CRM3311 Midterm 1

Medico-Penal Nexus Overview

• Moran: Highlights the fluid and historically shifting relationship between medicine, psychiatry, and law in understanding criminality and mental illness.

• Key Idea: Mental disorder in crime is shaped by the merging of disciplines (law, medicine, psychiatry, data).

• Language Rebranding:

  • Terms evolved: criminal lunacy, criminal lunatic, insanity, imbecility, disease of the mind → reflect medical/legal views at the time.

• Criticisms:

  • All mentally ill offenders treated the same regardless of crime severity.

  • Incarceration can cause or worsen mental illness.

Early History to 1914: Definitions and Institutions

• Law of Insanity Defense (1892):

  • Based on M'Naghten Rule (1843) – person not responsible if they couldn't understand their act was wrong.

  • Canada used "capacity to appreciate" vs. M'Naghten’s "knowledge".

• Problems:

  • Lack of infrastructure, training, and guidance.

  • Mentally ill were warehoused in jails due to lack of alternative placements.

Rockwood Asylum (1855-1905) General History

• Built in Kingston as a facility for criminally insane.

  • operated until 1905

• alternative to Kingston pen/Toronto asylum

• formal use of the term “criminal lunacy”

• Conflicts between Dr. Samson and Toronto Asylum’s Joel Workman on patient transfers.

  • Samson wanted to transfer patients to Toronto Asylum

  • Joel rejected and returned the patients

• governed initially by Dr. Litchfield: believed in treatment for all mentally ill (criminal or not).

  • incorporated lobrosian philosophy (individual pathology and inherent criminality)

• John Dickson: opposed Litchfield to not mixing criminal and non-criminal mentally ill patients as it was contaminative

  • Led to 1877 Penitentiary Act changes

    • criminally insane sent back to Kingston pen

M’Naghten Rule

• 1843

• Daniel M'Naghten attempted to murder Britain's prime minister Robert peel

• State of psychosis

• Found to be not responsible

• Insanity defense came out

  • Test of sanity

• Did the accuse experience insanity at the time of offense where they couldn't grasp that it was an illegal act

 

Conditions and Practices at Rockwood

Despite the treatment ethos, the asylum had:

• Widespread abuse and harsh conditions.

• Use of restraints, medicalization, and experimental treatments.

• Questionable methods like:

  • Bloodletting (including leeches),

  • Morphine and alcohol for treatment,

  • Trepanning (drilling holes in the skull to "cure" mental illness).

gender and mental illness

• Scholar Kathleen Kendall highlighted that women prisoners were often constructed as mentally ill and confined to Rockwood

  • reflecting gendered biases in the diagnosis and treatment of mental illness.

Psychiatry’s Growing Power (1870-1900)

• Rise of psychiatric expertise in court.

• Influenced by Lombroso: criminality seen as hereditary/pathological.

• Implications:

  • Few insanity acquittals.

  • Emphasis on biomedical explanations.

  • Terminology in law shifted (e.g., “natural imbecility”).

Royal Commission Report on Penitentiaries (1914)

• A major investigation into Kingston Penitentiary focused on:

  • Officer conduct, prisoner concerns, and institutional conditions.

• Findings (especially on the hospital range):

  • Mentally ill prisoners were warehoused without appropriate care.

  • Severe neglect of prisoner well-being.

  • The report strongly recommended reform, declaring the conditions unacceptable.

• partnership

  • after 1915

    • Efforts to intervene only for mental illness that developed during incarceration.

  • federal/provincial

    • Federal prisons offered compensation to provinces for treating mentally ill prisoners.

    • Provinces rejected these agreements, resisting responsibility for care.

    • Hospitals resisted prisoner transfers, perpetuating the cycle of neglect.

• lack of action = 1971 riot

1971 Riot

• Despite the 1914 commission and other similar investigations, little to no reform occurred.

• Status quo persisted, with neglect and abuse continuing.

