Mount Royal University May 25, 2011

MENTAL HEALTH AND THE JUSTICE SYSTEM

Patrick Baillie, Ph.D., LL.B.

BUILDING BRIDGES:

KEY PRIORITIES
Members of the public want safe communities Police officers want to protect potential victims, doing so, in part, by catching bad guys* Judges want to give sentences that send a message about unlawful conduct

* bad guys is based on the notion behind criminal law that the person knows what he or she is doing, knows that it is wrong, and does it anyway
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KEY PRIORITIES
Staff in remand centres, jails and prisons want to reduce overcrowding and provide quality services Staff in community agencies want to assist offenders in reintegrating to society, while also reducing the potential for re-offence

KEY PRIORITIES
We all want to stop the revolving door that brings repeat offenders back into contact with victims, with police, with the courts, with custodial facilities, and with community agencies.

SOCIETYS FEARS Man Kills 8 of His Neighbors;

John Denver Karaoke Drove Him Crazy

HAT YAI, THAILAND -- 52-year-old Weenus Chumkamnerd has been arrested for killing eight of his neighbours for their less-thanstellar karaoke performances to John Denvers Country Roads.
The Telegraph, March 08, 2008

SOCIETYS FEARS
CRAZY MAN KILLS SIX
Carpenter Runs Amuck in Lodging House with Shotgun

SAN FRANCISCO, May 7 -- Walter Charley Davis, a carpenter, in a t of insanity today shot and killed a family of six persons with whom he resided at 414 Pierres Street, in this city.
New York Times, 1907

AND THE FEAR PERSISTS

AND THE FEAR PERSISTS

VINCENT WEIGUANG LI
Came to Canada in 2001 and became a Canadian citizen in 2005. Worked in Winnipeg and Edmonton, as a labourer, at a fast-food restaurant, in newspaper delivery, and at Wal-Mart. Was described by employers as hardworking and reliable. Was married to a woman who sometimes worked as a waitress.

So, wheres the story?

HOMICIDE OF A STRANGER BY A PERSON WITH A PSYCHOTIC ILLNESS

Characteristics of these offenders:

Two-thirds had never received treatment with antipsychotic medication Compared to family homicide offenders, stranger homicide offenders were: More likely to be homeless; More likely to have exhibited antisocial behaviours; and, More likely to have fewer negative symptoms.

WHAT ARE THE ODDS?

Of Of Of Of Of winning Lotto 6/49 -- 1 : 13,983,816 / draw scoring hole-in-one -- 1 : 12,500 / hole being killed by lightning -- 1 : 5,000,000 / yr being killed in MVA -- 1 : 6,500 / yr dying from venomous plant or animal -1 : 3,441,325 /

yr Of being killed by stranger with psychosis - 1: 14,300,000 / yr

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CANADIAN MEDICAL ASSOCIATION 2008

RESULTS OF A NATIONAL SURVEY

Almost half of Canadians (46%) think people use the term mental illness as an excuse for bad behaviour. One in four Canadians are fearful of being around people who suffer from serious mental illness. Half of Canadians would tell friends or coworkers that they have a family member with a mental illness, compared to 72% for a diagnosis of cancer and 68% for diabetes. Most Canadians (61%) would be unlikely to go to a family doctor who had a mental illness and 58% would shy away from hiring a lawyer, child-care worker or nancial adviser who had a mental illness.
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CANADIAN MEDICAL ASSOCIATION 2008

RESULTS OF A NATIONAL SURVEY

This years report card shine a harsh, and frankly unattering light on the attitudes we Canadians have concerning mental health, said the CMA President, Dr. Brian Day, in a press release.

In some ways, mental illness is the nal frontier of socially-acceptable discrimination.

