Social Policy in Ontario

To heal and protect: mental illness and the justice system

Posted on January 22, 2011 in Child & Family Debates

Source: Globe & Mail — Authors: Kirk Makin

TheGlobeandMail.com – news/national
Published Friday, Jan. 21, 2011. Last updated Saturday, Jan. 22, 2011.   Kirk Makin, Milton, Ont.

The “headbanger” arrived in a police van and wasted little time in earning his nickname. “He would just dive at walls and doors,” smashing into them head-first, Janet Gauthier recalls.

“It is a very traumatic experience,” she adds. “There are cases here that would confound any psychiatric facility.”

But the Maplehurst Correctional Complex, where Ms. Gauthier is deputy superintendent, is not a psychiatric facility: The young schizophrenic is one of the thousands of mentally ill people flooding Canada’s prisons.

“We try to learn from each one of them,” Ms. Gauthier says, but the central lesson is simply that jail is an abysmal place to stuff the sick and demented.

The ritual is never-ending. Offenders who are often disoriented and babbling are disgorged at prison gates, leaving harried staff to gauge how dangerous they are and place them where they are least likely to run afoul of tougher inmates or try to take their own lives.

The mind-bending isolation of a segregation cell brings no peace to a depressed or unhinged mind. Nor does an environment of slamming cell doors, fear and intimidation. Behind bars, effective treatment is rarely more than a promise while reality is a severe shortage of psychiatric professionals and a patient population so diverse it can explode if different kinds of inmate mix.

The cost to society is immense. After clogging cell blocks for months or years, untreated prisoners often are released only to get into trouble all over again.

Recent figures indicate that nearly 35 per cent of the 13,300 inmates in federal penitentiaries have a mental impairment requiring treatment – triple the estimated total as recently as 2004, and far higher than the incidence of mental illness in the general population.

“The numbers are staggering,” says Correctional Investigator Howard Sapers, whose office oversees the operations of Correctional Services Canada (CSC).

Yet, even as correctional officials appeal for saner strategies, the federal government’s much-publicized policies designed to get tough on crime are pouring thousands of new offenders into prisons that are already perilously overcrowded.

“It is a huge problem,” Mr. Sapers says. “The pressures are going to be even more extreme.”

In a report last fall, Mr. Sapers was unsparing in his criticism of CSC’s long-term strategy for treating the mentally impaired more humanely and effectively. A recent infusion of $50-million represented a once-in-a-generation opportunity to shore up facilities for the mentally ill, but the money was mismanaged and poorly targeted, he wrote.

“Funding is delayed to such an extent that, at this pace, it could easily take decades to fully implement.”

Public Safety Minister Vic Toews, the government’s law-and-order point man, declined to comment on the situation this week, but CSC spokesman Suzanne Leclerc says the new laws will bloat the system with 4,500 new inmates by 2014.

Thus far, the government has committed $600-million to create 2,552 beds to accommodate them, but Mr. Sapers says the new and renovated cells are “based on existing designs that are inadequate. We are not going to see more common space, more therapeutic space or more treatment capacity.”

Jails are hard-wired to mete out punishment, not therapy, so the mentally impaired often go untreated, sometimes languishing in isolatation 23 hours a day.

Some correctional officials concede that the best they can do is limit the damage. “As long as there is a valid court order, we are required to admit them and take care of them,” says Steve Small, assistant deputy minister of correctional and community services for Ontario. “We do our best, but there are certainly other locations that would be preferable for these types of inmates.”

Cells on suicide watch

Less than an hour’s drive west of Toronto, Maplehurst is a sprawling complex guarded by high fences and overhead mesh (designed to foil slingshot delivery of drugs to inmates in the exercise yard) that primarily houses offenders on trial or waiting out adjournments. About 200 of its 1,200 inmates have a serious mental impairment, including schizophrenia, bipolar disorder, brain injuries and the effects of fetal alcohol syndrome. Others suffer from dementia or low intelligence and a lack of coping skills. The most floridly psychotic inmates are kept under suicide watch in bunker-like cells.

Unlike staff at a psychiatric facility, guards have difficulty responding instantly to emergencies – such as a recent case in which a schizophrenic became hysteric in the belief that his cell was crawling with mice and snakes. “Staff knew how terrified he was,” Ms. Gauthier recalls. “The look in their eyes was compassion. But they had to force him back in his cell.”

On a 50-man range reserved for the most severe cases, offenders float quietly between their cells and a narrow corridor with tables bolted to the floor. Like a herd of deer, they appear docile, yet leery; most are heavily medicated.

“I used to say that I had never seen anyone as sick as I had seen in hospital forensic units, but I can’t say that any longer,” Ms. Gauthier remarks. “A psychiatric facility has different equipment, a different model. Correctional centres were never set up to be mental-health centres.”

