Pathways to forensic mental health care in Toronto: a comparison of European, African-Caribbean, and other ethnoracial groups in Toronto

Can J Psychiatry. 2012 Jul;57(7):414-21. doi: 10.1177/070674371205700704.


Objective: To describe pathways taken to care by a sample of patients in a secure forensic unit who have been found not criminally responsible or unfit to stand trial, and to investigate the pathways taken by patients within 3 ethnoracial subgroups of origin: European, African or Caribbean, and Other.

Method: Fifty patients from secure forensic units were interviewed using the Encounter Form developed for pathways mapping undertaken in the World Health Organization field trials. Differences in the types of caregivers seen, the total number of caregivers seen, and the time taken to reach forensic psychiatric services were compared across the 3 ethnoracial groupings.

Results: Most people committed their index offence after they had already had contact with general mental health services. Few significant differences were observed in the pathways to secure forensic units across the European, African-Caribbean, and Other ethnoracial groups.

Conclusions: These findings suggest that improvements in general mental health services may be a key to decreasing the use of forensic psychiatric services. Further research is required to explore factors that may predict and prevent offending. Larger studies are needed to examine ethnoracial differences in pathways to care.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Black People / psychology*
  • Commitment of Mentally Ill*
  • Cross-Cultural Comparison*
  • Female
  • Health Services Accessibility*
  • Health Services Needs and Demand
  • Humans
  • Ill-Housed Persons / psychology
  • Male
  • Mental Health Services*
  • Middle Aged
  • Ontario
  • Patient Acceptance of Health Care / ethnology
  • Patient Care Team
  • Prisoners / psychology*
  • Public Assistance
  • Security Measures*
  • Unemployment / psychology
  • West Indies / ethnology
  • White People / psychology*
  • Young Adult