P-HSJCC Webinar Series: Race and Mental Health Court Diversion May 15, 2019 About today’s webinar: We will have a Q&A period at the end of our webinar. To ask a question, please type your question in the chat box. This webinar will be recorded. The recording and power-point presentation will be emailed to you following the webinar. Please complete the brief evaluation survey following the webinar. About the HSJCC Network: The Human Services and Justice Coordinating Committee (HSJCC) Network is comprised of: 39 Local Committees, 14 Regional Committees, and one Provincial HSJCC Each HSJCC is a voluntary collaboration between health and social service organizations, community mental health and addictions organizations and partners from the justice sector including crown attorneys, judges, police services and correctional service providers.

Community of Interest for Racialized Populations and Mental Health & Addictions invites you to a think tank exploring: Racialized Populations and Mental Health & Addictions Community of Interest (CoI) Race and Mental Health Court Diversion Provincial HSJCC Webinar May 15, 2019 Presented by: Candace Vena, CMHA Ontario Christine Conrad, CMHA Ontario Deqa Farah, Fred Victor Angela Yip, CAMH

Overview of today’s presentation Overview of the Racialized Populations and Mental Health and Addictions Community of Interest (CoI) Racialized Populations and Mental Health Court Diversion project background Project findings: Literature search findings Focus group findings Think tank findings CMHA conference Discussion: Do these findings resonate with you? Do you have anything to add to our findings? How can you use these findings in practice? Who can we share this with to continue momentum? Angela   Our presentation will highlight our most recent project which focused on the experiences of racialized persons with formal and informal mental health court diversion programs and practices in Toronto. The presentation aims to increase the understanding of how diversion is applied to racialized populations; raise awareness about the need for standardization of race-based data collection in the justice system and contribute to existing strategies to improve the overall well-being of racialized populations moving through justice system. It will also examine how perceptions of race in the justice system impact outcomes, as well as what is needed to effectively address systemic racial inequities. Outline/CoI Background/Project Background/Findings/Discussion/Next Steps

invites you to a think tank exploring: Community of Interest for Racialized Populations and Mental Health & Addictions invites you to a think tank exploring: Overview of the Racialized Populations Mental Health and Addictions Community of Interest Angela– talk about why CMHA developed the CoI. Began in 2011. The Racialized Populations and Mental Health and Addictions Community of Interest (COI) is a provincial forum for knowledge exchange and collaborative knowledge creation focused on issues related to racialized populations and mental health and addictions.  Outline/CoI Background/Project Background/Findings/Discussion/Next Steps

CoI’s Overall Goals Uppala/Angela?   The overall goals are to: Share innovative knowledge and practices of COI partners and other stakeholders. Convene a critical mass of stakeholders from across and beyond the mental health and addictions system to identify and respond to crucial issues impacting racialized populations. Strategically leverage existing or emerging evidence (including community-based, lived experience, peer-reviewed academic, and other sources of knowledge). Improve provincial, LHIN, and provider policy, planning, and practice related to racialized populations and mental health and addictions. Outline/CoI Background/Project Background/Findings/Discussion/Next Steps

CoI Partners Angela This CoI is supported by Evidence Exchange Network (EENet), part of the Provincial System Support Program (PSSP) at the Centre for Addiction and Mental Health, and led by the Canadian Mental Health Association, Ontario Division. Outline/CoI Background/Project Background/Findings/Discussion/Next Steps

Evidence Exchange Network Province-wide knowledge exchange network, supported by knowledge brokers. Connects stakeholders with each other and with the evidence they need to make decisions. EENet.ca Angela Evidence Exchange Network (EENet) is a mental health and addictions knowledge exchange network that connects stakeholders across Ontario. EENet promotes the use of different forms of evidence in decision-making, develops targeted knowledge translation resources, and supports and facilitates interactive exchanges across different stakeholders.  The EENet community includes researchers, clinicians, decision-makers, service providers, system planners, policymakers, persons with lived experience, and families. EENet has been supporting CoI’s since 2012, this CoI has been one of the ones from the start EENet’s communities of interest bring together individuals who are interested in a common problem so they can gather, develop and share existing or new knowledge that will help improve understanding and action around that problem. These CoIs take a provincial approach and focus on mental health and addictions, especially as it relates to systems and services. This is the 3rd round, started January 2016. is part of this round and has already had lots of activity. We support about 10 other CoIs/CoPs, including the Housing and Justice (led by CMHA Ontario, the Wellesley Institute, & CAMH) More information is available on our website: www.eenet.ca Located in CAMH’s Provincial System Support Program. Outline/CoI Background/Project Background/Findings/Discussion/Next Steps

