Prison vs. Hospital

FarrellWeir, thanks for the post. I haven't had a chance to take a look at the video yet, but will.

As for your question, wow, a thorny one, to be sure -- and I'm sure scientists and philosophers and psychologists could weigh in in many different ways.

I'd certainly be interested in hearing more about how Ontario prisons and hospitals are similar and different in their approaches to addressing mental health....

It's an interesting question.

I was reading a news piece today where the accused in a murder trial was given the diagnosis of schizophrenia. In the comments below the story, people were pretty positive he would get off and be sent to a hospital rather than jail. 

It came down to this; jail is a place you pay for your crimes rather than a place to be rehabilitated. For others though, it was simply a safety issue to get this man away from others. In that way, prisons and asylums have shared a need to protect 'us' from 'them'. 

Maybe it's about rethinking the current systems and what their goals are/ should be.

Yeah, my thoughts exactly!

Also, if you think about it our society is almost like a giant parent (metaphorically of course) and I don't know about everyone else but I would personally prefer to be raised by an authoritative (flexible, open-minded) parent rather than one with an authoritarian (punishment driven, set in their ways) approach. Just a thought!

HI, I'll just add a thought to this stimulating topic.... that more  mentally ill people are being detained in prisons is an outcome of the government policies of the 90's and subsequently, when hospital beds were cut back and people were supposed to be supported/rehabilitated in the community, but that didn't go as planned because funding for programs and community living wasn't adequate,... so it wasn't surprising that people with mental issues soon began to come to the attention of the police, d/t vagrancy, nuisance, theft, etc..... and end up in the justice system. It's a complex issue, but that's the short version, IMHO.

Thanks for the interesting topic FW.

Thanks for the input Michael!

I figured it had something to do with the strain put on the psychiatric system accompanied by outdated laws/policies. I'm glad that I've gotten some responses from a few people because until now I've felt quite alone on this topic. I think it's because I think about it too ethically/philosophically ("Why do we have prisons?") and end up losing a lot of the concrete evidence that way.

Looking forward to more thoughts!

The big question we need to ask is how committed we are to justice vs. revenge vs. rehabilitation. We need to ask ourselves if we want a system that simply warehouses people for a period of time without rehabilitation, or do we want to focus on rehabilitation?

Just to quickly compare some number (sources available upon request, or you could Google this):

Recidivism:
Norway: 20%
Canada: 35% male, 20% female
USA: 67%

Incarceration rates:
Norway: 73/10,000
Canada: 114/100,000

USA: 716/100,000
Russia: 502/100,000

Check out some of the documentaries produced by National Geographic and MSNBC - "Hard Time", "LockUp" and so on. Youtube and National Geographic Channel: http://channel.nationalgeograp...m/channel/hard-time/ (our system is a lot different from the American system, but IMHO we don't want to go this route)

There's an episode in there somewhere about prisoners with mental health issues in the justice system rather than the health system - it's the one episode that really got me down about how the "justice" system works.

Check out this photo essay on a Norwegian Prison: http://www.time.com/time/photo...9307,1989083,00.html).

Check out this CNN Opinion article on the use of solitary confinement on minors: http://www.cnn.com/2013/04/15/...solitary-confinement. And read up on the Ashley Smith case here in Canada.

(keep in mind that any media depictions are usually following an agenda of portraying these systems in either the most positive or negative light possible, but that said, it's still pretty difficult to watch at times - tell me this isn't revenge and torture)

We're not perfect, but at least we don't rank up there with Russia, Rwanda, Cuba, and the USA...

Thanks Dave! I'll have to look into these links and watch some National Geographic sometime. I'm feeling less alienated on this with each new comment haha.

It's a really important question, and it's a core part of defining ourselves as a society. Our society has a set of laws, rules, and regulations, written and unwritten, on how we are expected to behave, and how we are expected to treat one another.

Now, when someone steps outside of these rules, how do we treat them? I think we're pretty quick to simply say that you've broken a rule and you must be punished. Now, speaking as a father/parent, I know first hand on a small scale how ineffective and inefficient this is.

As people keep breaking the law, the mindset is to give bigger and harsher punishments, thinking this will act as a deterrent. At least in our household, this ain't so. What's been really effective is to actually go out and sit down over an ice cream cone and talk out the problem.

