Care Trajectories in the Ontario Forensic Mental Health System: Associations With Ethnoracial Status, Country-of-Birth, Citizenship, and Language Fluency

Racialized people are over-represented in the forensic mental health system, yet little is known about how ethnoracial status and associated proxies (country-of-birth, citizenship, and official language fluency) relate to care trajectories and length of time spent in the system. This study investigates the associations of ethnoracial status, country-of-birth, citizenship status, and official language fluency with the forensic mental health trajectories of 283 people found Not Criminally Responsible on account of Mental Disorder (NCRMD) in Ontario, Canada. A majority (54%) of patients were not White, 41% of the sample was born outside of Canada, 28% were not Canadian citizens, and 6% were not fluent in either of Canada's official languages (English and/or French). Being born outside of Canada, not being a Canadian citizen, and not being fluent in an official language were associated with longer times spent under the care of the forensic system. Being born outside of Canada and a lack of official language fluency continued to be significant correlates of time spent in the forensic system even after accounting for relevant factors including violence risk, primary diagnosis, and index offense severity. Results are discussed within the context of optimizing forensic mental health services that are effective, equitable, and just.