Tag Archives: legal system

The Challenge of Mental Illness in the Justice System Part 3: Victims

This is the third in a three-part post about a talk given by the Chief Justice of the Supreme Court of Canada, The Right Honourable Beverley McLachlin, about the interactions between people who are mentally ill (her term) and the justice system of Canada. Part 1 briefly discussed the history of the treatment of people with mental illness in Canada, and then described the current situation with regards to the criminal court system. Part 2 discussed the interactions between people with a mental illness and the civil courts. Part 3 will discuss the mentally ill as victims of the justice system.

This post will discuss violence against people with disabilities.

All quotes are from my notes and are not verbatim.

Many Canadians will be familiar with several stories of people diagnosed with a mental health condition being killed by police officers. Byron DeBassige, 28, was shot and killed by police officers in February 2008 (Toronto). Howard Hyde, 45, was tasered and killed by police officers in November 2007 (Halifax). Ashley Smith, 19, committed suicide in jail while prison guards watched in October 2007 (Kitchener). Reyal Jensen Jardine-Douglas, 25, was shot and killed by police officers in August 2010 (Toronto). While Robert Dziekanski does not appear to have had a mental illness, his “irrational” behaviour after having been detained in the airport for 10 hours is the reason police officers gave for tasering him multiple times and leaving him to die in October 2007 (Vancouver).

The Chief Justice specifically focused on the case of Byron DeBassige, reading from the Toronto Star article I linked above. She went on to state that she believes that the police wouldn’t have shot DeBassige over two lemons and a knife had they known he was ill. In light of the other cases I’ve linked to, I don’t agree with her – in several of those cases the police were firmly and repeatedly told the person they killed was mentally ill. I don’t believe police officers as a whole have risen above the ableist prejudices that lead to psychophobia (fear of people with mental health conditions), simply because there’s been no real attempt in Canada to combat it.1

The Chief Justice went on to discuss how prejudice and fear can affect people with a mental illness: “I’d like to shift the focus to millions of mentally ill people who do not break the criminal law, who remain untreated or inadequately treated, and at liberty. Too often they are simply victims: Victims of discrimination, ignorance, societal inefficiency, and sometimes of violence that too often ends with their death.”

As a woman with a diagnosed mental health condition, I’m twice as likely as my non-disabled counterparts to be the victim of a violent crime, including rape. [Source is PDF] I’m also significantly less likely to be violent than my counterparts. And yet, even on FWD (in comments that are unapproved), it’s not rare for people to equate my diagnosis with abuse. It’s not uncommon for me to be sitting in a classroom of people who know that I campaign for disability rights and have talked a lot about the prejudices that face people with mental health conditions and have my classmates talk about how “crazy” people are violent. After learning I was going to this talk, one of my classmates told me that, should she ever murder someone, she’d claim temporary insanity and just spend a few months in care and then be released. All I could think of was Ashley Smith, who threw crab apples at the postman and died in jail.

The stark truth is too often we discriminate against the ill. We pass them lying on the street but ignore pleas for housing, reluctant to give them jobs even when they’ve struggled valiantly to overcome their illness. We marganilise them.

We need to know more if we’re going to avoid the specter of mentally ill as victims. Related to this is the lack of social coordination on behalf of the mentally ill. All who play a role in an ill person’s life must find ways to communicate and talk to each other. They fall through the cracks. There must be better communication between agencies if we are to prevent more mentally ill people from becoming victims.

This last quote is, in sum, why I felt a lot of frustration with this talk. Throughout, the Chief Justice talked about agencies, she talked about police officers, parole officers, and judges, she talked about what people can do. At no point did she quote an actual person with a mental illness. At no point did she suggest that people talk to those of us who have a mental health condition, and find out what we want and need. At no point did she talk about attempts by the justice system to include people with mental health conditions on tribunals or in the discussions about how the justice system can do better on this issue. Nothing about us without us really shouldn’t be a daring concept, but it seems it is.

