Exploring the Production of “Dangerous Persons” in Forensic Psychiatry: A Critical Ethnography of the Ontario Review Board (ORB)

Abstract

Forensic psychiatric nursing is a specialty at the junction of two well-researched intersecting systems with two different mandates: criminal justice (public protection) and health care (public good). Nurses’ involvement at one of the systems’ points of juncture, review board (RB) hearings, has largely been left unexplored. At RB hearings, a panel of legal and health care professionals determines if persons unfit to stand trial (UST) or not criminally responsible on account of mental disorder (NCRMD) represent significant threats to the safety of the public, and orders conditions aimed at keeping the community safe. The aim of this research project was to explore how psychiatric and public safety discourses construct the identity of persons UST or NCRMD during RB hearings, and nurses’ contribution to such identity construction. Critical ethnography methodology was employed, mobilizing three data sources: interviews with forensic psychiatric nurses, observations of RB hearings, and RB documentary artifacts. A poststructuralist lens was used to discern how RB culture produces truths about persons UST or NCRMD that sustain the hegemony of public safety and psychiatric discourses. The main finding was that the forensic psychiatric structure leverages therapeutic nursing interventions and documentation as evidence of deviancy, so that persons UST or NCRMD can be objectified and produced as dangerous, prior to socially rehabilitating them. Discursive structures sustaining the forensic psychiatric system inscribe nursing care within a disciplinary scheme, rendering it coercive and punitive. Thus, a care-and-custody dichotomy is insufficient to explain the complex processes at play in forensic psychiatry. These findings have implications for research, practice, and education in forensic psychiatric nursing, nursing ethics, and other nursing specialties on the medico-legal borderland.