2005 Annual Report
INTRODUCTION:
Operation of
a Mental Health Court program is a constant learning experience for those
involved. Successes and failures influence
approaches to be taken for future cases.
There is no ‘one formula’ which will work in every case, and we have had
to think ‘outside the box’ for solutions, while continuing to adhere to the procedures
and parameters of the Criminal Code. With
maturity of the program and insight gleaned from five years experience new
protocols and practices have been established and continue to evolve.
In addition
to challenges in the areas of mentally ill young offenders and addictions, we are experiencing an increasing
caseload not only in the number of referrals but in the complexity of the
cases. The resultant pressures on time,
community based resources and accommodation for the mentally ill and
intellectually disabled are of increasing concern to all involved with the
program.
The Mental
Health Court team has faced these challenges in the belief that the program does
achieve its stated objectives. Since
becoming a permanent program of the Provincial Court of New Brunswick in Saint
John on November 14, 2003, the Mental Health Court program has operated
on the premise that it is an effective and innovative method to provide access
to justice for those who have a mental illness or an intellectual disability
which has brought them into conflict with the law, as well as for those
affected by that conflict and for the community. The recent evaluation results highlighted in this report now
confirm that belief and premise.
Significant
challenges remain. These include extending
the program to youth as defined under the Youth Criminal Justice Act;
incorporating substance abuse and addictions programs as a component of the Mental
Health Court program; continuing
education of the members of the Mental Health Court team and continuing the
process of evaluation.
In this
report we present some statistical analysis of the past year and the past 5
years of the court’s operation. 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. In 2004, for ease of
reporting and comparisons, the calendar year was adopted as the reporting
year. Accordingly the statistics
generated for the first five weeks of the pilot project ( November 24 to
December 31,2000) have been incorporated into the 2001 reporting year.
REFERRAL ACTIVITY IN PAST YEAR:
This year saw a 62% increase over the number of referrals to the
Court from the previous 2004 year and nearly double from the first year of the
Court’s operation.
The increase may be the result of several factors but chief among these
appears to be more public awareness of the existence and benefits of the Court
program. Mental health service
providers and Duty defence counsel have continued to advise clients about the
program. Crown counsel, when appropriate note is made in police reports, have
suggested that counsel consider making a referral. As well more private
counsel have been referring clients and participating with the Mental Health
Court Team.
To accommodate this increase, the time of each Court session was enlarged
from one half day to one full day every two weeks. This has cut down on the ‘waiting time’ for accused and reduced
the resultant time pressures on the team.
While waiting room space is restricted in the present court building,
arrangements for more seating have now been made in the form of an unused
adjacent courtroom.
The following summary provides a general view of the number of cases
handled in the program over the past year:
ACTIVITY FOR
THE PERIOD
|
Number of
Cases continuing from 2004 as of January 1, 2005 |
15 |
|
|
Number
of New Cases presented for period |
39 |
|
|
Total number of cases handled |
|
54 |
|
|
|
|
|
Disposition of cases handled : |
|
|
|
Active
cases as
of December 31,2005 : |
|
|
|
- in
Admission Phase (in
eligibility or compliance stage) |
14 |
|
|
-in
Program Phase (accepted
into and taking a program) |
12 |
|
|
Number found unfit to stand trial or not criminally responsible |
1 |
|
|
Number found to be ineligible for program |
7 |
|
|
Number of voluntary withdrawals |
2 |
|
|
Number removed from the program to regular court |
2 |
|
|
Number who successfully completed program and Graduated |
15 |
|
|
Total |
|
54 |
REFERRAL ACTIVITY
IN PAST 5 YEARS:
The
following summary indicates the number of new cases referred to the Court each
calendar year:
|
Year |
No.
of new referrals |
|
|
|
|
2001* |
20 |
|
2002 |
21 |
|
2003 |
30 |
|
2004 |
24 |
|
2005 |
39 |
* includes 3 cases referred between Nov 24 to Dec. 31,2000
This
indicates a trend of increasing referrals. The number of referrals to the Mental Health Court program each
year averaged over the past 5 years is 27 cases.
EVALUATION STUDY
An
evaluation study, funded through the Medical Research Fund of New Brunswick
, was conducted 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).
( www.gnb.ca/0391/MedicalResearch-e.asp.)
Preliminary work for this type of study was completed in 2004 with the
financial assistance of The Greater Saint John Community Foundation
( www.saint-john-foundation.nb.ca)
Using a
comparative approach, this naturalistic, prospective study compared mental
health outcomes, legal outcomes and quality of life outcomes of mentally ill
accused who participated in the Mental Health Court with those who did not. The study identified, and with their
consent, tracked 25 mentally ill accused who had participated in the Mental
Health Court program and 22 mentally ill accused who did not. The two groups had similar composition in
regards to age and sex demographics, occupations and diagnosis. Other factors such as global level of
functioning, living arrangements and past psychiatric hospitalization showed a
variance between the two groups which appeared within acceptable limits.
