Mental Health and The Criminal Justice System

The Criminal Justice System in Canada (Butler, Rossiter, & Nicholls, 2022)

• 3 main parts

  • Law enforcement (police)

  • Adjudication and dispositions (courts, Review Boards)

  • Agencies responsible for detaining and supervising sentenced offenders (correctional facilities and community corrections, forensic mental health services)

• Responsibility shared between federal, provincial, and municipal governments

  
  

overrepresentation of people w mental illnesses in the criminal justice system

• # of police encounters w persons w mental illnesses have increased significantly

• once arrested ppl w mental illnesses more likely to be charged, less likely to be released on bail, likely to spend considerably longer in custody before receiving bail

• onerous bail conditions contribute to revolving door cycle of rearrest, recharging, and reincarcerations, especially among ppl w mental illnesses

Impact of Deinstitutionalization

• Process of shifting mental health care from institutional care to community-based outpatient settings

• Reduction in inpatient beds outpaced expansion of community-based services and supports (Livingston et al., 2011)

• in post-deinstitutionalization era, people are regularly discharged to the street or shelters (Forchuk et al., 2006)
  

Risk Factors for Crime and Violence among people w mental illnesses

• Most people with mental illness never engage in violence and are more likely to be victims of violence than perpetrators

• Risk of violence can be diminished by access to quality mental health services (Langeveld et al., 2014)

  
  

Social Determinants of Heath and Criminal Behaviour

• Poverty explains part of relationship between mental illnesses and other social problems
  • E.g., lower educational attainment, under- employment, substance use, reduced likelihood of prosocial attachments (Draine et al., 2002)

• Experiencing homelessness increases risk of incarceration, and incarceration increases risk of future homelessness (Moschion & Johnson, 2019)

• Stigma towards people with mental illnesses remains pervasive

  
  

Criminal Justice Diversion

• Diversion: redirection of people away from criminal justice system and towards services believed to address needs leading to offending

• Often accomplished through coordinated and integrated efforts between mental health, criminal justice, and social service systems (Livingston et al., 2008)

Police Interactions w People w Mental Illnesses

• Many people with mental illnesses who encounter police are dealt with informally

• Police often play role of “street corner psychiatrist” and serve as primary source of referral to psychiatric care (Lamb et al., 2002)

• Training in recognizing symptoms of mental illnesses and using de-escalation techniques can reduce level of force and other negative outcomes

  
  

Common Pre-Arrest Diversion Models

• Crisis Intervention Training (CIT)
  • Originally developed in US
  • Trained officers assist general patrol when call has been flagged as mental health related
  • Goals: safety, increased connection to mental health services, strategic use of law enforcement, reduction of trauma (Usher et al., 2019)

• Toronto MCIT
  • The MCIT is a collaborative partnership between participating hospitals and the Toronto Police Service (TPS). The program partners a mental health nurse and a specially trained police officer to respond to 911 emergency and police dispatch calls involving individuals experiencing a mental health crisis. When MCIT attends a call, they will, assess the person in crisis; and, connect the person to an appropriate follow−up service

Forensic MH Systems

• If a person has been arrested and charged with a crime, and their mental health is called into question,
  • The accused may be found unfit to stand trial because of a mental disorder
  • If the case proceeds to trial and during the proceedings the judge or jury determines the person did commit the act underlying the offence, the accused or Crown may raise NCRMD defence
  • At the time of verdict, the judge may order a psychiatric assessment
  • The accused is remanded to psychiatric hospital and evaluation is conducted

  
  

Fitness to Stand Trial

• Section 2 of the Criminal Code stipulates that a person is unfit to stand trial (UST) if they are unable on account of mental disorder to
  • Understand nature or object of proceedings
  • Understand possible consequences of proceedings
  • Communicate with counsel

• If person is found UST, court may make initial disposition, but Review Board will review disposition within 90 days

• Two disposition options: conditional discharge or detention order

Criminal Responsibility

• Can only be raised if the accused has put their mental condition in issue by raising NCRMD defence or it is determined that the accused has committed the offence in question

• Finding of NCRMD is neither acquittal nor finding of guilt

• NCR accused generally come under purview of Review Board system

• In reality, NCR verdicts are rare

• NCRMD cases represented less than 1% of adult criminal court cases processed annually for each of the ten reporting provinces and territories and this proportion remained relatively stable over the period studied

CASE: Vince Li - NCRMD

• According to section 16 of the Criminal Code:

• No person is criminally responsible for an act committed or an omission made while suffering from a mental disorder that rendered the person incapable of appreciating the nature and quality of the act or omission or of knowing that it was wrong

MH Courts

• Typically supported by psychiatrists, mental health workers, other social services staff

• Intended to prevent incarceration of people with mental illnesses

• Criticisms: paternalistic; may inadvertently “encourage” police to arrest people with mental illnesses with intention of ensuring priority access to treatment

• Limited research on effectiveness

  
  

The Impacts of Imprisonment on Psychological Well-Being

• Many people who are incarcerated suffer long-term social and psychological consequences (Schnittker, 2013)

• Experiences of violence and victimization leading to trauma prior to incarceration are very common

• Mental health concerns, e.g., PTSD, may be exacerbated or caused by conditions of confinement

• Prisoners with mental illnesses may have diminished ability to cope with stress of incarceration (Metzner & Fellner, 2010); have higher rates of disciplinary infractions (due to behaviours considered punishable misconduct)(Abramsky & Fellner, 2013)

• Added dangers of solitary confinement