MENTAL HEALTH COURT: TREATMENT vs. PUNISHMENT August 13, 2018

MENTAL ILLNESS AND THE CRIMINAL JUSTICE SYSTEM Historically, a disproportionate number of people with mental illnesses are caught up in the Criminal Justice System.

GROWTH OF PROBLEM The growth of this problem became more apparent in the later part of the twentieth century due to: 1. De-institutionalization In NL from 1994–1995 3 long-term care units closed. 2. Stricter tests for involuntary commitment 3. Lack of support services

HISTORICAL TIMELINE Mental Health courts are now situated at the intersection of the criminal justice system, mental health treatment, substance abuse interventions and other treatment services and systems. As a result of the 2003 Judicial Inquiry into the sudden deaths of Norman Reid and Darryl Power, the idea of a mental health court was proposed. Research began in 2004, a model was proposed and began operation in January 2005. Since that time, the MHC has evolved and currently offers a more focused and specialized approach to treatment services.

MHC SERVICE UMBRELLA Includes three separate groups that work together to provide seamless services to clients. These include: Mental Health Office, Legal Aid Court Support Services, Eastern Health Department of Justice Provincial Court Crown Attorneys Office Adult Corrections

All agencies and services work together to All agencies and services work together to improve outcomes for those people with mental illnesses involved with law enforcement, the courts and correction services.

MHC: 10 ESSENTIAL ELEMENTS 1. PLANNING & ADMINISTRATION 2. TARGET POPULATION 3. TIMELY PARTICIPANT IDENTIFICATION & LINKAGE TO SERVICES TERMS OF PARTICIPATION 5. INFORMED CHOICE

MHC: 10 ESSENTIAL ELEMENTS 6. TREATMENT, SUPPORT & SERVICES CONFIDENTIALITY COURT TEAM MONITORING ADHERENCE TO COURT REQUIREMENTS 10. SUSTAINABILITY

PLANNING & ADMINISTRATION Consistent planning, dedicated courtroom and staff. Courtroom # 8, every 2nd Wednesday at 2pm. Judge Court Clerk Crown Attorney Probation Officer Bi-weekly intake meetings at Mental Health Office Strategic planning meetings quarterly to discuss program development.

TARGET POPULATION Individuals aged 18 or older with persistent and recurring mental illness and/or acquired brain injury where the criminal behaviour has its origins in the mental disorder and related issues. Further these individuals will have deficits in relation to their community support network. 1. 18 years and older 2. Psychiatric Diagnosis 3. Responsibility for behaviour 4. Agree to work with a team Referrals come from multiple sources

TIMELY PARTICIPANT IDENTIFICATION Referral Screening Assessment Application to the Court Treatment/treatment contract Status Sentencing No Waitlist

TERMS OF PARTICIPATION Agreeable to working with a psychiatrist Engage in developing personal treatment contract Engagement with a team approach Awareness of roles and expectations of his/her team No plea, but take personal responsibility for behaviour

INFORMED CHOICE Program is voluntary Education regarding the court process and possible outcomes Repercussions of not adhering to the treatment contract

TREATMENT, SUPPORT & SERVICES Comprehensive and individualized treatment plan/contract Assertive case management is essential Outreach Support Monitoring (wellness and medication) Teaching Consultation *Team serves as a conduit of information for the court regarding the status of treatment

CONFIDENTIALITY Confidentiality is presented at screening interviews and repeated throughout assessment and treatment Only information relevant to the charge is presented to court as a legal document

THE COURT TEAM Court Support Team - 2 Social workers - 2 Licensed practical nurses - 2 Lawyers - 1 Paralegal - 2 Psychiatrists Team members engage in cross-training to develop knowledge and skills of each others professions Consistent and reliable staffing over the past 13 years has enriched the clients’ overall court experience 80% of clients have a one point engaged with psychiatry

MONITORING ADHERENCE Court Support Supervision Prior to sentencing, while client works on their treatment contract with Court Support Services (average 6-12 months) After sentencing, supervision may include Court Support Services and probation (maximum 3 years)

SUSTAINABILITY CLIENT Aftercare/follow-up with mental health services (ex. Psychiatry, Trauma, CHANNAL, Stella Burry) PROGRAM Working with key partners in Mental Health & Addictions, and Criminal Justice Outreach to the community Data

GOALS & OUTCOMES Court Support Services assist individuals who have had contact with the law in re-establishing themselves in the community with an appropriate level of support. In other words Mental Health Court is an alternative to the status quo. Our goal is to make changes – one person at a time - so many people are not cycled again and again through jail, courtrooms and our city streets. True to this objective, clients have reported a more positive outcome proceeding through Mental Health Court versus Provincial Court (ex. no record, no jail time)

GOALS & OUTCOMES According to a 2012 Mental Health Office report “clients who received Court Support Services were significantly less likely to re-offend within 2 years. Conversely, clients who did not avail of the court support services referred to them were significantly more likely to reoffend within 2 years.” (The Mental Health Office of the NL Legal Aid Commission, Process Evaluation: A Quality Assurance Tool)

CLIENT FEEDBACK “There is great teamwork with the staff in the Office. I have never seen such teamwork in my life. There was never any disconnect- everything ran smoothly.” “There were no back doors. They were very straightforward - providing the good with the bad - and did not whitewash anything.” “They have been such a very great help, especially for counseling, but not just for my mental illness. They [helped me] pick away at certain things - basically what led up to my conflict with the law.” (The Mental Health Office of the NL Legal Aid Commission, Process Evaluation: A Quality Assurance Tool)

REARCH 2014 An evaluation of court support services program was completed, by Eastern Health in Nov 7, 2014. This reviewed data from the previous 12 months. Findings included: Employment prior to program – 29% Employment during the program – 54% Volunteer work prior to program – 4% Volunteer work during the program – 12% Education prior to program – 0% Education during the program – 20.8%

RESEARCH 2014 – cont’d Access to psychiatry prior to program – 29% Access to psychiatry during the program – 100% Access to specialized services prior to program – 8% Access to specialized services during the program – 25% Access to case manager prior to program – 21% Access to case manager during the program – 83%

RECIDIVISM RATES ( 1 yr period) Hospital admission rates and frequency of PAU visits were decreased by half when compared to prior to the program, and one year post completion. This suggests that the program is positively impacting hospitalization utilization among its clients. 74% of program participants had not reoffended at the point of data collection.

Schizoaffective/Schizophrenia Generalized Anxiety Disorder DIAGNOSIS Bi-Polar Major Depression Schizoaffective/Schizophrenia Generalized Anxiety Disorder Post Traumatic Stress Disorder * Approximately 80% of clients fall under concurrent disorders (ie. alcohol, street drugs, prescription drugs)

Mischief (ie. property damage) Resisting Arrest Causing Disturbance CHARGES Uttering Threats Theft Assault Mischief (ie. property damage) Resisting Arrest Causing Disturbance Breach of Probation/Undertaking

CONTACT INFORMATION Social Workers: Cindy Elgar 777-7876 Brenda Lacey 777-7787 LPNs: Cindy Eddy 777-7875 Paul Kennedy 777-1046 Lawyers: Joan Dawson 726-8966 (303) Jennifer Curran 726-8966 (302) Paralegals: Tania Vatcher 726-8966 (304)

COMMENTS OR QUESTIONS Thank You!