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Introduction to Research in the Division of Forensic Psychiatry

 The Division of Forensic Psychiatry promotes research across all disciplines designed to advance scientific knowledge and evidence-based practices in Forensic Mental Health Science.  

Publications by Members of the Division of Forensic Psychiatry

1.  Shumlich, E., J. (2015). New Forensic Facility Opens its Doors for Research. Crime Scene, Canadian Psychological Association, 21, 33-34. Link to the publication here.

2.  Beach, C., Dykema, L.R., Appelbaum, P.S., Deng, L., Leckman-Westin, E., Manuel, J. I., McReynolds, L., & Finnerty, M.T. (2013). Forensic and nonforensic clients in assertive community treatment: A longitudinal study. Psychiatric Services, 64(5), 437-444.  Link to the Pubmed listing here.

3. Prakash, A., Raheb, H., Chiu, S., Goble, l., Kononiuk, M., Cernovsky, Z., Bureau, Y., Lalone, L., Prakash, A., Swaminath, S., Komer, B., & Sidhu, G.  (2014).   Does substance use mitigate or aggravate insanity defenses?  Preliminary findings of RMHC-Forensic-100 study.  Research Insights of Regional Mental Health Care London and St. Thomas, 11(4). 
Presented at the annual Research Half Day, May 14, 2014. 
Link to the published abstract here

4. Tomlinson, M., Hoaken, P. N. S., Desjardins, N. (2014, July). The impact of dialectical behaviour therapy on aggressive behaviour in a forensic psychiatric patient population.  Poster presented at the International Meeting of the International Society for Research on Aggression. Atlanta, Georgia.

5. Tomlinson, M., Hoaken, P.N.S., Desjardins, N, Balsom, R. (2015, March). An evaluation of dialectical behaviour therapy for forensic psychiatric patients. Paper presented at the American Psychology-Law Society Conference. San Diego, California.

Grants Currently held by Members of the Division of Forensic Psychiatry

Check back for updates

Events in the Division of Forensic Psychiatry

For information about events happening in the Division of Forensic Psychiatry, please visit our events page.

Opportunities for Residents and Clerks

The Division of Forensic Psychiatry is interested in working with trainees at all levels who have a potential research interest (there are always several ongoing projects available).  Please contact Carole Bowles for more infomation.

Treatment and Interventions:

1.    Psychosocial Factors Database Research Project

Ms. Mary Ellen Ruddell, Principal Investigator, Co-investigators Ms. Donna Lynam & Ms. Val Momney
This research is an attempt to determine psychosocial determinants that are statistically linked to individuals entering the Forensic system. All 340 closed- chart audits have been completed, results will be collated, and then we will draft a paper for hopeful publication.

2.    Adventure Based Counselling

Ms. Mary Ellen Ruddell, Principal Investigator Co-investigators, Dr. Rod Balsom, Ms. Heather Dehn, Ms. Karen Lewis & Dr. Craig Beach.
This research attempts to answer the question Does participation in an in-patient psychiatric Adventure Based Counselling (ABC) program improve client outcome? Four program groups have completed the research assessment questionnaires. Presentation of a paper for publication is anticipated for December, 2015. We would like to particularly acknowledge the support and contributions of psychology students at Western University.

3.    Healthy Living Initiative

Ms. Jean Marie Steward & Ms. Mary Ellen Ruddell
This program group addresses Diabetes and Metabolic syndrome as well as patients’ general well-being through holistic measures. It includes nutrition, fitness, happiness, leisure, support and spirituality. We have completed a literature review and anticipate submitting a Research Ethics Board proposal by January, 2016. 

 Research Interest Group Themes

1.    The Effectiveness of Dialectical Behaviour Therapy in a Forensic Psychiatric Population  

Monica Tomlinson, Dr. Peter Hoaken, Dr. Nina Desjardins, Dr. Rod Balsom
Aggressive forensic psychiatric patients are more challenging to rehabilitate than patients who are not aggressive (Bowers et al., 2011). Delays in the rehabilitation of aggressive individuals are associated with longer hospitalizations, high financial costs, increase in staff burnout, and poorer patient outcomes (Bader, Evans, & Welsh, 2014). Dialectical behaviour therapy (DBT) is a cognitive behavioural approach designed to decrease aggression by enhancing emotional regulation, interpersonal effectiveness, distress tolerance, and mindfulness. While DBT has been adapted and for use with forensic psychiatric populations internationally (McCann, Ball, & Ivanoff, 2000), no evaluations of DBT have been conducted in Canada to determine whether DBT meets the needs of a Canadian forensic psychiatric population. To evaluate DBT’s effectiveness in reducing aggression in a Canadian forensic psychiatric sample, a randomized control design using a waitlist control group was employed. 10 patients were randomly assigned to participate in six months of DBT and 10 were randomly assigned to a DBT waitlist. Data analyses will be completed in April 2015. Preliminary analyses suggest downward trends in aggressive behaviour, anger, and trait hostility over the course of DBT. The results from this study will contribute to more standardized and effective interventions for reducing aggressive behaviour among forensic psychiatric patients in Canada and across the world.

