Summer Studentship in Forensic Psychiatry

About

The aim is to identify the most highly cited papers in the field of schizophrenia research, categorize these thematically, identify any associated trends and contextualize these with respect to advancements in the field over the review period.

The Web of Science (/ or another suitable search facility) online citation indexing service will be searched for the topic of “schizophreni*” within the Web of Science categories of “Psychiatry”, “Neurosciences”, “ Pharmacology”, and “Clinical Psychology”. The search will be limited to journal articles, reviews and editorial material published in the English language between a certain range. Inclusion will be limited to items cited 400 (this may change depending on search results) times or more i.e., citation classics.  Each search result will be evaluated to ensure its relevance to schizophrenia and excluded where deemed irrelevant. This will be based on a review of citation information including article title, abstract, source journal and keywords. Included articles will be analyzed with regard to journal of origin, article type, authors, institution, citations, year and country of origin. Identified articles will then be sub-classified thematically and analyzed for trends (scales/measures, medical psychiatry, clinical trials/management, mechanisms/translational studies, imaging investigations and epidemiological/population health studies).

Goal

This project will introduce the student to bibliometrics. They will gain an introduction to preparing a poster for presentation, and a familiarization with working in forensic psychiatry, more generally. The specific goal will be to produce a poster presentation (for a regional / national / international academic conference) and potentially a manuscript for publication in a peer-reviewed journal. Given this project relies on data in the public domain, and is a data analysis undertaking, these deliverables are reasonable as the student could continue the project after the elective if required. 

Similar projects:

The most cited works in major depression: the 'Citation classics' - PubMed
Citation classics in epilepsy | Wilson | Reviews in Health Care
The most cited works in Parkinson's disease - Ponce - 2011 - Movement Disorders - Wiley Online Library
The Most Cited Works in Tourette Syndrome - Neethu Mariam, Andrea Eugenio Cavanna, 2012
 

No.

The student will have the option to gain clinical experience of an inpatient minimum secure forensic ward (ideally, by joining my weekly team review), in addition to a forensic outpatient service (ideally, by joining weekly clinics). Otherwise, there will be scope for the student to attend the weekly psychiatry grand rounds (remotely) and the monthly local forensic forum sessions, in addition to any other training events that may coincide with their placement. Depending on availability, there may be scope for the students to visit other sites within the forensic service to observe, e.g., mental health court, or jail.

Dr. Owen O’Sullivan is a Staff Psychiatrist in the Forensic Division of the Complex Care and Recovery Program at the Centre for Addiction and Mental Health. He is an Assistant Professor in the Department of Psychiatry at the University of Toronto. He has completed post-graduate studies in cognitive neuroscience and mental health law, in addition to a fellowship in medical education. His academic interests incl. mental health law and policy, forensic mental health, quality improvement, medical education, humanities and digital health innovations.

• This scoping review would aim to create a robust framework for clinicians to approach these sensitive topics with informed, evidence-based perspectives
• Learning Objectives:
  • Understand the Current Concepts and Clinical Frameworks
    • Explore existing definitions and categorizations of paraphilic bestiality within clinical and forensic settings.
    • Review contemporary clinical models used to assess and treat individuals with paraphilic bestiality.
    • Identify challenges and gaps in the clinical understanding and treatment of individuals with bestiality-related interests.
  • Examine Approaches to Assessment
    • Investigate current methods for assessing individuals with bestiality interests, focusing on psychological evaluations, diagnostic criteria, and risk assessments.
    • Evaluate the reliability and validity of assessment tools used in clinical practice and forensic settings.
    • Discuss the ethical considerations involved in assessing individuals with such interests.
  • Explore Forensic and Civil Legal Considerations
    • Examine the legal landscape surrounding paraphilic bestiality, including criminal liability, civil lawsuits, and the intersection of mental health and law.
    • Analyze current legal standards and frameworks in both forensic and civil settings, particularly in relation to individuals who engage in or have interests in bestiality.
    • Assess the role of mental health evaluations in forensic legal proceedings and their impact on legal outcomes.
• Goals of Conducting the Scoping Review:
  • Map Existing Literature:
    • Identify and synthesize existing research, case studies, and legal frameworks to provide a comprehensive overview of clinical, legal, and forensic perspectives on paraphilic bestiality.
  • Highlight Key Themes and Gaps
    • Highlight significant themes, controversies, and unanswered questions in the current body of knowledge.
    • Identify gaps in both clinical and legal literature to inform future research and practice in these areas.
  • Inform Clinical and Forensic Practices
    • Provide evidence-based insights to clinicians, forensic professionals, and legal practitioners about best practices, challenges, and emerging trends in the assessment and management of individuals with bestiality-related interests.

