Mental health issues and the Canadian criminal justice system^**

* Paper submitted 13 April 2015 for review and possible publication in the Contemporary Justice Review. An earlier version of the paper was presented at ‘8th Educational Conference on Mental Health: Mental Illness, Offending Behaviours, and Criminal Justice Services’ in Toronto, Ontario (17 October 2013).

Abstract

The critics assert that a significant proportion of incarcerated individuals suffers from mental health issues, i.e. ‘the criminalization hypothesis.’ The current paper reviews the scholarly literature to address five interrelated questions: (1) What are the risks of those classified as mentally ill for committing crimes and, in particular, violent crimes? (2) As the gatekeepers to the criminal justice system, what happens during ‘first encounters’ between the police with those who have mental illnesses? (3) What community-based services are available for effective diversions as an alternative to incarceration for those with mental illnesses? (4) What are the impacts of treatment options upon those experiencing mental illnesses while incarcerated, including the impact upon recidivism? (5) What types of pre-release planning and community responses have the most positive effects to help reduce recidivism and assist offenders in coping with mental health issues in the Canadian context? After summarizing key evidence pertaining to these questions, the paper presents case studies as exemplars of ‘best practices’ to illustrate promising directions conducive to integrated, holistic, and effective responses at the intersection of the criminal justice and mental health systems.

Keywords:

• Mental health
• inmates
• criminalization hypothesis
• risk factors
• recidivism
• best practices

Notes

* Paper submitted 13 April 2015 for review and possible publication in the Contemporary Justice Review. An earlier version of the paper was presented at ‘8th Educational Conference on Mental Health: Mental Illness, Offending Behaviours, and Criminal Justice Services’ in Toronto, Ontario (17 October 2013).

1. A national study of inmates in the United States determined that nearly 15% of federal inmates had diagnosable mental illnesses (Wilper et al., 2009), while Fazel and Seewald’s (2012) meta-analysis of 81 studies across 2 dozen countries determined that about 4% of those incarcerated met the criteria for ‘severe mental illness’ such as psychoses.

2. Similarly, the evidence confirms that mental health issues are more prevalent among young offenders as compared with the non-institutionalized population (Teplin et al., 2006). For example, youth involved in delinquency have higher rates of externalizing disorders, such as oppositional defiant disorder (ODD) and conduct disorder (CD) (Vogel & Messner, 2012; see Ruchkin, Koposov, Vermeiren, & Schwab-Stone, 2003). While the current paper focuses on adults, the evidence reveals that the risks of externalizing behaviors, anxiety, and depression may be even higher among the young offender population (Timmons-Mitchell et al., 1997; Vermeiren, 2003).

3. These figures are remarkably similar to Steadman, Osher, Robbins, Case, and Samuels’s (2009) estimates that 14.5% of men and 31% of women in U.S. jails had been booked with serious mental health issues.

4. Wood and Beierschmitt (2014) recommend an even more activist police service to identify ‘hotspots of vulnerability’ in cities with the aim of working with communities and businesses to enhance behavioral interventions in places known to involve high levels of risk.

5. The Restorative Policing Program in San Rafael involves an impressive degree of inter-agency coordination. The program consists of a multi-agency team of social service, criminal justice, and treatment-providing agencies that meet to develop case management plans for each client referred by law enforcement (California Task Force, 2011). Fay (2009) has argued that the program has been especially effective in reducing recidivism and ensuring proper treatments as an alternative to incarceration. The challenges, though, involve the territoriality of many service providers (especially in regard to funding requirements) and their willingness to share resources and work cooperatively with other stakeholders in the system.

6. Hughes and Peak (2013) offer a critical review of mental health courts in terms of psychotropic drug prescriptions and their long-term health impacts, as well as issues surrounding informed consent and voluntary participation.