Recidivism Drops in Those Supervised by Mental Health Courts

An article published in the June 18th edition of Psychiatric News:

By Aaron Levin

Research on the outcomes of mental health courts is steadily accumulating, and the results show promise, but some critical questions remain unanswered.

Criminal defendants who complete programs supervised by mental health courts are less likely to be rearrested in the following two years, according to a new study by North Carolina researchers appearing in the May Psychiatric Services.

About 72 percent of those who completed the program were not rearrested in that time, compared with just 19 percent of those who were expelled from the program and 37 percent of those who chose to leave, said Virginia Hiday, Ph.D., a distinguished professor of sociology and anthropology, and doctoral student Bradley Ray, M.A., both at North Carolina State University.

To read the entire article, please click here.

Also see:

Nova Scotia's Mental Health Court Program

Speech from the Throne 2010

An excerpt from today's Speech from the Throne:

My government will undertake a new Mental Health Strategy to revamp mental health and addiction services. And the provincial Mental Health Court is already helping to ensure that those who suffer with mental illness are treated with the respect and care they deserve, while ensuring that the justice system is also well served.

To download the entire Speech from the Throne 2010, please click here (PDF)

Please click on the image to enlarge it.

Mental health court takes first cases

An article published in today's edition of The Chronicle Herald:

'It’s not about the crime, it’s about the person'

By Davene Jeffrey

The first sitting of the province’s mental health court wrapped up quickly Thursday afternoon in Halifax.

With just five cases on the docket, the session was over in just 15 minutes. And unlike in other courts, most of the participants seemed happy to be there.

"The docket will grow," said legal aid defence lawyer Kelly Rowlett. "There are a lot of mentally ill people who have filtered through the criminal court and forensic system."

Ms. Rowlett is one of two lawyers who will defend people who appear in the mental health court.

In the inaugural session Thursday, three men and two women facing charges ranging from assault with a weapon to mischief appeared in the court. Four of the five were eager to have the mental health court handle their cases.

One woman said she wanted time to review information on the program before deciding.

A team including a nurse and social worker will now interview the four and determine whether they are eligible for the program.

The atmosphere in the mental health court is meant to be collaborative rather than adversarial, said Crown attorney Sandi MacKinnon. The clients must acknowledge their guilt and sign a form stating they are entering the program voluntarily.

"It’s not about the crime, it’s about the person," Ms. Rowlett said.

And while the court is designed to be a better fit for people with mental health issues, it is also a good situation for Ms. Rowlett and Ms. MacKinnon, they said.

"In a previous life, I worked with individuals with disabilities and I was a community advocate," Ms. MacKinnon said.

That’s what led her to become a lawyer.

"It’s almost like coming full circle for me," she said.

Ms. Rowlett used to work in insurance litigation before she began to represent mentally ill clients.

"It’s kind of nice to make a difference every once in a while," she said.

Ms. Rowlett said her clients "are really wonderful, caring people who appreciate the assistance."

The mental health court has been in the works for two years.

Ms. MacKinnon said a lot of mental health services are available, but the job of the court and its team of workers will be to co-ordinate those services in developing programs for the people who come through the courtroom doors.

After a program has been set up for a client, he or she will be required to return to court so the judge can assess whether progress is being made.

In many cases, the criminal charges will eventually be stayed, Ms. MacKinnon said.

She said cases involving people who are found to be not criminally responsible for their actions will remain in the regular court system.

Ms. MacKinnon said the purpose of the mental health court is not to avoid criminal convictions for clients but to provide the supports they need to avoid coming into conflict with the law repeatedly. In that way, the public is protected, she said.

The Crown does anticipate some glitches as the new court gets underway.

For instance, Ms. MacKinnon said, few resources are available to help people who have experienced brain injuries.

"This segment of the population is going to be somewhat challenging," she said.

The court’s second session will be next Thursday.

Also see:

Youth Mental Health and the Criminal Justice System

London's Mental Health Court

Reading List: Mental Health Diversion Courts

Mental health court lauded

An article published in yesterday's edition of The Chronicle Herald:

Conference today on system’s benefits

By John McPhee, Health Reporter

Much more needs to be done to support the mentally ill in Nova Scotia, but the creation of a mental health court is a good start, advocates say.