• Led to a major riot in 1971 at Kingston Penitentiary:

  • Lasted several days.

  • Sparked by prisoners’ resistance to inhumane confinement.

  • Resulted in deaths and significant attention to prison conditions.

Expansion of the Prison System

• Aimed to disperse the inmate population across multiple institutions:

  • Collins Bay (built 1930)

  • Saskatchewan Penitentiary (opened 1911)

  • Dorchester Penitentiary (opened 1880)

• However, cooperation between prisons and hospitals remained minimal.

  • Resistance to integrating mental health treatment into the correctional system continued.

Kraepelinian Influence (Early-Mid 20th Century)

• Emil Kraepelin: Introduced a foundational model of psychiatric classification.

• His work strongly influenced how mental disorders were diagnosed and categorized, especially post-1945.

• Set the stage for the modern DSM-style approach to mental health.

Psychotherapeutic Interventions (1960s-1970s) Milieu Therapy

• Emphasized structured therapeutic environments.

• Encouraged patient autonomy, challenging traditional hierarchical models of care.

• Aimed to reduce power imbalances between patients and therapists.

• Promoted decision-making and self-regulation within the institution.

• Used peer modeling, where more senior patients exhibited prosocial behavior.

• Criticism: Despite intentions, true power balance was rarely achieved.

Psychotherapeutic Interventions (1960s-1970s) Group Therapy

• Became common in the 1960s–70s.

• Cost-effective and scalable.

• Used for support, social learning, and emotional expression.

• Still prevalent today in both correctional and psychiatric settings.

Pharmacological Interventions

• 1950s onward: Introduction of mood disorder medications.

• Sodium Amytal:

  • Used for impulse control, particularly in those with sexual offenses.

  • Sedative properties, but highly addictive.

• Marked the start of drug-based treatment models in institutions.

Behavioral Modification Techniques: Aversion Therapy

Created negative associations with undesirable behavior (e.g., substance use or deviance).

Behavioral Modification Techniques: Electric Shock Therapy

• ECT = electroconvulsive therapy

• Widely used in Canada for schizophrenia and severe depression.

• Originally administered while patients were awake.

• Now performed under anesthesia, but historical use was invasive and traumatic.

• Known effects:

  • Memory loss

  • Cognitive damage

  • Personality changes

  • High cardiovascular risk

Reinforcement and Punishment Models

• Rewarding prosocial behaviour, punishing antisocial acts.

• Still common in both mental health and correctional institutions today.

Psychosurgery

Lobotomy:

• Involved severing connections in the frontal lobes.

• Used to treat various mental illnesses.

• Highly invasive and dangerous, often resulting in:

  • Severe cognitive impairments

  • Loss of personality

  • Emotional blunting

• Now recognized as an unethical and harmful practice.

Reform and Redefinition (1972-1992) Early Legal Reform Efforts

1970s: Law Reform Commission of Canada

• Conducted studies aimed at legal reform.

• 1976: Advocated for diversion of mentally ill individuals away from prisons.

  • Emphasis on treatment, assessment, and judicial discretion.

  • Called for judges to consider psychiatric care instead of incarceration.

Reform and Redefinition (1972-1992) Landmark Case

Owen Swain (1985)

• Background:

  • In 1983, Swain assaulted his family while in a state of psychosis.

  • Initially jailed, but then transferred to a mental health facility for treatment.

  • At trial (1985), Swain was found Not Criminally Responsible due to mental disorder.

  • However, existing law required indefinite detention under the authority of the provincial lieutenant governor.

• Legal Challenge:

  • Swain's lawyers argued this violated the Canadian Charter of Rights and Freedoms, especially:

    • Section 7: Right to life, liberty, and security.

    • Section 9: Protection from arbitrary detention.

    • Section 12: Protection from cruel and unusual punishment.

    • Section 15: Equality before and under the law.

• Impact:

  • Led to the development of Bill C-30 (1992).

