Innovative Mental Health Strategies: mental health is not criminal justice

There has been a common trend over the past few decades to deinstitutionalize psychiatric services in Canada. In fact, “deinstitutionalization of psychiatric services in 1960s and 1970s and has been continuous for the past 40 years.”[1] Due to the lack of psychiatric facilities, the consequence of this trend has led patients to be discharged into the community.[2] This has left a growing gap in social services supports for our most vulnerable populations who struggle with psychiatric issues. Growing up with a parent who struggled with psychiatric illness, this has led me to invest a lot of time over the years to understand the prevalence of vulnerable people who end up in the criminal justice system and what becomes of them.[3] The literature regarding this issue seems to suggest that due to the lack of supports at the community level, this has left a vulnerable population inappropriately locked up in prisons rather than being treated for their illness.

The Canadian Alliance on Mental Illness and Mental Health reports that the “criminal justice system is rapidly becoming the largest mental health provider in the country.”[4] In addition, the World Health Organization reports that due to the lack of social supports, prisons have “sometimes been used as a dumping ground for people with mental disorders.”[5] Canada has not been immune to this trend and the data suggests that individuals who have complex mental health needs are becoming more criminalized and advancing through the criminal justice system at an alarming rate. For example, Correctional Services of Canada (CSC) has reported that the “proportion of federal offenders with significant mental health needs have more than doubled between 1997 and 2008.” [6] The data suggest that this trend does not seem to be subsiding. In fact, the Office of the Correctional Investigator reports that mental health disorders in Canadian prisons are two to three times more common than in the general community.[7] Not only is it more common for individuals with mental health needs to be incarcerated, the data also seems to suggest that “people with mental illness face a higher risk of arrest… than the general population.”[8] The Canadian Mental Health Association “attributes the expanding rate of incarceration of individuals with mental health problems and mental illnesses is due to the lack of a national mental health strategy for Canada.”[9]

Not only are vulnerable people being inappropriately locked up in prisons rather than being treated for their illness, the trend seems to also suggest that mental illness is a driver of costs in the criminal justice system.[10] A study conducted in 2016 out of Alberta reports that as complex needs cases advance through the criminal justice system, so does the cost on the system and to taxpayers.[11] This is an expensive solution “given that the length of stay in a federal penitentiary is a minimum of 2 years and costs the Canadian taxpayer the amount of $189,106.50 annually.”[12] There are more effective ways to reduce costs then locking away the problem. A mental health strategy that provides proper interventions at earlier stages in the criminal justice process should be a critical goal for government and policy makers. Research shows that there are many points of intercepts [13] where thoughtful interventions can occur that focus on treatment rather than punishment to reduce days in custody and recidivism rates for offenders with mental health needs. These interventions could promote stabilization and recovery for vulnerable people and offer long term solutions.

There is no doubt that the issues surrounding mental health in the criminal justice system are complex and challenging, however a lack of mental health strategies are placing a large burden on our system. One innovative solution that can be created to combat this issue is an Interdisciplinary Criminal Advocacy Team (ICAT), which is a one stop shop that provides case management and long-term interventions to assist vulnerable individuals in conflict with the law to prevent their advancement to subsequent stages within the criminal justice system. This model of treatment would focus on rehabilitation rather than punishment. The mission of the ICAT team would provide interventions at every stage in the criminal justice system to promote stabilization and recovery in vulnerable populations. This model is based off the Sequential Intercept Model that allows for “a series of points of interception at which an intervention can be made to prevent individuals from entering or penetrating deeper into the criminal justice system.”[14] Ideally, “most people will be intercepted at early points.”[15] There are multiple interception points where individuals could be referred to ICAT including “law enforcement and emergency services; initial detention and initial hearings; jail, courts, forensic evaluations, and forensic commitments; re-entry from jails, prisons, and forensic hospitalization; and community corrections and community support.”[16]

This humanistic approach would encompass a wrap around service delivery model where interdisciplinary professionals such as Lawyers, Psychologists, Psychiatrist, Addictions Counsellors, Case Managers and Social Workers work together under one roof as a team to treat individuals in conflict with the law by offering rehabilitation rather than punishment. The goal would be to treat the cause of offending behaviours and to reduce recidivism rates and days in custody. The Interdisciplinary Criminal Advocacy Team would be a better use of taxpayer dollars as it would operate under a non-profit organization and it would be governed by a Board of Directors using service delivery guidelines and outcome measures. This framework would be cost effective as professionals would be paid a base salary under a general operating budget rather than accumulating expensive outside consulting fees or private practice costs. In addition, taxpayer costs would be reduced, and efficiencies would be maximized because the team would work closely together and operate without service gaps to meet the needs of the clients at earlier stages. This framework would allow professionals to properly manage these cases and provide long-term interventions so vulnerable individuals in conflict with the law do not advance to subsequent stages within the criminal justice system.

Endnotes

[1] Patricia Sealy & Paul Whitehead, “Forty Years of Deinstitutionalization of Psychiatric Services in Canada” An Empirical Assessment (2011), 49:4 Canadian Journal of Psychiatry 249-257 at 249.

[2] Ibid.

[3] “Law Students willingly work overtime to present at Accessing Justice” UM Today News (27 April 2018) online: <http://news.umanitoba.ca/law-students-willingly-work-overtime-to-present-at-accessing-justice/>.

[4] “Criminal Justice System; The Largest Mental Health Provider in the Country” (8 February 2015), online: Canadian Alliance on Mental Illness and Mental Health <http://www.camimh.ca/criminal-justice-system-the-largest-mental-health-provider-in-the-country/>.

[5] “Mental Health and Prisons,” online: World Health Organization, <http://www.who.int/mental_health/policy/mh_in_prison.pdf>.

[6] Howard Sapers, “Mental Health and Corrections” (2011), online: Office of the Correctional Investigator <http://www.oci-bec.gc.ca/cnt/comm/presentations/presentations20120318-eng.aspx>.

[7] Ibid.

[8] Alene Kennedy-Hendrick, Haiden A. Huskamp, Lainie Rutkow, Colleen L. Barry, “Improving Access to Care and Reducing Involvement in the Criminal Justice system for People with Mental Illness” (2016) 35:6 Health Affairs, Health Aff 1 at 6.

[9] “Mental Health Strategy for Corrections in Canada,” online: Federal-Provincial-Territorial Working Group in Mental Heath <http://www.csc-scc.gc.ca/health/092/MH-strategy-eng.pdf>.

[10] Philip Jacobs, Jessica Moffatt, Carolyn Dewa, Thanh Nguyen, Ting Zhangd, Alain Lesage, “Mental Health Services Costs Within the Alberta Criminal Justice System” (2016) 47 Intl J L and Psychiatry 102 at 102.

[11] Ibid.

[12] “Criminal Justice System; The Largest Mental Health Provider in the Country” (8 February 2015), online: Canadian Alliance on Mental Illness and Mental Health <http://www.camimh.ca/criminal-justice-system-the-largest-mental-health-provider-in-the-country/>.

[13] Mark Munetz & Patricia Griffin, Use of the Sequential Intercept Model as an Approach to Decriminalization of People With Serious Mental Illness (2006), 57:4 Psychiatric Services 544-549 at 544.

[14] Ibid.

[15] Ibid.

[16] Ibid.