The Schizophrenia Society of Nova Scotia will hold a conference today in Halifax to highlight the benefits of the court, which the province announced this summer.

"I think it’s only a logical step," said Stephen Ayer, executive director of the society, in an interview. "The idea is to get the person to the point where they can reintegrate themselves into society with a treatment plan. But the person has to accept responsibility for their crime."

Other provinces, including New Brunswick, have had mental health courts for years. The society has pushed for one in Nova Scotia for a long time, Mr. Ayer said. He’s not sure why it took so long for the province to move on the issue.

"Some would argue it’s not necessary, that it’s (the responsibility) of mental health services," he said. "But who’s going to start the process — Health or Justice? Health is dragging its feet and has been for years on the treatment of the mentally ill. Somebody has to start somewhere."

Judge Alfred Brien will speak about the success of the N.B. mental health court system at the conference, which will start at 8 a.m. at 12 Wing Shearwater. Other speakers will include Judith McPhee, of Nova Scotia’s Justice Department, who will explain the province’s plans.

The once-a-week sitting at the Halifax court will not hold trials, but rather will serve as a setting where the court can work out alternatives to jail sentences and set up treatment programs.

Under the system, which begins Nov. 2, provincial court Judge Bill MacDonald will take cases recommended by a mental health court team.

Mr. Ayer said the court’s success hinges on the province improving other supports for the mentally ill in society, such as housing and employment programs.

"That’s where we’re challenged," he said. "I’m going to be interested in hearing the answers on that."

More information on the conference can be found at www.ssns.ca.

Nova Scotia Speech From The Throne

From page 10 of yesterday's Nova Scotia Speech From The Throne:

My government will improve support for individuals with mental illness, and for their families.

We will collaborate with mental health service providers to identify, monitor, and refer youth requiring mental health supports.

Community-focused living bungalows will be developed to provide appropriate, respectful care for individuals coping with mental illness.

Next month, the first mental health court will open and will help people who need counselling and treatment instead of being held in custody or put in situations where conflict may arise.

Vancouver judge: Community court works

An article published in todays edition of The Chronicle Herald:

By The Canadian Press

VANCOUVER — It's the personal anecdotes that tell the story of Vancouver's community court for judge Thomas Gove [pictured].

One year after opening Canada's first court to fully integrate the legal process with health, housing and social services, Gove measured the project's success Thursday by recounting the impact on a drug addict who was nudged into a residential detox program while doing street cleaning as community service for theft.

Gove also spoke about a chronic offender, approaching 60 years old, who was in court on a theft charge.

With the assistance of court workers, he has held down a full-time job for the past six months and not committed any further crimes. Keeping that man away from crime is probably saving $100,000 a year in the cost to merchants, police, the court system and prisons, the judge said.

He recounted details, as well, about a case earlier this week that reflects how different the community court is from a traditional courtroom. The offender broke down in tears after the judge made a strong personal appeal to her.

``Don't you understand, all the people here are trying to help you?'' Gove recalled saying to her. ``What is it we are not doing right? What more can we do? What is missing?''

Vancouver's community court, located in the heart of the city's drug-infested, poverty-ridden Downtown Eastside, was opened one year ago with considerable fanfare.

The jury is still out on the new system. Statistics for the first year of operations have not yet been compiled.

James Threlfall, the acting chief justice of the provincial court, said Thursday an analysis of the impact of the community court on the court system will be completed later this fall.

But Gove, the presiding judge who has been involved with the project since it began, was positive about the court's track record so far.

The court has achieved ``real successes,'' he said in an interview. More cases are resolved sooner, offenders are required to make fewer court appearances, more appearances happen on the day they are scheduled, crime is reduced in downtown Vancouver and, he believes, the rate of reoffending has been reduced.

He was ``frustrated'' that more housing, detox centres and mental-health services were not immediately available for offenders, but he was reluctant to be critical.

The organizations are going in the right direction, he said, adding that more housing has become available in recent months.

Gove could not really think of anything the court should have done differently over the past year.

``The first year has been the experiment - how do we do this? The next year is going to be whether we really (pass) the test - how much impact are we going to have?'' he said.

Cases involving theft from autos, stores and homes, mischief, assaults, drug possession and shoplifting are heard in the community court, while more serious crimes remain in the traditional court system.

Gove said the court saw about 2,000 people in its first year. Around 25 per cent, according to a rough estimate, were repeat offenders.

