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Fighting Fires

Network, Winter 2005

Mental health court support programs in Ontario were created to build bridges between the criminal justice system and community services. Yet the day-to-day job of the mental health court support worker often feels more like fire-fighting than bridge-building. With not enough services available in the community and people not knowing where to turn for help, much of the support worker’s time is spent responding to crises.

“I hate to say it, but we’re dealing with the fires as they come up rather than looking at the origins, or keeping the fires out,” observes Rick Gadde, mental health court support worker for the Canadian Mental Health Association (CMHA), Sault Ste. Marie Branch.

Opportunities for prevention do exist. Gadde often works with family members, for example, to help them negotiate the sometimes confusing rules under the Mental Health Act that can be used to get people into treatment and prevent situations from escalating.

But in most cases, by the time the court worker gets connected with a person in need, that person has already been charged with an offence and may already have had several court appearances. “Oftentimes, we get people on their third or fourth appearance,” says Courtenay McGlashen, manager of the mental health court support program for the CMHA Peel Region Branch. “They’ve just been bouncing around because no one really knows what to do with them.”

Mental health court support programs currently exist in fewer than 20 communities across the province, usually as a service provided by a local mental health agency. Seventeen CMHA branches in Ontario, including Sault Ste. Marie and Peel Region, run court support programs, although they vary in size and services offered.

The CMHA Toronto Branch mental health court support program in the Scarborough Courthouse is one of the biggest and best organized in the province. Managed by Frank Sirotich, the program includes two diversion workers and a case manager, as well as two psychiatrists who attend on a regular basis. The Scarborough program is one of five mental health court support programs serving the Toronto area. The others are located in Etobicoke, North York, and downtown Toronto at College Park and Old City Hall.

Both Gadde and McGlashen, on the other hand, work alone and serve communities that span large geographic distances. In addition to the court in Sault Ste. Marie, Gadde says, “There is a need out in the region,” in the smaller neighbouring communities of Wawa, Blind River, Elliot Lake and Thessalon. McGlashen admits it’s a challenge to cover the region of Peel and that “on any given day I could be in five different courtrooms at the same time.” A little relief is in sight, however — CMHA Peel recently received new funding for case management workers, and some of those staff will work with the diversion program.

The position of mental health court support worker is a new one in the field, and Gadde and McGlashen have come to their roles by different routes. McGlashen started his job in Peel on a student placement, and his training consisted of a hands-on “crash course” in the criminal justice system provided by the duty counsel and other court professionals.

Gadde took on the job six weeks after his “retirement” from a previous career that included positions in two provincial ministries, supervising social work students, and being a police officer. To support his current role, he has participated in training from North Bay Psychiatric Hospital on such topics as fitness screening, fetal alcohol spectrum disorder, post-partum depression and concurrent disorders. In return, Gadde offers training to other providers, including suicide intervention.

Court support workers and other professionals with the CMHA Toronto program also benefited from specialized training, including a three-day course on risk assessment provided by the Centre for Addiction and Mental Health. Sirotich says that while formal training is important, court support workers do a lot of “learning on the job,” especially in understanding the criteria the court system uses to make a decision on whether or not someone is suitable for diversion or for a bail release from jail.

McGlashen identifies mental health diversion as the “primary function” of the mental health court support program. He defines diversion as “a way of taking someone with criminal charges out of the criminal justice system and steering them towards the mental health system.” The Peel program successfully diverted 56 individuals from the criminal justice system into mental health treatment in 2003-2004. Only 3 percent of those individuals have since re-offended.

Most of the people who are diverted from jail to the mental health system have been charged with non-violent crimes, known as “class one” offences. Examples of these include public disturbances, such as yelling at people in public, breach of probation, and mischief charges. More serious offences, such as “uttering threats,” can also be diverted, depending on the circumstances.

Gadde provides an example of “one of the simpler situations” — a woman with no criminal history who was charged with “simple assault” after she “grabbed hold of somebody.” At the time of the assault, the woman was changing her medications, a process that can significantly affect the person’s behaviour. Based on this and other factors, Gadde recommended that her case be diverted, with conditions that included writing a letter of apology to the victim, performing community service and keeping the peace. The Crown accepted the recommendation and set a date two months later to follow up with the woman to make sure she had met all the conditions.

