1. Mental Health and the Law Forensics studies course A panel discussion Presenting Evelyn Wilson RN BSc.N (C)COHN Employed by the MCSCS ( Ministry of Community Safety and Correctional Services) 1

2. Mental Health and the Law Forensics studies course A panel discussion Overview of Provincial Facilities Statistics Overall Trends Trends focusing on incarcerated mentally ill Health care Multidisciplinary Teams in Corrections Community Partners Case studies On line Resources Contact info Discussion 2

3. Mental Health and the Law Forensics studies course A panel discussion Overview of Provincial Facilities Detention /Correction =25 range in capacity from 25 t0 1,500 inmates Treatment=2 ;both with approx capacity of 150 -Algoma Treatment Unit and Remand Centre - Ontario Correctional Institute Co-operative initiative=1 -St Lawrence Valley Treatment Unit 3

4. Mental Health and the Law, Forensics studies course A panel discussion Corrections Population: 2007/08, approx.65 per cent of the institutional population were remanded. 2007/08, the average number of days stay in remand was 35.5. 2002/03 to 2007/08, the number of women admitted to custody in increased by approx. 31 per cent As of May 30, 2008, Ministry estimated 15 per cent of inmates required some form of clinical intervention for mental health issues. The number of accused with mental health alerts remanded to provincial custody increased by 44.1 per cent over the last decade. Aboriginal Peoples continue to be over-represented in Ontarios correctional system, as is the case nationally. 4

5. Mental Health and the Law Forensics studies course A panel discussion Recidivism : A return to correctional supervision on a new disposition within two years of release from a provincial sentence to incarceration or the completion of a community disposition Trends over the past decade indicate there has been moderate decreases in recidivism. the trend seems to indicate that the more serious the charge the more likely the person is to be a repeat offender 5

6. Mental Health and the Law Forensics studies course A panel discussion Special needs The number of inmates with psychiatric issues has continued to grow since the 2008 statistics to have grown but numbers are not definitive. A large part of the recorded information is self reported. It is speculated that many new admissions have become more forthcoming in reporting there history of mental illness. The tracking information that is entered into the system does not differentiate between specific diagnoses. What is captured in the inmate tracking system can be substance abuse, depression, FASD, etc 6

7. Mental Health and the Law Forensics studies course A panel discussion CMHA findings Research shows that a person with mental illness is more likely to be arrested for a minor criminal offence than a non-ill person. The range of mentally disordered offenders currently in jails and prisons is somewhere between 15 to 40%; highly disproportionate to the occurrence of mental illness in the population at large 7

8. Mental Health and the Law Forensics studies course A panel discussion The CMHA sees as Contributing factors : Lack of sufficient community support High rate of substance abuse The Forensic label. Problems with treatment Lack of specialized cross-training for both criminal justice and mental health professionals. Lack of timely access to mental health assessment and treatment 8

9. Mental Health and the Law Forensics studies course A panel discussion Health care in Corrections Nurses-general duty Mental health nurses Challenges in meeting College of nurses professional standards Security first 9

10. Mental Health and the Law Forensics studies course A panel discussion Multidisciplinary Team Members Internal : Correctional officers Social workers/classification Chaplaincy Nurses Psychiatry Psychologists Senior management 10

11. Mental Health and the Law Forensics studies course A panel discussion Multidisciplinary teams members contd Our Community Partners: Probation and parole CMHA, court diversion Schedule One Hospitals, Local Emergency Departments Police Crown Attorneys office Public health HJSCC John Howard Society, E. Fry, Aboriginal agencies 11

12. Questions in relation to the Ministry of Community safety and Correctional Service 12 Mental Health and the Law Forensics studies course A panel discussion

13. Case study J.W. 64 year old gentleman with no prior criminal record with suspicion of dementia He was in LTC when he sexually assaulted 3 vulnerable defenceless men Charged, arrested and remanded in custody at the HWDC Could not return to LTC because of offences Assessed for fitness, found fit CCAC demanded a psycho-geriatric assessment in order for them to be re-involved 13