PSSP provides capacity and expertise in: Knowledge exchange Implementation Coaching Equity and engagement Evaluation and data management PSSP’s provincial office is in Toronto with nine regional offices located throughout Ontario. Angela, EENet is housed in PSSP at CAMH With offices around Ontario and working collaboratively across sectors, CAMH’s PSSP moves evidence to action to transform mental health and addictions systems in Ontario and build capacity in Ontario so that people can co-create and use evidence to improve policy, programs, and practice. The Centre for Addiction and Mental Health (CAMH) is the largest mental health hospital in Canada, and a world leader in mental health and addiction research. The Provincial System Support Program (PSSP) at CAMH works with communities, service providers and other partners across Ontario to move evidence to action to create sustainable, system-level change. Outline/CoI Background/Project Background/Findings/Discussion/Next Steps

Background COI’s goal is to improve policy, planning and practice for racialized populations in mental health & addiction. Previous work: Explored how racialized individuals and communities in Ontario accessed hospital emergency departments for mental health and addictions related reasons 2-year work project looking into exploring OCAN use to advance health equity. Held series of webinars to share knowledge & promising practices. Angela Lack of socio-demographic data collection within the health system is a major barrier for equity-related planning at the individual, organizational and provincial levels. is interested in building more equitable mental health services and outcomes for marginalized populations, particularly racialized groups a collection of socio-demographic data via the Ontario Common Assessment of Need (OCAN). A think tank was held in 2015 to explore the potential of the tool for advancing equity in the mental health system Stakeholder consultations to identify promising practices to explore the potential of the Ontario Common Assessment of Need (OCAN) to advance health equity. Outline/CoI Background/Project Background/Findings/Discussion/Next Steps

Racialized Populations and Mental Health Court Diversion Project Overview Deqa #mhjusticeandrace Outline/CoI Background/Project Background/Findings/Discussion/Next Steps

Background In 2017, the COI started its new project to focus on criminal court diversion programs and practices to examine racialized populations’ experience within the mental health court services. This involved focusing on formal mental health diversion programs as well as informal diversion practices for racialized persons with mental health and addictions issues in the criminal justice system. Deqa The purpose of the project was to explore the experiences of racialized individuals as they interact with mental health court support services in Toronto. We wanted to identify successes, gaps and barriers within the system and make recommendations for change. #mhjusticeandrace Outline/CoI Background/Project Background/Findings/Discussion/Next Steps

Project Objectives Increase understanding of how diversion is generally applied, specifically to racialized populations. Raise awareness about the need for standardization of race-based data collection throughout the criminal justice system, in order for issues of equity to be properly addressed through evidence-based policies and practices.  Contribute to existing strategies to improve the overall wellbeing of racialized populations moving through the criminal justice system. Examine perceptions of race in the justice system and how those perceptions impact the outcomes, as well as what is needed to effectively address systemic racial inequities. Deqa Explain what the CoI’s objectives were for the racialized populations and mental health court diversion project Currently there is anecdotal information indicating that racialized populations may not be offered mental health diversion as often as other populations, however more evidence is needed to understand how equity is applied to racialized populations in this context. Outline/CoI Background/Project Background/Findings/Discussion/Next Steps

Overview of Activities Information/Literature scan Focus groups held in Toronto: Mental Health Case Managers Mental Health Court Workers PWLE – Mental Health Court Diversion PWLE – Non Court Diversion Backgrounder report – released December 2018 Think tank – took place January 7, 2019 Presented at CMHA Conference – April 2019 Deqa Provide a quick overview of the activities completed to date – no need to go into too much detail about the focus groups and think tank day as we will revisit this in the findings * #mhjusticeandrace Outline/CoI Background/Project Background/Findings/Discussion/Next Steps