Preliminary
results of this one-year study were presented at the International Congress of
Law and Mental Health in Paris July 2005.
Taking into
consideration certain noted limitations, some of the most notable findings and conclusions
of the study are that
- Mental Health Court
participants spend less time in jail or hospital compared to regular court
participants.
-
76% of the Mental Health Court participants successfully completed the program resulting in either the charges being dropped ( with no criminal record) or
avoidance of going to jail.
- in the Regular Court group, all the
participants were convicted and
acquired a criminal record and 64% of the Regular Court participants went to jail.
- Mental Health Court participants get
significantly more community
mental health services.
As well the
results of the study indicate that the Mental Health Court participation aids
in stabilizing mental illness and that relative stability continues even after
discharge from Mental Health Court.
This
empirical study confirms that the important objectives of the Mental Health
Court are being achieved. The results
of this will allow health and justice personnel to gain insight into the
efficacy of the Mental Health Court program.
THE MENTAL HEALTH COURT TEAM
Notwithstanding
the many challenges faced this past year, it must be observed that the team
members, individually and collectively, continue to demonstrate a very high
level of commitment and enthusiasm for the Mental Health Court program. This is reflected in the results achieved to
date.
In
recognition of their work, the Chief Judge of the Provincial Court of New
Brunswick Camille Dumas made a presentation to each member of the Mental Health
Court team at a meeting on the 5th year anniversary of the inception
of the Mental Health Court. The
following were recognized:
(a) Dr. Vinod Joshi
Psychiatrist
. From the inception and development
of the Mental Health Court program Dr.
Joshi has continued to serve in this critical position on the Team. His professional knowledge, diagnostic
abilities and insight provide valuable input to the Team on accused who are
applying to and participating in the program as well as to available treatment
programs. His professional liaisons
with colleagues in public and private practice who have patients in the program,
allow for their input and ensure overall continuity of approach.
Dr. Joshi has
made presentations on the Mental Health Court at national and international conferences.
He has been instrumental in arranging for evaluation studies of the Mental
Health Court program as well as in the establishment of the Mental Health Court
website: http://www.mentalhealthcourt-sj.com
(b) Patrick Wilbur
Crown
Prosecutor . Mr. Wilbur has continued to serve as the Crown
prosecutor on the Mental Health Court team.
Bringing to the team his experience as both a defence counsel and a
prosecutor, he provides that necessary balance and fairness by ensuring that
the public interest is protected and the ends of justice are properly served.
(c) Margaret Gallagher
and Brian Ferguson Duty
Counsel Mrs. Gallagher and Mr. Ferguson have acted as duty defence counsel for the past 5 years. The Court, Team and the accused are
fortunate to have available their legal talent and personal skills. Both have the ability to communicate easily
with accused and their families and friends and establish a rapport which
enables them to effectively represent the accused. Both demonstrate a high
level of professionalism in protecting the rights of the accused and working
with other members of the team.
(e) Shawn Parlee
Probation
Officer When Marilyn Estey chose to
further her career in the Federal civil service, Mr. Parlee accepted the
position on the team. His
demonstrated interest in the program together with his monitoring skills and
organization abilities have all contributed to the success of the Court this
past year.
(f) Robert Dickison
Community Caregiver Mr. Bob Dickison of the Salvation
Army has continued to provide valuable input from the viewpoint of the
caregivers who provide secure and safe accommodation for participants. He continues to aid the Team in the securing
of accommodation for participants as well as providing insight and solutions to
everyday issues faced by participants as well as caregivers.
(g) Sharon Lowe
Court
Staff The Chief Judge recognized the contribution of Mrs. Lowe who
performs the important secretarial role to the Judge and the Court. In addition to her duties and court
stenographer for the Court she has capably maintained the records of the
referrals, dispositions and outcomes for the Court, coordinated the
pre-appearance conferences and served as communication link in matters related
to the Court’s operation.
(h) Judge Alfred Brien It
has been my pleasure to continue to sit as the presiding judge. I do not believe that I can improve upon my
remarks of last year so I will re-iterate them. 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.
To me, on both 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 February
2005 the Mental Health Court team accepted an invitation to visit the Portage Centre facility at Cassidy
Lake, Kings County N.B. This facility
provides residential addiction rehabilitation program for young persons. ( http://www.portage.ca/ )
At the time,
one of the participants in the Mental Health Court was undertaking
rehabilitation treatment at Portage and the Team met with this young man, his
mother and members of the facility. With
the cooperation of Portage, addiction programs for youth with co-occurring
disorders of major mental illness and addiction is now an available component
of a Mental Health Court treatment program.