2.    The Evidence-Based Practices in Forensic Mental Health Task Force 

Sponsored by the Forensic Directors Group (FDG) of Ontario, the Evidence Based Practice in Forensic Mental Health (EBPFMH) Task Force is a collaborative research project involving researchers, forensic mental health professionals, program leaders and government policy makers.  The FDG is comprised of the Administrative and Clinical Directors from each of the nine provincial forensic programs, as well as ex officio Ministry of Health and Long Term Care (MOHLTC) representation.  The FDG was established to provide direction and coordination to the provincial forensic program encompassing 9 hospitals including the Southwest Centre for Forensic Mental Health Care in St. Thomas.  This partnership has the following objectives: (1) To conduct a literature review of best practices in Forensic Mental Health and Addictions; (2) To develop a consensus on delivery of forensic services and advise the FDG on the development and dissemination of guidelines; and (3) To facilitate the development of an integrated and coordinated performance monitoring system across provincial forensic mental health services.

In order to increase the likelihood of acceptance of or “buy in” by all of the hospital programs, sub-group membership has been determined according to a set of explicit rules.  In this way, provincial partnerships are successfully strengthened by participation in every sub-group, and “ownership” is increased by having input into all of the final products created by those groups.

The Task Force established sub-groups in nine content areas: (1) Risk Assessment; (2) Inpatient Risk Management; (3) Community Risk Management; (4) Substance Abuse; (5) Anger/Impulsivity; (6) Sexual Deviance; (7) Personality Disorder; (8) Treatment of Serious Mental Illness in a Forensic Setting; and (9) Community Reintegration.  It was agreed each of the sub-groups would produce several work products, including: (1) an annotated bibliography; (2) a narrative review of the literature; (3) a description of each best practice identified in the literature review; (4) a draft of proposed practice guidelines; (5) educational and training documents; and (6) a list of proposed KPIs based on the review of the literature.

Each sub-group must report their progress back to the EBPFMH Task Force.  All products developed will require approval from the Task Force as well as the FDG.
The SWCFMHC currently has two members supporting this work.  Janice Vandevooren (Director of the SWCFMHC) is the Chair of the Community Reintegration sub-group and Mary Ellen Ruddell, MSW, RSW is a committee member on the Substance Abuse sub-group.  

3.    The Relationship Between Executive Cognitive Functions and Aggression in a Forensic Psychiatric Population

Authors: Erin Shumlich, Kelsey Gould, Dr. Peter Hoaken and Dr. Rod Balsom

The present study profiles Executive Cognitive Functions (ECFs) of a forensic psychiatric population. There is a history of research attempting to target the predictive measures of violence and aggression, including research looking at how socioeconomic status, social groups, and genetic factors predict violence (Flannery et al., 2005; Kashani et al., 1999). Recent research links deficits in cognition to aggression and violence for a correctional population (Tapscott et al., 2012); however, how ECFs relate to violence and aggression in a forensic population is yet unknown. The current study further extrapolates the relationship between specific cognitive deficits and the nature of violence. ECFs include flexibility of thinking, inhibition, problem solving, planning, impulse control, concept formation, abstract thinking, and creativity (Homack et al., 2005). Specifically, the Kaufman Brief Intelligence Test, Second Edition (KBIT-2) and the Delis-Kaplin Executive Functioning System (D-KEFS) are used to assess the relationship between specific ECFs and criminal activity (e.g. type, severity, and frequency) for forensic psychiatric patients. It is expected that deficits in impulse control and planning will be related to the nature of the index offence and increased aggression within the forensic psychiatric hospital. Violence and crime have immense social impact; understanding and treating specific cognitive deficits underpinning aggression and crime is essential in order to ensure the successful reintegration of forensic psychiatric patients and the safety of society as a whole.