Despite all of my complaining, I actually did enjoy this talk. It’s not very often that people admit that prejudice and fear play a strong part in the way people with mental illnesses are treated, by society in general and the justice system in particular. As a Canadian, it makes me happy that the Chief Justice of the Supreme Court is speaking about this, because her authority lends weight to what she’s speaking of, and because I know the Supreme Court is aware of the issues that she’s raising. I also appreciate that she takes the time to speak on this issue often. I was recently emailed the text of a similar talk she gave in 2005. Making law students and lawyers (as well as the general public) aware of these issues may help prevent future cases like Ashley Smith’s suicide.

I would obviously like that more awareness of these issues was addressed in a helpful and thoughtful manner in the newspapers, in classrooms, and on the internet. Chief Justice McLachlin is doing good work, and I’m very glad of the opportunity presented by Dalhousie University to see her talk in person.

Dal News wrote about this presentation as well.

  1. There is, however, an attempt to point out that “mental illness costs Canadians $51 Billion a year“. I don’t think we battle prejudice against mental health conditions by talking about how much it costs, especially since I think it would be more accurate to say “discrimination and stigma related to mental health conditions costs the economy $51 Billion a year”, but what do I know? I’m just a crazy lady.

“The Challenge of Mental Illness in the Justice System” – Part 2: Civil Court

This is the second in a three-part post about a talk given by the Chief Justice of the Supreme Court of Canada, The Right Honourable Beverley McLachlin, about the interactions between people who are mentally ill (her term) and the justice system of Canada. Part 1 briefly discussed the history of the treatment of people with mental illness in Canada, and then described the current situation with regards to the criminal court system. This part will discuss the interactions between people with a mental illness and the civil courts. (Everything in quotes is from my notes, which are not verbatim.)

One of the anecdotes the Chief Justice opened her talk with was about an incident that occurred when she was articling. She discussed receiving a phone call from a woman who had been institutionalized, and told her that she only had two minutes to be on the phone. “I’ve been locked up, and I need to get out,” she whispered. The Chief Justice related how this woman had been forcedly institutionalized by her very respectable husband, who decided she was “overly emotionally, somewhat hysterical, had convinced the doctor to sign the papers. The authorities had come and she was taken to the mental institution.”

I got the impression – perhaps wrongly – that the Chief Justice wanted us to see this woman as someone who had been wrongfully institutionalized because she wasn’t actually mentally ill. She told the anecdote as part of the history of institutionalization, having just described it as a way “to get rid of someone you didn’t want, like a wife giving you trouble.” [s.e. smith wrote about this a bit when reviewing Fingersmith at this ain’t living.] This is a pretty common narrative when people discuss fear of institutionalization, and you’ll often see this story play out in pop culture. It gives the impression that forced institutionalization isn’t wrong, except when it’s someone who’s totally sane. The mentally ill, on the other hand, can be treated without care.

The focus of this section of her talk was on the “difficult ethical and legal problems” arising in the civil court. “On the one hand lies liberty of the individual, and the right of the individual to make decisions. On the other lies the tragic reality that the mentally ill cannot make rational decisions. Surely, their loved ones argue, we should be able to impose treatment to the point where they can have the capacity to make rational decisions about his or her treatment.”

Again, the Chief Justice focused on the change in how people with mental illness can legally be treated as a result of the Charter. She touched briefly on the history of forced hospitalisation, and how this had originally been forced treatment as well. Now, apparently, people are only forced into hospitalisation if they’re considered a danger to themselves or others. (From what I’ve gathered talking to people in Canada who have been hospitalised as a result of mental illness, there’s a lot of pressure to agree. This can vary from loved ones saying “We just want what’s best for you!” and the attendant guilt-related issues, to “if you don’t agree we’ll call the police and you can go to the asylum instead”.)

In describing “the issue being whether the person possess sufficient cognitive ability to make rational treatment decisions about his or her health”, the Chief Justice focused on the particulars of one case, referred to as the Starson Case. [There’s a brief overview of it on Wikipedia, and here are some follow-up news articles and discussion.]

Again, according to my notes:

At the time of the action Professor Starson was detained in a psychiatric hospital as a result of a finding of Not Criminally Responsible. The physicians believed he needed medication, but Professor Starson refused. His physicians found that he was not capable of making a decision with respect to his medical treatment.

