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Criminalization of the mentally ill : a study of psychiatric services within the Lower Mainland Regional… Chow, Lily Lucia 1991

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CRIMINALIZATION OF THE MENTALLY I L L : A Study o f P s y c h i a t r i c S e r v i c e s W i t h i n The Lower Mainland R e g i o n a l C o r r e c t i o n a l  Centre,  H e a l t h Care Centre By  /  LILY LUCIA CHOW B.A., Simon F r a s e r U n i v e r s i t y , 1986 B.S.W., The U n i v e r s i t y o f B r i t i s h Columbia, 1987 A THESIS SUBMITTED IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF SOCIAL WORK in THE FACULTY OF GRADUATE STUDIES SCHOOL OF SOCIAL WORK  We accept t h i s t h e s i s as conforming to the required  standard  THE UNIVERSITY OF BRITISH COLUMBIA June 1991 ®Lily L u c i a Chow, 1991  In presenting  this thesis in partial fulfilment of the requirements for an advanced  degree at the University of British Columbia, I agree that the Library shall make it freely available for reference and study. I further agree that permission for extensive copying of this thesis for scholarly purposes may department or by  his or her  representatives.  be granted by the head of  It is understood that copying or  publication of this thesis for financial gain shall not be allowed without my permission.  The University of British Columbia Vancouver, Canada  DE-6  (2/88)  my  written  A B S T R A C T  This ill.  paper examines t h e p l i g h t of the i n c a r c e r a t e d After  have  a  consideration  contributed  services  to  throughout  Columbia,  the  participant  identify  the  Lower were ill  philosophy  and  p a t t e r n of  of  a  informal  qualitative  and  formal  study  using  i n t e r v i e w s , and  Methods which was undertaken t o  the m e n t a l l y  i l l i n d i v i d u a l s who a r e  a term of imprisonment i n the H e a l t h Care Centre of the Mainland  eighteen  Regional  incongruencies provided  the  i n the  C o r r e c t i o n a l Centre.  formal p a r t i c i p a n t s .  offenders,  alienation,  for  on  Comparative  needs  A lack  critical of  between  analysis  organizational our  social  Altogether  there  They i n c l u d e d s i x m e n t a l l y  s i x c o r r e c t i o n a l personnel,  professionals.  lies  current  reports  observation,  Constant  of the h i s t o r i c a l f a c t o r s which  North America, and s p e c i f i c a l l y i n B r i t i s h  paper  Strauss'  serving  the  mentally  and s i x h e a l t h  care  of the major f i n d i n g s commitment,  policies  and  b a s i s f o r program recommendations.  and the  practices -  The c h a l l e n g e  b u i l d i n g of a v i s i o n t h a t values humane treatment  the m a r g i n a l members o f our s o c i e t y .  T A B L E  O F  C O N T E N T S  ABSTRACT LIST OF TABLES LIST OF APPENDICES  PAGE i i V vi  CHAPTER 1 BACKGROUND TO THE STUDY 1 H i s t o r y of the North American Mental H e a l t h System.. 1 Moral Treatment and the Asylum 2 The Mental Hygiene Movement and Psychopathic H o s p i t a l s 4 Community Mental H e a l t h Movement 6 The Community Mental H e a l t h Movement i n Canada.. 9 The.Community Mental H e a l t h Movement i n B r i t i s h Columbia 11 Summary 14 The C r i m i n a l i z a t i o n of the M e n t a l l y 111 15 Cost Versus Care: The Dilemma 19 2  SYSTEMS OF CARE FOR THE MENTALLY I L L IN THE PROVINCE OF BRITISH COLUMBIA . 21 Riverview Mental H o s p i t a l 21 Forensic Psychiatric Services 24 Lower Mainland R e g i o n a l C o r r e c t i o n a l Centre .... 28 E n t r y t o the System 33 Concluding Comment 38  3  THE RESEARCH DESIGN D e f i n i n g M e n t a l l y 111 O f f e n d e r s Purpose of Research Issues S e l e c t e d f o r Research Research Design Methodology ( i ) Data C o l l e c t i o n ( i i ) Sampling ( i i i ) The I n t e r v i e w ( i v ) Data A n a l y s i s (v) E t h i c s (vi) Discussion  40 40 43 45 46 47 47 48 52 52 53 54  - iv -  4  RESEARCH FINDINGS AND DISCUSSION C h a r a c t e r i s t i c s of the Sample ( i ) M e n t a l l y 111 Offenders ( i i ) Service Providers F i n d i n g s and D i s c u s s i o n I Alienation ( i ) M e n t a l l y 111 Offenders ( i i ) C o r r e c t i o n a l Personnel ( i i i ) H e a l t h Care P r o f e s s i o n a l s Discussion I m p l i c a t i o n s of the A l i e n a t i o n F i n d i n g ( i ) M e n t a l l y 111 Offenders ( i i ) Service Providers II O r g a n i z a t i o n a l Commitment Discussion I m p l i c a t i o n s of the O r g a n i z a t i o n a l Commitment F i n d i n g Summary I I I Where Do They Belong? ( i ) M e n t a l l y 111 Offenders ( i i ) C o r r e c t i o n a l Personnel ( i i i ) H e a l t h Care P r o f e s s i o n a l s Discussion I m p l i c a t i o n s of the F i n d i n g on the Incongruencies Between S t a t e d S o c i a l P o l i c i e s and A c t u a l P r a c t i c e s Summary and Concluding Comment  Footnotes Bibliography Appendices A B C D E F G  Young A d u l t Chronic P a t i e n t s Interview Guide Consent Form For M e n t a l l y 111 Offenders Consent Form For S e r v i c e P r o v i d e r s Data A n a l y s i s Memorandum I n i t i a t i v e s and a Look t o the Future  58 58 58 59 61 61 61 65 70 74 75 75 76 78 82 86 89 90 91 91 92 95 96 100 103 104 113 ...113 115 116 118 120 123 124  - v -  L I S T  Number 1  O F  T A B L E S  PAGE Sample D i s t r i b u t i o n  50  - vi -  L  I  S  T  O  F  A  P  P  E  N  D  I  C  E  S  APPENDIX A - Young A d u l t Chronic P a t i e n t s B - Interview  Guide  C - Consent Form f o r M e n t a l l y 111  Offenders  D - Consent Form f o r S e r v i c e P r o v i d e r s E - Data A n a l y s i s F - Memorandum G - I n i t i a t i v e s And A Look To The  Future  -Vll-  When I c o n s i d e r the b r i e f span of my l i f e , Swallowed up i n the e t e r n i t y b e f o r e and behind i t , The s m a l l space t h a t I f i l l , or even see, E n g u l f e d i n the i n f i n i t e immensity of spaces, Which I know not, and which know not me, I am a f r a i d . And wonder t o see myself here r a t h e r than t h e r e , For t h e r e i s no reason why I should be here, Rather than t h e r e ; now, Rather than then. On b e h o l d i n g the b l i n d n e s s and misery of man, On s e e i n g a l l the u n i v e r s e and man without l i g h t , L e f t t o h i m s e l f , as i t were, A s t r a y t o t h i s corner of the u n i v e r s e , Knowing not who has s e t him here, What he i s here f o r , or what w i l l become of him, Incapable of a l l knowledge, I b e g i n t o be a f r a i d . As a man who has been c a r r i e d w h i l e a s l e e p To a f e a r f u l d e s e r t i s l a n d , And who w i l l wake not knowing where he i s , And without any means of g u i t t i n g the i s l a n d , And thus I marvel t h a t people a r e not s e i z e d With d e s p a i r a t such a m i s e r a b l e c o n d i t i o n . Blaise  P a s c a l (1623-1662)  -  1 -  C H A P T E R B A C K G R O U N D  OISJE  T O  T H E  S T U D Y  XM'X'RODTJCTIQM  To  understand  services,  i t  historical  and contemporary s o c i a l  the  manifestation  overt  our  is  current  essential  and  delivery  that  we  of  mental  health  the  various  examine  f a c t o r s t h a t have i n f l u e n c e d  c o n t r o l of mental i l l n e s s .  