  • Recognized the importance of due process, rights protections, and balance between care and public safety.

Reform and Redefinition (1972-1992) Key Transformation

• Terminological Shift:

  • Replaced outdated terms like "natural imbecility" and "disease of the mind" with “mental disorder.”

  • Introduced NCRMD (Not Criminally Responsible by Reason of Mental Disorder) — still in use today.

• Changes to Court Processes:

  • Eliminated indefinite detention.

  • Introduced three possible dispositions for NCRMD individuals:

    1. Absolute Discharge – Full release, no conditions.

    2. Conditional Discharge – Community release with treatment/monitoring requirements.

    3. Detention in Hospital – Secured mental health facility; most restrictive.

       • Reviewed annually by provincial/territorial Review Boards, composed of mental health and legal professionals.

• Guiding Principles:

  • Minimal intrusion on individual rights unless necessary.

  • Decisions balanced between:

    • Public safety

    • Severity of mental illness

    • Stability and treatment progress

Reform and Redefinition (1972-1992) Critical Perspectives

David Garland (Critical Criminologist):

• Critiques the fusion of psychiatry and law as producing complex power dynamics.

• Warns of:

  • Expanded classification systems and authority structures.

  • Increased control and surveillance under the guise of care.

  • NCRMD being treated as a public safety risk, despite research showing lower recidivism rates.

Erving Goffman - Asylums (1955-1956) Research Approach

Ethnography

• Timeframe: 1955–1956

• Method: Ethnographic fieldwork in a mental health institution.

  • Immersed himself for one year.

  • Observed the daily routines, behaviors, and social dynamics of patients.

  • Provided a qualitative, sociological analysis.

• Publication: Asylums: Essays on the Social Situation of Mental Patients and Other Inmates

  • A seminal critique of psychiatry and the structure of psychiatric institutions.

  • Emphasized the loss of freedom, voluntary containment, and social isolation of patients.

Total Institutions

• Defined as places that:

  • House people long-term, often involuntarily.

  • Are cut off from wider society.

  • Have rigid authority structures and strict routines.

• Examples: Mental hospitals, prisons, military camps, boarding schools, etc.

• Characterized by:

  • Detachment from the outside world

  • Deep power imbalances

  • Internal hierarchies that reinforce control over inmates/patients

“The Keepers and the Kept”

• Describes the sharp divide between staff and patients:

  • Staff's perception: Patients are bitter, secretive, and untrustworthy.

  • Patients' perception: Staff are condescending, controlling, and mean.

• Highlights a mutual distrust and power struggle.

• Reinforces the institutional culture of dominance vs. submission.

Institutionalization

• Long-term confinement shapes a person’s identity and social functioning.

• Creates difficulty in reintegrating into society, especially for:

  • Long-term mental health patients

  • Prisoners with indeterminate or life sentences

• Outside world evolves (e.g., technology, pace of life), but institutions remain static and highly regulated.

Mortification of the Self

• Draws on Harold Garfinkel’s "Degradation Ceremonies".

• Describes how institutions strip away personal identity through:

  • Clothing (e.g., uniforms or gowns)

  • Labels and classifications (e.g., "mentally ill")

  • Conformity to rigid schedules and expectations

• Results in:

  • Dehumanization

  • Preservation of an imposed identity (e.g., patient, inmate) over individuality

Deinstitutionalization (1960s–1980s and beyond) Historical Context and Philosophical Shift

• Began in the 1960s as a response to critiques of mental health institutions and the conditions within them.

• Influenced by:

  • A growing humanitarian philosophy.

  • Emphasis on individual rights and freedoms.

• 1982: Canada's Charter of Rights and Freedoms formally established.

  • Catalyzed legal and social shifts in mental health care.

  • Highlighted the harms of long-term institutionalization and promoted a rights-based framework for care.

Sealy (2012) = two foundational principles

• Community-Based Support

  • Individuals should have access to mental health services within their own communities.

