Research Summary: Approaches to Addressing Serious Mental Illness in the Canadian Criminal Justice System
Background
Serious mental illness (SMI) refers to a mental, behavioural, or emotional disorder that has a significant impact on daily functioning, such as schizophrenia, major depression, and bi-polar disorders. Although the vast majority of individuals with SMIs do not commit crimes and are non-violent, they are overrepresented in the Canadian criminal justice system (CJS). The literature suggests the following approaches may help to address the needs of individuals with SMIs throughout the CJS.
Law Enforcement
In Canada, past research has shown that law enforcement recruits receive between 1-24 hours of mental health training (Cotton & Coleman, 2008). The Mental Health Commission of Canada put forth the Training and Education about Mental Illness for Police Organizations (TEMPO) framework to help law enforcement organizations develop and assess their mental health training programs. It suggests that officers should receive approximately 35 to 40 hours of mental health training to build the knowledge and skills required to interact effectively with people living with mental illnesses.
Specialized teams have been initiated in some regions across Canada to improve responses to crisis situations involving individuals with SMIs. The deployment of a co-response team including one specially trained officer and one mental health professional has been linked to lower arrest rates, increased referrals to community mental health services, and reduced total response time (Shapiro et al., 2015). Another promising practice across Canada is the use of the interRAI Brief Mental Health Screener, a mental health screening tool developed to help law enforcement officers recognize indicators of SMIs and to communicate their observations to mental health professionals (Hoffman et al, 2016).
Court System
If an individual living with an SMI is charged with a crime, they may be redirected to a mental health court (MHC). MHCs are less formal, composed of a multidisciplinary team of judges, lawyers, and mental health professionals that offer diversion programs that provide an alternative to criminal sanctions. These courts are on the rise in Canada; however, more research is needed to understand their short- and long-term benefits for Canadians with SMIs. In the United States, MHCs have been linked to lower rates of reoffending among people who have committed violent and non-violent offences (Anestis & Carbonell, 2014; Sarteschi et al., 2011).
Custody
The use of mental health screening tools is essential for identifying individuals with potential mental health needs in custody. Furthermore, it is important that assessment and treatment prioritize individuals with SMIs, and that these individuals have access to a continuum of services that match their level of need. To prevent delays in assessment and treatment, telecommunication can be used to connect inmates to mental health professionals who are not readily available in their region. Inmates could also be transferred to a community hospital or mental health facility to receive treatment.
Pharmaceutical and non-pharmaceutical treatments are both associated with improved mental health outcomes and institutional behaviour; however, mental health treatment is not consistently linked to lower rates of reoffending (Barnao & Ward, 2015; Morgan et al., 2012). To reduce criminal recidivism, it is therefore important that mental health services are accompanied by correctional programming that is based on the principles of risk, need, and responsivity (Bonta & Andrews, 2017).
Community Corrections
For individuals with SMIs who have been incarcerated, transitional planning for community re-entry is most effective when it is initiated early and identifies appropriate community mental health services prior to release. It is also important that individuals be released with a valid health card and a sufficient supply of medication. Unfortunately, this is not always the case, which prevents individuals from accessing services in the community (Delveaux et al., 2017). Agreements could also be developed to improve information sharing and collaboration across institutions and community-based services to improve continuity of care upon the individual’s release.
Individuals with SMIs (especially those with concurrent personality and/or substance use disorders) are more likely to have their community sentence revoked for technical violations than those without an SMI or a concurrent disorder (Skeem et al., 2014; Stewart et a., 2018). It is therefore important for community supervision officers who work with individuals with SMIs to receive additional mental health training and be encouraged to use non-custodial sanctions in response to minor violations.
Notably, community-based mental health services are limited for criminal justice-involved individuals with SMIs. Many mental health service providers do not feel comfortable providing services to this population and are not adequately trained or equipped to safely address their needs (Desai, 2010). The Secure Treatment Unit located in Brockville, Ontario is one of the only facilities designed to accommodate both safety and mental health needs in Canada. More secure treatment units would be required to accommodate the needs of individuals with SMIs who need a higher level of security than can be met in the community.
Conclusion
Many promising practices have been identified for improving care and reducing the overrepresentation of individuals with SMIs in the CJS (see Figure 1 for a summary). These practices have been implemented in some jurisdictions, but could be used more broadly to better address the needs of this population. Figure 1. Promising practices for addressing the needs of criminal justice involved individuals with SMIs.
Figure 1. Promising practices for addressing the needs of criminal justice involved individuals with serious mental illnesses
Image Description
This flowchart represents the promising practices for addressing the needs of criminal justice involved individuals with serious mental illness within each level of the criminal justice system. The first box at the top of the diagram is the criminal justice system which branches out to three boxes representing the three levels in the criminal justice system: Law Enforcement, Court System, and Corrections.
The first level, Law Enforcement branches out to a box which lists the promising practices. These are:
- Increase and standardize mental health training
- Use screening tools to assess and communicate symptoms of mental illness
- Increase resources for specialized response teams
The second level, Court System branches out to a box Mental Health Courts, which then branches out to a box listing the promising practices. These are:
- Increase and standardize mental health training
- Use screening tools to assess and communicate symptoms of mental illness
- Increase resources for specialized response teams
The third level, Corrections, branches out to two boxes- Custody and Community. Both of these boxes branch into the same box which lists promising practices that are necessary in both custody and the community. These are:
- Screen everyone for mental illnesses
- Allocate resources based on severity of mental health needs
- Increase access to mental health care using technology (e.g., videoconferencing)
- Address criminogenic needs in addition to symptoms of mental illness.
This box of promising practices for Corrections gets further branched out into two boxes, separating promising practices for only custody and only community. The first box lists promising practices only relevant for custody which are:
- Mental health training for all staff
- Offer a continuum of services
- Refer acute cases to treatment centers or community hospitals
The second box lists promising practices only relevant for the community which are:
- Begin transition planning early
- Link people to community mental health services
- Share information
Source
Pedneault, C. I., Perley-Robertson, B., Mularczyk, K., & Prevost, H. (2021). Approaches to addressing serious mental illness in the Canadian criminal justice system (Report No. 2023-R001). Public Safety Canada: Ottawa, Ontario.
See full report for cited sources.
Additional Sources
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Research Summaries are produced for the Crime Prevention Branch, Public Safety Canada. The summary herein reflects interpretations of the report authors’ findings and do not necessarily reflect those of the Department of Public Safety Canada.
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