Not applicable.

Students will be able to select from a range of clinical experiences within the forensic division, including sexological assessments with the sexual behavior clinic (SBC), court-ordered psycho-legal assessments in the brief assessment unit (BAU), and/or inpatient/outpatient treatment for forensic individuals under the Ontario Review Board.

Dr. Paul Benassi is a forensic psychiatrist working in the Forensic Division, and Work, Stress and Health Program at the Centre of Addiction and Mental Health, and the Insight Health Solutions program at Trillium Health Partners. He attained certification in Forensic Psychiatry through the Royal College of Physicians and Surgeons of Canada (RCPSC). He completed his subspecialty training in Forensic Psychiatry through the RCPSC-accredited program at the University of Toronto. He is an Assistant Professor at the University of Toronto in the Faculty of Medicine’s Department of Psychiatry and the Dalla Lana School of Public Health’s Institute of Health Policy, Management and Evaluation (IHPME). Regarding clinic teaching, Dr. Benassi is the lead training physician in the CAMH Sexual Behaviour Clinic (SBC) for the Forensic Subspecialty fellowship at the University of Toronto. 

The research team is hoping for some support expanding on and writing up a literature review around the use of contingency management in the treatment of substance use disorders in persons with serious mental illness and in the forensic mental health system.  We have conducted a preliminary literature review to map out a pilot for the use of contingency management in the forensic outpatient service.  We could benefit from a learner to support us in building upon our preliminary literature review and support with the write up of the literature review in preparation for submission to an academic journal.  Depending on the progress we make with ethics approval, there may also be opportunities to support the development of the program proposal or analysis of outcomes from the pilot program.

Background/Problem:  Approximately 50% of clients within CAMHs forensic service have a diagnosed substance use disorder in addition to diagnosis of major mental disorder (Schizophrenia 80%; add in other dx).  All client’s in CAMHs forensic service have a judicial order, or disposition, issued by the Ontario Review Board which spells out conditions that a person much abide by.  This very commonly included is a prohibition to the use of alcohol, cannabis or illicit substances and a requirement that the patient provide urine for the purpose of drug screens.   Despite this prohibition of substance use, many clients in the forensic program struggle to maintain substance abstinence, resulting in delays to their progression through the forensic system and setbacks, including readmission to hospital or delays in getting a more liberal disposition.   

The care that clients in CAMHs forensic service currently receive for concurrent substance use issues is mapped out in the Forensic Model of Care Concurrent Disorders Pathway.  Current care includes screening, consultation, and evidence-based interventions including one to one and group treatment and where indicated, pharmacological consultation and support.   Within the outpatient setting, contingencies (rewards, consequences) related to desired behaviour (abstaining from substance use) are limited to punative consequences such as increasing reporting/supervision or readmitting the client to inpatient as a result of concerning substance use.  There is a large body of evidence demonstrating the effectiveness of reward based contingency management to target positive behavioural change realted to substance use however clinicians have few tools to connect changes to substance use with an immediate reward.  There is a need to develop and structure opportunities for this reward based contingency management treatment for those struggling with setbacks and restrictions related to substance use within the forensic outpatient service. 

There is a body of research demonstrating the effectiveness of contingency management (CM) in treating substance use disorders for clients with a major mental disorder.  CM is an operant conditioning-based intervention for substance use disorders (SUDs) that uses rewards, such as prizes or redeemable vouchers, to reinforce target behaviors, including abstinence from substance use. As noted by Rodas and colleagues (2023) in their recent systematic review, “CM is being used within the field of addictions research and has demonstrated promising results. Multiple meta-analyses have demonstrated its effectiveness in reducing alcohol, tobacco, amphetamine, cocaine, cannabis, and opiate use, with medium to large effect sizes (Beneshek et al., 2014; Schierenberg et al., 2012; Secades-Villa et al., 2020). Studies comparing CM against other psychosocial interventions have typically concluded CM as superior to other behavioral and pharmacological treatments (Budney et al., 2006; Miguel et al., 2016; Petry et al., 2012). Moreover, among individuals with severe mental illness (SMI), CM appears effective in reducing substance use. In a recent meta-analysis examining the effect of CM in patients with a psychotic-spectrum disorder and comorbid SUD, Destoop et al. (2020) found CM to offer a small, significant clinical advantage over standard treatment options on abstinence rates as patients who received CM in conjunction with standard.   

