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Criminalization & Mental Health

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Rebecca Tidswell

on 23 November 2013

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Transcript of Criminalization & Mental Health

WHAT IS CRIMINALIZATION?
Mental Health
Mental
health
is a persons condition in regards to their psychological and emotional well-being.(Austin & Boyd,2010)
Objectives


Correlation Between Crime and Mental Illness
Criminalization & Mental Health
Presented By Rebecca Tidswell & April Reid.
Monday,November 18th 2013
Discuss current knowledge about criminalization and mental health and reflect on opinions and ideas.
Discuss Forensic Psychiatric Nursing
Discuss the correlation between mental health and criminalization.
Discuss legal aspects of Forensic Psychiatric nursing.
Discuss nursing implications for Forensic psychiatric nurses.
Crime:
An act or omission which constitutes an offense and is punishable by law (Oxford Dictionary, 2013).
Criminalize:
To turn an activity into a criminal offense by making it illegal (Oxford Dictionary, 2013.
Criminality:
The quality or state of being a criminal and participating in illegal activity.(Merriam-Webster,2013)
Criminal:
A word used to describe somebody who has committed an action which is against the law.(Oxford Dictionary, 2013)
Mental
disorder
is a condition characterized by alterations in a variety of factors including mood,affect,behavior,thinking and cognition.
(Austin & Boyd,2010)
Mental
illness
is a term used to mean all diagnosable mental disorders. (Austin & Boyd,2010)
The Criminalization of Mental illness
The criminalization of the mentally ill has frequently been attributed to the deinstitutionalization movement which occurred in the 1960 and continues today. (Austin & Boyd, 2010)
When compared to the general Canadian public mental health issues are up to three times more common among federal correctional populations.(Austin & Boyd, 2010)
In the past decade the number of individuals with significant mental health needs within the federal correctional system in Canada has more than doubled.(Austin &Boyd, 2010)
Discuss crime and mental health as seperate entities.
Self Reflection:

Take a moment to self reflect on the case study. How would you feel caring for this patient? Do you think his sentence of being not criminally responsible is fair?Relfect on any bias or sterotypes you feel about mental health and crime.
Deinstitutionalization:
Down sizing or eliminatination of psychiatric hospitals with a new orientation to community based services. (Austin & Boyd, 2010)
Lack of appropriate mental health polices, coupled with insufficient community based services, results in lack of timely access to treatment and professional care. Many may result to criminal behavior for survival or as a result of a symptom experience.
(Peternelj-Taylor, 2008)
Transinstitutionalization:
A process whereby individuals, supposedly deinsititionalized as a result of community care policies, in practice end up in different insititutions, rather then their own homes. For example, the mentally ill who are discharged from hospitals are frequently found in prisions.
(Oxford Dictionary, 2013)
A 2008 study found over 30% of the corrections population in BC had been diagnosed with a substance abuse disorder and an additional 26% were diagnosed with a mental disorder. Of those diagnosed with a substance abuse disorder, more than 75% were also diagnosed with a non drug-related mental disorder (Canadian Mental Health Association, 2013)
Determinants Of Health In Forensic Clients
Majority of forensic mental health clients have long neglected physical and mental health care challenges as well as socioeconomic issues. Their health and psychosocial problems that they experience are often complex and multifaceted,contributing to the challenges encountered in their attempts to engage in treatment, relapse prevention and reintegration into society. (Austin & Boyd,2010)
Which determinants would be affected in a forensic mental health client?
Health Status of Federally Incarcerated VS. General Canadian Population
Socioeconomic factors:
Twice as likely not to have finished high school
Nine times more likely to be unemployed

Health behaviors :
More then twice as likely to smoke cigarettes
Thirty times more likely to inject drugs
Ten time more likely to have an alcohol or substance abuse disorder

Mental health Disorders:
More then twice as likely to have a mental disorder
Three times more likely to have schizophrenia in males and 20 times more likely in females

