ottawa Chapter
• Youth Services Bureau (YSB)
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29. Thank youThank you
to our clientsto our clients
for sharing their storyfor sharing their story
Sean CliftonSean Clifton
Francis LaveauxFrancis Laveaux
Michael StewartMichael Stewart

30. Q & A
Special thanks to Martin Manseau and
John Espadero for their precious help
with the multimedia