Methods: The student will continue to build on our literature review the published scientific literature to identify studies that look at use of contingency management in persons with SMI for substance use, and where possible, engaging in forensic care. The review is designed based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist, and utilizes Covidence software (www.covidence.org) to organize the data.

Innovation/Significance: By reviewing the literature, this study will inform us about the needs of this population and inform best practices in development of our pilot program.

• Dissemination: This literature review will be prepared for submission to a peer-reviewed journal for potential publication. It will also be submitted for presentation at a conference.

A medical student is sought to support presentations/posters of this initiative at academic meetings as well as dissemination for academic publication (i.e. reviewing relevant literature and writing for publication). 

Learning Objectives/Goals that are specific for the student:

• To understand the process for completing a systematic review.
• To develop critical appraisal and synthesizing skills of relevant literature
• To develop and enhance writing skills for academic publication and presentation skills at academic meetings.
• To develop greater awareness of the forensic mental health system, and management of concurrent disorders with this population in this setting. 

In process of obtaining approval through CAMHs Quality Project Ethics Review around the pilot a CM program for substance use in the outpatient service.

Learners will have the opportunity to work alongside Dr. McMaster in the Forensic Outpatient Service.  Learners gain experience in the assessment and treatment of complex clinical presentations involving treatment resistant major mental illness and comorbidity including substance and personality disorders. There is opportunity to learn about risk assessment and management of individuals in the ORB system and observe testimony at Ontario Review Board hearings. 

Robert McMaster completed his psychiatry training in 2013. He is a Forensic Psychiatrist with a diverse interest and practice. He works at CAMH with patients who have severe and persistent mental health diagnoses. Additionally, he consults to correctional facilities, is actively involved in outreach psychiatry, and works within the field of addiction medicine. He completed his subspecialty training in 2017 and is an Assistant Professor at the University of Toronto.

Background

Some literature indicates that individuals with Autism Spectrum Disorder are over-represented within the Criminal Justice System (Esan, Chester, Gunaratna, Hoare & Alexander, 2015). There is limited research on clinical, forensic qualities and treatment outcomes for this population (Esan, et al, 2015). The focus of the Forensic Mental Health System is often on stabilization of the psychiatric illness and risk mitigation (Aga, Vander Laenen, Vandevelde & Vanderplasschen, 2020). Differences in both behaviour and social interactions can present challenges for therapeutic engagement within the Forensic Mental Health System as these patients may not meet forensic markers that are applied for patients with other mental illnesses (Esan, et al, 2015).

Aim

To identify gaps in current practices and improve the quality of care and treatment for patients with Neurodevelopmental Disabilities/Autism within a Forensic Secure Unit.

Objectives

1. Review of the literature of current interventions and treatment options for patients with Neurodevelopmental Disabilities/Autism within the Forensic System
2. Basic understanding of the competency level of staff surrounding the evidence-based care and treatment of this patient population
3. Implementation of evidence-based care and treatment options for Neurodevelopmental Disabilities/Autism patients within the Forensic System

References

Aga, N., Vander Laenen,. F., Vandevelde, S., & Vanderplasschen, W. (2020). A qualitative inquiry on recovery needs and resources of individuals with intellectual disabilities labelled not criminally responsible. Journal of Applied Research in Intellectual Disabilities, 33(4), 673-685.

Esan, F., Chester, V., Gunaratna, I.J., Hoare, S. & Alexander T.R. (2015). The clinical, forensic and treatment outcome factors of patients with autism spectrum disorder treated in a forensic intellectual disability service. Journal of Applied Research in Intellectual Disabilities, 2015(28), 193-200.

No.

Dr. Ali works in the inpatient and outpatient program in the Forensic Service at CAMH. She also consults to the Mental Health Courts and maintains a private practice, conducting third-party assessments for civil and criminal proceedings. Students can have exposure to inpatient and outpatients under the Ontario Review Board, unfit patients on the inpatient unit on Treatment Orders, and assessments of sexual violence, non-sexual violence, and criminal responsibility.

Dr. Ali completed medical training at the American University of the Caribbean in 2013.  She completed her general psychiatriy training at Icahn School of Medicine at Mount Sinai in New York. She completed her forensic psychiatry training at Albert Einstein School of Medicine also in New York. She holds her sub-specialty qualification through the American Board of Psychiatry and Neurology as well as the Royal College of Physicians and Surgeons of Canada.  Dr. Ali is the Medical Education Lead and the Wellness Lead of the Forensic Division. She is an assistant professor in the Department of Psychiatry at the University of Toronto.