Four times more likely to have a mood disorder
Four times more likely to die of suicide
Factors Contributing to Incarceration Of Those With Mental Ilnness
Lack of sufficient community supports

High rates of substance abuse
The "Forensic" Label
Lack of training for both criminal justice and mental health professionals
Lack of timely access to treatment
Many individuals with mental illness are not able to access appropriate and timely treatment; many have co-occurring substance abuse disorders and engage in criminal activities to support their drug habits; whereas others have long histories of committing crimes of survival(Peternelj-Taylor, 2008)
Research consistently shows that a person with mental illness is more likely to be arrested for a minor crime such as causing a disturbance, mischief and minor theft as opposed to non ill persons. (Canadian Mental Health Association, 2005)
What is Forensic Nursing?
Forensic nursing refers to nurses who integrate psychiatric and mental health nursing philosophy and practice within a sociocultural context that includes the criminal justice system to provide comprehensive care to clients,families and communities.Forensic nurses must meet competing demands of custody and care.
(Austin & Boyd, 2010)

Forensic Nursing has many sub-specialties where nurses practice at the clinical-legal interface, tending to victims and offenders living and deceased (Kent-Wilkinson,2010 p.425). For example Forensic Psychiatric Nursing.
Role of Forensic Psychiatric Nurse
Make culturally sensitive biopsychsocial health assessments
Design and implement treatment plans
Engage in case management activities such as organizing,accessing, negotiating, coordinating and integrating services and benefits for individuals and families.
Promote and maintain health and manage the effects of illness's through teaching and counseling.
Provide care for physical and mental health problems
Manage and coordinate systems of care integrating the needs of patients,families and community's.
Assess for risk of violence/suicide.
Educate client about the justice system process.
Advocate for the patients needs and rights.
Canadian Standards Of Psychiatric and Mental Health Nursing.
Standard I:Provides competent,professional care through the development of a therapeutic relationship
Standard II:Preforms/refines client assessments through diagnostic and monitoring function
Standard III: Administers and monitors therapeutic interventions.
Standard IV:Effectively manages rapidly changing situations.
Standard V:Intervenes through the teaching-coaching function.
Standard VI:Monitors and ensures the quality of health care practices.
Standard VII:Practices within organizational and work-role structure.
(Austin & Boyd, 2010)



Legal Aspects
Criminal Code Regarding Assessment:

672.11 A court having jurisdiction over an accused in respect of an offence may order an assessment of the mental condition of the accused, if it has reasonable grounds to believe that such evidence is necessary to determine
• (a) whether the accused is unfit to stand trial;
• (b) whether the accused was, at the time of the commission of the alleged offence, suffering from a mental disorder so as to be exempt from criminal responsibility by virtue of subsection 16(1);
• (c) whether the balance of the mind of the accused was disturbed at the time of commission of the alleged offence, where the accused is a female person charged with an offence arising out of the death of her newly-born child;


Criminal Code Regarding Assessment cont'd
• (d) the appropriate disposition to be made, where a verdict of not criminally responsible on account of mental disorder or unfit to stand trial has been rendered in respect of the accused; or

• (e) whether an order should be made under section 672.851 for a stay of proceedings, where a verdict of unfit to stand trial has been rendered against the accused.

(Criminal Code, 2013)
Community Treatment Orders
A type of mandatory outpatient treatment, usually initiated by a physician, that can require a person with a mental illness who does not meet provincial involuntary admission criteria to comply with stipulated treatment.
Community Supports: Community Support Program
-The Community Support Program (CSP) is a part of Stella’s Circle. It provides intensive home-based care to individuals with complex mental health needs with the goal to reduce the length and number of admissions to hospitals or prisons and to improve each participant’s quality of life.

-Tailored to the individual needs of each participant, CSP provides holistic supports that promote wellness, independence and integration into the community.

-In 2012-2013, CSP worked with 40 participants, providing 25,000 hours of support.