Guards and nursing staff on the mental-health ranges appear genuinely caring, referring to inmates by name and keeping elaborate charts of any change in behaviour that may point toward a suicide attempt or sudden attack. However, they are not always trained in the finer points of mental illness.

“A schizophrenic may think that a guard is the devil and start calling him really foul names,” Ms. Gauthier says. “If he were a healthy person, he would be up for misconduct. One of the challenges is to understand that this is a symptom of an illness.”

Graham Glancy, a forensic psychiatrist who works three days a week at Maplehurst, sounds like a battlefield medic as he describes what it’s like to process patients in 20-minute intervals all day long: “Basically, it’s a matter of medication and management – and trying to drop one little pearl of wisdom on them.”

Some offenders are violent or hallucinate wildly, but exercise their right to refuse treatment. Staff can try to persuade local hospitals to medicate them involuntarily, Dr. Glancy explains, but getting them there requires diplomacy. “You have to be very careful about it. I can only send one or two at a time, or the hospital can get swamped.”

On another range, 50 inmates with brain damage or subnormal intelligence gaze warily at strangers. All they have in common is the fact that, in prison, they’re highly vulnerable. Some are chronic bedwetters. Others are old, scraggly and demented. Some are hulking men, but behave like school kids.

“The developmentally delayed are the forgotten population,” Ms. Gauthier says. “… It is like putting four-year-olds in custody. They cry all day for their mommies. Social workers give them colouring books and crayons.”

She recalls an inmate who arrived clinging desperately to a Beanie Baby, which prison rules didn’t allow in his cell. “He had never been separated from it. He finally let us take a picture of it so he could hold that.”

How did Canada’s prison system turn into a holding tank for mentally damaged individuals?

Many officials trace it to the deinstitutionalization of psychiatric patients over the past 30 years. Patients wound up on the street when neighbourhoods shunned them and social-service agencies failed to provide adequate housing or care. In many cases, their mental state deteriorated, and they turned to crime, everything from the mundane to murder.

“We see people who … felt there was no other way,” says Mr. Small, the assistant deputy minister. “We also see people with mental-health issues who couldn’t even form the intent to commit a crime.”

Treating mentally damaged offenders can be close to impossible in provincial jails, where inmates are on short court remands or serve sentences of less than two years. Longer federal sentences allow time for treatment, but it’s rarely available.

“There are waiting lists for almost every program at every institution,” says Mr. Sapers, the federal investigator. “Although a program may be advertised as being available at a particular institution, it very likely isn’t. This is where it all falls apart.”

If mentally impaired inmates do not get appropriate treatment, they’re unlikely to qualify for early parole, winding up warehoused until their sentences are almost over. Thus, parole officers have little time to help them return to the community. “This leaves them at a higher risk of reoffending,” Mr. Sapers says. “It is a great irony. The cycle is very counterproductive.”

Correctional officials scramble to link the mentally ill with agencies that can provide beds and medical care after they are released, Mr. Small says. But many offenders have wandered far from home or been abandoned by their families, making it an enormous challenge.

To complicate matters more, ex-convicts with mental problems tend to be shunned even by well-meaning agencies. “Once you have been in jail, you have a stigma,” Ms. Gauthier says. “Those beds are closed off, so we end up having to rely a lot on hostels and transition housing.”

Uncertainty on the horizon

Looking ahead to the spike in the penal population, the correction service says it has no idea how many new inmates will require mental-health care. Ms. Leclerc says her department works hard to meet its legislative mandate “to provide every inmate with essential … services” and “reasonable access” to services that aren’t essential, but “will contribute to the inmate’s rehabilitation and successful reintegration into the community.”

In the past five years, she adds, the $50-million has been spent largely on assessing new inmates and helping offenders after they are released. But Mr. Sapers says that money has done little to make treatment or more suitable accommodation available to most inmates.

He says it is urgent that the federal government work more closely with provincial correctional systems and psychiatric hospitals.

If not, Maplehurst’s Ms. Gauthier adds, people like the headbanger will remain caught in a revolving door between jail and the street. “The primary concern is getting medication and the right treatment,” she says. “There was a day when these offenders all would have been in psychiatric facilities. That day is gone. Now, we have incarceration.”

And what has become of the young schizophrenic?

To prevent further damage, he was placed in a special restraining cot and had to wait in his own private hell until the hospital could be persuaded to medicate him. Returned in a much more placid state, he was able to complete his two-month sentence and then released.

For how long is anyone’s guess.

Kirk Makin is The Globe and Mail’s justice reporter.

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Tags: corrections, crime prevention, mental Health, youth

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