This  sociological  p e r s p e c t i v e i s supported  article  C o n t r i b u t i o n s of S o c i o l o g y t o the Understanding of  The  Mental  Disorder.  mental  illness  He s t a t e s : " i t i s d i f f i c u l t t o conceive process  c u l t u r e and s o c i e t y "  This  chapter  by Mechanic (1983) i n h i s  outside  the  contours  of a  of a p a r t i c u l a r  (p.17).  surveys  the h i s t o r i c a l  e v o l u t i o n of the North  American mental h e a l t h system.  HISTORY  In  OF  THE  their  Chronically that  Mentally  authors delivery  system,  MEKTTAT- H R K T . T H  of  Reform  SYSTEM  i n the  Care of the  111, M o r r i s s e y and Goldman (1984) suggest  of  treatment  reviewed  institutional  Cycles  treatment  cycles  environmental  AMERICAN  article  i n the  separate  WORTH  of  the m e n t a l l y  reform, and  with new  each  ill,  there are three  initiating  l o c u s of c a r e "  "a  new  (p.785).  The  the development of the mental h e a l t h s e r v i c e and  reforms"  coined  the  (p.785).  term "a c y c l i c a l p a t t e r n of The p a t t e r n of i n s t i t u t i o n a l  - 2 reforms can be summarized i n three stages 1)  moral treatment and the asylum;  2)  the  mental  hygiene  movement  as f o l l o w s :  and  the  psychopathic  h o s p i t a l ; and 3)  the  community mental h e a l t h movement and the community  mental h e a l t h  WORM. T R E A T M E N T  Prior not  deviants  to  i l l i n d i v i d u a l was  The l u n a t i c s or the insane  such as the m o r a l l y d i s r e p u t a b l e , the i n d i g e n t , the c r i m i n a l s , the possessed, and the p h y s i c a l l y  handicapped. either  ASYLDH  t r e a t e d no d i f f e r e n t l y than the other groups of  vagrants,  were  THE  from the community.  generally  social  AMD  the 19th Century, the m e n t a l l y  ostracized  were  the  to  centres.  Individuals the  who  deviated  from the s o c i a l norm  r e s p o n s i b i l i t y of t h e i r f a m i l i e s or were l e f t  t h e i r own d e v i c e s ,  l a n g u i s h i n g i n the c o u n t r y s i d e .  Only the  b e h a v i o u r a l l y v i o l e n t i n d i v i d u a l s were c o n f i n e d i n j a i l s - . 3  The reform  early  19th  movement  aimed  fortunate  members  p.786).  This  two  States. the  Tuke  of  a t b e t t e r i n g the c o n d i t i o n s of the l e s s society"  (Morrissey  and Goldman, 1984,  sentiment was h i g h l y i n f l u e n c e d by the works of  Europeans  William  Century gave r i s e t o a "broad-based s o c i a l  and in  These  institutional  one  American  England, three  and  - P h i l l i p p e P i n e l i n France, Dorothea  Dix  in  the  United  i n d i v i d u a l s were the e a r l y reformers i n  management of the m e n t a l l y  ill.  While P i n e l  -  ordered  the  treatment, and  release Tuke  the  for  for  mentally  Massachusetts. specialized Morrissey  the  Her  the  for  of  shocking  i l l to  efforts  facilities  the i n s t i t u t i o n a l environment,  development  revealing  confined  -  of chains and the abolishment of b a r b a r i c  revolutionized  advocated  responsible  3  the  asylums.  was  c o n d i t i o n s endured by State  resulted  Dix  Legislature  of  i n the c o n s t r u c t i o n of  mentally  i l l individuals.  As  and Goldman (1984) s t a t e :  "The 'moral t r e a t m e n t ' . . . [ P i n e l , Tuke, and Dix]...championed c o n t r i b u t e d t o the growing acceptance of a medical-psychological rather than a t h e o l o g i c a l model of mental i l l n e s s and l e d t o the establishment of asylums f o r i t s treatments" (p.786). The  belief  that  "insanity  into  small,  p.786). where an  atmosphere and of  care  asylums  ill  of  Goldman,  1  1984,  small p u b l i c i n s t i t u t i o n s  However, w i t h the r i s e of urban  increased  dramatically.  understaffed. to  The  large,  Asylums  transformation  became  from  "small  custodial institutions"  (Ibid)  to the i n c r e a s e d use of p h y s i c a l c o n t r o l , and i n d i v i d u a l i z e d moral treatment was  individuals  neglected,  the ' d i s t r a c t e d  r a p i d i n d u s t r i a l i z a t i o n , the number of p a t i e n t s  therapeutic  concept  as  &  belief  r e c e i v e humane care and g a i n s k i l l s i n  kindness.  and  support  (Morrissey  defined  would  overcrowded  lent  asylums"  were  of  e s s e n t i a l l y the  be cured by s e g r e g a t i n g  pastoral  'patients'  need  moral treatment was  could  Asylums  population in  of  were  isolated,  confined and  i n remote areas,  abandoned.  w i t h warehousing. As M o r r i s s e y  lost.  the  Mentally  and were soon  Treatment was  & Goldman (1984) p o i n t  synonymous out:  -  4 -  "By the 1870s...the f u n c t i o n of s t a t e asylums had been c l e a r l y delineated. The central purpose was defined by s t a t e legislatures i n terms of c u s t o d i a l care and community protection; treatment was of secondary importance. Emphasis was p l a c e d on the custody of the l a r g e s t number of patients a t the lowest p o s s i b l e c o s t . The small p a s t o r a l r e t r e a t t h a t o f f e r e d hope and humane care had been transformed i n a general-purpose solution t o the w e l f a r e burdens of a s o c i e t y undergoing rapid i n d u s t r i a l i z a t i o n " (p.786).  THE  MENTAL  The rise  demise  to  hygiene  the  MOVEMENT  second  great  deal  order  to  of  namely E m i l K r a e p e l i n , Eugene B l e u l e r ,  The works of these i n d i v i d u a l s generated a  optimism w i t h i n the p s y c h i a t r i c p r o f e s s i o n .  recognized  as  part  profession,  psychiatrists  professional  l e g i t i m a c y by d e v o t i n g  research.  