Project Findings #mhjusticeandrace Candace & Christine will discuss project findings. #mhjusticeandrace Outline/CoI Background/Project Background/Findings/Discussion/Next Steps

What does the Literature say? In the United States, there is an overrepresentation of Caucasian males in mental health courts. Racialized immigrant populations and Indigenous populations have a higher prevalence of mental distress and/or risk of suicide than the average Canadian Statistics show that there is an over-representation of racialized populations, particularly Indigenous and Black populations, in frequency of arrests and incarcerations in Canada There is a pressing need for further research on the treatment of racialized populations in the Canadian criminal justice system. Candace – briefly highlight what was found in our lit review: As it pertains to mental health court diversion and support services in general As it pertains to racialized populations in the justice system As it pertains to racialized populations and mental health and addictions #mhjusticeandrace Outline/CoI Background/Project Background/Findings/Discussion/Next Steps

Focus Group Results Purpose of focus groups was exploratory Shed light on the experiences and needs of racialized individuals interacting with mental health court support services and diversion in Toronto Targeted focus group participants included: Service providers: mental health case managers & mental health court workers Service users: PWLE who received mental health court diversion and PWLE who did receive formal diversion 20 participants shared their experiences and perspectives; 3 through individual interviews and 17 through focus groups Candace: Flyers were sent through the CoI networks to recruit a targeted group of individuals for the focus groups: Service providers - MH case managers and MH court workers and Service Users - PWLE who received MH diversion, PWLE who did not receive MH diversion The purpose of the focus groups was exploratory – the COI wanted to explore the experiences of racialized individuals as they interacted with mental health court support services and diversion in Toronto. In total, 20 participants shared their experiences and perspectives; three did so through individual interviews and 17 took part in two separate focus groups. Thanks to CMHA Toronto for their help in facilitating these focus groups. Also thanks to Sound Times for providing their space and clients for an additional focus group session. #mhjusticeandrace Outline/CoI Background/Project Background/Findings/Discussion/Next Steps

Highlighted Themes Most service users reported a lack of awareness and transparency around diversion and mental health court support services Both service users and service providers felt that race affects how an individual is treated in the criminal justice system Some service users expressed distrust and a loss of hope in the justice system Other factors including class, immigration and citizenship were identified as intersecting issues that affected how racialized populations were treated in the criminal justice system Candace: Highlighted themes from focus group results: Lack of awareness and transparency around diversion programs -  lack of awareness around diversion and mental health court support services during the initial stages of their criminal cases confusion around court processes in general as well as specifically around diversion, lack of transparency regarding court/legal processes. 2) Race and culture (or perception of race and culture) impacts the treatment of individuals in the justice system Most service users agreed race affects how they are treated in the criminal justice system Most service providers also agreed that race plays a role in the ways in which racialized populations are treated (Encounters with police were also highlighted as defining moments in the direction a case goes) 3) Other intersecting factors in the treatment of racialized populations in the justice system: poverty, immigration and citizen Service providers noted issues of immigration and citizenship were also relevant and closely connected to people’s experiences in the justice system. 4) Distrust and loss of hope in the justice system - Justice system is broken – no one is there to help etc. Preliminary Recs based on focus group findings: Given the small sample size for this study, broader consultation with additional stakeholders is highly recommended. Given the limited participation of female and transgender service users and the absence of additional 2SLGBTQIA+ identities in this needs assessment, it is recommended that the participation of women and non-binary individuals be proactively incorporated into the methodology of future needs assessments or research studies. While the focus for this needs assessment was the experiences of racialized populations in general, the findings show that there might be considerable differences in experiences among different populations. Differences within racialized populations may impact individuals’ particular experiences with the justice system and/or diversion programs and warrant further exploration. More research is needed to explore interconnections between issues of race, poverty, immigration and citizenship as they relate to court diversion access or denial. #mhjusticeandrace Outline/CoI Background/Project Background/Findings/Discussion/Next Steps

Results from the Think Tank Day Christine #mhjusticeandrace Outline/CoI Background/Project Background/Findings/Discussion/Next Steps