It usually isn't the action that's the problem, but there's something underlying the action that's the issue. I just dealt with something that turned out to be a bad case of peer pressure. But if I hadn't sat down and talked it out, I just would have punished the action, not addressed the underlying issue and the punishment would have been ineffective in the long run. Instead, I gave my son some coping skill for the next time.

Expend that up to a bigger scale. It takes time, money commitment, and a fundamental change in the way we look at "criminals", but which society would you rather live in?

The one that doesn't assault and kidnap people: for substance use/abuse (people who are sick/need help), who have mental health issues/illnesses and who too impoverished to pay for food/housing; then lock them all up in one big compound so they can hurt each other.

*Inhale...Exhale* Sorry about that, I got a little bitter there. Anyway, thanks for the input. I really like the way you've laid out your information.

No worries, FarrellWeir -- and thanks, Dave, for all the great resources!

Are you familiar with Housing First? To quote: ‘Housing First’ is an approach to ending homelessness that centers on quickly providing homeless people with housing and then providing additional services as needed. http://www.homelesshub.ca/topi...using-first-209.aspx

The Mental Health Commission of Canada has been running a research project around thins: At Home/Chez Soi. Check out: http://www.mentalhealthcommiss...es-and-projects/home

The results so far are remarkable. 70% of HF participants are in housing after the first year, as opposed to 30% in treatment-as-usual. We're saving 54 cents on every dollar spent on health and justice system usage. And more. (At Home Early Findings Report - Volume 3 - September 2012  http://www.mentalhealthcommiss.../5029?terminitial=23)

The best part is that the federal government committed a lot of money in the last budget to support this approach.

There's some good happening in the world

Yaaaaay! Now if the rest of the world would follow suit.

Hey there,

 I had a lovely smart son who struggled with mental illness all his life, and we tried repeatedly thru different avenues to understand what he was up against. No success. Long story, sooooo while on probation for misdemeanors he checked himself into hospital for a metnal health assissment.  However,after he was arrested out of a mental health facility for "failure to appear for addictions treatment" he almost gave up all hope of feeling normal ever. He was put back in jail for three months and not allowed to finish the intensive residential treatment he was in.  Very sad...and frustrating from a mothers point of view. 

In 2007 he was discarged, attempted suicide and was put back in jail for breeching probation.  When he came out , I took him home where he went manic, tried to rob a store.....and was shot dead by police.  

Since then I was invited to sit on the Correctional Service Canada in a citizens advisory capacity.  While involved a psychiatrist took me aside, knowing my interests in mental illness treatments in corrections, and showed me that he got no information on the mental state of the offender/accused when released.  I was not surprised but learned that CSC is supposed to, withing the first 90 days of an offender being incarcerated, undergo a psych assessment.  So when I was involved in meetings with probation officers regarding an offender being released I always asked the question "what is his mental state or where is his/her psych report?"  they always told me they dont get anything like that....why not?....its just that way.  sigh. 

At a point when I was getting very focused on this issue, and was sent for training as chairperson of the Citizens Advisory Commitee...I was locked out. They sited that I held myself out as an expert.  No proof....no evidence. I was told to leave and was relieved of my volunteer position. 

So when the news of Ashley Smiths death in Kitchener's Grand Valley Institution hit in 2007....I contacted the family in Nova Scotia to know more.  I visited with Coralee Smith in Dartmouth NS for a week in 2011. Now the inquest is going on in Toronto and I recomment you follow what happened to this young girl...who's only offence was tossing crab apples at the mailman.

The mentally ill are not protected, diagnoses, treated or cared for in our jails, prisons, detentions centres and megaprisons.

I believe the outcome of Ashley Smith's Coroners Inquest recommendations will change this to some degree.  But with Harper's policypush for more prisons.....I just dont know.

Karyn Graham

Thank you so much for sharing your/your son's story Karyn, I'm sure you've already heard this a thousand times but: I'm sorry for your loss...and not just the loss of your son but the loss of your trust in the system that was supposed to protect and help your son.

It's also unfortunate that you were locked out of your volunteer position because you sound like a very strong person. I'll be sure to check out the inquest(s) going on throughout Canada.

Thanks again Karyn.

thank you Farrell...the sentiments never get old...it is always good to hear.

A return to college to obtain certification as a Social Service Worker was the fastest way for me to get into a role of supporting others like my son is the plus moving forward.

Thanks again, Karyn

Thanks for your story Karyn; I'm sorry for your loss and your experience. I hope the inquests into Ashley Smith's experience, and experiences like that, produce some concrete results and changes to the system.

