Saint John

Mental Health Court

A program of the Provincial Court of New Brunswick

Annual Report  

for 1 year period ending November 19, 2004,

with Cumulative Summary for 4 year

 period ending November 19, 2004

 

 

Introduction:

 

This is the first annual report prepared since the Mental Health Court became a permanent program of the Provincial Court of New Brunswick in Saint John on November 14, 2003.

 

The Mental Health Court program continues to provide innovative access to justice for those who have a mental illness or intellectual disability which brings them in conflict with the law, for those affected by that conflict and for the community.   The program operates in accordance with its stated objectives and continues to develop effective procedures and practices. 

 

During the three-year development phase of the model, a great deal of useful and important data on the operation of the Court was gathered. It was decided that a cumulative summary with data from the inception of the pilot project to date would be appropriate and beneficial to provide an overview of the court’s operation.

 

Caseload for the Past Year:

 

The past year has seen an increase in the number of referrals to the Mental Health Court program over the experience of the previous three years.  This has resulted in an increase in the number of cases on the active case load.  While the Court retains some flexibility in scheduling the return of cases, so as not to have more accused appearing before the court than can reasonably be handled on any one sitting afternoon, the increase is placing a strain on the resources, the team and, in some respects, the accused.  

 

To relieve this strain it may be necessary to consider enlarging the time of each Court session from one half day to one full day every two weeks.

To lessen the anxiety felt by some accused in the length of waiting time between the time fixed for their appearance and the time of that appearance, the Court will have to consider expanding the staggered hour regime now being utilized.  Waiting room space is restricted in the Court building and arrangements will have to be made to provide more adequate seating for those accused who have to wait as a result of the number of cases on the docket.

 

The following summary provides a general view of the cases handled in the program over the past year:

 

                                    ________________________________________________________________________

   SUMMARY

for the period Nov.18, 2003 to Nov. 19 2004

 

 

                                              

 

Evaluation:

 

Following the decision of the Medical Research Fund of New Brunswick to fund a unique evaluation study of the Court, the work commenced under the direction of the principal researcher, Dr. Vinod Joshi, (Consultant Psychiatrist, Community Mental Health Center), and researchers Dr. Pamela Forsythe (Consultant Psychiatrist, Community Mental Health Center) and Dr. Abraham Punnan (Professor, Department of Mathematics, University of New Brunswick Saint John).  The one-year study will address development of scientific evaluation procedures for accused persons participating in the Mental Health Court.  It will compare mental health outcomes, legal outcomes and quality of life outcomes of mentally ill accused who participate in the Court with those who do not.   

( www.gnb.ca/0391/MedicalResearch-e.asp )

 

The identification and recruitment of suitable control and comparison groups as well as the collection and analysis of data about the members of such groups is progressing well.  It is hoped to have some preliminary results available in the summer 2005. 

 

This will be an important study the results of which will allow health and justice personnel to gain insight into the efficacy of the Mental Health Court program.

 

Preliminary work for this type of study was completed last year with the financial  assistance of The Greater Saint John Community Foundation

( www.saint-john-foundation.nb.ca)   

 

 

The Mental Health Court Team:

 

The team members, individually and collectively, continue to demonstrate that high level of commitment and enthusiasm for the Mental Health Court program needed to produce the results achieved to date.  Individual recognition of their respective contributions is appropriate and the order of doing so is random.

          (a) Judge

 

It has been my pleasure to continue to sit as the presiding judge.  My involvement with the Court, from inception of the pilot project to the permanent program, continues to be not only a significant learning experience but a most rewarding one.  On an anecdotal and statistical basis, the positive results achieved while working with the dedicated  members of the Team and the provincial court staff, as well as the accused, their caregivers and family members, continues to demonstrate the value of such a program in our community. 

 

In January 2004, the Hon. Judge David Walker of the Provincial Court of New Brunswick in St. Stephen, provided leave relief for me by presiding over a sitting of the Court.  Judge Walker has indicated an interest and willingness to assist the court by sitting at various times when needed.

 

(b) Psychiatrist

 

Dr. Vinod Joshi continued to serve in this critical position on the Team, as he has since the inception and development of the program.   He continues to bring to the Team and the accused a high level of professional knowledge and insight,  providing valuable input on accused who are applying to or participating in the program.   He also has been successful in liaisons with colleagues  who have patients in the program to allow their input and ensure overall continuity of approach.  His continued efforts to ensure proper evaluation of the program is most appreciated.

 

(b) Crown Prosecutor

 

This year saw three changes in the position of the Crown Prosecutor as a member of the Mental Health Court team.  Fortunately continuity in approach and interest has been maintained by each successor to the position. 