He applied to the Ontario Capacity and Consent board to review that decision. The Board agreed with the doctors. He was in almost total denial of the illness (Wikipedia tells me he was diagnosed with Bipolar Disorder) so could not relate information to his disorder.

The matter was appealed to the courts and the lower courts in Ontario ruled he was capable of making decisions. This case then went to Supreme Court and the issue was the interpretation of the test for capacity. The majority ruled that Professor Starson had the capacity to make a choice and accordingly the Board’s order was overturned.

The story doesn’t end there. After the Supreme Court decision in 2003, his condition deteriorated. In 2005, his treating physicians found him incapable of managing his care. With his mother providing substitute consent, doctor’s began medicating. In 2007 he was discharged to outpatient status. In 2009, he was still contesting the decision to be forced into treatment.

The Chief Justice then went on to describe the debate about the treatment of people who are mentally ill as being between those that argue that the law should never permit mandatory treatment, and those who argue that mandatory treatment should be expanded to cover more instances than it does. In Canada, she said, “Liberty can be curtailed only exceptionally – when there is genuine risk of harm to his or herself or others, or when a person is cleary incapable of making decisions necessary for medical care.”

One of things I noted in this section of her talk was the very distancing language the Chief Justice used throughout. While at one point she did describe how we can feel sympathy for Professor Starson’s fight to determine his own treatment versus that of his mother’s fight to get him the treatment she felt he needed, most of the time the Chief Justice spoke as though no one in the audience would ever be touched by these decisions. As I said in the first part of this, I’m uncomfortable with a circle drawn around people with a mental health condition, and another around people who work in the legal or medical profession, with no overlap. The whole thing read a bit too much like “you can tell who’s crazy by looking at them, so I know none of you are.”

There is one more part to this discussion, which focuses on the mentally ill as victims of the justice system.

“The Challenge of Mental Illness in the Justice System” – Part 1: Criminal Court

On Tuesday evening, the Chief Justice of the Supreme Court of Canada, The Right Honourable Beverley McLachlin, gave a talk in Halifax about people with a mental illness (her term, which I will use throughout) and their interactions with the justice system, both civil and criminal. For me, it was an interesting, although slightly, frustrating talk (I dislike the way people with mental illness and people who work in the medical or legal profession were treated as two different and distinct groups, with no overlap).

Like most people who follow disability-related news, I’m well aware of both the high levels of mentally ill people incarcerated in Canada and the frightening number of fatalities when someone with a mental illness interacts with the police. [Read More on this on FWD: Record of the Dead. I love policy. Publicity and the Taser. What is Justice.]

As the Chief Justice herself said, it’s an issue that many people want to sweep under the rug. I often see people wanting to pretend that each incident of a person being killed by the police as an individual issue, rather than a disturbing trend. As an activist, it’s heartening for me to know that the Chief Justice of the Supreme Court of Canada believes this is a systemic problem, and one that we need to fix.

I’m going to divide my discussion of this talk into three parts, just as the Chief Justice herself did. Part one is an introduction to the situation in Canada, as well as touching on issues that can occur when people with mental illnesses interact with the criminal justice system. Part two will focus on civil cases, specifically on people who have a diagnosed mental health condition refusing treatment and the response of the court. (I’m sure that will be fun. /sarcasm) Part three will talk about people with mental health conditions being victims of the justice system.

The Chief Justice began her talk with a brief history of the treatment and stigma around mental illness, focusing on how people used to believe that mental illness was a sin, or a sign of possession, or the fault of the mentally ill person. She then went on to detail how scientific advances have combated these stereotypes. (I wanted to move the country where mentally ill people are not blamed for having a mental health condition or considered weak or told to shut up, but I think we come at this from different perspectives.) She also touched briefly on the history of forced institutionalization in Canada, first in sanitariums outside of the city, and then in hospitals within it. She ended this section by discussing the de-institutionalization movement, which often left people with a mental illness with no skills to find a home or a job, and no ties to the community having been in the institutional setting for years. To quote my notes, which are not verbatim:

“The streets are dominated by many people with mental illness. We must now interact with them in society. Where once the legal solution was simple, now it is complex and expensive. Decent housing, drugs, hospitals, psychiatrists cost money. With so many competing demands on the health care, the claims of the mentally ill hover on the margins.”

