appropriate services, treatment and supports to those who are in
the system.
The vast majority of people living with mental health problems and illnesses are not involved with the criminal justice system. In fact, they are more likely to be victims of violence than perpetrators.100 Nevertheless, they are
over-represented in the criminal justice system; that is, there is a much higher proportion of people living with mental health problems and illnesses in the criminal justice system than in the general population. The reasons for this over-representation are complex. Clearly, people are involved in the criminal justice system because of criminal behaviour. However, lack of access to appropriate services, treatments and supports have also had a powerful influence on this situation.101 This over-representation has increased as the process of de-
institutionalization of people with living with mental health problems and illnesses, coupled with inadequate re- investment in community-based services, has unfolded.102 Estimates suggest that rates of serious mental health
problems among federal offenders upon admission have increased by 60 to 70 per cent since 1997.103
First and foremost, efforts to reduce this over-representation should focus on preventing mental health prob- lems and illnesses and providing timely access to services, treatments and supports in the community.104 This
is particularly important for youth, because of the great potential for prevention and early intervention to keep them out of the criminal justice system and to recoup initial investments through saving the costs of incarcera- tion in the future.105
Diversion programs (including mental health courts and restorative justice programs) are the next line of defence. They can redirect people who are about to enter the criminal justice system by providing access to needed services, treatments and supports.106 They do not work, however, unless there are services in the com-
munity to support the people who are being diverted. It is also important to ensure that people working in the justice system are aware of the value of diversion programs and know how to refer and encourage people to access services. In addition, people with complex combinations of mental illness and developmental disabilities (‘dual diagnosis’) should also be able to benefit from diversion programs.
MHCC National Trajectory Project. With oversight by the MHCC Mental Health and the Law Advisory Committee, this project aims to improve the understanding of policy makers, clinicians, and the public of the implications of current regula- tion and practice for individuals declared not criminally responsible due to a mental disorder (NCR-MD). Through a large longitudinal cohort study in Quebec, Ontario, and British Columbia, the project is examining the ability of the Criminal Code to balance the need to protect the rights of individuals living with mental health problems and illnesses and to provide appropriate and targeted care, with the need to protect public safety.107
When people living with mental health problems and illnesses do end up in the criminal justice system—whether in remand, correctional or forensic facilities—they have a right to reasonable access to mental health services consistent with professionally accepted standards.108 While some progress has been made in building capacity
to deliver these supports and services, there continue to be significant shortfalls in meeting the mental health needs of youth and adults in the criminal justice system, particularly those with serious and complex mental health needs. Without access to appropriate treatment, these individuals can get caught up in a vicious cycle of isolation, restraint, and segregation.109 A national strategy setting out expected outcomes for mental health
services in correctional settings would be a significant step in the right direction.
Many criminal justice systems around the world are working more closely with ‘civil’ mental health systems. In some cases, this has involved a transfer of the responsibility for mental health service delivery with a view to enhancing the ability of the criminal justice system to deal with mental health issues, and improving the continu- ity of services from the time of people’s first interactions with the police, throughout their involvement with the system, and as they return to life in the community.110 We need to learn more about how these ideas would work
in Canada, and learn from the provinces that have tried similar approaches.111 At a minimum, correctional and
forensic facilities need to make sure that everyone has a comprehensive plan to address continuity of mental health services following discharge, and to ensure that the basic requirements, such as social support, housing, medication, and proper identification documents, are in place.
Finally, the police have a critical role to play in improving the response of the criminal justice system to mental health problems and illnesses. They are the gate-keepers of the criminal justice system and frequently the first on the scene when someone is experiencing a mental health crisis. That makes it essential for the police (and other front-line criminal justice and corrections workers) to have the very best education and training in how to interact with people living with mental health problems and illnesses. Most police agencies in Canada recognize the need to improve education and training in this area and are working actively to address this need.
MHCC Police Projects. 112, 113, 114 The MHCC Mental Health and the Law Advisory Committee has completed a review of basic
and in-service police education and training in interactions with people living with mental health problems and illnesses, as well as a study of these interactions from the perspective of people living with mental health problems and illnesses.