  • Emphasized the value of family and social networks that were often lost in institutional care.

• Investment in Community Services

  • The high costs of operating large psychiatric institutions led to promises of redirecting funds to community care.

  • Core belief: quality care could be more accessible and cost-effective outside institutions.

Durham (1989): 3 Key Themes of Deinstitutionalization = Psychotropic Medication

• Rapid expansion and use of psychiatric drugs (e.g., sedatives, antipsychotics).

• Key tool in behavioral control and symptom management.

• Seen as:

  • Cost-effective

  • Easily distributed

  • Viable for outpatient treatment

• Enabled many individuals to function outside institutions.

Durham (1989): 3 Key Themes of Deinstitutionalization = Human Rights/ Humane Care

• Recognized historic harms of long-term confinement.

• Legal reforms to:

  • Commitment laws: shifted from vague treatment-based justifications to "harm to self or others" as a threshold for involuntary admission.

  • Ensure:

    • Right to appeal

    • Right to legal representation

    • Right to have rights explained

• Movement from forced containment to voluntary care models (though not without limitations).

Durham (1989): 3 Key Themes of Deinstitutionalization = Finances

• Economic logic:

  • Institutions were costly to maintain.

  • Community-based care offered a cheaper alternative.

• However, in practice:

  • Funds were not adequately reinvested into community infrastructure.

  • Created gaps in care, especially for those with severe needs.

Sealy and Whitehead (2004) - Contradictions in Care

• Closure of psychiatric facilities led to:

  • Decrease in dedicated psychiatric beds.

  • Increase in psychiatric patients occupying general hospital beds.

• Reason:

  • Inadequate community services to meet the rising demand.

Transinstitutionalization

• Definition: The shift of individuals with mental illness from psychiatric institutions into other institutional settings.

• Current reality:

  • General hospitals have seen higher rates of mental health admissions.

  • Many individuals formerly served by state mental health facilities are now being absorbed by the criminal justice system (CJS) or emergency departments.

Criminalization of Mental Illness

• Community members report antisocial or unusual behaviors to authorities.

• Without appropriate mental health referral systems, individuals are:

  • Arrested or charged, not directed to care.

  • Subject to criminal records for behaviors stemming from psychiatric conditions.

• Result: Mental illness becomes criminalized instead of treated.

Multi-Institutional Displacement

• People with untreated mental illness are now shuffled through:

  • Shelters

  • Jails and prisons

  • Emergency rooms

  • Deportation systems

  • Other temporary or inadequate institutional settings

• The criminal justice system has become a de facto mental health provider, especially for those who:

  • Lack access to proper treatment.

  • Cycle in and out of prison without receiving support.

• Diversion programs exist but are limited and often ineffective at stopping criminalization.

Is Anybody Listening? (2019 Report)

• By the BC Schizophrenia Society and BC Psychiatric Association.

• Key findings:

  • 29% increase in mental health admissions over 11 years.

  • No increase in the number of psychiatric beds during that time.

  • Resulted in:

    • Overcrowded ERs with psychiatric patients waiting for hours or days.

    • Early discharges before stabilization.

      • Patients often not fully assessed.

      • Leads to relapse, readmission, or criminal justice involvement.

    • Concerns from families and health professionals about the lack of care continuity.

    • Voluntary patients often denied admission due to priority given to involuntary holds.

    • High turnover prevents long-term recovery.

    • Some individuals discharged directly to shelters, worsening outcomes.

• Conclusion: The system is underfunded, overstretched, and failing to provide adequate care.

Historical Representations of Mental Health

• Media has historically portrayed mental illness negatively, emphasizing:

  • Risk, danger, and unpredictability.

• UK (1996) study:

  • Nearly 50% of news articles linked mental illness to criminal behavior or violence.

• Particularly schizophrenia:

  • Highly stigmatized.

  • Frequently (and falsely) associated with violence.