One thing the Chief Justice highlighted in this section was the lack of hospital beds for people needing a psychiatric evaluation. When I worked in a mental health-related job, I know there were dedicated beds at the hospital for people brought in for psychiatric evaluation, but because beds were at a premium, they were sometimes given to other types of patients. This, in turn, both increases tensions between people who work within the mental health system and people who work primarily with physical illness (as though these are entirely separate things), as well as making it more difficult for police officers to bring people who may be living with a mental illness into the hospital for evaluation. Many of us can agree that a prison cell isn’t a place for someone who is having a mental health-related crisis, but sometimes there’s no place else to go.

The Chief Justice then introduced her discussion of people with mental illness and the criminal justice system by bringing up the Charter challenges to the system that existed pre-1982.

As a brief history lesson: Canada instituted the Charter of Rights and Freedoms in 1982, which guaranteed rights such as the right to be free from discrimination based on mental or physical disability. Now cases can be brought before the Supreme Court as “Charter Challenges” – the case is about whether or not the law itself is illegal by violating the Charter. In terms of people with mental illness in Canada, if they were found to be “not guilty by reason of insanity”, they were held under a Lieutenant-Governor’s Warrant, taken to an institution, and held there without any trial, without a judge, and with the case only being reviewed periodically. It was, in essence, incarceration without trial or any possibility of parole. This was Challenged as being unconstitutional, and the system had to change.

Again, to quote my not verbatim notes:

Parliament got to work and they drafted a series of provisions, known as Part 20 of the Criminal Code. These provisions are very advanced. They have set up an alternate route whereby mentally ill people who are charged with crimes are, after a hearing before a judge, declared Not Criminally Responsible. If they are declared NCR, then they do not go through the ordinary court system. They go before a NCR Board (this is Provincial). The board has an obligation to determine what is the least invasive way of looking after their illness. May give them an absolute discharge if there is no danger to the public and they can be released into society. They can give a conditional discharge, which is a discharge under medical supervision, and this can vary from part-time hospitalization to being in the community. Or they can, if the Board feels the danger to the community is such, require the person to remain in custody in a hospital.

There are reviews every year. The board deals with their cases and gets some familiarity.

This system is working very well. It works humanely. It works in a fair manner where mentally ill people can come before boards in an informal way. It is also providing adequate protection to the public. This is on the whole a positive development.

We still have problems: lack of hospital facilities. Before this system can start to operate a judge has to say that the person is NCR. Requires psychiatric assessment in a hospital. Sometimes trouble getting them into the hospital. A number of judges have spoken out about this. Reported in newspapers. Also problems in finding facilities for young people. 13 year old girl ended up having charges stayed because the authorities were unable to provide a proper youth setting for her evaluation and care. She was sent to prison instead, which was totally inappropriate. I mention these cases to show there are strains in the system.

I’ve had a bit of interaction with the Mental Health Courts from when I worked in the system. Like many things involving people with a mental illnesses, these courts are underfunded and very busy. There are very strict rules about who qualifies as “mentally ill enough” to be seen in this court, which means that people who should be here are instead sent back to the regular criminal courts. Everyone involved looks at this and knows it’s a problem, but the money isn’t there to solve it.

Deportation by Default: 15% of Immigration Detainees in the US Have Disabilities That Impair Their Understanding of Deportation Proceedings

Human Rights Watch and the American Civil Liberties Union released a report yesterday shedding some shocking light on the immigration detention system in the United States. According to ‘Deportation by Default,’ 15% of immigration detainees have mental illnesses or intellectual disabilities that render them unable to present their cases or understand immigration proceedings in court. Many were held for indefinite periods, like Jose Antonio Franco Gonzalez and Guillermo Gomez-Sanchez, two men who were held in detention for almost five years without adequate care.

Representation is not mandated or guaranteed for people undergoing immigration proceedings:

Some were able to hire lawyers, others received pro bono representation – but there is no automatic right to court-appointed counsel, and most were not represented, the report said. (source)

I know I couldn’t represent myself in immigration proceedings and have a fighting chance at winning, personally, and I have a lot less working against me than many immigration detainees do. The fact that counsel is not appointed for people who may be navigating an unfamiliar legal system in a language they may not understand is, to be blunt, a horrific miscarriage of justice.