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THE ONE-TIME OFFENDER

What makes a person just snap? Really, are there no warning signs? These individuals are not predatory and likely not even opportunistic offenders, but, rather, individuals who in a given set of circumstances, act out. Those circumstances may include periods of stress, depression, relationship conict, economic uncertainty, work transitions, or other contributors to impaired mental health

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A 2010 STUDY OF WHOS INCARCERATED

JIM COOK AND KATHY MURPHY, CORRECTIONAL SERVICES DIVISION ALBERTA SOLICITOR GENERAL AND PUBLIC SECURITY

Study looked at every admission to a provincial correctional facility between 1979 and 2009. A total of over 250,000 admissions were studied. For 125,000 individuals, only 1 admission was recorded during the study period. For 38,000 individuals, more than 5 admissions

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PERSONS ADMITTED TO ADULT CUSTODY IN ALBERTA

Percentages

15 9 50 26
1 admission 2-3 admissions 4-5 admissions 6 or more admissions

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AVERAGE AGE AT FIRST ADMISSION

Age (in years)
30 23 15 8 0 1 admission All admissions Chronic (6 or more admissions) 29

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CHRONIC OFFENDERS (CO)

WHO ARE THEY?

Vancouver Police Department (2008) monitored 379 CO, including 27 super chronics The average CO being monitored has 39 convictions. Top 10% of group has average of 77 convictions each. Six offenders have over 100 convictions each. Their offending often directly supports their drug addiction.

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CHRONIC OFFENDERS (CO)

WHO ARE THEY?

VPD Chronic Offender demographics: 84% were born in Canada; 70% were Caucasian; Average age was 35 years; and, Offence record frequently covers 20 years or more.

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CHRONIC OFFENDERS (CO)

WHO ARE THEY?

VPD data shows: 78% of CO were noted to have substance abuse issues; 25% of CO were noted to have some form of mental disorder A number of chronic offenders have some indications of anti-social personality disorder.

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CHRONIC OFFENDERS (CO)

Offence categories in VPD data: 54% property offences 18% non-compliance offences; 8% violent offences; 8% drug offences; and, 12% other offences.

WHO ARE THEY?

Compare to Cook and Murphy: 61% of super CO had index property offences, 57% had index non-compliance offences, and 20% had index Mischief /Disturbance offences.

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RISK FACTORS THE USUAL SUSPECTS

Who is most at risk for recidivism? Early onset Male Substance abuse problems Childhood or adolescent maladjustment Mental health problems

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RISK FACTORS THE USUAL SUSPECTS

In summary, CO are likely to: Have early onset of problems; Have a history of substance abuse; Have a history of mental health problems; Have antisocial personality traits; and, Offend out of perceived necessity, often related to substance abuse.

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THE MENTAL HEALTH OF POLICE OFFICERS

(SCORES FROM MMPI-2-RF)
70 Law enforcement (n = 674) CPS (n = 66)

60

50

40

30 RCd RC1 RC2 RC3 RC4 RC6 RC7 RC8 RC9

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NEW YORK POLICE DEPARTMENT 2004

SURVEY OF 1500 OFFICERS / 574 PARTICIPANTS

29% of police officers found to have one DSM diagnosis, with another 4% having two or more DSM diagnoses. Two-thirds of those diagnosed were diagnosed with an anxiety disorder; onethird were diagnosed with clinical depression.
Source: G. Kapalka et al., 16th Conference of the International Society of Environmental Epidemiology

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RCMP - 2009
PTSD is the third most common medical condition in the RCMP. I didnt really talk about it because I knew it was my own personal experience. I didnt feel that I would benet in any way by talking about it because I felt ... it was just part of the job and you were expected to do this. You brought it home with you and you carried it around everyday. You tried not to. ... I especially noticed it when, after hours, my mind became lled with thoughts of what had happened, what I had seen. ... It seemed like too much time that I spent thinking about things.

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PRISONS AND MENTAL ILLNESS

Bureau of Justice Statistics (2006): 24% of inmates in state prisons had a recently diagnosed mental illness; 14% of inmates in federal prisons had a recently diagnosed mental illness; 56% of inmates in state prisons reported recent symptoms of a mental health problem; 45% of inmates in federal prisons reported recent symptoms of a mental health problem; and, State prisoners with a history of mental health problems were twice as likely as other prisoners to have been injured in a ght since admission.

