Lack of hous­ing for forensic psy­chi­at­ric patients `a five­ alarm ­blaze crisis’

`I have never, ever in my life seen a bot­tle­neck in the sys­tem like this,’ says expert lit­ig­ator

SUSAN CLAIRMONT

15 Sep 2025

`I have never, ever in my life seen a bot­tle­neck in the sys­tem like this,’ says expert lit­ig­ator

Forensic psy­chi­at­ric patients are wait­ing for oth­ers to die and free up trans­itional hous­ing in the com­munity so they can leave their costly hos­pital rooms and make way for new patients.

The bot­tle­neck across Ontario is “a five­ alarm­ blaze crisis” pre­vent­ing patients from being dis­charged — even when they are med­ic­ally cleared to do so, says Anita Szi­geti, a top Cana­dian men­tal health justice lit­ig­ator.

The trickle­down effect of that bed blocking, says Szi­geti, can keep forensic patients “lan­guish­ing” in jail for months while they await admis­sion to a psy­chi­at­ric hos­pital unit.

“Lives are going by,” she says. For those who think patients found not crim­in­ally respons­ible (NCR) for offences deserve to be locked up forever, Szi­geti says there’s something else to con­sider when keep­ing someone under gov­ern­ment care: “We’re burn­ing tax­payer money.”

In a coun­try grap­pling with a hous­ing crisis, forensic psy­chi­at­ric patients “are always the last to get the hous­ing they need,” says the Toronto ­based law­yer.

“These cli­ents are not pop­u­lar,” says Szi­geti, who rep­res­ents Joey Tobin, a Hamilton man who killed his father, and Shafaq Joya of Toronto, who killed his room­mate. Both were found NCR and are under the care of St. Joseph’s Health­care’s forensic psy­chi­at­ric unit at its West 5th Cam­pus.

A per­son is gen­er­ally found NCR when, due to a major men­tal ill­ness at the time of their offence, they were unable to under­stand the nature and con­sequences of their actions, or that they were wrong.

Szi­geti declined to speak about any of her cli­ents for this story.

But she points out that most NCR cases do not involve hom­icides, or even viol­ence. Many of her cli­ents are accused of fail­ing to appear in court, mak­ing threats, mis­chief, dam­age to prop­erty or other lower ­level crimes. But once found NCR, they “can end up in the sys­tem for a dec­ade.”

For 30 years, the law­yer has rep­res­en­ted NCR cases, often at the Ontario Review Board (ORB), which cur­rently has jur­is­dic­tion over about 1,500 people found by a court to be unfit to stand trial or NCR on account of men­tal dis­order.

“I have never, ever in my life seen a bot­tle­neck in the sys­tem like this. It’s a crisis,” she says. “The lack of hous­ing across the sys­tem is the worst I have ever seen. The sys­tem is cav­ing in on itself.”

It’s so unfair to NCR patients that defence law­yers are less likely to recom­mend bor­der­line cli­ents for an NCR assess­ment because “they’re going to be in hos­pital sig­ni­fic­antly longer than they need to be there because of a hous­ing short­age,” says Szi­geti.

The bot­tle­neck works like this: the num­ber of NCR patients is rising at a rate of about 10 per cent a year, accord­ing to the web­site of the ORB. That is dis­pro­por­tion­ate to pro­vin­cial pop­u­la­tion growth as well as to increases in the gen­eral arrest rate, accord­ing to the ORB’s last annual report.

Even after they have been des­ig­nated NCR by the court, the accused often get stuck in jail for months because there are no forensic psy­chi­at­ric hos­pital beds open in the province.

The cost of keep­ing an inmate incar­cer­ated is about $345 a day, accord­ing to a 2024 Cor­rec­tional Ser­vice of Canada report.

But our justice sys­tem says NCR patients need to be in a hos­pital, not a jail. And that can run upward of $1,400 a day — or more than half a mil­lion dol­lars each year — for a patient’s care, says Szi­geti, mak­ing those spots the most expens­ive psy­chi­at­ric beds in the province.

