Breaking Down Barriers

for better success in changing times

Community in Concert: We CAN Work it Out

Elizabeth WhiteOctober 28, 2011Canadian Criminal Justice Association CongressQuebec City, Quebec

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Background Shelter and Access Towards an Integrated Network Community Connections CAROW initiative

◦ Ontario Projects

What’s NewWhat’s Next

Introduction

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“Violence and mental disorder is a small part of the overall picture of interpersonal violence but one where there is a significant possibility of reducing the levels of violence by improved risk assessment and treatment intervention.”

Bradford, JMCanadian Journal of Psychiatry

Vol. 53 No. 10 October, 2008. Canada

Why It Matters

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St. Leonard’s Society of Canada is a membership based, charitable organization founded in 1967. Our mission is to provide a humane and informed justice policy and responsible leadership to foster safe communities.SLSC addresses the needs of the community and its members by promoting socially responsible conduct throughout the justice system in an effective and ethical manner.

Endorse evidence based approaches to criminal and social justice Conduct research and develop policy Support its member affiliates Advance collaborative relationships and communication among individuals

and organizations dedicated to social justice

Who We Are and What We Do

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Deinstitutionalization intended to reduce in-patient service in favour of community-based outpatient services

Essential redistribution of funds did not happen Community-based programs overburdened and

under-trained

The Background

Deinstitutionalization has led to approximately

90% less beds in psychiatric facilities

By default, individuals end up in the criminal

justice system

End Result: Criminalization of

people with mental illnesses

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Stigma and Discrimination Inadequate community

health services Inadequate training for

service providers Inadequate Funding Eligibility criteria

A Web of Complexities

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Ontario: Since 2004, the total number of mentally disordered inmates increased by 5.7%

Just over 18 % of the 8,948 inmates had a psychiatric disorder. (June 2010)

31% of the 575 female offenders 30% of the jail population is developmentally

delayed, psychiatric disorder, and serious drug and alcohol

Quebec: People with schizophrenic disorders @4 times, people with major depression @3.5 times

Both groups equally overrepresented in homelessness 7

Current Statistics

Newfoundland & Labrador 2008 - @ 25% male and @60% female inmates had mental disorder diagnosis on admission.

@90% have mental health issues when substance abuse and antisocial personality included.

Federal 13% male and 29% female admissions present mental health “problems”.

Roughly doubled since 1996/97. International: Population increasing 5-10%

each year in prison and hospital.8

Current Statistics

Issue: reducing the criminalization of individuals with mental health problems

Need to close gaps in services to the population

Issue: Many service providers find themselves ill-equipped to deal with individuals who suffer from mental health & social problemsLack of effective collaboration and partnerships between systems has had a huge impact on available services

The Challenges

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Mental Disorder Shelter Criminalization

Connecting the Issues

Canada Health Act S.3: “protect, promote and restore the physical and mental well-being of residents of Canada and to facilitate reasonable access to health services without financial or other barriers.”

We must strive to achieve compliance with the legislative framework.

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Why A Strategy is Essential

Focus on a Perspective of Change

Encourage Initiatives

that focus on Reducing

Stigma and Discriminatio

n

Develop Community

Capacity

Promote a Continuum of

Care

Develop tangible protocols

Build on values of dignity and respect

Promote sustainable communities

Improve Availability and Accessibility

Generate flexible and adaptable strategies

Focus on the individual

Identify shared goals and objectives

Incorporate the social determinants of health

Include community demographics

Promote and support advocacy

Develop an action plan

Develop a holistic approach

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Creating a National Mental Health Strategy:Models to Consider

The Corrections and Conditional Release Act S.86 states that CSC shall provide inmates (not ‘offenders’) “essential health care and reasonable access to non-essential mental health care that will contribute to their rehabilitation in the community”.

Once term of incarceration is complete, offenders become eligible for health services under the Canada Health Act

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Canadian Legislation

Too many years of closed doors and revolving doors in and out of hospitals, shelters and prisons

Duty of care for CBRFs?◦ no direct case law: this does not mean that one

does not exist“Although the state’s responsibility and ability to

protect against troubling incidents is reduced outside the walls of institutions, the phenomena of recidivism and reincarceration or relapse and rehospitalization display a continuity of state interest in these situations of diminished liberty” Kaiser, A. 2010

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Turning Revolving Doors into Doors of Opportunity

Development of a Strategy focused on Mental Health, “a state of well-being”, rather than Mental Illness

Goal of Equitable and Timely Access◦ Seamless integration of services

Recovery: Living well with disease Gap: Little mention then of corrections

Now: CSC co-chairs the FPT Correctional working group on mental health: MHCC participates.

At Home:Chez Soi – CSC participates

Mental Health Commission of Canada: Toward Recovery and Well-Being

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Community Awareness Increased Exchange of Knowledge on Effective

Interventions Promote Cross-Sectoral Understanding and

Collaboration Enhanced Capacity for Staff in

Residential Programs and Training Contribute to a National Strategy

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Community Connections:Project Goals and Outcomes

Increased awareness of service providers Communities are better informed about

the criminalization of citizens with mental health issues.