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PRISONS AND MENTAL ILLNESS

Over one-third of all inmates in federal penitentiaries have a mental health problem requiring treatment. Providing mental health services in provincial jails is hampered by the short length of average sentences (~ 39 days). Providing mental health services in federal penitentiaries is hampered by limited resources. Without access to treatment services, mentally ill offenders serve longer into their sentences, leaving little time for supervised community reintegration, which may actually increase the risk of re-offence.
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PRISONS AND MENTAL ILLNESS

The plight of offenders with mental disorders in prisons has become a major focus and priority of my Office. We know that the prevalence of offenders with signicant mental health issues upon admission has doubled in the past ve years.
Howard Sapers Office of the Correctional Investigator, 2009

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PRISONS AND MENTAL ILLNESS

While the precise numbers and denitions might be in some dispute, it is increasingly clear that we are confronted with a very sizable, vulnerable and distressed population. Federal prisons are housing the largest psychiatric populations in the country.
Howard Sapers Office of the Correctional Investigator, 2009

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PRISONS AND MENTAL ILLNESS

Recommendations from the 2009 Annual Report of the Office of the Correctional Investigator: CSC should bolster recruitment of clinical mental health professionals;* CSC should immediately implement intermediate mental health care units; and, Clinical management plans should be developed, involving interdisciplinary teams.
* 20% vacancy rate in CSC psychology positions in 2010

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Results from the MHCC National Trajectory Project Dr. Anne Crocker (Lead Investigator)

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Please note: The information presented in the following four slides is drawn exclusively from the Quebec sample and may not be indicative of results from the Ontario and British Columbia samples.

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MENTAL HEALTH COURTS / DIVERSION PROGRAMS

By 2010, there were over 250 mental health courts in the United States. Multiple studies show lower rates of recidivism after participation in a mental health court. Participants in mental health courts spend less time in jail than the same participants previously processed in traditional courts. Reduced rates of homelessness, less hospitalization, and reduced rates of substance abuse have also been found.
e.g., Schneider, R.D. Mental health courts and diversion programs: A global survey. Int J Law & Psych 2010.

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MENTAL HEALTH COURTS

SCHNEIDER 2010

It is clear that the problems we are facing within the criminal justice system would not be nearly so pressing had the civil mental health system been operating in a more potent manner. Most of the accused who come through the court house doors have extensive civil mental health histories. So, the civil mental health system had carriage of the matter, but either the individual escaped its clutches, or they were released prematurely, or they fell through some legislative gap. We should be reinvesting in mainstream civil mental health care and perhaps encouraging less the expansion of the courts role as a principal dispenser of mental

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PROGRAM GUIDELINES FOR JUSTICE AND MENTAL HEALTH LIAISONS

In 2006, the Human Resources Committee of the Canadian Association of Chiefs of Police endorsed a set of guidelines to assist police services in the development of programs and services related to police interactions with persons with mental illness. Put simply, the guidelines describe the people and the connections that must exist for better communication between elements of the justice system.
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PROGRAM GUIDELINES FOR JUSTICE AND MENTAL HEALTH LIAISONS

Each organization should foster a culture in which mental illness is viewed as a medical disability not a moral failure, and in which persons with mental illness are treated with the same degree of respect as other members of society.

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THE CONSENSUS PROJECT

A PROJECT OF THE COUNCIL OF STATE GOVERNMENTS

The single most signicant common denominator shared among communities that have successfully improved the criminal justice and mental health systems response to people with mental illness is that each started with some degree of cooperation between at least two key stakeholdersone from the criminal justice system and the other from the mental health system.

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SOME FINAL RECOMMENDATIONS

Better collaboration must occur between Ministries of Justice, Health, Corrections, Education, Employment, Childrens Services, and Social Services; Mental Health Commission of Canada (MHCC) must, in the National Strategy, include attention to assessment and treatment in forensic populations; MHCC Opening Minds campaign must address myths about dangerousness and mental illness and must pay attention to immigrant populations and

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SOME FINAL RECOMMENDATIONS

MHCC Knowledge Exchange must provide strategies for intervention and treatment with offenders, with reluctant clients, and with families; and, MHCC Partners Program must advocate for necessary legislative changes.

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QUESTIONS?
Dr. Patrick Baillie 3500 26th Avenue NE Calgary, Alberta CANADA T1Y 6J4

phone: (403) 943-5662 e-mail: courtdoc@hotmail.com

or

Patrick.Baillie@albertahealthservices.ca

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