Mental health and criminal justice: a long and dysfunctional relationship (Ed McIsaac)

Mental health and criminal justice have a long and dysfunctional relationship.

Inevitably it seems our desire for punishment overtakes both the needs of the individual offender suffering from mental illness and our collective long-term interest in reintegrating these offenders effectively.

In the mid-1800s, driven by concern for the high number of mentally ill individuals housed under inhumane conditions within the prison system, a movement emerged advocating for the humane, enlightened treatment of individuals with mental illness. Consequently, the number of mentally ill within the prison system was significantly reduced. Over time these new places of sanctuary and treatment, due in part to overcrowding, became viewed as warehouses for the mentally ill.

In the 1960s, faced with growing costs and concerns over the effectiveness and fairness of housing individuals in these institutions, governments began a program of releasing the mentally ill into the community. This deinstitutionalization process was to be supported by an extensive network of community mental health resources to enable the mentally ill to integrate into their communities.

The movement of the mentally ill from institutions to the community was significant. In 1959, there were 65,000 beds in mental hospitals across Canada; by 1976 the bed count had dropped to 15,000 in provincial hospitals and 6,000 in general psychiatric units.[1]

The promised network of community mental health resources in support of deinstitutionalization was never fully realized. This inevitably led to increased contact between the mentally ill and the criminal justice system which in turn resulted in an increase in their incarceration rates. In the early 70s the U.S. also embarked on a “war on drugs – tough on crime” campaign, which resulted in a massive increase in their prison population, with a disproportionate number of those incarcerated suffering from mental illness.

In Canada, we are at the front end of our own campaign of “tough on drugs and crime”, and we can rest assured that our prison population will continue to rise and that the percentage of individuals suffering from mental illness within that population will continue to grow.  Currently, of the 15,000 federal inmates, between 10 and 15% have a significant mental health diagnosis on admission, and 14% have had a previous history of psychiatric hospitalization. The Correctional Service has only 675 treatment beds.

The Correctional Investigator in commenting on the treatment of offenders with mental illness at the federal level stated in his 2010–2011 Annual Report, “Simply put, there is not enough capacity, resources, or professionals to meet the increase demand being placed on a system that was never intended to cope with such a profoundly ill population.” In April of 2012, the government announced the closing of one of its four facilities designated to the treatment of mentally ill offenders, with no word on how these treatment beds would be replaced.

The public attention became focused on issues surrounding mental health and imprisonment with the death of Ms. Ashley Smith in 2007. Ms. Smith, a teenager, died in a segregation cell of a federal penitentiary while under twenty-four suicide watch. Two independent investigations were initiated. One by the Ombudsman of New Brunswick, focused on the services provided by the provincial youth justice and mental health systems prior to her transfer to the federal system. The second by the Correctional Investigator, focused on the 11-month period of federal custody and the circumstances of her death.

Both reports were scathing. The Correctional Investigator, in finding that the death was preventable, concluded: “The tragic death of Ms. Smith not only speaks to a breakdown within federal corrections. The federal/provincial health care and corrections systems collectively failed to provide Ms. Smith with the appropriate care, treatment, and support she so desperately required. A concerted effort, with leadership from the highest levels, is clearly needed to fix the lack of coordination and cohesiveness between jurisdictions, and between federal/provincial correctional systems and mental health providers.”

In many ways we have returned to the mid-1800s.

The immediate challenge is twofold.  First, establish humane, responsive community mental health options to incarceration for individuals who come into conflict with the law. Second, ensure that those offenders suffering with mental illness, who are in prison, receive mental health services that address both their immediate needs and their future reintegration.

The time for jurisdictional infighting has long past.

–Ed McIsaac