• Empirical research contradicts these portrayals:

  • People with mental illness are more likely to be victims, not perpetrators, of violence.

• Many individuals form their primary understanding of mental illness through media, which can perpetuate misconceptions and stigma.

Whitley Study - Canadian Newspapers (2007-2010)

• Objective:

  • Examine changes in portrayal of mental illness following the creation of Canada's Mental Health Commission in 2007, which aimed to:

    • Reduce stigma.

    • Improve the mental health system.

• Method:

  • Longitudinal content analysis of newspaper articles.

  • Focus on keywords like:

    • Mental health, mental illness, schizophrenia.

  • Guided by questions about:

    • Violence, dangerousness, criminality.

    • Treatment, rehabilitation, recovery.

    • Structural issues (e.g., access to care).

• Findings:

  • 40% of articles emphasized violence, dangerousness, or crime.

  • Only 19% mentioned treatment.

  • Recovery or rehabilitation mentioned in just 18%.

  • Lived experience was missing from 83% of articles.

  • Few statements were made by mental health professionals.

• Conclusion:

  • Despite institutional reform, stigmatizing narratives persisted.

  • Media continued to frame mental illness through the lens of risk and threat, rather than support and recovery.

Whitley and Wang Study - Canadian Television (2013-2015)

• Medium shift: From print to TV coverage.

• Findings:

  • By 2015, 40% of portrayals were more positive.

    • Indicating some progress in reducing stigma.

• Implication:

  • Television began to include more balanced or supportive narratives, possibly due to:

    • Public advocacy.

    • Shifts in policy.

    • Greater awareness of mental health issues.

Context and Rationale

• Growing concern over the criminalization of mental illness, especially in relation to:

  • Systemic racism

  • Police brutality

  • Overrepresentation of racialized and mentally ill individuals in the CJS

• Call to action:

  • Defund the police in specific areas and reallocate funding to healthcare, particularly mental health services.

  • Recognition that mental health is public health and should be treated accordingly.

PAM - Psychiatric Ambulance (Stockholm, Sweden Model)

• PAM = Psychiatric Emergency Response Ambulance

• Launched in Stockholm County, Sweden ~2015.

• Funded as a dedicated alternative to police or general emergency response for:

  • Acute psychiatric crises

  • Suicidality

• Operates daily from 2 PM to 1–2 AM.

• Team Composition

  • 2 Registered Nurses (RNs) with psychiatric expertise

  • 1 Emergency Medical Technician (EMT)

  • Standard ambulance exterior, but equipped for psychiatric care:

    • Medications

    • Access to patient medical history/database

How PAM works and findings

• No age restriction on patients.

• Three priority levels:

  1. Life-threatening situations (e.g., suicide attempts)

  2. Acute but non-life-threatening

  3. Low-risk (e.g., transport to facility)

• Triage model ensures appropriate, non-policing responses.

findings

• 2020 qualitative study (based on interviews with ~30 patients from 2015–2016):

  • PAM handled over 1,000 cases in its first year.

  • 4 calls per day on average.

  • Suicide was the top reason for calls.

  • One-third of cases were resolved on scene, with:

    • Skilled de-escalation

    • Compassionate crisis intervention

• Patients reported:

  • “Caring encounters” that respected dignity and decision-making

  • Felt heard and empowered (vs. traditional, authoritarian responses)

  • Staff were non-judgmental, empathetic, and respectful

Critiques and limitations to PAM

• Not universally positive:

  • Some participants disliked that sirens and external markings made the ambulance identifiable as mental health-related.

    • Felt it violated privacy and increased stigma.

• Broader concerns:

  • Outside PAM, there is low trust in the mental health system:

    • Lack of access

    • Inconsistent quality

    • Insufficient infrastructure

  • PAM alone is not enough:

    • It's a valuable tool, but not a complete solution.

    • Broader systemic changes and more diverse services are still needed.

Canada Mental Health Structure

• Canada does not have a separate mental health system—it is integrated into the broader health care system.