14. Case study J.W Psycho-geriatric clinic required a risk assessment Risk assessment eventually completed at HWDC Psycho-geriatric assessment completed ; it was determined that he was not cognitively impaired enough to warrant admission to hospital. The doctor however felt he was unfit and NCR Second fitness assessment ordered, he was again found fit by the forensic assessment team 14 Mental Health and the Law Forensics studies course A panel discussion

15. Case study J.W. Case conference held to develop a plan for his eventual release from custody LTC still could not place him because he remained a risk There was no other viable discharge plan to be had J.W., admitted while in custody that he planned on sexually assaulting other males in the future 15

16. Mental Health and the Law Forensics studies course A panel discussion Case study J.W. CMHA submitted letter for court outlining concerns and to advocate for a NCR assessment ( at that point he had been in custody for almost one year) Because no viable discharge plan could be achieved it was determined that he was to be driven to ER at the local hospital He stayed at the hospital for one year 1:1 staff, he was diagnosed with schizophrenia 16

17. Mental Health and the Law Forensics studies course A panel discussion Case study J.W. He committed another sexual assault on a co-patient in the hospital, he was charged and remanded into custody at the HWDC Finally assessed for criminal responsibility and found responsible Languished in custody for several months before he went to trial,he was convicted of the sexual assault 17

18. Mental Health and the Law Forensics studies course A panel discussion Case study J.W. After serving his sentence there was still no place for him to be discharged to. He again returned to the hospital where he resided with 1:1 staff until he died. 18

19. Mental Health and the Law Forensics studies course A panel discussion Case study –Rob 51 year old gentleman, diagnosed with chronic schizophrenia and substance abuse(history of crack use and most recently marijuana) Staying at shelters for last 4 years, prior to that at RCF Refusing medications for last 3-4 years History of hospitalizations last time had been 4 years ago Had never attended for follow up with community psychiatrists Had 3 charges of assault on strangers in the community 19

20. Mental Health and the Law Forensics studies course A panel discussion Case study –Rob Many incarcerations for assaults and breach of probations Latest assault was on a female who he pushed into the road Refused help from public health out reach workers at the shelter Constant involvement with police- issued 38 tickets at Jackson Square for violation of his probation Refused to attend probation appointments Was sentenced to 6 months for assault on female 20

21. Mental Health and the Law Forensics studies course A panel discussion Case study –Rob While he was in custody his case was brought forward to the HJSCC Following discussion it was agreed the HWDC psychiatrist would place him on a Form One just prior to release with a planned admission to St. Josephs Mountain Site Admitted directly to the schizophrenia unit Was stabilized through compliance with treatment Placed on CTO 21

22. Mental Health and the Law Forensics studies course A panel discussion Case study –Rob Released from hospital to an RCF facility Has not returned to custody for 18 months Rob now says he does not want to go back to that lifestyle Attends psychiatric follow up in the community, attends probation appointments Does odd jobs for the owner of the RCF 22

23. Resources 1.Mental Health Strategy for Corrections in Canada: http://www.mcscs.jus.gov.on.ca/english/publications/Corrections/MCSCS_pubs_mental_health.html 2. Jailhouse Lottery: www.ontario.cmha.ca/network_story.asp?cID=56754 3.Ministry of Community Safety and Correctional Services : www.mcscs.jus.gov.on.ca 4. Annual Report of the office of the Correctional Investigator 2009-2100 http://www.oci-bec.gc.ca/rpt/annrpt20092010-eng.aspx 5. Criminalization of Mental Illness http://www.cmha.bc.ca/files/2-criminalization.pdf 6.http://www.mcscs.jus.gov.on.ca/english/publications/2008-2013SPFull/0813_sp_full.html http ://www.mcscs.jus.gov.on.ca/english/publications/2008-2013SPFull/0813_sp_full.html Case studies: Liane Taylor of Hamilton CMHA-With Thanks ! 23