Diversion is only one part of the day-to-day work of a mental health court support worker. In cases where diversion is not appropriate and people proceed through the criminal justice process, the court worker can help the court understand the psychiatric treatment needs of the accused. They also provide support to prisoners with mental illness, by helping them adjust to jail, for example, or helping them create a plan to come back to the community after they serve their sentence.

One key to the success of court support programs is the linkages they have developed with other players in the system. A wide range of criminal justice professionals can be involved with each individual before the court, such as Crown officers, defence or duty counsel, judges, and cell supervisors, as well as workers from the John Howard Society who provide supervision for people on bail. “We have excellent buy-in from these people,” says Gadde.

In addition to accessing the case management, clubhouse, counselling, vocational, peer and group support, and other services offered by their local CMHA, both Gadde and McGlashen also refer people to services elsewhere in the community — inpatient assessment and treatment, counselling for abuse and addiction, income support programs (such as Ontario Works and the Ontario Disability Support Program), and homeless shelters. “You name it, we use whatever we’ve got,” says McGlashen.

Forging links across sectors becomes easier when court support programs are able to demonstrate the effectiveness of their work. Before the program existed in Sault Ste. Marie, people who required an assessment to see if they were fit to stand trial had to be sent to North Bay Psychiatric Hospital, a process that required two police officers driving the individual five hours each way. According to Gadde, “80 percent of the people being shipped there were just being turned around and sent back because they were found to be fit.”

With the court support program available in their home community, the long trip to North Bay is no longer necessary. People with mental illness are being better served, police time is freed up, and the psychiatric beds that were being used to assess people are now available for other patients.

The clients that Gadde and McGlashen work with run the entire age spectrum, from a 16-year-old boy experiencing his first psychiatric crisis and causing a public disturbance, to a senior in her 70s, suffering depression and loneliness from the loss of her family and caught shoplifting for the first time in her life. Beyond the shared fact that they all have a mental illness and are involved, or at risk of becoming involved, with the criminal justice system, each person is unique.

Getting to know the person — who they are and what’s going on in their life that has led them into trouble with the law — is a key task for the mental health court support worker. “What I try to do is provide the court with a picture of who this person is,” says Gadde. He reviews the person’s background, talks with the police and court workers, and consults with the family, if possible.

“We get great information from families on what some of the issues are,” agrees McGlashen. “Families are usually the first contact we have with the individual. They would alert us that their loved one is in custody and needs some help.”

The family members suffer through the process as well. They are often in “dire straights themselves,” says Gadde. “They’re barely holding on as a care provider.” Finding help for family members is part of the court support worker’s role. McGlashen often refers people to the Family Association for Mental Health Everywhere (FAME), a local family support group with whom he has developed a good relationship.

Mental health court support workers offer their clients who qualify for diversion an opportunity to develop a plan that will not only satisfy the requirements of the legal system, but also help the person deal with the many issues involved in getting and keeping healthy.

“The court is only really concerned with supervision as a whole — are they getting their meds, are they seeing their doctor,” says McGlashen. But once the plan is accepted by the court, he “works with the individual to empower them to get where they want to go in life.”

Without the option of diversion, people suffer greatly when their mental illness is treated as a crime. “We’ve had people who had suicide attempts every time they had to come to court,” says McGlashen.

A key part of the job is helping people cope with the “huge intimidation factor” of being in the court, by “ensuring that clients and their support networks understand the court process entirely,” says Gadde. “One of the greatest rewards I have is the fact that people don’t feel alone.”

Gadde and McGlashen both describe their work as extremely rewarding. “I really feel that I’m doing good work,” says McGlashen, “because the criminal justice system is no place for somebody who is mentally ill. Having a chance to help somebody get out of the system, that’s great.”

Editor’s Note: On January 12, 2005, the Ministry of Health and Long-Term Care announced $27.5 million in new funding for community mental health services in Ontario to help people with mental illness stay out of the criminal justice system. The investment is intended to expand services in five key areas: crisis outreach and response, short-term residential crisis support beds, intensive case management, supportive housing services, and court support services.

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