 

As the year commenced, Mr. Steven Hinkley was serving as Crown Prosecutor and he continued until accepting a position in Canada’s  Northwest Territory.  Together with his predecessor, the late Philip Holland, he had helped develop the role of crown prosecutor within the Mental Health Court model.

 

In April 2004 Mrs. Lucie Mathurin-Ring joined the Mental Health Court Team as Crown prosecutor serving until November 2004 when she accepted a position as Legal Aid Duty Counsel.  In her short period with the Team she brought enthusiasm and understanding to this key position.

 

In November 2004, Mr. Patrick Wilbur joined the Mental Health Court Team as Crown prosecutor.  Drawing upon legal experience gained in the private practice of law, Mr. Wilbur has demonstrated interest and insight with respect to his new role.

 

(d) Duty Counsel

 

The Team has continued to benefit from the participation of two experienced and knowledgeable defence counsel, Mrs. Margaret Gallagher and Mr. Brian Ferguson.  Both of these counsel have been involved with the Court since its beginning and have assisted greatly in its development.  They continue to demonstrate those high levels of professionalism, understanding and caring which has well served the accused and the Court.

 

(e) Mental Health Services

 

Two individuals from the local Community Mental Health Centre have

once again provided their expertise and assistance to the Team and the program.  Continuing in the position of psychologist, Mrs. Jane Nason has worked with her colleagues at the Clinic to provide the services to participants of the program and keep the Team informed thereof. 

 

Mental Health Nurse Susan O’Brien is often in regular, daily contact with participants, their caregivers, family members, friends, physicians and court staff as well as other service providers in the community.  Her community contacts and first hand knowledge of the activities and progress of participants are very important to the Team in its work.   She has also been coordinating the video-taped exit interviews of participants who complete the program.

 

(f) Probation Officer

 

Ms. Marilyn Estey continued to fill this role during the past year.  Again this year the Team and the Court were able to rely on her background knowledge of participants, network of community contacts, and monitoring skills as well as her interest in the people with whom she works.    

 

(g) Community Caregiver

 

Secure and safe accommodation for participants is crucial and oftimes difficult to obtain.  To have the input from caregivers on individual  participants as well as on community issues in general is important to the Team and the Court.  Mr. Robert Dickison of the Salvation Army greatly aided the Team in the securing of accommodation for participants as well as providing insight and solution to everyday issues faced by participants as well as caregivers.

 

Education:

 

In March 2004 , the Community Mental Health Center, Saint John, presented to the Mental Health Court Team a day long session condensing the Journey of Hope.  This valuable educational session, under the direction of Ms. Judith Armstrong, exposed the team to many facets of mental illness and presented an opportunity to learn first hand from those involved in mental health treatment.  (http://www.ahsc.health.nb.ca/mentalhealth/saintjohnservices.shtml )

 

The court, through the work of Susan O’Brien, has introduced the use of ‘exit’ interviews of participants who complete the program and wish to relate their experience.  With the written consent of the participant these are video-taped for use by the Court for educational purposes only.

 

Over the past year, many medical and nursing students and other interested parties have had the benefit of observing first hand the operation of the Mental Health Court program.  This is an important part of the education objective of the Court as well as providing community involvement.

 

There is no question but that more educational opportunities and initiatives for the benefit of the Mental Health Court Team are needed.  Despite the absence of any funding for such, efforts must be made to ensure continuing education for the Team members. 

 

Reporting Year:

 

For a number of reasons, largely for ease of recording and presenting statistics for each year, it was decided that the reporting year should be changed to the calendar year commencing the year 2005.

 

Presentations:

 

Individual members of the Team have been called upon to make presentations to interested parties throughout the year including the following.

 

On invitation, presentations on the Court and its operation were made by Judge Brien in February 2004 at the Mid-winter Education Meeting of the Provincial Court Judges Association of New Brunswick and at Speakers Hour of the Law Students of the University of New Brunswick Law School in Fredericton.  

 

Two members of the Court team, Dr. Joshi and Ms. Sue O’Brien, made a presentation about the operation of the Court at the International Association of Forensic Mental Health Services in Stockholm, Sweden in June 2004. (www.iafmhs.org/iafmhs.asp?pg=conference )

 

In July 2004, Judge Brien and Dr. Joshi presented a workshop on the Court at the National Annual Meeting of the Canadian Mental Health Association (N.B.) and the Schizophrenia Society (N.B.) entitled “Honouring our Past, Charting Our Future” 

 (www.cmhanb.ca/files/program.pdf  )

 

Upcoming Events:

 

The International Academy on Law and Mental Health has invited Judge Brien and Dr. Joshi to make a presentation at its Annual Congress in Paris, France to be held in July 2005.   (www.ialmh.org/)

 

Highlights and Updates:

 

Following are updates from the last report of November 14,2003.