Multidisciplinary teams devise a plan that is intended to respond to the offender's underlying problems, whether it is mental illness, drug addiction, homelessness or poverty. The court enforces the plan as an alternative measure to traditional court-imposed penalties.

In the first 10 months, 568 people were involved with social, health and mental-health programming, 209 received housing. Offenders did 6,055 hours of community service.

Photograph by Sam Leung, The Province.

Also see:

Mental health court long overdue

An opinion piece published in today's edition of The Chronicle Herald:

By Marilla Stephenson [pictured]

THE TORIES MAY have promised it, the NDP may have delivered it and the Liberals may have backed it. But credit for this week’s announcement that Nova Scotia will finally establish a mental health court goes to the many justice system officials who have pushed for years, and then finally said enough is enough.

Remember the story of Jean Roberts, the 70-year-old Dartmouth woman who ended up in court for setting fire to her own apartment?

She was unable to properly care for herself, could not be cared for in a traditional nursing home and found herself in trouble with the law. She had been in and out of jail over an 18-month period after what her family described as a slow slide into dementia and mental health problems.

Sadly, during a court appearance, Roberts had asked to be returned to jail because she had nowhere else to go. But is jail really the right place for people like Jean Roberts?

In 2006, Judge Bill MacDonald said no, it was not. After releasing her from custody on a series of relatively minor charges, he ordered sheriff’s deputies to delivery her to the Health Department and to leave her in their care.

"Why should the criminal justice system have to come up with all the options?" the judge asked at the time.

"I don’t want to take the responsibility of putting her out in the parking lot. There needs to be a facility in our society to deal with people like Jean."

Since then, the previous Tory government did move to establish a transition shelter for people with mental health problems, though with just a handful of beds I doubt it is able to accommodate the needs that exist. Still, it was a start.

More recently, Nova Scotians have heard the disturbing testimony at the inquiry into the death of Howard Hyde, the Dartmouth man who died in custody in 2007 after police shocked him with a stun gun.

He suffered from paranoid schizophrenia, but was not sent for a mental health assessment as one doctor had requested after he had been taken into custody on a domestic assault charge.

But the long-promised mental health court has been slower to materialize.

The Tories had finally promised to have it in place April 1 of this year, but a delay was soon announced. Summer or fall was the new target. Of course, an election and a change in government soon followed.

Finally this week, Justice Minister Ross Landry, under the new NDP government, announced that it will open in Dartmouth in November.

Once a week — guess who? — Judge Bill MacDonald will hear cases that are recommended by a provincial mental health court team.

They will be diverted from the regular provincial court case stream, but will not include more serious crimes such as murder or sexual assault.

Landry says the new court will help to balance public protection requirements and the needs of those who suffer from mental illness and find themselves in trouble with the law.

"It ensures public safety, and at the same time ensures the accused’s health needs are met," said Landry.

The court will not hold regular trials. Those who appear in the mental health court will have given either an admission of guilt prior to a regular trial, or have received a guilty verdict in a regular court.

The intent will be to work out treatment options, and in some cases, charges could be withdrawn once treatment is complete, says Landry.

With the closures in past years of mental health residential facilities, more people have found themselves without the care options they need.

For some folks, this had led to life on the streets and an absence of needed medications. Landing in court on charges, followed by jail, should not be the only option our society can offer.

The new court is a long-awaited initiative that will require offenders to be responsible for their crimes, while offering a helping hand to those with mental illnesses so they can get on the road to better health.

Also see:

Mental health court: Delivering on Tory promise

New Mental Health Court to Open in Dartmouth

From the Nova Scotia Department of Justice website:

Justice Minister Ross Landry (left) tours the construction site of the new Mental Health Court which will open in Dartmouth, Nov. 2. He is joined by Stephen Ayer, Executive Director of the Schizophrenia Society of Nova Scotia. Minister Landry said the new court will help people who are in greater need of counselling and treatment instead of being held in custody or put in situations that may lead to confrontations.

Photograph courtesy of the Nova Scotia Department of Justice.

Justice Minister Announces Opening of Mental Health Court

A news release circulated today by the Nova Scotia Department of Justice:

The province's first court to help people with mental health illnesses will open in Dartmouth on Nov. 2.