The criminal justice side of the mental health system is addressed at length in The Mental Health Strategy for Canada (Section 2.4) with a list of recommendations that have been developed and accepted by a number of groups including the federal government. Hopefully we can see some results soon.

Best of luck in your studies!

I want to echo Farrell and Dave as well and thank you for sharing your experiences here Karyn!

Talking and sharing experiences helps to squash all that is and surrounds stigma.  I am determined to make a difference in how law enforcement is not a positive first responder to a person in mental health crisis.  I think that if the 911 dispatcher gave options to the caller for what kind of responder is required that it could save lives.  We cannot expect police to be trained well enough about mental crisis, but we can have medical personal or peer support workers to respond well. 

Just saying....Karyn

Some local police detachments work with local CMHA branches regarding justice diversion programs.  It is usually part of their crisis management services.  As CMHA branches operate separately they would each have their own acronym.  Halton's is COAST. 

FarrellWeir,

I found an article as to what I was referring to in Southern Ontario regarding Diversion Programs and Mental Health Services and Police working together.  This is a recently new initiative where mental health workers ride along with Police.

It's my understanding this is the first ride along program but programs like COAST have been around for awhile.  And like anything they improve with time, and training.

Mental health professionals ride along with Hamilton police:

http://www.cbc.ca/news/canada/...-with-cops-1.3024000

First, I'd like to applaud everyone for their thoughtfulness in the replies they've made to Farrell's inquiry. 

Second, I'd like to share a quote:

     "To Punish a man, You must Injure Him;

      To Reform a man, You must Improve him;

      And Men are not improved by Injuries." (George Bernard Shaw, if I'm not mistaken). I had seen it written on an index card, taped to the wall, in a prisoner's cell....

Third, What have we learned since the Mock Prison Experiment, at Stanford University, in the early 1970's? The primary Researcher in that was Philip Zimbardo, who wrote about that, and more recent events at Abu Gharib prison, in his book: The Lucifer Effect: Understanding how Good People do Evil. What criteria do we use to "judge" people's and organization's "behavior"? Is it Mature and Responsible or Immature and Irresponsible; or is it just "Right" or "Wrong"...Harry Allen Overstreet wrote a book about that titled: "The Mature Mind"....

Lastly, another quote: "The quality of a civilization can be judged by entering its Prisons"-I don't recall the author-at the moment...

P.S. In the Introduction of The Lucifer Effect, Zimbardo wrote about the role of our "Individualistic Culture", and how we acknowledge exemplary behavior ("Heroes") and abhorrent behavior, in our three primary institutions: Law, Medicine, and Religion-where we have "Law-Abiding Citizens" and "Criminals", Healthy people and "Sick" people, Saints and "Sinners". Is labeling people like defining them, and do we create "Self-fulling prophesies", when we do that to others? And where does "Unconditional Positive Regard" come in.

The U.S. had an answer to the end of "Slavery" (Irish, Chinese, and African), at the conclusion of our "Civil War", and "Peonage" took the place of "Slavery", and relied on locating certain industries in close proximity to Prisons. We, in the U.S., had already taken action to deal with "Native Peoples"-relegating them to "Reservations"-and ignoring many of their Civilized accomplishments, like the constitution of the Iroquois Confederacy-which gave Women the Rights to Assert, Debate, Vote, and Declare War, almost 1,000 years before the U.S. Constitution granted Women the Right of Franchise (Voting). 

Wow Robert, your post is awesome. That is so powerful! Thank you.

An update to the investigation into Ashley Smiths death in corrections in 2007. After the coroners inquest the jury tabled 70 recommendations to Corrections Canada, Howard Sapers, Canada's Correctional Investigator pushed for adopting these well thought out recommendation, however Corrections Canada will NOT be adopting any of these changes.  Sad day. 

The film "The Interventionalists" it shows a cop and psychiatric nurse riding together and arriving at three different crisis scenarios. This was shown at the Crime Preventions Coucil's annual Crime Prevention week, where I was asked to keynote.  I found it still troubling that police have to eliminate any threat ie: take control then ask the nurse to come in. I understand the police are trained this way, yet they are not educated in vulnerable populations.  When us...Affected Families of Police Homicide met with the Ministry Attorney Generals senior staff about our concerns we brought up a concern (outside of MAGs mandate) that police foundations courses should include a practicum in non-profits to gain genuine empathy and understanding of the people they will be serving.  It was well taken and felt to be a good idea.  We will be taking this to the Ministry of Education this year. We are gaining a healthy respect in government as the experts in our "world" and have many solutions we would like to table. 