 

(a)  Sittings

 

The Mental Health Court continues to sit every second Friday in Courtroom No. 3, 15 Market Square, Saint John, New Brunswick.  Pre-appearance conferences of the Mental Health Court Team commence at 12:30 P.M. and the court sits at the conclusion of the conference.  While pre-appearance conferences are not open to the public, as with all sittings of the Provincial Court, the court proceedings are open.

 

In the past six months there have been 13 sittings of the Mental Health Court.  The cumulative total is now 98 sittings over 4 years.

 

(b) Mental Health Caseload and Challenges

 

The Court continues to handle cases of mental illness and intellectual disability.  While the majority of cases handled involve a diagnosis of major mental illness (e.g. schizophrenia, psychotic disorder, bipolar disorder, major depression disorder) the Court successfully tested its model in a case  involving personality disorder.  This was a significant challenge for both the Mental Health Court Team and the accused, requiring a monitoring period of 18 months. 

 

In addition, as a test case, the Court incorporated substance abuse counselling as a major part of a program for a participant who was eligible to enter the program based upon a diagnosed mental illness and whose mental health stabilized while in the program but whose addiction was threatening to destabilize the participant.   The Court has long recognized the impact of substance abuse on mental health and the significant number of mentally ill persons who also have a substance addiction.   Also, the challenge of extending the program to young offenders remains active with the Court.

 

(c) Gender and Age

 

On a cumulative reporting basis, of the 94 cases handled by the Mental Health Court to date, 67% are males and 33% are females.

 

This shows an increase in the number of females handled by the Court over the past year in comparison to prior years.

 

Participants ranged in age from 18 to 67 years of age

 

(d) Caseload

 

While the majority of cases handled by the Court are from the Saint John area, the Court continues to take referrals from courts outside of Saint John.  To date referrals have been made from Provincial Courts sitting in Hampton, St. Stephen and Fredericton.

 

 The following is a cumulative summary of the cases handled for the period November 24,2000 to November 19,2004.   

 

 

CUMULATIVE SUMMARY

for the period Nov. 24, 2000 to November 19, 2004

 

Total  Number of Cases presented and dealt with by the M.H.C.	94
Active Cases[1] as of November 19, 2004	17
Number in Admission Phase (in eligibility or compliance stage)	08
Number in Program Phase  (accepted into and taking a program)	09
Closed Cases[2] as of November 19,2004	79
Number found unfit to stand trial or not criminally responsible	11
Number found to be ineligible for program	15
Number removed from program    - in Admission Phase	2
Number removed from program    - in Program Phase	1
Number of voluntary withdrawals - in Admission Phase	4
Number of voluntary withdrawals - in Program Phase	1
Number who successfully completed program and Graduated	45

 

 

 

(e) Graduation Rate

 

We continue to experience a high retention rate of accused in the program. The cumulative experience is:

       

Number of cases admitted into Program  Phase	57
Number of cases who graduated	45

 

 

                      

It will be observed from the above figures that 78% of those accused who were admitted to the Program Phase have successfully completed the program and graduated. This is a 5% increase from the last reported rate.

 

(f) Post Graduation:     

 

While it is to be expected that the nature and progression of some mental illnesses, together with external influences will cause some graduates to re-offend, the cumulative  experience shows a relatively high and stable percentage who do not re-offend after graduating from the Court program: 

         

Number who graduated and have not re-offended[3]	34
Number of second entries who graduated and have not re-offended [4]	8

 

Of those who did graduate from a program, 76% did not re-offend.   (As detailed in note 4, some allowances were made in the early stages of the pilot project.  It is noted that two individuals currently in the Program Phase have been admitted two times before.)  This represents a 6% increase in the overall rate of those who have not reoffended post graduation when compared to the last report.

 

(g) Program Duration

 

Program duration is dependant upon a number of complex factors (outlined in “How does an accused graduate?” in FAQ’s) . It varies with each individual case.  The Court continues to experience that longer program durations increase the chance that the graduate will not re-offend.  The average program duration is between 7 and 12 months. 

 

(h) Use of Incarceration

 

The Court continues to work to the goal to reduce the criminalization of and the use of incarceration for the mentally ill and intellectually disabled.  In the past 6 month period, remand to jail was used in only 2 cases.  Each involved a breach of an undertaking given to the Mental Health Court  and the remand was until the next sitting of the Court. 

 

Acknowlegements:

 

The Court is most grateful to those provincial government departments as well as private and community organizations from which many of the Team members come for their continued support of the program.  The program demonstrates the positive results which can be achieved from mutual cooperation and rationalization of resources amongst those parties working in similar fields and with like objectives.  I also wish to acknowledge the participants who, through hard work and commitment  have undertaken or successfully completed the program.  It can be a daunting task, but well worth the struggle for themselves and the community.

 

 

Judge Alfred H. Brien

December 10,2004