• Mental health care operates as another institutional system, comparable to prisons and the criminal justice system (CJS).

Barriers faced by racialized individuals

• Access and quality of care are significantly impacted by racism and systemic discrimination.

• Individuals report:

  • Infringements of trust due to racist interactions with health professionals.

  • Mental health consequences: depression, anxiety, PTSD.

• Stigma within communities:

  • Cultural silence and judgment around mental health discourage help-seeking.

  • People feel stigmatized for accessing services.

Institutional racism and discrimination

• Toronto Board of Health (Summer 2020) declared anti-Black racism a public health crisis.

• WHO: Racialized individuals experience elevated involuntary commitments—often a form of discrimination (e.g., police involvement).

• Ontario Human Rights Commission (2012):

  • Documented structural racism, racial profiling in mental health care.

  • E.g., Black women stereotyped as “angry,” immigrant women spoken to in belittling tones.

Western vs. Non-western mental health conceptions

• Western model:

  • Focuses on individual pathology, diagnostics (e.g., DSM).

  • Risk assessments based largely on white, male populations.

• Non-Western perspectives:

  • Indigenous and other cultural traditions emphasize balance, storytelling, spirituality, and holistic healing.

• Critique: Western systems exclude and marginalize these culturally grounded approaches.

Indigenous Mental Health and Systemic Trauma

Dr. Roland Chris John (Indigenous scholar):

• Documented the psychiatrization of Indigenous peoples post-residential school trauma.

• Survivors were pathologized, often prescribed medications instead of being supported in healing.

• His work faced silencing by institutional authorities.

• The dominant model ignored Indigenous healing knowledge and survivorship frameworks.

Misdiagnosis and Disparities

• Overdiagnosis of schizophrenia among African American patients.

• Underdiagnosis of mood disorders (e.g., bipolar disorder)—more often diagnosed in white patients.

• Chunn & Chan (2014): Black patients received higher dosages of psychotropic medication than white patients.

• DSM critiques:

  • Heavily used but reflects Western biases.

  • Tools built on probabilities often marginalize non-white populations.

  • Risk assessments often disadvantage Indigenous and racialized prisoners.

Violence and Use of Force in Facilities

• Reports of elevated force by staff, particularly security personnel, against racialized patients.

• Experiences of institutional violence remain an ongoing concern.

Ongoing Themes in terms of discrimination

• Systemic racism, institutional bias, and lack of cultural competence are embedded in mental health care.

• There is a theme of resistance and rejection of these systems by racialized individuals who feel marginalized or harmed.

• The mental health system perpetuates a cycle of disadvantage for racialized communities.

Disproporationate Use of Force

• chan and chunn

• Police are more likely to use force on individuals from racialized groups and those with mental illness.

• Demonstrates how intersecting identities (race + mental health) increase vulnerability during police encounters.

SIU - Special Investigations Unit

• An independent civilian oversight body for police in Ontario.

• Handles cases involving:

  • Use of force

  • Serious injury

  • Death

  • Sexual assault

• Mandate: Promote accountability and public trust by investigating police misconduct.

Wortley’s Findings (2013-2017)

• SIU cases involving serious injury or death examined.

• Key data:

  • 70% of police shootings that resulted in death involved Black Torontonians.

  • Demonstrates a disproportionate and lethal application of force against Black individuals in Toronto.

Criminalization Pathway and ongoing issues

• Racial profiling and systemic racism act as a pipeline into the CJS:

  • Increased police stops and surveillance.

  • Higher rates of charges, carceral sentences, and recidivism risks.

• Longer sentences and harsher treatment reflect a pattern of systemic criminalization.

ongoing issues

• Even post-incarceration, individuals from racialized communities face continued:

  • Discrimination

  • Surveillance

  • Barriers to reintegration

Root Causes of Overrepresentation

Over-targeted policing and racialized criminalization lead to:

• Higher incarceration rates for Indigenous and Black communities.

