Thank you very much. I want to begin by giving you a bit of my background, since I appear before you today in my personal capacity.
I have been an advocate for mental health rights for over 10 years. I have served as legal counsel to the Psychiatric Patient Advocate Office, which supports psychiatric in-patients with rights, advice, and patient advocacy over 35,000 times every year. I also led developments of Legal Aid Ontario's province-wide mental health strategy, which just launched in March 2016.
Over the years, I have also participated in many advisory boards and committees, including the Toronto Police Service's mental health advisory committee. I was co-chair of the Police Records Check Coalition, which worked with the Ontario Association of Chiefs of Police and others to develop the first provincial policy in that area. For the last several years, as you mentioned, I have also taught as a sessional professor at the University of Windsor in the faculty of law.
Thank you very much for having me here today and giving me this opportunity, and for undertaking the important business of considering the huge role of legal aid plans across Canada.
Legal aid, simply stated, helps people live their rights. It's about getting the advocacy that makes citizenship a meaningful thing, and this is, in a very real way, what we are talking about when we say “access to justice”.
Today, I want to focus on a very specific part of that question, and that is the criminalization of mental illness. There has obviously been a lot of work done on this topic, and over the last 15 years much of this work has been put into practice. We have been on a very clear trajectory away from criminalizing those with mental illness. We recognize that a punitive law-and-order approach doesn't work. It doesn't work in the public interest, nor does it work to protect public safety. Concepts like denunciation, deterrence, and imprisonment are in fact counterproductive when we're talking about mental illness. They exacerbate underlying problems and trigger causes that bring persons with mental illness into conflict with the law. But what of this progress has been formalized and systematized as part of our courts today? That is much more narrow. This is also the opportunity I'm encouraging this committee to consider today.
If you pick up your copy of the Canadian Criminal Code, you will find the mental disorder provisions in part XX.1. That whole section, for the most part, speaks to just 2% to 3% of the population, who have serious and persistent mental illness. It is a very well-defined system, but it exists only for those who are seriously and persistently mentally ill, those who are either unfit to stand trial or not criminally responsible due to mental illness. This is a very high threshold to meet.
While the Criminal Code mandates a comprehensive set of services and systems, it won't be accessed by most accused. Indeed, those found not criminally responsible represent just 1.8 out of every 1,000 criminal cases. What about everyone else who appears as accused in a criminal court? What about those with less serious mental illness: those who some of my colleagues describe as “quietly unwell” or those who are acutely unwell and in short-term crisis? What about those with a mental illness and an intellectual disability or cognitive impairment?
I am pleased to say that, over this time period, they have enjoyed some progress as well. It was just in 1999 that the first Mental Health Court began operating at Old City Hall in Toronto. That court was set up because there was recognition that traditional prosecution wasn't working. Over the last 15 years, such alternative approaches have bloomed across Ontario. That one court in Toronto became a source of hope and inspiration to judges, crowns, defence counsel, and the accused alike. The idea and the approach grew.
Ontario's Ministry of the Attorney General recently undertook a checkup survey. In 2015, they found that 52 of 52 criminal courts in Ontario now provide some kind of targeted mental health programming. That includes everything from formal mental health courts to drug treatment courts, post-charge diversion, bail programs specializing in mental health, and so on. These kinds of efforts have been developed not for the 2% to 3% of accused with serious and persistent mental illness but for the majority of the accused: the one in two, or more, who has some kind of mental health and addiction issue when they appear in a criminal court. It is a huge proportion of the accused, likely the majority.
There are huge potential benefits for federal leadership to help formalize these kinds of programs to address these needs of the majority of the accused. You can see what these benefits are by simply looking at what happens in these courts. Much depends on the work of court support workers and on duty counsel and defence counsel. They long ago recognized that mental health is only part of the picture, that treatment alone is not a silver bullet, and that illness is only a part of what puts the accused in a precarious spot and only part of their story.
Instead, they're assessing the needs of their clients based on these other factors, which will help their clients stabilize in the community. They're advocating for housing. They're advocating for income and social entitlements. They're advocating for access to health services. They're advocating for access to education and for the decriminalization of police records so that people can get education, work, volunteer, and even access housing. Most of all, they confront assumptions, prejudice, and fear. All of these are barriers, and all of these are social determinants of health that hold the accused back and contribute to recidivism and criminalization. In other words, the investment in legal aid, which goes to assisting these accused, is paid back multiple times over. There is a tremendous social return on investment in legal aid. The 2014 Department of Justice report on maximizing the federal investment in legal aid confirmed that such investments in legal aid can save money in areas of government spending such as health and social assistance.