The court was set up to help people who are in greater need of counselling and treatment instead of being held in custody or put in situations that may lead to confrontations.

"The government is seeking new ways to help those offenders who have mental health issues," said Attorney General and Justice Minister Ross Landry, today, Aug. 27.

"This court will look at the person and their illness, not just their crime when it comes to administering justice."

Two years of planning of the made-in-Nova Scotia court included input from representatives from police agencies, RCMP, Public Prosecution Service, legal aid, judiciary and several government departments.

The specialized court will sit one day a week at the provincial court building. Judge Bill MacDonald will hear the cases which have been recommended by the mental health court team as being eligible for the program. A team of mental health clinicians and lawyers will be at the courthouse to assess potential clients and assist with their needs through counselling and other support.

The mental health court program is based on the best practices of other jurisdictions, and is tailored to meet the needs of Nova Scotians.

FOR BROADCAST USE:

The province's first court to help people with mental health illnesses will open in Dartmouth on November 2nd.

The court was set up to help people who are in greater need of counselling and treatment instead of being held in custody or put in situations that may lead to confrontations.

Attorney General and Justice Minister Ross Landry says the government is seeking new ways to help those offenders who have mental health issues.

He says this court will look at the person and their illness, not just their crime when it comes to administering justice.

The court will sit one day a week at the provincial court building.

-30-

Media Contact:

Sherri Aikenhead
Department of Justice
902-424-3313
E-mail: aikenhsl@gov.ns.ca

N.S. mental health court on hold

An article published in today's edition of The Chronicle Herald:

By Jennifer Stewart, Court Reporter

The province’s plan to open a specialized court to deal with mentally ill offenders has been temporarily put on hold.

The mental health court was set to open April 1 in the Dartmouth Justice Centre on Pleasant Street. But now a spokeswoman for the Justice Department says it could be as late as the fall before the court is ready to deal with adult and some young offenders suffering from mental illness.

Carla Grant said there are two reasons for the delay: renovations and construction of a new courtroom are behind schedule and the steering committee overseeing the project has asked for more time to work on the court’s policies and procedures.

“They want to ensure that it’s done right,” Ms. Grant said in an interview Monday.

She said moving the Justice of the Peace Centre and renovating the existing courthouse turned out to be a bigger project than the department anticipated. She estimates the construction will take until at least June.

“It’s been a major renovation,” Ms. Grant said.

It was the fall of 2007 when Premier Rodney MacDonald announced in a throne speech that the province would set aside money to establish a mental health court to help deal with the staggering number of mentally ill people who get in trouble with the law.

According to a report from the Office of the Correctional Investigator, 12 per cent of men in federal institutions in 2007 had a mental disorder, up from seven per cent in 1997. The rate of mentally ill women in prisons was even higher, at 21 per cent, compared with 13 per cent in 1997.

Judith McPhee, chairwoman of the steering committee, said in an earlier interview with The Chronicle Herald that the province had earmarked roughly $500,000 to start up the specialized court, which will be evaluated throughout its first year of operation.

The steering committee is made up of representatives from the departments of justice, health, community services and health protection and promotion, as well as members of local police agencies, the Public Prosecution Service of Nova Scotia and Canada, Nova Scotia Legal Aid, local police and the judiciary.

Ms. Grant confirmed that hiring began earlier this year and said the mental health court now has a dedicated Crown attorney, legal aid lawyer and probation officers. She said the department is in the process of hiring a judicial assistant and will be looking for administrative support staff.

The Capital District Health Authority and the IWK Health Centre, who are partners on the project, are also hiring clinical personnel, she said.

“This continues to be an important initiative for the department,” Ms. Grant said.

Also see:

Mental health court long overdue

Canadian Mental Health Association urges governments to develop more appropriate solutions for the mentally ill housed in today's prisons (March 9th, 2009)

Mental health court long overdue

An editorial from the October 23rd edition of The Chronicle Herald:

IT’S BEEN a long time coming.

Ontario did it 10 years ago. New Brunswick followed suit five years ago.

The Nova Scotia government promised it a year ago in its throne speech, but it will be another six months before it’s up and running.

The good news, however, is that staff are being hired and facilities are being built to accommodate the province’s first mental health court, slated to open at the Dartmouth Justice Centre next April 1. It will be well worth the wait and the investment – about $1.8 million annually, plus $500,000 in additional start-up costs in Year 1.