• A disproportionate number of racialized individuals in prisons despite overall prison admissions decreasing.

OCI -Office of the Correctional Investigator - Reports

• OCI Annual Report (2018–2019):

  • Federal prison admissions declined overall, but:

    • Indigenous representation increased significantly.

    • Indigenous people are overrepresented, especially in federal institutions.

• OCI Report (2013):

  • “A Case Study of Diversity in Corrections: The Black Inmate Experience in Federal Penitentiaries”:

    • Between 1993 and 2003, there was a 75% increase in Black federal prisoners.

Indigenous Women in Prison

• Identified as the fastest-growing prison population in Canada.

• Major concerns raised by:

  • Elizabeth Fry Society:

    • Advocates for women and girls, especially those at risk of criminalization.

    • Provides intervention, support, and housing services.

• 2017 Public Statements:

  • Criticism of Edmonton Institution for Women (federal women’s prison).

    • Indigenous women with mental illness were not receiving appropriate or adequate care.

    • Conditions described as highly securitized, especially in high-security wings, which held a disproportionate number of Indigenous women.

  • Kim Pate (then-President of the Elizabeth Fry Society):

    • Emphasized the systemic neglect and indifference of Corrections Canada to provide proper mental health care and trauma-informed conditions.

    • Highlighted that most incarcerated women are not high-risk violent offenders, making extreme security measures inappropriate and harmful.

Poor Conditions and Institutional Failures

• Prison environments often lack:

  • Culturally appropriate services.

  • Trauma-informed approaches to care.

  • Recognition of the gendered and racialized pathways into criminalization.

• Many of these women are:

  • Survivors of violence, poverty, colonial trauma, and mental health crises.

• Correctional settings perpetuate harm instead of promoting rehabilitation or healing.

Case Study - Alan

• collins, 2012

• Identity: Aboriginal man, identifies as Two-Spirited.

• Early life:

  • Turned to substance use due to entrenched racism and homophobia.

• Teenage years:

  • Charged with attempted murder during a violent incident.

  • Found not criminally responsible, committed under Governor General’s Warrant to a psychiatric prison.

• Incarceration experience:

  • Subjected to sensory deprivation and psychotropic drugs.

  • Example of how the state experiments on marginalized individuals perceived as disposable.

• Later life:

  • Released to a community-based therapeutic center.

  • Brief success as a Peer Worker, but later reoffended following substance use and violence.

  • Sentenced to life in prison.

• Themes:

  • Institutionalization, trans-institutionalization, racism, discrimination against gender identity, state neglect, and harmful experimentation.

Mental Illness and Incarceration

• Canada:

  • 50% of inmates have a dual diagnosis (mental illness + developmental disability).

  • 85% of those arrested were under the influence of one or more substances at the time.

• U.S.:

  • Dual diagnosis often includes substance use disorder and major mental illness.

  • 2015 Human Rights Watch: "Callous and Cruel"

    • Black and Latino men with mental illness:

      • More likely to be punished, face use of force, and be disciplined for minor misconduct.

Solitary Confinement and Racial Disparities

• Black prisoners in the U.S.:

  • 4x more likely to be placed in solitary confinement.

  • Solitary terms are 40% longer than those of White prisoners.

• Punishment of symptoms:

  • Mental illness is frequently criminalized rather than treated.

  • Default institutional response = solitary confinement.

Deaths in Custody

• Common causes:

  • Lack of transparency and oversight in prisons.

  • Poor or non-existent mental health care.

  • Systematic gatekeeping prevents accountability.

Case Study: Jamycheal Mitchell (2016)

• Young Black man with suspected psychosis.

• Arrested in Virginia for stealing $5 worth of snacks.

• Ordered to a state psychiatric facility, but no beds were available.

• Held in jail custody:

  • Denied care, stopped eating, mental and physical health deteriorated.

  • Family’s pleas ignored.

  • Died in custody after several months.