To conduct a rapid review to synthesize existing literature on how forensic psychiatric hospitalization affects maternal identity, emotions, and experiences.

Potential Themes to Explore:

1. Emotional Impact: Guilt, distress from separation, impact of psychiatric hospitalization on bonding.
2. Maternal Identity: Shift in self-perception, loss of parental role, coping strategies.
3. Barriers to Mother-Child Contact: Institutional policies, legal restrictions, mental health barriers.
4. Resilience & Adaptation: How mothers navigate challenges, social support, therapeutic interventions.

Policy Implications: How institutions address maternal rights, recommendations for trauma-informed care.

No.

Students are welcome to join me in observing my clinical practice on the Women’s Secure Forensic Unit, the Forensic Early Intervention Services (FEIS) community clinic at CAMH, and the FEIS clinic at Vanier Correctional Facility. Under supervision, they will gain hands-on experience in key skills such as conducting patient interviews and collaborating within a multidisciplinary team. Additionally, students will have the opportunity to attend team review meetings and observe Ontario Review Board hearings.

Dr. Ipsita Ray is a dedicated psychiatrist with a specialized focus on women's mental health and forensic psychiatry. She is a staff psychiatrist at the Centre for Addiction and Mental Health (CAMH) and an Assistant Professor in the Department of Psychiatry at the Temerty Faculty of Medicine, University of Toronto. Dr. Ray primarily works with female patients in the forensic psychiatry division at CAMH and the Vanier Correctional Facility, addressing the complex intersection of mental health and the justice system. Her research explores the unique mental health challenges faced by women in forensic settings, aiming to improve care and outcomes. Passionate about education, she is actively involved in teaching undergraduate and postgraduate students, fostering the next generation of forensic mental health professionals. Through her clinical work, research, and mentorship, Dr. Ray is committed to advancing the understanding and treatment of mental health issues in forensic psychiatry.

Background

The transition from incarceration to community reintegration is a critical period that shapes post-release outcomes, yet research often prioritizes objective measures such as recidivism rates, employment status, or housing stability. Understanding the subjective experience of released prisoners—how they perceive their transition, challenges, and support systems—is essential for informing policy and practice that enhance rehabilitation and reduce reoffending.

Objective

This rapid review aims to synthesize existing literature on the subjective experiences of individuals released from correctional facilities, with a focus on their psychological, social, and emotional challenges, as well as their perceptions of support systems and personal agency in the reintegration process.

Methods

A structured rapid review methodology will be employed to identify and analyze qualitative and mixed-methods studies published in peer-reviewed journals. Databases such as PubMed, PsycINFO,  and Google Scholar will be searched using predefined keywords. Inclusion criteria will focus on studies that explore first-person accounts of reintegration challenges and successes, while excluding studies that rely solely on administrative or quantitative data. A thematic synthesis will be conducted to identify key patterns in the literature.

Expected Outcomes

Findings will provide a comprehensive overview of the psychological and social dimensions of prisoner reintegration, highlighting common themes such as stigma, identity transformation, mental health struggles, social support, and system navigation. By centering the voices of released prisoners, this review will contribute to a more nuanced understanding of reintegration, moving beyond institutional measures to explore the human aspects of post-release experiences. The insights gained will build on our work in the department relating to reintegration of people from correctional settings and will guide research on mental health support, peer mentoring programs, and policy reforms to facilitate successful reentry

N/A

The student will be able to attend clinical team meetings and observe patient interviews and assessments on a medium secure forensic unit, and will have the opportunity to observe occasional court ordered forensic assessments.

Dr Jones is Associate Professor in the Division of Psychiatry, University of Toronto.  He is a forensic psychiatrist and Medical Lead for Research and Fellowships at the Division of Forensic Psychiatry at the Centre for Addiction and Mental Health (CAMH) in Toronto, Canada. He has provided consultation to the Ontario Ministry of Community Safety and Correctional Services, and has led research on the measurement of severity of mental disorder in prison settings, factors associated with recidivism, and an appraisal of need for inpatient mental health services in provincial jails in Ontario. He has published over 60 research papers. His clinical role involves the assessment and treatment of people in forensic mental health and correctional settings, and he serves as an expert witness in Criminal Courts in Ontario.