Overburdened and understaffed: A national mixed-methods examination of Canadian forensic mental health and fitness to stand trial

The Canadian forensic mental health system operates within a decentralized, provincially siloed healthcare model, with the last national survey occurring two decades ago. With growing concerns regarding a U.S. "competency crisis", it remains unclear whether Canada faces similar pressures. This mixed-methods exploratory study provides an updated snapshot of Canada's forensic services and current fitness demands and capacities. We identified 40 forensic sites and 2,031 designated beds. 29 of these sites conduct inpatient fitness assessments, a 16% increase in sites since the early 2000s. Site Surveys (n = 17) and public data revealed significant provincial variability in capacities, service availability, and referral patterns at participating sites. Reflexive Thematic Analysis of interviews with service providers (n = 13) provided insights regarding system strengths and current challenges across four themes: Challenges to Providing Forensic Care, Growing Burden on Forensic System, Stigma and Lack of Support, and Identified Needs/Attempts at Change. Policy recommendations are discussed.