Overview of Think Tank Day Brought together over 100 participants in person and 50 more via webinar Representatives from the Ministries of Health and Long-Term Care, the Solicitor General, and the Attorney General; duty counsel; police and probation officers; court support workers and managers; mental health and addiction services providers; and persons with lived experience Keynote speakers including Dr. Akwasi Owusu-Bempah, University of Toronto and Anthony Morgan, City of Toronto’s Confronting Anti-Black Racism Unit Panel made up of lawyers, mental health court workers and a person with lived experience who shared personal experiences and observations of racism in the justice system Discussion on how to improve experiences and outcomes for racialized persons in the justice system Christine #mhjusticeandrace Outline/CoI Background/Project Background/Findings/Discussion/Next Steps

Discussion Questions for Think Tank Participants What supports, services or resources are needed before charges are laid to prevent racialized individuals with mental health or addictions-related issues from interacting with the justice system? How can racialized individuals going through the justice system be made more aware of the process and what’s happening?  Who should be promoting/recommending mental health court diversion? How can mental health court diversion be more accessible for racialized individuals and how can those who are not eligible receive the supports they need? Where in the criminal justice system pathway should race-based data be collected? Christine Think tank day participants were asked to discuss how can we improve experiences and outcomes for racialized individuals with mental illnesses in the criminal justice system? Think tank day participants were asked to discuss the following questions in small groups: 1. What supports, services or resources are needed before charges are laid to prevent racialized individuals with mental health or addictions-related issues from interacting with the justice system? 2. How can racialized individuals going through the justice system be made more aware of the process and what’s happening?  3. Who should be promoting/recommending mental health court diversion? 4. How can mental health court diversion be more accessible for racialized individuals and how can those who are not eligible receive the supports they need? 5. Where in the criminal justice system pathway should race-based data be collected? #mhjusticeandrace Outline/CoI Background/Project Background/Findings/Discussion/Next Steps

Key Recommendations Race-based data should be collected throughout the criminal justice system to better facilitate access to mental health court diversion for racialized individuals. Increase the number of culturally competent and trauma-informed services within the justice system, including specialized training for police officers. Every member of the justice system, including judges, police officers, and mental health court support workers should be responsible for promoting mental health court diversion. Culturally-specific system navigators are needed to share information and resources with justice-involved individuals. Mental health court locations and hours of operation should be expanded across the province. Christine #mhjusticeandrace Outline/CoI Background/Project Background/Findings/Discussion/Next Steps

CMHA Conference The COI was selected to present “Racialized Populations and Mental Health Court Diversion” at the 2019 CMHA Ontario Conference on April 1, 2019 Approximately 30 participants attended and built on the discussions from the think tank day Solutions for promoting mental health court diversion to racialized clients were discussed: Mobile crisis team workers can share mental health court information directly with clients Decreasing stigma will encourage more clients to their mental health or substance use condition Christine Outline/CoI Background/Project Background/Findings/Discussion/Next Steps

Final Report To be released in the near future Webinar participants will be notified by email when the report is available The report will be available online at: http://eenet.ca/the-racialized-populations-and-mental-health-and-addictions-community-of-interest Christine Outline/CoI Background/Project Background/Findings/Discussion/Next Steps

invites you to a think tank exploring: Community of Interest for Racialized Populations and Mental Health & Addictions invites you to a think tank exploring: Discussion #mhjusticeandrace Outline/CoI Background/Project Background/Findings/Discussion/Next Steps

Questions for Participants Do these findings resonate with you? Do you have anything to add to our findings? How can you use these findings in practice? Who can we share this with to continue momentum? Deqa #mhjusticeandrace Outline/CoI Background/Project Background/Findings/Discussion/Next Steps

For more information, visit: http://www.eenet.ca/node/1263#about Thanks for attending! For more information, visit: http://www.eenet.ca/node/1263#about Deqa Report will be available soon Continue disseminating this work We are also looking for a new CoI lead – anyone interested, please contact Angela. #mhjusticeandrace Outline/CoI Background/Project Background/Findings/Discussion/Next Steps