In November 2005, the team toured Centracare, a psychiatric facility in Saint John and met with staff for an
informal and informative discussion.
(http://www.ahsc.health.nb.ca/Programs/MentalHealth/tertiary.shtml)
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 that more
educational opportunities and initiatives for the benefit of the Mental Health
Court Team are needed. Plans to visit other
addiction and psychiatric facilities are underway. Despite the absence of any funding for such opportunities,
efforts must be made to ensure continuing education for the Team members.
PRESENTATIONS
On invitation, Mr. Patrick Wilbur and
Lucie Mathurin-Ring made a presentation to staff and visiting law students at
the Shepody Healing Centre Correctional
Service of Canada's Regional Treatment Centre in the Atlantic Region, attached
to Dorchester Penitentiary in Dorchester N.B.
www.csc-scc.gc.ca/text/
speeches/commish/02-09-04b_e.shtml
Two members of the Court team, Dr.
Joshi and Judge Brien made a
presentation outlining the operation of the Court and the results of the
evaluation study at the International Congress on Law and Mental Health
sponsored by the International Academy
of Law and Mental Health in Paris
France in June 2005. (www.ialmh.org/)
In December
2005, to mark the 5th anniversary of the operation of the Mental
Health Court, Chief Judge Camille Dumas of the Provincial Court of New Brunswick (www.gnb.ca/cour/06PCNB/index-e.asp)
made a special presentation to each current member of the Mental Health
Court team in recognition of their valuable contribution to the Court. On behalf of the Provincial Court he extended
the appreciation of the Provincial Court to the team members individually and
collectively. Photographs
of the presentation are posted on the Mental Health Court web site.
HIGHLIGHTS
AND UPDATES
In keeping
with previous annual reports, the following are highlights and updates on the
operation of the Court.
(b) Scope As noted above, the caseload has been
increasing with the number of referrals to the Court. This year’s increase of
62 % over the 2004 year appears to be
associated with increased awareness of the program generally and in particular
by counsel, police and health providers.
In addition to the educational aspect of such awareness, the increase
appears to reflect general acceptance of the benefits and positive results of
the program.
In the
developmental years of the program, the Court operated on a low profile
approach until it had a tried and tested model in place. Even though the model was confirmed and the
Mental Health Court made a permanent program of the Provincial Court in Saint
John in 2003, the Court has continued to operate on the same profile.
With the
exception of its web site ( www.mentalhealthcourt-sj.com
), which has been in operation since 2003, publicity of its existence and
operation is largely by means of word of mouth and the occasional article in the
media and ‘trade ‘ publications.
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 now accepts cases involving personality disorder and
co-occuring disorders where one of which is substance addiction.
Considering all
cases over the past 5 years, the percentage where the following was diagnosed
alone, as a co-occurring disorder or as a dual diagnosis*:
*
Co-occurring or concurrent disorder describes a condition in which a person has
both a mental illness and a substance abuse problem. In Canada dual diagnosis
usually refers to a person with a mental illness and a co-occurring
developmental disability. In the U.S. and
sometimes in Canada dual diagnosis is the term used to describe concurrent disorders. Source: Canadian Mental Health Association Fact
Sheet www.ontario.cmha.ca
|
Schizophrenia
|
22 |
|
Major
Depression |
5 |
|
Schizo-Affective
Disorder |
5 |
|
Pervasive
Developmental Disorder (Autism) |
3 |
|
Drug/alcohol
Dependence |
22 |
|
Malingering |
1 |
|
Bi-Polar
Disorder |
9 |
|
Adjustment
Disorder |
3 |
|
Personality
Disorder |
12 |
|
Borderline
Personality Disorder |
4 |
|
Mental
Retardation |
11 |
|
Acquired
Brain Injury |
2 |
|
Genetic
Syndrome |
1 |
As well the
Court continues to take referrals from courts outside the City of Saint John,
where circumstances allow.
(c) Challenges: The
Mental Health Court Team has been aware of the possibility that the program can
fall victim to its perceived success.
The concern has been addressed that individuals who might not, in the
absence of a Mental Health Court program, have faced a criminal charge
as a result of their actions, particularly if the action was of a minor nature,
might now face such a criminal charge in the hope or expectation that their
case will be referred to the Mental Health Court. The team has been vigilant in halting any perception of others who
may ‘innocently’ criminalize persons who might not otherwise be charged.