as  a  of  the  group,  In  mainstream medical  began  to  seek f o r  their efforts to s c i e n t i f i c  In h i s a r t i c l e H i s t o r i c a l O r i g i n s of D e i n s t i t u t i o n a l -  ization,  Grob (1983) p o i n t s out t h a t emphasis was p l a c e d on the  empirical  study  treatment  of mental d i s o r d e r s .  the  'curing  was  no  of  longer  technigues disease  HOSPITALS  T h i s movement was h i g h l y i n f l u e n c e d by three  Freud.  be  PSYCHOPflTHIC  c y c l e of i n s t i t u t i o n a l reform, the mental  psychiatrists,  Sigmund  AND  of the moral treatment movement e v e n t u a l l y gave  movement.  European and  HYGIENE  of  the  disease' a  etiology,  pathology,  And as such, the c h o i c e between  o r the ' c a r i n g f o r the m e n t a l l y  p r o f e s s i o n a l dilemma.  reflected  a  d i a g n o s i s , and  commitment  r a t h e r than t o p a t i e n t c a r e "  to  ill'  "The concern w i t h new medical  science  (Grob, 1983, p.26).  and  - 5 In Beers  his  autobiography,  (1908)  regarding  aroused  the  Mind That Found I t s e l f ,  a  tremendous  abysmal  treatment  Subsequently,  Beers  professionals  and  Hygiene.  A  Clifford  amount of p u b l i c sympathy of  the  mentally  ill.  s u c c e s s f u l l y gained the support of v a r i o u s formed  the  National  Committee  A c c o r d i n g t o M o r r i s s e y and Goldman  f o r Mental  (1984),  "This reform o r g a n i z a t i o n r e v i v e d the n o t i o n of the t r e a t a b i l i t y of mental disorder, e s p e c i a l l y by e a r l y i n t e r v e n t i o n w i t h acute cases. Mental H y g i e n i s t s advocated c r e a t i n g a 'psychopathic hospital , an acute treatment or r e c e p t i o n f a c i l i t y a f f i l i a t e d with university training and research i n s t i t u t e s " (p.787). 1  Although became  off  evident  providing  care  physically  to  a  that for  a  disabled,  behaviors  were  directly  1983).  case  in  A  good  start,  these  'psychopathic  heterogenous and  i t wasn't l o n g b e f o r e i t  group  individuals  linked  to  hospitals' -  the  whose  somatic  were  aged,  the  undesirable  disorders  (Grob,  p o i n t i s Grob's r e f e r e n c e t o the d e c l i n e of  l o c a l almshouses f o r the e l d e r l y i n the  U.S.:  "The decline, however, was more apparent than r e a l , f o r the number of aged m e n t a l l y ill persons committed t o mental h o s p i t a l s was rising steadily. What o c c u r e d , i n effect, was not a deinstitutionalization movement, but rather a transfer of individuals between different types of institutions. The s h i f t was l e s s a f u n c t i o n of medical or humanitarian concerns than a consequence of financial considerations...  local public officials s e i z e d upon the fiscal advantages inherent i n redefining senility in psychiatric terms...[as]...the burden of support would be t r a n s f e r r e d t o the s t a t e " (Grob, 1983, p.17). (my emphasis)  - 6 Again,  psychopathic  understaffed. the  wayside  for  the  absence  facilities  psychiatrists  outmoded  and  hospitals  became  passe.  who  Therefore,  clinics.  Many  less  of  development  as,  insulin  because  employed  community  their  therapy,  MKMTM. H E A L T H  certain  optimism  to  time and i n t e r e s t s  future  minimize  the  also,  shorter  became Goffman  a  into  and  1983)  treatment  d u r i n g the 1950s l e n t a of the m e n t a l l y i l l .  of P s y c h i a t r y .  The  promised  Not o n l y d i d t h i s change  use of i n t r u s i v e somatic treatment techniques but  viable (1961)  institutional alternative. identifying  institutionalization revolutionize  the  therapy,  of Chlorpromazine, an a n t i p s y c h o t i c drug,  the  health  HOVEHKHT  i n psychopharmacology  a  mental  their  stayed behind i n the  electroconvulsive  advances  alter  than  in  of v a r i o u s somatic treatment t e c h n i q u e s ; such  The  to  employed  to p r a c t i c e at out-patient  the p s y c h i a t r i s t s who devoted  were  remuneration  in  sought  who  psychosurgery, but not p a t i e n t c a r e . (Grob,  introduction  by  they were p e r c e i v e d t o be  financial  many  hospitals  the-  COHMTJNITY  and  u n d e s i r a b l e p l a c e s of employment  Psychiatrists  were  centres.  psychopathic  overcrowded  of government f i n a n c i a l support.  primarily  received  counterparts  became  The g o a l s of the mental hygiene movement f e l l in  In-patient  hospitals  public  provided and  stay  for psychiatric patients  Studies the  by Barton (1959) and  debilitating additional  professional  effects  ammunition  attitudes  of to  towards the  - 7 mentally  i l l . The C i v i l  Rights Movement a l s o served as a major  impetus.  As Bachrach (1983) notes: "the movement emphasized the i n a l i e n a b l e rights of the mentally i l l and t h e i r legitimate claim on society.... Deinstitutionalization sought t o exchange physically isolated treatment settings for services t o be p r o v i d e d i n the p a t i e n t s ' home communities on the assumption that community based treatment i s more humane and therapeutic. Since the p h y s i c a l i s o l a t i o n of p a t i e n t s was understood t o be i n e v i t a b l y accompanied by an i n s i d i o u s s o c i a l e x c l u s i o n that had to be c o r r e c t e d , those who pioneered i n d e i n s t i t u t i o n a l i z a t i o n objected to both the content and g u a l i t y of care i n large, o f t e n secluded, mental hospitals" (p.7).  Prompted director put  of  forth  Health only  by  the  the  the  Felix  (1961),  American N a t i o n a l I n s t i t u t e of Mental  Health,  first  Movement.  foregoing  major  factors,  Robert  p r o p o s a l f o r the Community Mental  In 1963, P r e s i d e n t Kennedy made the f i r s t and  presidential  address  on  mental i l l n e s s .  He s t a t e d t h a t  p s y c h i a t r i c i n s t i t u t i o n s were: "understaffed, overcrowded, so unpleasant that i t makes death the o n l y hope of r e l e a s e . . . . C e n t r a l t o a new mental h e a l t h i s community care, and p o u r i n g funds into outmoded institutional care should be r e p l a c e d because i t makes l i t t l e d i f f e r e n c e to the mentally i l l " ( c f . Group f o r Advancement of P s y c h i a t r y , 1978, p.302)..  