It has been obvious for years now that the criminal justice system is ill-equipped to deal with offenders with mental health issues.

The goal of a mental health court, as outlined in the province’s crime prevention strategy released last year, is to hold mentally ill offenders "accountable for their behaviour in a way that is supportive and sensitive to their illness."

In other jurisdictions, defendants who end up in a mental health court have typically committed crimes punishable by less than two years’ imprisonment.

If they were to go through normal channels, they would serve out their time in a provincial jail if the sentence includes a period of incarceration. The trouble is that throughout the entire criminal justice process, little gets done to address the underlying issue: the offender’s mental health problems.

Mental health courts change that dynamic. While jail remains an option, offenders usually spend less time there and get more access to mental health services instead.

Mental health courts do not – contrary to some public perceptions – give offenders an opportunity to "plead insanity" and to get off scot-free. (Besides, one can suffer from any number of mental or behavioural disorders and remain perfectly sane.)

Indeed, under the mental health court model Nova Scotia is developing, the accused must first be determined fit to stand trial and show a willingness to take responsibility for their actions.

The emphasis under this system is on dealing with the offender through teamwork as much as it is on dealing with the offence.

This makes eminent sense. It is pointless to fill our jails with mentally ill individuals who are not criminals at heart. It’s intervention they need, not incarceration.

But addressing those needs also requires infrastructure. In future, let’s hope Nova Scotia also sees the wisdom of spending more than a measly four per cent of its health budget on mental health.

Click on the image to magnify it.

To download this April 2007 issue of The Society Record, click here (PDF).

Mental health court to open for April 1

From today's edition of Metro Halifax:

By Paul McLeod

The courtroom is being built, the staff are set to be hired in the new year, and by April 1 Nova Scotia will have its own mental health court.

Calls for a specialized court for people with mental illness have grown louder in recent years after incidents such as the death last year of Howard Hyde, who suffered from schizophrenia.

Other provinces such as Ontario and New Brunswick already have such courts, which are tailored to deal with the intricacies of people with mental health in the justice system.

Yesterday Justice Minister Cecil Clarke said staff were set to be hired in January, with the goal of the court opening in April. Dartmouth provincial court is being renovated to create the new room.

“Quite simply, we want to make sure people do not find themselves behind bars, but in a proper housing setting and treatment program for their mental illness,” said Clarke.

The annual operating budget is projected at $1.8 million, but first year costs are expected to range up to $2.3 million Clark explained.

For more information on the illustrated book, click here.

Letter to the Editor from the SSNS

A letter to the editor published in today's edition of The Chronicle Herald:

Re-engage society

In response to Ainslie MacDougal and Stanley Kutcher’s April 23 opinion piece, a mental health court will better serve the mentally ill by introducing, and sometimes re-introducing, a certain population of these individuals to much needed mental health care. The cost-effectiveness of these courts compared to the traditional means of incarceration is just another indicator of how beneficial these courts will be for everyone.

Our everyday involvement with people who live with schizophrenia/psychosis, as well as their family members and friends, and our expertise with the many issues all of these individuals encounter make the Schizophrenia Society of Nova Scotia a logical collaborator in the mental health court planning process. When the idea was conceived, we were asked to participate in preliminary talks. However, at this point, we have been left out of the planning process. We remain hopeful that the provincial government will re-engage the society as it moves forward with developing a mental health court.

Matthew H.W. Jack, policy adviser, Schizophrenia Society of N.S.

Addressing mental-health concerns fails in jails

From today's edition of The Chronicle Herald:

By Ainslie McDougall and Stanley Kutcher

The province of Nova Scotia has received some recent criticism regarding its detention facilities, such as accidental releases of inmates, an escaped inmate while transferred offsite, as well as the overcrowding of facilities. When considering the issue of overcrowding, it is important to highlight several issues. The answer is not to build more jails and employ more prison guards, but rather to take a closer look at the individuals who are overcrowding these jails and examine why they are there.

While the exact number is unknown, it has been estimated that as many as half of the incarcerated population suffers from mental illnesses, substance abuse problems, and/or learning disabilities. Because of a shortage of services and a lack of understanding by society, the mentally ill are not receiving the care they require and instead are being criminalized by being sent to prisons.