With respect
to youth (under the age of 18 years) who have come into conflict with the law
as a result of a mental illness or intellectual disability, two cases have been
referred to the Court. One is currently
participating in the program and one has been transferred back to regular Youth
court. The additional challenges with
youth are in part of a legal nature and in part of a dependence nature. Legally the input of the parents is mandated
and when the wishes of the parents and those of the youth conflict this adds to
the difficulties of trying to work with the youth and the parents. The dependence issue relates to accommodation. In order for a mental health court program
to operate successfully, the participant requires a safe and secure residence
as well as good nutrition. Often the
youth is dependent upon the parents who have a responsibility to provide the
necessities of life. If the youth has
been disruptive at home, yet home is the only placement available, the
challenge of stabilizing the mental health of the youth is further compounded.
Another
major challenge continues to be with respect to cases of co-occurring disorders
where one of the disorders is substance addiction. Last year, the Court successfully incorporated substance abuse
counselling as a component of a Mental Health Court 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. This year the Court accepted a referral of
a youth with a major mental illness and a drug addiction. With this experience, the Court is
anticipating referrals of other such cases both youth and adults.
(e)
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 Moncton,
Hampton, St. Stephen and Fredericton.
The
following is a cumulative summary of the cases handled for the period of 5
years ending December 31,2005 with a 4 year comparison figure.
For 5 years ending Dec 31,2005
with 4 year comparison
|
No. of Years completed |
5 |
4 |
|
|
|
|
|
Total Number of Cases presented and dealt with
by the M.H.C |
134 |
96 |
|
|
|
|
|
Active
Cases[1] as of December 31
in last year of the period |
26 |
17 |
|
|
|
|
|
Closed
Cases[2] as of December 31
in last year of the period |
108 |
79 |
|
|
|
|
|
Number who successfully completed
program and Graduated |
60 |
45 |
|
|
|
|
|
Number found unfit to stand trial
or not criminally responsible |
12 |
11 |
|
|
|
|
|
Number found to be ineligible for
program
|
22 |
15 |
|
|
|
|
|
Number removed from program |
7 |
3 |
|
|
|
|
|
Number of voluntary
withdrawals |
7 |
5 |
|
|
|
|
(f)
Graduation Rate We continue to experience a high
retention rate of accused in the program. The cumulative experience is:
|
|
5
Years |
4
Years |
|
Number of cases admitted into Program Phase |
77 |
57 |
|
|
|
|
|
Number
of cases who graduated |
60 |
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.
(g) Post Graduation The nature and progression of some mental
illnesses, together with external influences will cause some graduates to
re-offend. The cumulative experience to
date however confirms a high and stable percentage of those who do not
re-offend after graduating from the Court program:
|
Number who
graduated over 5 year period |
60 |
|
Number who
graduated and have not re-offended |
49 |
|
Number of second
entries who graduated and have not re-offended [3] |
7 |
Of those who
did graduate from a program, 82% did not re-offend. This represents a 6% increase in the overall rate of those
who have not re-offended post graduation from the year 2004 when the rate was 76%.
There may be
several reasons to account for this positive trend and at this juncture we can only
speculate. However one logical
inference from this trend may be that the Mental Health Court program is attaining
its stated objectives.
Of those who
entered the program for a second time ( see note 3) two re-offended and were
admitted for a third program. Both of
these third entries have not re-offended.
(i) 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 3
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.
In
these cases the breach was failure to keep the peace ( usually aggressive behaviour towards a fellow
resident, caregiver or property). It has
been reported that the short period of remand ( average 3 days) had a calming
effect upon the accused, similar to a “time out”, and also a calming effect upon
the other residents and caregivers who were upset by the aggression. In each case the group home or special care residence
agreed that the accused could return to that residence.
ACKNOWLEDGEMENTS
The Court continues
to express its gratitude to those Provincial government departments as well as
private and community organizations, from which members of the Team 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 among those parties working
in similar fields and with like objectives.
Special acknowledgement
must be made of those participants who, through hard work and commitment, have
undertaken or successfully completed the program. It is often a daunting task, and many struggle with their illness
or disability but persevere. While
there is a legal benefit which flows to those who graduate, it is the
realization that they have achieved something significant in the stabilization
of their mental health, which makes this struggle so worthwhile not only for
them, but for the community overall.
Judge Alfred H. Brien
March 2006
[1] A case is classified as ‘active’ if currently in either the Admission or the Program Phase.
[2] A case is classified as ‘closed’ if no longer in either the Admission or Program phase ( i.e. on graduation, withdrawal, removal, or a finding of “unfit to stand trial”.
[3] In the early stages of the pilot, while in the process of determining program duration and defining successful completion, some accused were graduated within 3 or 4 months and then re-offended. Learning that this duration was too short and that program duration is an important factor in success, these accused were allowed to enter a program for the second time.