Hence, reform  in  movement  the  emergence  the  United  of  the t h i r d c y c l e of i n s t i t u t i o n a l  States  was f o r m a l l y endorsed  -  the  community mental h e a l t h  by the Community Mental  Health  Centre  Act  policy  of  in  the  psychiatric changing Rights  Community  abandonment  profession;  attitudes  Movement;  and  After a l l ,  therapeutic  and  of  were  Homelessness Morrissey Mental  their  and  the  towards the m e n t a l l y i l l ;  finally,  the  anticipated  " I f community based care was humane)  and  Fourth  cheaper  (Bachrach,  one  Cycle  by  the  the  Civil  economic  b e t t e r (both  ( l e s s c o s t l y ) how 1983,  p.7).  with  of  Reform,  Goldman  and  of the key d e f i c i t s of the Community  Centre Act of 1963.  mandates  efforts  hospitals  a r t i c l e The Alchemy of Mental H e a l t h P o l i c y :  identified  Health  specific  1985  social  r e s u l t of s e v e r a l  psychiatric  c o u l d i t s s u p e r i o r i t y be denied?"  their  the  and the  the advent of p s y c h o t r o p i c medication;  public  savings.  In  psychiatry,  deinstitutionalization  factors:  more  1963.  That i s , i t d i d not p r o v i d e  f o r the mental h e a l t h c e n t r e s t o " c o o r d i n a t e state  mental  hospitals  or  to  c h r o n i c p a t i e n t s " (p.728). "As a result, mental health centres primarily served new p o p u l a t i o n s i n need of acute s e r v i c e s and f a i l e d to meet the needs of acute and c h r o n i c p a t i e n t s d i s c h a r g e d i n ever increasing number from public . hospitals. Furthermore, c e n t r e s were not required to p r o v i d e f o r housing or income support for d i s c h a r g e d mental p a t i e n t s . Homelessness and i n d i g e n c y were p r e d i c t a b l e outcomes f o r many" ( I b i d ) . Leona Bachrach (1978) adds: "Perhaps the most s e r i o u s s i n g l e i s s u e i s the fact t h a t the deinstitutionalization movement, which was o r i g i n a l l y designed to provide the c h r o n i c a l l y m e n t a l l y i l l r e l i e f from the inhumane conditions of  care f o r  - 9 institutions, has l e t these p a t i e n t s ' f a l l through the c r a c k s ' . These p a t i e n t s — t h e very ones who have been dehumanized through oversight and d e n i a l i n past--have somehow, in the process of reducing s t a t e h o s p i t a l populations, largely been lost t o the s e r v i c e d e l i v e r y system" (p.575).  The  question  between been  our  is  that  and  society.  p o p u l a t i o n w i t h i n the community  economically  literature.  The r e a l i t y  impoverished, p e r v a s i v e l y  disadvantaged, e m o t i o n a l l y a  C e r t a i n l y , the l i t e r a t u r e d u r i n g the p a s t  has  supports always  Gralnick  presented  (1983)'s  comment:  an enormous problem t o aggravated  r a t h e r than  i t " (p.12).  their  MKNT*T.  review in  HRALTH  of  Canada,  MOVEMENT  the  331 CATiATXA  history  of  mental  population"  (p.386).  to d e c l i n e "  health  Herman and Smith (1989) a s s e r t t h a t  i s c e r t a i n i s t h a t mental h o s p i t a l s m a s s i v e l y Furthermore, t h i s p o p u l a t i o n  declined i n "continues  (Ibid).  Although been  disengaged,  f a r c r y from being a p a r t of the  D e i n s t i t u t i o n a l i z a t i o n has  'depopulation'  has  ill  strongly  COMMLHI-LTY  "What  mentally  rejected;  illness  In  the  society.  years  lessened  in  vocationally  mainstream  "mental  length  isolated,  repeatedly  five  of the 1950s and the c u r r e n t r e a l i t i e s has  at our  socially  exploited,  THE  ideals  discussed  remains  of how we can account f o r the v a s t d i f f e r e n c e  the impact of the community mental h e a l t h movement  l e s s e x t e n s i v e l y documented i n Canada than the U n i t e d  - 10 States, example, absence  what  i s documented shows remarkable s i m i l a r i t i e s .  Allodi of  hospital  a  and  comprehensive  patients  conditions,  Kedward  will  (1973) support  return  system,  Kedward, an  Eastwood, article  Allodi, i n 1974  P s y c h i a t r i c Care, and i n i t ,  that  in  "former  the  mental  to pre-nineteenth-century  and become a s o c i a l o u t c a s t  i d e n t i t y or s p e c i a l i z e d s e r v i c e s "  published  concluded  For  [ s i c ] , w i t h no d e f i n i t e  (p. 289).  and  Duckworth  of  Toronto  t i t l e d The E v a l u a t i o n of Chronic  the authors s t a t e :  "While nobody would wish t o r e t u r n t o the unhappy conditions of indifference and apathy found i n asylums i n the p a s t , a r i g o r o u s examination of r e c e n t mental h e a l t h statistics does not n e c e s s a r i l y j u s t i f y the assumption that the modern mental h o s p i t a l is w h o l l y redundant or a n a c h r o n i s t i c . . . . I f , in addition, as some authors suggest, l a r g e numbers of p a t i e n t s d i s c h a r g e d from mental hospitals have j o i n e d the ranks of the homeless and the p r i s o n p o p u l a t i o n , the radical changes i n management of severe psychiatric syndromes i n western c o u n t r i e s during the l a s t decade or more may prove t o have had a less satisfactory impact upon patient s t a t u s than i s commonly supposed" (pp.522-523).  Similarly,  Herman  and  Smith  (1989)  made  the  commentary: "But i n Canada l i k e the U n i t e d S t a t e s , there was no absence of problems. Few mourned the shrinkage or l o s s of mental h o s p i t a l s , but soon, t h e r e were complaints of patients being 'dumped' i n t o the community w i t h some ending up i n n u r s i n g homes, g a o l s , or ghettos. The i s s u e s of homelessness and chronic illness, though l e s s prominent than  following  - 11 in the United S t a t e s , were s i m i l a r l y d e c r i e d by many social planning agencies and interested groups.... I n Canada, as a whole, the availability of u n i v e r s a l m e d i c a l care has favourably influenced i t s d i s t r i b u t i o n , [sic]...However, removal of the f i n a n c i a l barriers does not guarantee t h a t those more in need of care a c t u a l l y r e c e i v e i t . The c h r o n i c a l l y m e n t a l l y i l l a r e not the most popular p a t i e n t s , and the g u a l i t y of care available t o them v a r i e s from province t o p r o v i n c e " (p.387).  Finally, makers,  perhaps  i s the  what  i s most t r o u b l i n g f o r s o c i a l p o l i c y  realization  t h a t community care i s simply not  cheaper than i n s t i t u t i o n a l care (Herman and Smith, 1989).  THE  COMMUMITV  The health was  year  MKHTAI.  H ^ » T . T H  »K)VKHBBT  IH  BRITISH  COLUMBIA  1957 marked the b e g i n n i n g of the community mental  movement  within  the p r o v i n c e  of B r i t i s h Columbia.  