In Ontario, there are 11 forensic psy­chi­at­ric facil­it­ies: Brock­ville Men­tal Health Centre; Provid­ence Care Centre in King­ston; North Bay Regional Health Centre; Royal Ott­awa Men­tal Health Centre; Way­po­int Centre for Men­tal Health Care in Pen­et­an­guishene; South­w­est Centre for Forensic Men­tal Health Care in St. Thomas; St. Joseph’s Health Care in Lon­don; Thun­der Bay Regional Health Sci­ences Centre; Centre for Addic­tion and Men­tal Health in Toronto; Ontario Shores Centre for Men­tal Health Sci­ences in Whitby; Syl Apps Youth Centre in Oak­ville; and St. Joseph’s Health­care’s West 5th Cam­pus in Hamilton.

While St. Joe’s is oper­ated by the Min­istry of Health (MOH), some of the other facil­it­ies are privately owned and oper­ated, which means there is “little con­sist­ency” around fund­ing, staff­ing, secur­ity levels and other resources, says Szi­geti. Or when it comes to policies about things like passes into the com­munity or patient priv­ileges. And com­munity sup­port sys­tems to trans­ition patients back into the out­side world when they are deemed well enough also vary.

Szi­geti says St. Joe’s forensic unit at its West 5th Cam­pus “is very likely the best health­care centre for people in the forensic sys­tem.”

The build­ing, which opened in 2014, “is beau­ti­ful. It’s a five ­star hotel com­pared to some of the oth­ers,” she says.

Staff at St. Joe’s are “the best in the province,” and she advoc­ates for her cli­ents to trans­fer to Hamilton from other insti­tu­tions — even though moves within the sys­tem can take up to two years.

She has seen cli­ents who failed to pro­gress at other facil­it­ies thrive at St. Joe’s. Still, the hos­pital is not without its prob­lems.

In recent months, Szi­geti has had two cases against St. Joe’s go to the Court of Appeal for Ontario that raised the issue of inad­equate sup­port­ive resources in the com­munity to allow NCR patients to trans­ition out of the hos­pital.

The first case con­cerned Joya. While the court of appeal upheld the ORB’s decision not to allow him to live in the com­munity, a St. Joe’s doc­tor told the hear­ing there were no psy­chi­at­rists in Hamilton — out­side of the forensic unit — who could prop­erly care for him.

The second case was Tobin. The court said St. Joe’s hadn’t done enough to find him trans­itional hous­ing in Hamilton, even though it knew for years it would need to.

Trans­itional hous­ing units for NCR patients have sup­port from med­ical and social work­ers and are fun­ded by the MOH.

The Spec­tator asked the MOH how many trans­itional beds it funds in Hamilton. Rather than provid­ing an answer, the min­istry told the news­pa­per it must file a Free­dom ­of­ Inform­a­tion request, which is often an expens­ive, time con­sum­ing and fruit­less pro­cess.

The Spec­tator has filed the request, but has not received any inform­a­tion.

The cost of sup­port­ive hous­ing for an NCR patient is about $3,000 a month, says Szi­geti — less than the cost of jail or the hos­pital.

Szi­geti told The Spec­tator one of the prob­lems with St. Joe’s is that once a forensic patient receives an abso­lute dis­charge and is no longer under the hos­pital’s care, its highly spe­cial­ized staff can no longer see them. Hos­pital doc­tors agree that is the offi­cial policy, but they have told the ORB they would never leave a patient without care.

There are inad­equate sup­ports in place in Hamilton, Szi­geti says, and the ORB will some­times agree to keep patients under care — because that is the only way to provide them with the sup­port they need.

“There is a massive hole in those ser­vices,” she says. “It’s glar­ing in Hamilton.”

There is also a catch­22. Hos­pit­als say they won’t allow an abso­lute dis­charge unless there are com­munity ser­vices in place. But com­munity organ­iz­a­tions say they won’t duplic­ate ser­vices provided by the hos­pital and so won’t begin provid­ing care until after the abso­lute dis­charge.