(Stella's Circle, 2013)

The Just Us Women’s Centre, which is part of Stella’s Circle, collaborates with other community agencies to provide programs and services for women who have been in conflict with the law.

In just four years, over 300 women have been involved in Just Us programming where staff have provided individual and group counseling covering areas such as addictions, impulse control, healthy relationships and emotion management, as well as other support services.

In 2012-2013, approximately 90 women availed of services provided by Just Us Women’s Centre with an increasing prevalence of self-referrals.
(Stella's Circle, 2013)
Community Supports: Just Us Women Centre
Community Supports: HOPEworks
HOPEworks, part of Stella's Circle, is a part-time pre-employment program that provides individuals affected by mental health issues with opportunities to develop basic work skills, interpersonal skills, and self-confidence. This enables them to further their education or training and to pursue, obtain and maintain employment.

Through employment groups and programming that have been tailored to individual strengths and abilities, HOPEworks provides a unique service, assisting those with complex barriers prepare to enter/re-enter the workforce within a supportive environment.

This past year, over 130 participants received employment counseling, support and maintenance services.

For example; the Hungry Heart Cafe (Stella's Circle, 2013)

Mental Health Strategy for Corrections in Canada
Vision: “Building Wellness along the Continuum of Care: Connecting Services” Individuals in the correctional system experiencing mental health problems and/or mental illnesses will have timely access to essential services and supports to achieve their best possible mental health and well-being. This will improve individual health outcomes and ultimately contribute to safe communities

Those in federal penitentiaries, Correctional Service Canada (CSC) is required by statute, for the inmates “to provide essential health care, including medical, dental and mental health care, and reasonable access to non-essential mental health care that will contribute to the inmate’s rehabilitation and successful reintegration into the community” (Corrections and Conditional Release Act [CCRA], 1992, c.20, s.86).

As part of this regime, all federal, provincial and territorial correctional jurisdictions are responsible for the care of individuals with mental health problems and/or mental illnesses in their facilities.



Forensic Nursing:A Model For Care
Nursing Implications
Develop a therapeutic relationship to gain a deeper understanding and appreciation for the client.
Ensure professional development in the area of forensic psychiatric nursing though education and research.
To self reflect and explore preconceived ideas, attitudes, beliefs and stereotypes towards both criminal activity and mental health.
Understand the comprehensive needs of individuals and ensure culturally competent care.


(CMHA, 2005)
Problems with treatment regime
UST and NCRMD
UST( unfit to stand trial) is when it is recognized that the accused is not fully capable of instructing legal counsel, or not capable of understanding the nature and the consequences of the trial (can later be found “fit” and tried in court and convicted, or deemed NCRMD)

NCRMD: the accused is deemed not responsible for the crime they committed based on their mental state at the time the offense was committed. Although it is not a finding of guilt, the court may give the following dispositions:
detention in hospital
conditional discharge
absolute discharge

(Austin & Boyd, 2010)
(Austin & Boyd, 2010)
Nursing Implications Cont'd..
Ensure adequate knowledge on the legal systems and areas where it may affect a forensic client.
Advocate for the best interest of the client.
ANY QUESTIONS??
Thank you for your attention and participation!!
References

Bloom, J. (2010). "The Incarceration Revolution": The abandonment of the seriously mentally ill to our jails and prisons. Journal Of Law, Medicine & Ethics, 38(4), 727-734. doi:10.1111/j.1748-720X.2010.00526.x

Canada, M. H. (2013). Issue: Mental Health and the Law. Retrieved November 7, 2013, from Mental Health Commission of Canada http://www.mentalhealthcommission.ca/English/issues/law?routetoken=74cf2e79b2d6achhhhhh8cb1308c1c52aa4281&terminitial=24

Canadian Mental Health Association (2005). Criminalization of Mental Illness. Retrieved from http://www.cmha.bc.ca/files/2-criminalization.pdf