It  the year when t h e f i r s t community mental h e a l t h c l i n i c was  established.  In  1959,  Psychiatric provincial  the B.C.  Association mental  government c o n s u l t e d regarding  h e a l t h system.  w i t h the American  the f u t u r e d i r e c t i o n s of the The recommendation was c l e a r  - mental h e a l t h s e r v i c e s should be r e g i o n a l i z e d .  Regionalization clinics, hospitals, boarding  of  2  services included p r o v i n c i a l t r a v e l l i n g  i n - p a t i e n t p s y c h i a t r i c emergency s e r v i c e s w i t h i n aftercare home  programs,  f o r discharged  psychiatric  local  patients,  r e g i o n a l mental h e a l t h c l i n i c s , and a  - 12 new  Mental  complement and  Health the  policy.  Branch  of  service  Act.  goals  A l l of  these  were  designed  of the D e i n s t i t u t i o n a l i z a t i o n p h i l o s o p h y  In t h e i r 1967-68 annual r e p o r t , the Mental the  Ministry  provider  to  to  of  the  Health  Health  r e d e f i n e d i t s r o l e from a  f a c i l i t a t o r of r e o r g a n i z a t i o n of the  p r o v i n c i a l mental h e a l t h programs.  In  1976,  Community  Dr.  Care  John  Cumming  Services  and  h i s colleagues published  i n Vancouver:  I n i t i a l P l a n n i n g and  Implementation,  an  development  mental h e a l t h s e r v i c e s w i t h i n B r i t i s h Columbia.  of  a r t i c l e t h a t has had major i n f l u e n c e on the  The authors made the f o l l o w i n g o b s e r v a t i o n : "The burden on Vancouver General Emergency resulted i n low morale and l i t t l e t h e r a p e u t i c work, most s t a f f time being invested i n f i n d i n g h o s t e l s or other p l a c e s i n which t o dispose of p a t i e n t s . Worse s t i l l were t h e large numbers o f p a t i e n t s who f o u n d a c c e s s t o treatment only through the police, j a i l or courts where they were either certified or remanded t o t h e m e n t a l h o s p i t a l " (p.20). (my  emphasis)  In  1979,  government make the  were found  to  John Cumming was requested by the p r o v i n c i a l  assess  the  e x i s t i n g mental h e a l t h s e r v i c e s and  some recommendations f o r f u t u r e a c t i o n . Mental  Report, the  Dr.  H e a l t h P l a n n i n g Survey,  perhaps  provincial  the  only  a l s o known as the Cumming's  n o n - c r i t i c a l comment made r e g a r d i n g  p s y c h i a t r i c h o s p i t a l was:  d e p r e s s i n g , none were [ s i c ] shocking" most  troubling  was  In t h i s Report of  that  "While many s e t t i n g s (p.57). What Cumming  "In p r a c t i c e  many  eligible  - 13 patients  are  list....the direct  refused  number  function  resides  or  supported  -  admission  of  patients  level  of  placed  that  of c o n s i d e r a t i o n s  what  or  care  are  other he  a  waiting  admitted  become a  than where the  needs"  (p.55).  patient This i s  by the f i n d i n g s w i t h i n the community care teams.  example,  "Almost  getting  hospital  respect  to  believe  some  feel  able  such  as  the  all  team  to  members  mentioned  care d u r i n g p e r i o d s discharged  patients do  and  of r e l a p s e "  about i t " (p.25). 'lack  of  conducted  this a  became  (p.17).  in With  ill-treated  and  Generic c r i t i q u e s  cohesion',  'lack  of  ' d u p l i c a t i o n of s e r v i c e s ' found commonly i n  the American l i t e r a t u r e a l s o found t h e i r way  During  difficulty  are being e x p l o i t e d and  little  For  p s y c h i a t r i c p a t i e n t s , "Team members  'fragmentation',  coordination',  What  on  same  study  on  evident  time the was  period,  the  into this  report.  City  Vancouver  of  Hard t o House P s y c h i a t r i c C l i e n t s . that  our  local  remarkably s i m i l a r to the American e x p e r i e n c e .  experience  was  That i s :  "A small percentage of ' d i f f i c u l t ' cases i n the community are utilizing a disproportionately large percentage of available s e r v i c e s on a continuing basis without s a t i s f a c t o r y improvement in their l i f e c o n d i t i o n " (p.6).  In  his  article  The  Homeless M e n t a l l y  111:  Vancouver, Simon Davis (1987) made the f o l l o w i n g  A Report from observation:  "Overall, the survey r e v e a l e d t h a t , f o r many of the mentally i l l , l i f e i n the i n n e r c i t y meant a tenuous, unstable, socially impoverished s o r t of e x i s t e n c e , w i t h people  - 14 struggling often unsuccessfully - to maintain i n t e r p e r s o n a l r e l a t i o n s h i p s and a sense of independence" (p.12). SUMMARY  In  their  analysis  reforms'  -  movement  and  health  the  three  ' c y c l e s of i n s t i t u t i o n a l  the moral treatment and asylums; the mental hygiene psychopathic  movement  and M o r r i s s e y  of  and  h o s p i t a l s ; and the community mental  community mental h e a l t h c l i n i c s - Goldman  (1985) made the f o l l o w i n g comment:  "Each of these reforms promised t h a t e a r l y treatment of acute cases would prevent chronic mental i l l n e s s . Each innovation proved s u c c e s s f u l with acute and m i l d e r - not chronic - forms of mental d i s o r d e r y e t f a i l e d to eliminate c h r o n i c i t y or t o fundamentally alter the care of the s e v e r e l y m e n t a l l y i l l . In each c y c l e , the optimism of reform gave way t o pessimism and t h e r a p e u t i c nihilism towards increasing numbers of i n c u r a b l e c h r o n i c mental p a t i e n t s . In the face of an expanding population of needy p a t i e n t s , p u b l i c support turned t o n e g l e c t " (p.727). Moreover, "The zeal of community mental health activists f o r t r y i n g t o s o l v e s o c i a l problems without a l s o f o c u s s i n g on the need f o r humane care of the c h r o n i c a l l y m e n t a l l y ill, in part...contributed t o the new s e t o f s o c i a l problems associated with deinstitutionali z a t i o n " (p.728). In summary then, as Brad Pearce (1990) s t a t e s : "The United S t a t e s began and progressed w i t h deinstitutionalization a t a much f a s t e r pace than Canada, hence many of the u n a n t i c i p a t e d problems and conseguences of deinstitutionalization, such as homelessness, criminalization, community r e s i s t a n c e and poverty, were f i r s t evident there. These  problems a r e now c l e a r l y e v i d e n t i n Canada a s we 'catch u p t o t h e U n i t e d S t a t e s " (p.2). 