The Canadian Mental Health Association, Ontario Division (CMHA Ontario) recently participated in the coroner’s inquest into the death of Soleiman Faqiri. Their aim was to provide expertise to the coroner and jury on the intersection of the mental health and justice systems.
Mr. Faqiri was detained at the Central East Correctional Centre during what witnesses have described as a “psychiatric emergency.” He died at the Centre on December 15, 2016. His cause of death was deemed to be restraint in a face-down position and injuries from his struggle with guards.
CMHA Ontario received public standing in the inquest to advance mental health and mental health programs in the community, particularly as it applies to individuals‘ interactions with law enforcement and promoting good mental health treatment for individuals in custody.
Naushaba Degani, CMHA Ontario’s Chief Quality and System Performance Officer, was called as a witness to provide evidence to the jury on gaps in the mental health and justice systems. Degani spoke to how these gaps negatively impact individuals experiencing serious mental health crises within the legal system and detained in correctional facilities.
Degani’s testimony included highlighting the need for health care in corrections to be integrated with the provincial health care system so that “any door is the right door.” This means that anyone who has healthcare issues in any institution should be assessed and referred to the appropriate services, specialists, and treatment options consistent with the individual’s goals of care.
“Soleiman did not go to an assessment that would have likely resulted in him receiving specialized healthcare because he was in, essentially, the midst of a psychiatric emergency,” inquest counsel told the jury.
As the jury continues to hear about the lack of adequate healthcare resources in Ontario’s correctional system, Degani shared important examples of policy changes that could fundamentally transform both our correctional and mental health systems, including:
- Developing formal partnerships, protocols and pathways to ensure community-based mental health services, hospitals, and correctional institutions work together to communicate, share information, make referrals, and move people through a system rife with care gaps, delays and waitlists.
- Ontario Shores, Scarborough Health Network, CMHA Toronto and CMHA Durham are developing a pilot to ensure individuals diagnosed with schizophrenia receive integrated care that is evidence based regardless of setting and where they are in their recovery journey.
- Ensuring high quality, evidence based care is available in all settings, including correctional settings, and investing in resources to support consistent implementation, evaluation and standardization of both community mental health care and correctional health care. This is consistent with the “principle of equivalence,” which mandates that incarcerated persons should enjoy the same quality and standards of healthcare that are readily available in the community. (United Nations Standard Minimum Rules for the Treatment of Prisoners, also known as the Nelson Mandela Rules)
- Developing strong partnerships between correctional facilities, hospitals, and community-based service providers and investing in community-based mental health services to ensure that people don’t end up in the justice system in the first place. For those with mental health needs who are in corrections, ensure health care is integrated between community and the correctional setting.
- Ensuring rapid assessment, transfer and access to mental health providers is provided in a timely way, based on clinical status and urgency.
- Implementing programs like “prison in-reach teams” where teams of mental health providers work within correctional institutions could be one way to get better mental health service inside institutions – particularly for those struggling with homelessness and housing precarity where correctional institutions are often the first point of contact with mental health providers.
“We know that people in prison have a higher prevalence of infection from disease, mental health issues, and substance use needs,” Degani told the jury. “People living and working in prisons come from our communities and return to them after periods of incarceration. We have a duty to address prisons health concerns because they are a public health issue.”