Szi­geti says Hamilton needs a “forensic com­munity treat­ment team” fun­ded by the MOH, which would include forensic psy­chi­at­rists, nurses and social work­ers. Patients would con­sent to par­ti­cip­ate as they trans­ition out of the NCR stream and the pro­gram would be oblig­ated to accept them. Szi­geti says most of her cli­ents want care because they want to get well.

“In Ontario, the gov­ern­ment provides fund­ing for tem­por­ary trans­itional hous­ing spe­cific­ally for forensic men­tal health patients, which is a vital resource for these indi­vidu­als,” said a state­ment from Dr. Gary Chaimow­itz, head of forensic ser­vices at St. Joseph’s Health­care. “But find­ing per­man­ent hous­ing for forensic patients remains a sig­ni­fic­ant chal­lenge due to a num­ber of bar­ri­ers, includ­ing stigma and a severe hous­ing short­age. The team at St. Joe’s is highly skilled at help­ing find hous­ing for patients, regard­less of these bar­ri­ers, but it is often a dif­fi­cult and lengthy pro­cess. St. Joe’s is ded­ic­ated to work­ing with these patients to help con­nect them with the hous­ing sup­ports they need.”

Some cli­ents don’t require con­tinu­ing care after being dis­charged, says Szi­geti. But they could still use fin­an­cial assist­ance find­ing hous­ing, which is a key com­pon­ent to main­tain­ing good men­tal health.

“The sys­tem that has been pieced together is almost incom­pre­hens­ible,” she says. “The rules are so com­plic­ated.”

NCR patients who have been com­pletely dis­charged often have to rely on com­munity pro­grams based on their dia­gnosis, such as the Schizo­phrenia Soci­ety.

Though the province has the author­ity to take away the liber­ties of an NCR patient, it doesn’t guar­an­tee the resources they need to rein­teg­rate back into soci­ety — which is the entire goal of the NCR sys­tem.

The province needs to develop spe­cial­ized ser­vices for those com­ing out of the NCR stream, says Szi­geti. She says in North Bay, there are just two beds that fit the needs of one of her cli­ents.

“Staff said someone would have to die for a bed to open up. People are wait­ing for other people to die so they can come out of hos­pital.”

“That is not a fisc­ally smart way to handle the sys­tem,” she says.

She points to one bright spot in Hamilton’s NCR trans­itional sys­tem — Emmaus Place.

The Aik­man Avenue apart­ment build­ing oper­ated by Good Shep­herd is one of only “a hand­ful of hous­ing options” for NCR patients leav­ing St. Joe’s, says Szi­geti. Oth­ers include small homes run by Good Shep­herd and other com­munity organ­iz­a­tions.

About 15 of the build­ing’s 64 units are within the Trans­itional Rehab­il­it­a­tion Hous­ing Pro­gram (TRHP) for NCR patients, accord­ing to John Lee, dir­ector of homes and sup­port­ive hous­ing for Good Shep­herd. The TRHP beds are fun­ded by the MOH, with the money flow­ing through St. Joe’s first.

Emmaus offers 24­7 sup­port for all its ten­ants, many of whom have exper­i­enced home­less­ness and addic­tion along­side mental health issues. An on­site com­munity mental health nurse mon­it­ors med­ic­a­tion com­pli­ance.

Once NCR ten­ants are fully dis­charged from the justice sys­tem, Emmaus allows them to age in place, says Lee. That means those ten­ants have an oppor­tun­ity to stay per­man­ently at Emmaus.

“Sup­port­ive hous­ing is health care,” says Lee. “Giv­ing a per­son a home, a neces­sary net­work of social sup­port, eases the bur­den our health care is under.”

Emmaus Place gets its name from the Gos­pel of Luke.

Two dis­ciples walk­ing to the vil­lage of Emmaus were joined by Jesus, but they didn’t recog­nize him. They invited him to din­ner and when Jesus blessed their bread, they sud­denly saw who he was.

“We jour­ney with people in their struggles and their pain, and in their joys and sor­rows,” says Brother Richard MacPhee, chief exec­ut­ive officer of Good Shep­herd. “Not always recog­niz­ing the hid­den Christ.”