The ACLU concludes its summary of the situation with this rather damning commentary:

Due process is part of judicial integrity. It’s a basic principle that this country has decided to prioritize. It’s one of our greatest exports — we send people all over the world to talk about rule of law and how to reform judicial systems but we’re not doing it here in our fastest growing judicial system [the immigration courts].

Not every non-citizen with a mental disability is entitled to remain in the United States; but everyone is entitled to a fair hearing and a chance to defend his or her rights. If the US government is going to detain and deport individuals with mental disabilities, it must do so in a way that respects their human rights, honors US human rights commitments, and ensures fair and accurate court decisions.

The circumstances and situations documented in this study, incorporating interviews with 104 people, are something that the United States should be deeply ashamed of. The justice system in the United States is often touted as a paragon of equal access and fairness; we are told that everyone has access to due process, to representation in court, to the right to understand legal proceedings. Yet, for disabled immigration detainees:

Deficiencies exist throughout the arrest, detention, removal, and deportation process, violating the human rights of affected individuals and offending both American and international standards of justice. The shortcomings include no right to appointed counsel; inflexible detention policies; lack of substantive or operative guidance for attorneys and judges as to how courts should achieve fair hearings for people with mental disabilities; and inadequately coordinated care and social services to aid detainees while in custody and upon release.

The report documents cases of people who did not understand what deportation meant and lacked the ability to comprehend deportation proceedings; one subject asked to be deported to New York, for example. Some interview subjects had intellectual disabilities or untreated mental illnesses that made it functionally impossible to understand what was happening, while others were in extreme emotional distress and had difficulty comprehending the proceedings, let alone communicating. At least two cases included US citizens wrongfully subjected to deportation proceedings. One North Carolina native had bipolar disorder, was unable to understand the case against him, and could not represent himself in court, so he was deported to Mexico. Another, a US citizen since childhood, would have been deported if it weren’t for the actions of an attorney with the Florida Immigrant Advocacy Centre.

The report urges Congress to require appointment of lawyers for all people with mental disabilities in immigration courts. It recommends mandatory training for immigration judges to recognize mental disabilities, and calls for repeal of a regulation allowing a mentally disabled detainee to be represented in court by the warden of the detention facility. (source)

This recommendation would certainly be a step in the right direction if it was followed. It’s clear that we have been subjecting disabled detainees to grave injustice, and it’s going to take a lot of work to remedy that. People with disabilities are also poorly served in the US court system in general, but attorneys at the ACLU point out that deportation proceedings are among the most complex legal matters people can encounter, with the fewest protections in place; if there’s any place where inability to understand court proceedings has high stakes, a deportation hearing is definitely high on the list.

“Owing to their mental disability, people may not be able to share their experience with the judge in a way that helps him understand that they have a mental condition or a valid claim,” says Deborah Fowler, Texas Appleseed’s legal director. “This is particularly true for asylum seekers who have suffered trauma or persecution in their home countries.” (source)

Another serious problem for people trapped in immigration detention is that it can be stressful, exacerbating mental health issues and causing emotional distress for people with intellectual disabilities. Being shuffled from facility to facility has documented ill health effects on nondisabled people, and those effects can be even worse for people with disabilities, especially when they are denied adequate care and treatment. Judges, uncertain about what to do with detainees who clearly do not understand the proceedings, can place cases in a form of legal limbo, leaving people adrift in the immigrant detention system for years.

If this report outrages you as much as it does me, I urge you to contact Congress to tell them that you would like to see this report followed up, and want to see Congress taking the concluding recommendations seriously. If you are in the US, your own Representative is the best bet for a contact and/or you can write your US Senators. If you are outside the United States, please consider contacting a member of the House Subcommittee on Immigration, Citizenship, Refugees, Border Security, and International Law or the Senate Subcomittee on Immigration, Refugees, and Border Security and explaining that while you are not in the United States, you are gravely concerned by this report and feel that it reflects poorly on the position of the US in international society (and anything else you care to add). You can also drop a line to President Barack Obama, should you feel so inclined.