Diversion specialty courts are therefore an approach with considerable promise, but there are also troublesome aspects. First and foremost is that these special mental health programs tend to be ad hoc. Over the years, they have grown up here and there, often in isolation. They typically depend on cobbling together local resources.
Some of the specialty courts meet once a day and some meet once a month. They tend to be rather idiosyncratically defined. Some have clear eligibility and diversion criteria and some more or less do it on the fly. There is, in other words, lots of discretion, lots of variation, and very little consistency. Often, frankly, there is much confusion about procedure and options and about the intersection of criminal law and health care. There is often uncertainty about what practices and frameworks are best. Nonetheless, we see the considerable promise.
From my perspective, everyone is now pulling in this direction and wants to see these programs succeed through further investment and normalization. Supporters of these kinds of initiatives include the following.
In 2013 the fifth national symposium on reinventing criminal justice recommended that consideration be given to whether Criminal Code amendments are required to allow for earlier assessments of the mental health needs of the accused, thus removing legislative barriers to these kinds of diversion and mental health programs growing.
In 2014 the Department of Justice advisory panel on criminal legal aid made the recommendation to address the lack of system coordination and to increase efficiencies, in part by targeting high users of the system and addressing the particular needs of particular groups, namely, those with mental health issues.
In 2014 the Mental Health Commission of Canada's national strategy made it priority 2.4 that we should increase the availability of programs to divert people living with mental health problems, including mental health courts.
In 2016 Ontario's Ministry of the Attorney General convened a round table on criminal mental health, and in part it endorsed a recommendation to the minister to investigate promising models of diversion and to consider standardizing the approaches being taken.
In 2016, I'm proud to say, Legal Aid Ontario released its province-wide mental health strategy. This included a comprehensive mental health training program and an ongoing learning tool developed by and for criminal lawyers. LAO's strategy also expanded financial and legal eligibility for mental health clients and established a multi-year commitment to innovate.
I'm here today to encourage the federal government to join this chorus and to do its part. It would go a long way to achieving that goal in the mandate letter of the Minister of Justice to address gaps in services to those with mental illness throughout the criminal justice system.
I would suggest that it would also greatly help maximize the federal investment in legal aid as well as help direct future and expanded investments with the greatest potential impact. It promotes earlier resolution. It streamlines processes. It reduces breaches and administration of justice offences, and most importantly, it supports the accused in defining their own pathway to recovery.
How do we get there? I would like to make six recommendations for you to consider today.
First, consider reviewing the Criminal Code definition of “mental disorder” to expand that definition, or to create a separate category of mental disorder short of “not criminally responsible” or “unfit to stand trial”. Frankly, this would better reflect the reality of what is happening on the ground in courthouses today. It would also better include those with dual and concurrent diagnoses, intellectual disabilities, cognitive impairments, acquired brain injuries, fetal alcohol syndrome, and so forth.
Second, you may consider reviewing the Criminal Code to formalize options like alternative measures or diversion procedures for those with a mental disorder short of NCR or unfit. Again, this would reflect what is happening on the ground, and it would provide a more comprehensive and evidence-based approach to conflicting efforts to reform bail, drug treatment courts, mental health diversion, and so-called community or accommodation courts.
Third, it would be very helpful to lead and promote the standardization of best practices. For example, I would suggest that federal investment in legal aid funds could be earmarked or expanded for courts that adopt models that are demonstrated to be effective. It would also be a means to encourage them to do so.
Fourth, invest in research. Frankly, there's a dearth of research in this area. The federal government could consider a range of possibilities, including making this a focus of the renewed mandate of the Mental Health Commission of Canada, or perhaps consider establishing a specialized Canada research chair, or even investing in groups that already have national scope, like the Association of Legal Aid Plans of Canada. This would ensure that approaches were evidence-based, and it could also ensure that a focus would be given to the special mental health needs of women and of aboriginal accused.
Fifth, as part of the research agenda, consider specific models of alternative or diversion courts. Today there are many approaches. There's a huge variety in what's going on in courthouses across the province of Ontario and across the country. Many of these have promising potential. At the same time though, some courts are looking to get beyond a purely therapeutic model to models like the risk-need-responsivity framework, which helps identify social factors that exacerbate mental illness.
Sixth, any such work in any of these areas I've just highlighted must be done in partnership with the mental health community and with those who have lived experience of the system. As this community often says, “Nothing about us without us”. They're experts in their disability and their experience, and they should be front and centre as part of any reform movement.
Thank you.