Hello Karyn,

Thanks for posting your replies. It must be so hard for you every time this issue comes up (and I know advocacy at systems level can be so frustrating)

I discovered the 'non-impact' of coroners recommendations when my son died of his overdose while a patient in a psychiatric ward. The coroner's had an investigation and then a formal inquiry (one step below the full out coroners inquest)

They came up with some amazing recommendations that would/could prevent this happening to another patient. In my 'naive-ness', I just assumed that those recommendation had to be implemented as a means of re-course to avoid other preventable deaths.  Imagine my shock and dismay to learn that there is no governing body or any means to enforce the implementation of those coroner recommendations.

As you said Karyn, ..."so sad"

Betty-Lou Kristy

Lived Experience/‘Family’ Advocate- Mental Health, Addiction, Trauma & Bereavement

Some police departments (at least in the U.S.) are using a new and different approach with people seeming to be dealing with mental health challenges, based on a "Risking Connection" approach. At the April 2013 meeting of the New Hampshire Mental Health Consumer Council, the Chief of the Concord Police Department, and two members of their CIT team did an hour or so presentation about this. Two other "urban" communities were also using a similar approach, in N.H.

     The [national] Council of State Government's Criminal Justice/mental Health Consensus Project's latest update had an update on this issue. I don't have the web address handy, but if you 'google' "Council of State Governments+Criminal Justice/Mental Health Consensus Project" some relevant information should appear.

Betty-Lou and Karen,

     Imagine the shock of people who didn't realize the Aboriginal Schools existed in Canada...and Imagine the Solicitor General of Canada, beginning an "Investigation" of the four Protestant sects that operated those schools....and Imagine the Solicitor General of Canada negotiating "reparations" and an "apology", ....and Imagine the Solicitor General of Canada trying to get a "Truth and Reconciliation" process like Nelson Mandela helped formalize, when he was released from Prison in South Africa, ...and Imagine the Solicitor General of Canada publishing a report addressing all I've noted in this post...because I've read parts of the Solicitor General of Canada's report on the Aboriginal Schools, at our U.S. National Center for PTSD Library...Do you think the circumstances of your son's death, and the situation Karyn noted about Ashley Smith's death in corrections, are isolated incidents, possibly "co-incidences", or part of a pattern? Would a Journalist like Deirdre McGuire-who covered the Iran-Contra hearings for MACLEANS magazine, be able to identify and describe such a pattern....that might require a report with recommendations from the Solicitor General of Canada, or a public tribute to a 13 year old boy named Craig Kielburger from Thornhill, Ontario who raised enough concern about child labor, throughout the world, that Kathlyn Gay wrote a book detailing Craig's experience from age 12, and his efforts to bring international attention to this problem, and speaking about his trips with IPEC at age 13 to Nepal, India, Pakistan, Thailand, Bangladesh, to see child labor first hand. If he had known then, that the Trans-Pacific Partnership would somewhat resemble NAFTA, I'm sure he'd have visited the Parliament building in Ottawa, too! But, just Imagine...

Wow Robert, you are a 'living library' of info! I wish I could crawl into your brain for a while. Thank you for your most recent reply/post (again)

Betty-Lou Kristy

Lived Experience/‘Family’ Advocate- Mental Health, Addiction, Trauma & Bereavement

Yes wow! Great verbage! 

I met Craig K at a dinner event in Kitchener and have his signed book you mentioned.  He is inspiring my journey to drive change after my son's death by police.  I need to be the mother who pushes and pushes for change in way police shoot vulnerable people and use their own rules to justify this. I reach out to families who have lost loved ones the same as our family. The Affected Families of Police Homicide, Ontario are holding a Memorial for those killed by law enforcement....Wednesday Oct 7th 12 noon until done.  We will have speakers,reading of the names, placement of flowers and a canvas showing the number who have been shot in Ontario. 

I invite you to attend and will be creating an event on the eenet calendar for this.

yes....imagine....

Karen and EENet Connect members

I was just reading about a Police Chief in, I think, Saskatchewan, who takes what might be considered a "Trauma-Informed" approach...it was on ACEsConnection.com (?April 7th, 2015 ACEs Daily Digest, if my short term memory is working). I best go back and check it for sure, as he did quite a demographic analysis....I'll try to do a follow-up post, and include a link if I can.