In a statement on March 8, 2007, Supreme Court Chief Justice Beverley McLachlin stated, "Such people are not true criminals, not real wrong-doers in the traditional sense of those words. They become involved with the law because they are mentally ill, addicted or both." Similarly, many police officers believe that mentally ill perpetrators represent a disproportionate number of individuals incarcerated for minor crimes. Some family members have noted that crimes may be committed or encouraged to be committed in order for the mentally ill person to be arrested. This may represent a "faint hope" that arrest will lead to treatment that for a variety of different reasons is not otherwise available.

There are alternatives to longer prison sentences (which studies show are not effective in decreasing repeat offences and stopping the "revolving door process"), such as drug treatment courts and mental health courts, which may meet the treatment needs of those with mental disorders. These courts attempt to identify and address the underlying causes of the criminal activity (such as behaviours associated with mental illness).

Mental health courts have been successfully implemented in many parts of Canada, as well as in the United States, and are specifically designed for those who have committed low level crimes (i.e. those who would be sentenced to incarceration in a provincial facility). These courts attempt to connect with community-based treatment through the interventions of mental health professionals. Studies in the United States show those who have gone through the mental health court received more access to mental health services and spent fewer days in jail than if they were sentenced in a criminal court.

These "problem-solving" courts are also more cost-effective for taxpayers. According to Juristat, Statistics Canada (2004-2005), the cost of incarcerating a federal prisoner was $93,000 per year, and $52,000 per year in a provincial institution. On the other hand, it costs approximately $8,000 for an individual to obtain addiction treatment through a drug treatment court. We are aware that the province of Nova Scotia is considering the development and implementation of similar courts and we encourage the Department of Health to move ahead quickly and thoughtfully in this matter.

We need to move away from the common misconception that locking someone up and throwing away the key is an appropriate manner by which to address mental health problems in our society. Mental illness and addiction are health issues and are not effectively dealt with by the criminal justice system.

The independent audit called for by Justice Minister Cecil Clarke is inadequate as it is not addressing the pressing issues facing provincial jails. Fundamental changes need to be made to the system.

Ainslie McDougall is with the IWK Health Centre. Dr. Stanley Kutcher is Sun Life Financial Chair in Adolescent Mental Health, IWK, and a professor in the department of psychiatry, Dalhousie University.

Photograph of Dorchester Penitentiary by Verne Equinox.

Two questions to ponder

A quote from an article published in the December 31st issue of the Halifax Daily News:

Mental-health advocates say the Hyde case and the cases of accused-murderer Race and stabbing victim Ayer highlight the need for more services for the mentally ill in Nova Scotia.

So why has the Nova Scotia government not announced any new resource allocations for mental health services?

Or have they?

Mental Health Courts Bill Targets Multiple Problems

Proposed [U.S.] legislation to promote mental health courts would require the attorney general to report on the rate of serious mental illness among state, federal, and local inmates nationwide.

To read this entire article by Rich Daly, published in the December 21st issues of Psychiatric News, click here.

Mental health court step in right direction

An editorial from the December 11th edition of the Halifax Daily News. To read the editorial, click here.

For a related article from The Canadian Press and posted by CBC.ca, click here.


For more information on the above book, click here.

Court for mentally ill on way — province

Director: N.S. has ‘great need for general mental health services’

An article published in the November 24th edition of The Chronicle Herald:

By Jennifer Stweart, Court Reporter, with Dan Arsenault, Crime Reporter, and The Canadian Press

The province has committed to establishing a mental health court in Nova Scotia that would deal with mentally ill offenders.

"It’s in development," Justice Department spokeswoman Cathy MacIsaac said Friday. "I can’t really give you any further details."

The announcement came Thursday as part of the Conservatives’ throne speech. But it received little attention because of the buzz surrounding the death earlier in the day of Howard Hyde.

Officers arrested the Dartmouth man early Wednesday. He died Thursday, 30 hours after Halifax Regional Police used a stun gun to subdue him.

Mr. Hyde [lived with schizophrenia] — a perfect candidate to be dealt with in mental health court.

Dr. Scott Theriault, clinical director of forensics and specialty services for mental health, said the news has him "cautiously excited."

"In Nova Scotia, we have a great need for general mental health services," he said. "There’s no doubt that with more robust general mental health services, you would have fewer people with mental illnesses finding themselves in conflict with the law."