  • No wrongdoing acknowledged by jail.

  • Investigations found:

    • Lack of cooperation from jail.

    • Inadequate health care and mental health programming.

Systemic issues in bail and custody

• Bail system:

  • Fees and restrictions make it difficult for poor and racialized people to gain release.

  • Those labeled as "dangerous" are often denied bail, reinforcing incarceration.

• Structural racism:

  • Embedded in both mental health systems and criminal justice systems.

  • Results in a cycle of disadvantage and containment that recurs across decades.

Reach Out Response Network - Toronto-Based Mental Health Emergency Response

Overview

• Location: Toronto, Canada

• Co-Creator: Asante Haughton - instrumental in developing a mental health emergency response team with a civilian-only approach, aimed at reducing police involvement in mental health crises.

Key Features of the Reach out Response Network and Service Details

Mental Health Emergency Response Team:

• Operates without police involvement.

• Focuses on civilian-led interventions to support individuals in crisis.

• 9-1-1 Integrated: Accessible through Toronto's emergency services.

• Aimed at reducing police escalation during mental health incidents.

Service Details

• Target Audience:

  • Individuals 16 years and older experiencing a mental health crisis.

  • Accessible 24/7 in four areas of Toronto.

  • Designed as an entirely voluntary service with the option of follow-up care.

Response team in reach out response network

• Mobile Teams:

  • Comprised of highly trained professionals:

    • Social Workers

    • Nurses

    • Crisis Response Specialists

  • De-escalation: Focus on crisis de-escalation at the scene and follow-up support.

• Post-Visit Support:

  • Follow-up calls from the response team within 48 hours to ensure continued care.

  • Case managers offer support services such as:

    • Addiction services

    • Nursing care

    • Housing assistance

Philosophical approach with community-led initiative of reach out response network

Philosophical Approach

• Trauma-Informed: The program takes into account the trauma often experienced by racialized communities and individuals in crisis.

• Anti-Black Racism Perspective: Prioritizes anti-racist strategies to better serve Black communities and reduce systemic harm.

• Anti-Oppressive Framework: The initiative recognizes and addresses systemic oppressions affecting marginalized groups.

• No-Wrong-Door: Individuals can access services for themselves or for others without being turned away.

Community-Led Initiative

• Culturally Competent and Accessible: Ensures that mental health services are accessible and equitable, especially for marginalized and racialized groups.

• Funding and Support: The program is designed to secure necessary funding to sustain its services, ensuring accessibility and reliability of support.

Youth Homelessness (Ben Roebuck) Key Points

• Drug addiction and mental health struggles often contribute to youth homelessness.

• Sexual orientation or gender identity conflict leads to 20-40% of youth homelessness.

• Family conflict (e.g., violence, rejection due to sexual orientation/identity) is a major contributor.

• Many youth leave foster care or child welfare systems due to abuse and violence, but changes in legislation now allow them to return to care after 16.

• High rates of childhood trauma, with 51% experiencing physical abuse, 24% experiencing sexual abuse, and 63% experiencing at least one form of abuse.

• Victimization: Over 63% of homeless youth report being victimized multiple times within a year.

Stories of Youth Homelessness

• Kristin: Struggled with sexual assault, turned to drugs as a coping mechanism.

• Jake: Left a violent home, turned to prostitution for survival after being sexually assaulted in foster care.

• Ryan: Engaged in theft after experiencing theft himself while on the streets.

• Dustin: Became involved in group muggings after being robbed.

COVID-19 vs. Homeless Youth

• Mental Health: Increased anxiety, depression, sleep disturbances, and rising rates of suicide attempts.

• Substance Use: Significant rise in use and overdoses during the pandemic, with youth 15-24 being the fastest-growing group hospitalized for opioid overdoses pre-pandemic.

• Barriers:

  • Lack of access to phone/internet/technology.

  • Virtual care is a challenge, and in-person support is essential for youth experiencing homelessness.