Cross-sectoral understanding Improved training for correctional and

residential service providers

Project Outcomes

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From the survey data 7 CBRF locations participated in site studies and roundtables with local mental health service providers in New Westminster B.C., London ON, Toronto ON, Joliette QC, Halifax NS

All participating CBRFs worked with individuals who have mental health disorders

Most predominant disorders included: PTSD, schizophrenia, bipolar disorder, depression, generalized anxiety, FASD

All expressed a difficulty with connecting clients to appropriate services in the community

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Key Findings: Community Connections Site Studies

Resistance on the part of mental health agencies to work with CBRF clients due to criminal histories, especially if they involve violence

Networking is predominant method of being made aware of services in the community*

Privacy laws/policies are the greatest obstacles to information sharing among services and limit the disclosure of care plans

Majority of CBRFs do not have a mental health worker on staff

Respondents were split on whether their discharge planning practices were successful – early planning appears to be the key to successfully connecting residents to community services

Key Findings: Community Connections Survey

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Assessing Needs Accessible mental health care Identifying what works Building Bridges

Community Connections:What is needed

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Community Connections: Key Principles

• Having accurate diagnoses pre-release and creating treatment plans to be carried out by CBRF staff

Accuracy

• Between CBRF and individual pre-release

• Between CBRF, the resident, and community mental health agenciesPartnerships

• Establish a support system that is accessible post-warrant expiry

Discharge Planning

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Circles of Support and Accountability (CoSA) Reintegration for high risk sex offenders Restorative Justice principles Circle concept – Wrap-around Potential circles for other populations

Community-Based Residential Facilities Integrate into community-based mental health

services

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Promising Practices: Accept - Circles and Conditional Release

Create choice - Give voice Connections Clubhouse relies on mental health

clients to design and deliver community supports - Clients gain responsibility and confidence

Recovery has been defined as “living well in the presence or absence of one’s mental illness” Patient centred Beyond silos

Promising Practices:Empowerment and Recovery

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In facilities/residences 24 hour one on one support Wrap around services

Trusting relationships with staff CSC

Improving mental health services within institutions Implementing community mental health strategies Risk of suspension and revocation in the group who

received Community Mental Health Specialist Service was 34% and 59% lower, respectively, than the comparison group (CMHI Evaluation)

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Community Connections:Promising Practices and Progress

Work in Coalition Cleaning Coalition: No one owns it, everyone is

invested in it Meet People at their Point of Need

Intensive second stage residential program Open the Doors

Welcome the community in, go out into the community

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WCommunity Connections:Promising Practices and Progress

Macro level change in legislation is needed to create formalized interagency structures

Policy allowing for transitional housing to be adequately funded, and ensure mental health services are available for offenders on conditional release

Encourage support from local municipalities Mental health housing with staging/graduated systems Streamline application processes for housing, ID cards Increase inter-agency communication

Community Connections:Suggested Solutions

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Stigma and Discrimination from the community, direct service providers, and the media

Not enough training for community corrections service providers

Never Enough Funding Eligibility Criteria

Community ConnectionsThe Complexities of

Connecting

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Positive Outcomes for Participants:

Establishing connections to potential funders

Tours of CBRFs have been requested by community corrections personnel and health service providers

CBRF execs have gone on tours of second stage housing initiatives in hopes of gaining new ideas and approaches to creating their own

Community ConnectionsThe Benefits of Connecting

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Spring 2011: Implement a Strategy using awareness of service provision excellence and destigmatization to achieve access

Provincial, Federal and Local

Pulling the Pieces Together

Forum

CAROW Collaboration

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Connect

Share Ideas

Create Opportunities

Boost your Benefits!

Communication Collaboration Agreement on success

indicators Broad-based

evaluations Overarching principles

What can be done?A Web of Solutions

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For Everyone: Have a plan Human rights focus Programs and policy to be evidence-based Shelter The Individual is the centre

What the Strategy Needs to Succeed

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The Message Quote from CBRF staff, Community Connections

Survey: “I suppose the key point is that we are a

community based program and are willing to partner with any stakeholders to ensure appropriate services are available and

accessible.”

(Re: survey question What are some key points that mental health services need to know about your facility and the work that you do?)

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“It starts with having a place to stay, having support, and then trying to find the balance to make sure they don’t fall through the cracks.”

- British Columbia Case Study Interviewee.

The Way Forward

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Their deaths must lead us to better solutions.

Reyal Jensen Jardine-Douglas

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They Mattered

Ashley Smith

Edmond Yu

Reyal Jensen Jardine-Douglas

Timothy Mclean

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St. Leonard’s Society of Canada208-211 Bronson AvenueOttawa ON K1R 6H5613.223.5170 slsc@on.aibn.com www.stleonards.ca

“People, even more than things, have to be restored, renewed, revived, reclaimed and redeemed; never throw out anyone.” - Audrey Hepburn

Conclusion

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