1  (ray emphasis) THE CRIMINMJZATiaN OF THE MENTALLY UJ.  Review popular  press  problems In  of professional  his  j o u r n a l s , academic l i t e r a t u r e ,  and  i n d i c a t e s a p l e t h o r a of c r i t i c i s m s r e g a r d i n g the  generated article  from  Care  the Community Mental H e a l t h Movement.  of the Chronically  Mentally  111 - A  N a t i o n a l D i s g r a c e , Robert R e i c h (1973) m a i n t a i n s t h a t : "Freedom t o be s i c k , h e l p l e s s , and i s o l a t e d is n o t freedom....Our p r e s e n t p o l i c y o f discharging helpless human beings to a hostile community i s immoral and inhumane. It i s a r e t u r n t o the Middle Ages, when the mentally i l l roamed t h e s t r e e t s and l i t t l e boys threw rocks a t them" (p.912).  Similarly,  Dumont  (1982)  concludes  that  deinstitutional-  ization i s : "nothing more or l e s s the c u t t i n g of mental a patina of community we are returning to s i t u a t i o n " (p.367).  Although State,  Reich  similar  than a p o l i t e term f o r h e a l t h budgets. Under mental h e a l t h r h e t o r i c t h e pre-Dorothea D i x  was d e s c r i b i n g  sentiments  have  the e x p e r i e n c e of New been  expressed  York  by v a r i o u s  individuals  a l l a c r o s s North America.  (1986)  example, suggests t h a t " D e i n s t i t u t i o n a l i z a t i o n , not  as  a  for  Lightman  concept but r a t h e r as a p r a c t i c e , must rank as one of the  greatest that  W i t h i n Canada,  frauds  treatment  o f our day"  (p. 26).  of the mentally  Although i t i s agreed  i l l i s the r a i s o n d ' e t r e of  - 16 the  Community  "become and  Health  increasingly  cheap way  easiest  and  mentally  out"  Movement, many argue t h a t i t has  apparent t h a t s o c i e t y has  (Zusman and  cheapest  ways  Lamb, 1977,  out  chosen the easy  p. 887).  One  of  the  i s the c r i m i n a l i z a t i o n of  the  ill.  Perhaps in  Mental  -  this  one  of the most f r e g u e n t l y c i t e d American  area  is  Criminalization  of  Side-Effect  a  of  that  Mentally New  Abramson argues as  Mental  of  Marc  Abramson's  Disordered Health  (1972)  Behavior: Law.  articles  In t h i s  The  Possible article,  follows:  "If the e n t r y of persons e x h i b i t i n g m e n t a l l y disordered behavior i n t o the mental h e a l t h system of social control is impeded, community p r e s s u r e will f o r c e them i n t o the criminal justice system of social control. Further, i f the mental h e a l t h system i s forced to r e l e a s e m e n t a l l y d i s o r d e r e d persons into the community prematurely, there w i l l be an increase i n pressure f o r use of the criminal j u s t i c e system t o r e i n s t i t u t i o n a l i z e them....From my own vantage p o i n t as a psychiatric consultant...mentally disordered persons arrest  are and  being increasingly subjected to criminal prosecution....Police  seem to be aware of the more s t r i n g e n t criteria under which mental health professionals are now accepting responsibility f o r i n v o l u n t a r y d e t e n t i o n and treatment, and thus regard a r r e s t and booking into jail as a more r e l i a b l e way of s e c u r i n g involuntary detention of m e n t a l l y d i s o r d e r e d persons. Once the c r i m i n a l j u s t i c e machinery is invoked, i t i s f r e g u e n t l y hard to stop" (p.15).(my emphasis)  Within  Canada,  (1977)'s r e s e a r c h  and  specifically  Toronto,  f i n d i n g s support the "hypothesis  Allodi that  et the  al  - 17 reduction  of  increment between  in 1969  hospital  beds  has  been  associated  with  the number of p s y c h i a t r i c p a t i e n t s i n j a i l " and 1973.  from Ottawa conclude  an  (p.3)  S i m i l a r l y , B o r z e c k i and Wormith (1985)  that:  "There i s a limit to society's a b i l i t y to absorb the large numbers of people discharged....Therefore, when people with psychiatric illnesses show symptomatic b i z a r r e b e h a v i o r , the p u b l i c tends t o invoke the c r i m i n a l justice system t o remove them from the community...changes in civil commitment proceedings and more limited psychiatric placements have placed bureaucratic obstacles in the way of emergency admissions. Therefore, arrest becomes a much l e s s cumbersome method t o remove the d i s r u p t i v e psychiatrically i l l person. The p o l i c e cannot be f a u l t e d on such a practice....If the 'forfeited' patients continue to be socially disruptive and continue t o be excluded from psychiatric facilities, they w i l l be r e a d i l y accepted by the c r i m i n a l justice system. In e f f e c t , i t has become the system 'that can't say no'" (pp.242-3).  Furthermore, 111:  Part  I,  i n the a r t i c l e C r i m i n a l i z a t i o n of the M e n t a l l y the  authors H o l l e y and A r b o l e d a - F l o r e z (1988)  from C a l g a r y , a s s e r t e d t h a t although: "the p r e v a l e n c e of p s y c h i a t r i c i l l n e s s among criminal populations i n Canada has been p o o r l y documented, a v a i l a b l e data indicate that as much as 65 p e r c e n t of p r o v i n c i a l l y jailed offenders may be mentally i l l . Evidence from other c o u n t r i e s shows a range of between 10 and 50 p e r c e n t (pp.81-82).  Within Hemphill  our  own  local  (1989) conducted  system,  Stephen  Hart  the f i r s t r e s e a r c h study t o  and  James  determine  the  prevalence  Disordered Centre  Offenders As  576  admissions,  three  months.  psychometric  tests  service  utilization  by  Mentally  (MDOs) a t the Vancouver P r e t r i a l S e r v i c e s  (VPSC).  assessed of  and  of  part  of  this  well  medical and s o c i a l h i s t o r y .  Hart and Hemphill  (459 d i f f e r e n t inmates) over a p e r i o d  Assessment as  study,  as  was  based  review  of  on  a  series  of  each i n d i v i d u a l ' s  Hart and Hemphill concluded t h a t :  "The p r e v a l e n c e r a t e of MDOs among admissions observed i n the s u r v e y — 2 3 . 