Ms. MacIsaac said there’s no word on when the specialized court could be up and running, or how much it will cost.

She said the department is keeping an eye on the performance of mental health courts in other areas, including Toronto and Waterloo.

Staff Sgt. Rudy Smith of Waterloo Regional Police said the court in his area has been a great success.

In operation since September 2005, the specialized court — held every Tuesday — provides more services faster, he said.

"They weren’t getting the counselling or the help they needed," Staff Sgt. Smith said of mentally ill offenders. "The whole idea is to get them as much help as possible quicker than if they’d gone through the normal process."

Joanna Blair, Mr. Hyde’s sister, was unaware Friday that other provinces have mental health courts, but said she thinks there should be improvements to the way society handles people with psychiatric problems.

"I think that in the psychotic condition (my brother) was in, . . . (he) should have been dealt with by subduing him in some manner other than a Taser gun, possibly by an injection of medication," she said. "And I say that hesitantly because I have questions about that" as well.

Ms. Blair said she thinks her brother should have been kept at the East Coast Forensic Hospital, where he could have met with a psychiatrist and been medicated before his bail hearing Thursday.

Jean Hughes, a professor at Dalhousie University who specializes in psychiatric nursing, said officers need specific training on how to deal with the mentally ill to ensure such encounters don’t escalate into violence.

She said offenders who are paranoid can be easily spooked, especially if they have had violent encounters with police in the past.

Mr. Hyde, for example, was shocked with a stun gun by police during an arrest in 2005, and his sister said he had had other altercations with police before then.

"Once you’ve had encounters where people have used violent or corrosive or intrusive means of working with you, then you learn to expect that that’s probably going to happen again," said Ms. Hughes, a former vice-president of the Canadian Mental Health Association.

"For the large portion of our population, the only people you can call are police. So that puts tremendous onus on them.

"What we do know is with good training, people can learn alternative methods for de-escalating situations."

Mental Health Courts: A Strategy That Works

From the September 21st issue of Psychiatric News:

By Aaron Levin

Criminal defendants with mental illness stay out of jail longer when they are enrolled in programs that divert them from the prison system to the mental health system.

Mental health courts offer an alternative to sending still more people with mental illness to jail. Judges, public defenders, district attorneys, case managers, therapists, probation officers, and psychiatrists together closely supervise defendants selected for these diversion programs, helping with housing, medical care, psychotherapy, education, and job training or coaching.

The goal is to prevent these defendants from committing more crimes and to help them find a place in the community. Offenders who complete the program can have charges dropped or expunged (Psychiatric News, April 21, 2006).

About 90 mental health courts operate around the country, yet little is known about the extent to which they reduce the chances of a defendant's committing another crime.

Now a study of the mental health court in San Francisco documents reduced levels of recidivism, as measured by the time to re-offending, although questions remain about what accounts for outcomes and who gets to participate in the programs.

Dale McNeil, Ph.D., a professor of clinical psychology in the Department of Psychiatry, and Renée Binder, M.D., a professor in residence in the Psychiatry and the Law Program at the University of California, San Francisco, compared 170 criminal defendants who entered the mental health court with 8,067 other offenders who received treatment as usual, consisting of passage through the criminal justice system. All subjects had been diagnosed with some mental illness, and two-thirds were charged with felonies. Defendants selected for diversion included a higher proportion of persons with developmental disabilities or severe mental illness—like schizophrenia, delusional disorder, or bipolar disorder—than the control group.

The researchers used a propensity weighting system to overcome nonrandom assignment and intention-to-treat analysis to include all offenders enrolled in the program, not just those who completed its requirements.

Participation in the mental health court program predicted a longer time before offenders faced any new charge or a new violent charge, wrote McNeil and Binder in the September American Journal of Psychiatry.

After at least six months of follow-up, 81 (48 percent) of the enrollees had completed the program, 45 (26 percent) were still in it, and 44 (26 percent) had left, whether voluntarily, for noncompliance, or other reasons. The mental health court graduates remained at a lower risk of recidivism even after they left the court's supervision, according to follow-up analysis.

At 18 months, mental health court participants were 26 percent less likely to be charged with any new crime and 54 percent less likely to be charged with a violent crime, they said (see chart).