Canadian Mental Health Association (2012).
Mental Health and the Criminal Justice System.
Retrieved from http://www.cmha.bc.ca/get-informed/public-issues/justice

Crime. (2013). In Oxford Dictionary Online. Retrieved from http://www.oxforddictionaries.com/definition/english/crime?q=crime

Criminal. (2013). In Oxford Dictionary Online. Retrieved from http://www.oxforddictionaries.com/definition/english/criminal?q=criminal

Criminality. (2013). In Mariam-Webster Dictionary Online. Retrieved from http://www.merriam-webster.com/dictionary/criminality

Criminalize. (2013). In Oxford Dictionary Online. Retrieved from http://www.oxforddictionaries.com/definition/english/criminalize?q=criminalize

Felthous, A. (2013). Prisons and mental health: Introductory editorial: Hospitalizing mentally ill patients. International Journal Of Law & Psychiatry, 36(3-4), 185-187. doi:10.1016/j.ijlp.2013.04.011

Freedberg, P. (2008). Integrating forensic nursing into the undergraduate nursing curriculum: a solution for a disconnect. Journal Of Nursing Education, 47(5), 201-208. doi:10.3928/01484834-20080501-05

Gildberg, F. A., Bradley, S. K., Fristed, P., & Hounsgaard, L. (2012). Reconstructing normality: Characteristics of staff interactions with forensic mental health inpatients. International Journal Of Mental Health Nursing, 21(2), 103-113. doi:10.1111/j.1447-0349.2011.00786.x
Government of Canada (2013). Criminal Code. Retrieved from http://laws- lois.justice.gc.ca/eng/acts/C-46/page-358.html#h-223

Government of Canada (2013). Mental Health Strategy for Corrections in Canada. Retrieved from http://www.csc-scc.gc.ca/health/092/MH-strategy-eng.pdf

Hawthorne, W., Folsom, D., Sommerfeld, D., Lanouette, N., Lewis, M., Aarons, G., & ... Jeste, D. (2012). Incarceration among adults who are in the public mental health system: rates, risk factors, and short-term outcomes. Psychiatric Services, 63(1), 26-32.

Huxter, M. J. (2013). Prisons: the psychiatric institution of last resort?. Journal Of Psychiatric & Mental Health Nursing, 20(8), 735-743. doi:10.1111/jpm.12010

Jacob, J., Holmes, D., & Buus, N. (2008). Humanism in forensic psychiatry: the use of the tidal nursing model. Nursing Inquiry, 15(3), 224-230.

Kent-Wilkinson, A. (2010). Forensic psychiatric/mental health nursing: responsive to social need. Issues In Mental Health Nursing, 31(6), 425-431. doi:10.3109/01612840903506444

Lovell, D., & Jemelka, R. (1998). Coping with mental illness in prisons. Family & Community Health, 21(3), 54-66.

Peternelj-Taylor, C. (2008). Criminalization of the mentally ill. Journal Of Forensic Nursing, 4(4), 185-187.

Stella’s Circle (2013). Annual Report 2012-13. Retrieved from http://stellascircle.ca/uploads/Annual_Report_2012-13_website.pdf

Transinstitutionalization. (2013). In Oxford Dictionary Online. Retrieved from http://oxfordindex.oup.com/view/10.1093/oi/authority.20110803105342839

Yang, S., Kadouri, A., Révah-Lévy, A., Mulvey, E., & Falissard, B. (2009). Doing time: a qualitative study of long-term incarceration and the impact of mental illness. International Journal Of Law & Psychiatry, 32(5), 294-303. doi:10.1016/j.ijlp.2009.06.003

Stigma
People living with mental illnesses are often portrayed by the media as being dangerous

When criminals are described on television they are often depicted as having a mental illness and of being "evil"

It is easy for those living with a mental illness to self stigmatize because of how they are seen by the population as a result of the media

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