8 % — w a s h i g h i n an absolute sense. Because of t h e m e t h o d o l o g i c a l s t r e n g t h s of the survey, however, we a r e confident that t h i s figure i s an a c c u r a t e one. As w e l l , i t i s w e l l w i t h i n the range r e p o r t e d by other r e s e a r c h e r s " (p.45). With  respect  to  the f u t u r e  of  t h e Vancouver  S e r v i c e s Centre, Hart and Hemphill suggest t h a t : " t h e r e a r e two f a c t o r s t h a t may foreshadow a rise i n the p r e v a l e n c e of MDOs. F i r s t , the trend towards deinstitutionalization is continuing. Should the p r o v i n c i a l government follow through on i t s s t a t e d p l a n s t o t r i m the p o p u l a t i o n a t Riverview, VPSC can expect to receive a s i g n i f i c a n t number o f those patients discharged into the Greater Vancouver area....A second r e l e v a n t f a c t o r i s the imminent c l o s u r e of the Lower Mainland Regional Correctional Centre (LMRCC). At p r e s e n t , because i t has a r e l a t i v e l y l a r g e health care c e n t r e , LMRCC houses a number of inmates (both remanded and sentenced inmates) with serious mental d i s o r d e r s . I f the facilities c u r r e n t l y under c o n s t r u c t i o n t o replace LMRCC have fewer h o s p i t a l and s e g r e g a t i o n beds a v a i l a b l e f o r MDOs, VPSC can probably expect t o r e c e i v e some of the 'excess' MDOs" (p.46).  Pretrial  - 19 COST VERSES CARE:  In  their  question  THE DILKHWft  article,  Borzecki  and Wormith (1985) r a i s e d the  of "why a p u b l i c alarm should be r a i s e d over the situation since the c r i m i n a l i z a t i o n phenomenon may simply r e f l e c t changes i n the relative use of two methods f o r d e a l i n g w i t h the socially aberrant. I t i s obvious from a simple actuarial, financial model that society finances both systems, and i t may be less expensive t o d e t a i n persons i n j a i l " (p.246).  Although their  Belcher  question,  individuals displaced  to  appropriately  individuals"  ill  should  treatment  he does  was not  responding  directly  to a c r i m i n a l j u s t i c e system t h a t i s not care  for  (p.194).  subscribes be put  the  mental  (Borzecki  designed  that society  t o a r e h a b i l i t a t i v e model, the which  not  h e a l t h needs of these  Furthermore, " t o the extent  i nfacilities  and c a r e "  to  argue t h a t " R e s p o n s i b i l i t y f o r these  needs to remain i n the mental h e a l t h system and  be  ethically  (1988)  mentally  specialize in their  and Wormith, 1985,  p.246).  (my  emphasis)  In of  his  mental  p l e a f o r a broad p u b l i c p a r t i c i p a t i o n i n the health  quite convincingly  services  choice  i n Canada, Lightman (1986) argues  that:  "all social and economic p o l i c y i n any society i s built upon fundamental value choices. The f r e q u e n t l y - c i t e d argument of economic n e c e s s i t y - t h a t we have no c h o i c e but t o c u t back government spending i n the social and health areas i n order to conquer  - 20 inflation and t o c o n c o m i t a n t l y reduce the deficit - i s fallacious. I t i s not a statement of any o b j e c t i v e f a c t or r e a l i t y , but rather reflects a particular constellation of presumed s o c i a l p r i o r i t i e s . The message f o r p r o f e s s i o n a l s and o t h e r s concerned to protect our s o c i a l and h e a l t h systems i s that future debate must address fundamental questions of v a l u e s and not become bogged down in econometric t e c h n o l o g i e s " (p.25).  -  21 -  C H A P T E R S Y S T E M S IM  O F C A R E  T W O  F O RT H E  T H EP R O V I N C E  m_i  MENTAT.T.Y  O F B R I T I S H  C O L U M B I A  IMTBODDCTIOH This  chapter  provincial  psychiatric  designed  to  population.  itself  RIVKRVIKW In  begin  by b r i e f l y  institutions  accommodate I twill  correctional finds  will  within  move  that,  mentally i l l  on t o the  e i t h e r by d e f a u l t  housing a group of m e n t a l l y i l l  one p r o v i n c i a l o r by d e s i g n ,  individuals.  MKHTaL H O S P I T A L  1964,  the  British  Columbia P r o v i n c i a l Mental  amalgamated  with  Crease C l i n i c ,  and  what  i s now t h e p r i n c i p a l i n - p a t i e n t  formed  facility period,  a  general  Assessment  Unit  hospitals.  Adolescent  Sciences  Complex  Treatment a t the  hospitals  would  unit,  psychiatric  During t h i s  time  b e g a n t o emerge. O f psychiatric Examples  are  units the  o f Vancouver General H o s p i t a l , t h e Hospital  i n V i c t o r i a , the  C e n t r e i n Burnaby, and t h e H e a l t h University  i n this decentralization  local  Hospital  psychiatric  development o f i n - p a t i e n t  Martin P a v i l i o n of Royal Jubilee  Implicit  stay  o f community f a c i l i t i e s  the local  Maples  the  series i s the  Psychiatric Eric  a short  of the province, Riverview Hospital.  importance within  t h e two  t h e Lower M a i n l a n d  the chronically  then  institution  describing  offer  of British  Columbia.  movement was t h e i n t e n t short-term  treatment  that for  - 22 acutely ill  mentally  patients  However, in  i l l p a t i e n t s , and r e f e r c h r o n i c a l l y m e n t a l l y  to  Riverview  Hospital  as the Cumming's Report  arranging  admissions  universally  of  complained  f o r long-term  (1979) i n d i c a t e d :  patients  of  by  to  staff  treatment. "Difficulty  R i v e r v i e w i s almost members  of  services  throughout the p r o v i n c e " (p.56).  What  became  evident  was  that  d e s p i t e the development of  various  psychiatric  chronic  m e n t a l l y i l l remained unmet.  community  mental  u n i t s i n l o c a l h o s p i t a l s , the needs of the  health  deinstitutionalization seeking Health  Act  policy,  and  consistent  patients  with  were d i s c o u r a g e d from The B.C.  the  individual  must  be  seen  by  two  others,  can  the  facility.  The  irony  individuals  are  denied  because  others.  They  because their  Mental  the  medical  Only i f i t i s agreed between the two p h y s i c i a n s  the i n d i v i d u a l i s of 'unsound mind' and a 'danger'  simply  the  (1964) r e q u i r e d and s t i l l r e q u i r e s t h a t , except f o r  practitioners.  or  movement  admission t o any p s y c h i a t r i c f a c i l i t y .  emergencies,  that  Under the a u s p i c e s of the  individual  they are  have  the  be  admitted t o a p s y c h i a t r i c  is  that  to  many  itself  turned is  not  mentally i l l  local psychiatric  p r e s e n t a 'danger'  frequently  psychopathology. sufficient  this  admission  may  facility  have  of  to s e l f  units  t o s e l f and/or  to  away from the h o s p i t a l equipped t o accommodate  O f t e n , the acute l o c a l h o s p i t a l s do not  s t a f f r e s o u r c e s t o ensure s e c u r i t y nor do they  appropriate  room t o c o n t a i n the p a t i e n t ' s a c t i n g - o u t  - 23 behaviors. patients  I t would seem l o g i c a l then, t h a t these should  be  a l l , Riverview was  transferred  'dangerous'  t o Riverview H o s p i t a l .  