Their findings, said McNeil and Binder, "provide evidence of the potential for mental health courts to achieve their goal of reducing recidivism among people with mental disorders who are in the criminal justice system."

Furthermore, since many defendants in the San Francisco program were charged with violent crimes or felonies, results with this more-difficult population argued for expanding the use of mental health courts beyond individuals who have committed minor offenses, as is the case in some other areas, they said.

Other studies have shown that outcomes vary little between violent and nonviolent offenders or for those diagnosed with more severe illness, said mental health court expert Henry Steadman, Ph.D., of Policy Research Associates in Delmar, N.Y., in an interview with Psychiatric News. "No research shows that a particular type of person does more poorly."

Steadman directed a study of 21 mental health court programs sponsored by the Substance Abuse and Mental Health Services Administration. He found that 42,518 screenings, assessments, and evaluations resulted in 32,917 decisions about whether to divert them to a treatment program. Only 2,001 of those decisions recommended diversion to mental health courts, and 1,237 of those were accepted by judges.

Although many decisions were needed to divert a few individuals, ultimately, disproportionate groupings by age, race, and gender predicted those chosen to take part.

Enrollees were more likely to be older, white, and female, wrote Steadman in the study published in the August Psychiatric Services. "That could represent bias, or it could result from the mechanism of assessment."

An array of people feed information into the system, he said—prosecutors, judges, mental health experts, public health nurses in the jails—making it hard to tease out the source of any overrepresentation of a particular demographic.

"I speculate that the people selected are seen as less threatening to the community, but the community needs to take a chance on a wider group," he said.

The study did not look at clinical data or outcomes.

These mental health courts may have benefits for society that go beyond just reducing crime. A recent study, described as the first of its kind, of 352 defendants by the RAND Corporation in courts in Pennsylvania, "Justice, Treatment, and Cost," found that participation in the jail-diversion program resulted in an increased use of mental health services and a decrease in jail time during the first year after entry into the program. Higher mental health care costs were almost balanced by the reduced costs for keeping the individual locked up. A two-year follow-up found a "dramatic" reduction in jail costs, although most of that came at the end of the second year, as mental health care costs leveled off.

Steadman agreed with McNeil and Binder that more intensive research is needed to support the case for mental health courts.

"All case studies show promising results," he said. "Now we need to use the same research methods in many different courts and look at for whom mental health courts work. What are their demographics, their social history, and their clinical history?"

"Effectiveness of a Mental Health Court in Reducing Criminal Recidivism and Violence" is posted here.

"Factors in Disproportionate Representation Among Persons Recommended by Programs and Accepted by Courts for Jail Diversion" is posted here.

The RAND report, "Justice, Treatment, and Cost," is posted here.

The photograph at the top of this posting, while not directly related to the above story, is of the Mental Health Court Team located in Saint John, New Brunswick. Click on the photograph to magnify it.

Mental health courts gain popularity across Canada

Crown Attorney Ruth Peters Wakeham and Newfoundland Provincial Court judge David Orr in a Mental Health Court in St. John’s.

Photo by Joe Gibbons

Donalee Moulton writes in the June 1st, 2007, edition of The Lawyers Weekly:

[...]

In Nova Scotia, no formal investigation into the issue is underway, but the establishment of a mental health court is clearly being bandied about. The Nova Scotia Barristers’ Society devoted the most recent issue of its monthly newsletter to the topic. In that issue, Frank Hoskins, chief Crown attorney for the Halifax Region and Special Prosecutions, noted that, “Currently, Nova Scotia has an Adult Diversion Program, which is a post-charge, pre-trial option to the criminal justice system. A pre-charge option is worthy of consideration as it would create another viable alternative to deal with minor offences.

“In cases where it’s more appropriate,” he added, “this would enable specifically trained police officers to divert an accused away from the criminal justice system. More serious offences could be directed to the mental health court where judges and lawyers qualified or trained to deal with cases of this nature (and with ready access to the appropriate health professionals, which could include psychologists, psychiatrists and case workers) could develop and implement an appropriate treatment plan.”

[...]

... “The custodial response to people with mental health problems is an historic one,” said Archie Kaiser, a professor in the Faculty of Law and Department of Psychiatry at Dalhousie University.

“To incarcerate people merely because we have failed to develop appropriate supports has always been shameful,” he added. “In 2007, this is totally unacceptable.”