Dear members of the House of Commons Standing Committee on Justice and Human Rights, I would like to thank you for the opportunity to discuss mental health supports for our jurors.
I'm Dr. Katy Kamkar, clinical psychologist at the Centre for Addiction and Mental Health and assistant professor within the department of Psychiatry at the University of Toronto. I'm also director of Badge of Life Canada, which is a peer-led national charitable organization for police, corrections, and first responders across Canada who are dealing with psychological injuries suffered in the line of duty. I'm also serving on the Canadian Institute for Public Safety Research and Treatment's national policing research committee. I'm also part of the scientific advisory committee of the Anxiety Disorders Association of British Columbia, as well as a founding and credentialed member of the Canadian Association of Cognitive Behavioural Therapies.
Do our jurors need access to mental health support? The answer is yes. Mental illnesses have a major impact on our economy. The estimated annual health care costs are about $51 billion Canadian. Driven in part by the fact that mental health problems are associated with reduced productivity at work and increased absenteeism, sick leave, short-term and long-term disability, the costs associated with mental health disabilities are also higher than are those for physical related disabilities and are seven times more likely to reoccur.
Focusing on mental health promotion, prevention, and early intervention would benefit the public, employers, workers, families, insurance companies, and our society. The focus would produce a positive return on investment including reduced social, occupational, mental, and physical disability, reduced medical utilization, improved therapy outcomes and prognosis, with a return to healthier functioning, improved social and family relationships, and improved well-being and quality of life.
Serving on a jury can lead to an increased stress level as well as significant psychological distress and emotional difficulties, including feeling anxious, depressed, helpless, and overwhelmed. The emotional experience can increase vulnerability to psychological disorders, including depression, anxiety disorders, substance-use disorders, as well as trauma and stressor-related disorders.
Within Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, the DSM-5, there is a greater recognition and understanding of vicarious trauma that can occur after experiencing repeated or extreme exposure to aversive details of traumatic events. Our jurors can be exposed to diverse, traumatic, and gruesome evidence during their service, through detailed written materials, photographs, audio content, videos, and graphic verbal descriptions. Jurors also tend to witness first-hand the emotional impact traumatic events can have on victims, families, and witnesses. The exposure to such evidence and sequelae tends to be repeated throughout the day and over a period of time.
There are additional stressors that compound the risk for mental health problems among jurors, including feelings of isolation, limited social support, and fear of making a mistake. In addition there are jury discussions, deliberations, and verdict renderings that involve worry and anxiety about trial-related decisions, including determining the outcome of trials, such as the guilt or innocence of a defendant. The stressors are further exacerbated by social and time pressures inherent in providing jury service.
In some cases trial materials resembling a juror's own personal history can substantially increase vulnerability to mental health problems. Similarly, materials involving violence or crimes against people, or crimes involving children also tend to increase vulnerability to mental health problems. We need to implement a care plan for jurors. That care should begin early as part of pre-service preparations. Education about the potential impact of traumatic material during the jury service, common psychological symptoms one might experience, what constitutes normal reactions, and what reactions should be taken as warning signs for engaging more help should be provided.
Healthy coping resources should be provided prior to trial to help with anticipatory anxiety and this transition from normal life to jury service. The same resources should be available during the trial to minimize the negative consequences of service. During the trial, there should be a support system with, for example, social and psychological support in place to help reduce self-isolation, maintain jurors' mental health and well-being, and provide adaptive and healthy coping with regard to feelings of helplessness, anxiety, stress, or any emotional difficulties.
Funding and access to evidence-based mental health interventions following court cases should be available when needed. Mental health experts should be available for providing evidence-based mental health services. Consultation with a mental health professional, a psychologist, and/or a psychiatrist should be strongly recommended for an accurate diagnosis and discussion of various treatment options. Contact information should be provided for jurors to have access to additional mental health services if needed.
Evidence-based cognitive behavioural therapy, CBT, is effective for numerous psychological disorders and is at least as effective as medication. Research suggests that CBT offers the most benefits when completed with a trained mental health professional. The gains that are observed with CBT are long-lasting and tend to be maintained longer than improvements achieved by medication alone. Upon meeting with a health care professional, it is also important to establish a clear treatment plan and goals and to monitor progress toward those goals.
Dear members of the House of Commons Standing Committee on Justice and Human Rights, I would like to thank you again for the opportunity to discuss mental health supports for our jurors. Providing funding for evidence-based treatment and having a support system in place for Canadians who are performing such an important civic duty would be essential for all the reasons just mentioned and will contribute to the mental health promotion of Canadians and be a positive return on investment. Most important, it's the very human thing to do.
Thank you.