After  designed  "for the b e n e f i t of ' p a t i e n t s who do not f i t ' - - t h e most s e v e r e l y and c h r o n i c a l l y i l l , f o r whom adequate assessment and treatment is not p o s s i b l e w i t h i n the acute h o s p i t a l or in community o u t p a t i e n t s e t t i n g s . This capacity i s r e q u i r e d f o r cases where the individual or the community must be protected and a l s o when the mental i l l n e s s is so severe t h a t p a t i e n t s r e q u i r e s t r u c t u r e and good n u r s i n g c a r e , not t o mention the safety and security of an a s y l u m - l i k e environment" (Mental Health Consultation Report, M i n i s t r y of H e a l t h , P r o v i n c e of B.C., 1987, p.13).  However,  the  reality  is  that  Riverview  is  at  present  undergoing  a  major  d e i n s t i t u t i o n a l i z a t i o n process i t s e l f .  stated  a  local  conference sponsored by Riverview H o s p i t a l  at  (November was  1989),  approximately  approximately  While cultivate for  while  it a  community  in  1950,  in  1989  its  total  was  800.  i s commendable t h a t Riverview H o s p i t a l i s able t o respectable  number  placements,  criteria.  statutory  guidelines  admission  because,  agreement  to  criminal  the i n - p a t i e n t p o p u l a t i o n of Riverview  5,500  admission  the  As  the  That of  the  of r e s o u r c e s f o r i t s p a t i e n t s key  issue  here i s the  i s , many i n d i v i d u a l s who Mental  Health  Act  are  strict  meet the denied  amongst other reasons, t h e r e i s an i n f o r m a l  r e f u s e p a t i e n t s who  may  have had involvement  with  j u s t i c e system or are c u r r e n t l y b e f o r e the c o u r t .  - 24 It  is  assumed  'difficult', are  the  Services  that  or  responsibility  patients  are  too  'violent',  f o r t h e i r f a c i l i t y , and  of  either  the  Forensic  that  they  Psychiatric  or the c r i m i n a l j u s t i c e system.  British  established Forensic  in  1974.  for  individuals  who  Governor.  In  Services  Forensic Its  are  and  at  addition,  by  Act,  courts held  P s y c h i a t r i c Commission  primary  Services  the  provide  required  SERVICES  Columbia  Psychiatric  assessments  are  these  'dangerous'  FORENSIC PSYCHIATRIC The  -  the  community  mandate,  under the  was B.C.  i s to p r o v i d e p s y c h i a t r i c to  provide  treatment  for  the d i r e c t i o n of the  Lieutenant  Forensic  Outpatient  Psychiatric  f o l l o w - u p care f o r i n d i v i d u a l s  t h e i r probation orders to receive  who  psychiatric  treatment.  The  Forensic  psychiatric those  Psychiatric  facility  individuals  who  located meet  Institute at  one  Port or  is  an  in-patient  Coquitlam designed f o r more  of  the  following  criteria: 1)  remanded by c o u r t  2)  found ' U n f i t t o Stand  3)  found  4)  serving a p r o v i n c i a l j a i l sentence (two y e a r s l e s s a day) and are certified under the B.C. Mental H e a l t h Act.  'Not  A brief discussion  f o r p s y c h i a t r i c assessment; Trial';  G u i l t y by Reason of  Insanity';  of these four groups i s warranted.  -  The is  primary  to  This  provide mandate  who  that  mandate of the F o r e n s i c P s y c h i a t r i c Commission c o u r t ordered  is  based  pre-trial  p s y c h i a t r i c assessments.  on the long h e l d view t h a t i n d i v i d u a l s  an  the nature of a t r i a l . individual  defence.  A  remanded  for  goal  is  legal  to  noted  not  1  may time  an  under  the  also  individual  is  receiving  'Fit  t o Stand  Mental  can  a  the  he or she i s  are s e v e r e l y m e n t a l l y  individual  the  is  i s found ' U n f i t to Stand T r i a l ' ,  never become ' F i t ' .  i l l or of  I t should  a l s o be  be c e r t i f i e d a s m e n t a l l y  Health  Act  and  concurrently  be  Trial'.  individual  is  found  'Fit'  to stand t r i a l ,  the  wish t o address the mental s t a t e of the i n d i v i d u a l at of  the  as  have  and, of  offence.  individuals  Insanity'  pleasure  the  I n d i v i d u a l s who  that  preference  Institute  is  a p s y c h i a t r i c term, must be r e t u r n e d t o  F i t to Stand  Once  own  n e c e s s a r i l y the case as the primary  if  i n t e l l i g e n c e may here  deemed  t o p a r t i c i p a t e i n h i s or her  P s y c h i a t r i c I n s t i t u t e f o r treatment u n t i l  disordered  court  than  'Fit'.  limited  c o u r t r e q u i r e s assurance  assessment  i n d i v i d u a l who  rather  found  is  determine  An  Forensic  able  psychiatric This  Trial'.  is  The  and  common misconception i s t h a t an i n d i v i d u a l who  treatment.  of  -  are b e f o r e the c o u r t should be able to f u l l y comprehend  appreciate  the  25  to  under  the  order i s r e s c i n d e d .  Insanity who  Lieutenant  not  are found 'Not  be r e t u r n e d the  is  a  defence of  G u i l t y By Reason  t o the F o r e n s i c P s y c h i a t r i c  Warrant of Committal, remain a t  the  Governor i n d e t e r m i n a t e l y u n t i l  the  - 26 The  last  group  comprised  certified  under  the  provincial  prison  sentence.  admission the  to  demand  returned initial  to  a  of  Health  host  some  of  institution  stabilization.  Absence  institution, As  they a  Status  have  result,  rehabilitation  have been  while  serving  a  To  from  these  Depending on  i n d i v i d u a l s are  immediately be  fair,  following since  do  these  P s y c h i a t r i c I n s t i t u t e on their  host  correctional  t o be c o n f i n e d i n the maximum they  programs  Act  who  Psychiatric Institute.  a r e p l a c e d a t the F o r e n s i c  Temporary  area.  individuals  T h i s group i s of low p r i o r i t y f o r  spaces,  their  signs  individuals  Mental  the F o r e n s i c  f o r bed  of  not  have  and o n l y r e c e i v e  security  the b e n e f i t of the  psychopharmacological  treatment.  During between  the the  Services,  an  Act.  Psychiatric  outpatient  Psychiatric  availability this  Forensic  where  Forensic Health  past two y e a r s , a p r o t o c o l  protocol  Outpatient  client  bed  spaces.  this  i s also  i s t h a t i t i s a broadening of admission  Forensic  s t r i c t admission c r i t e r i a of other p s y c h i a t r i c  of  Psychiatric  Forensic  patients  who  on the  Perhaps what i s important w i t h  the  group  Inpatient  dependent  the  the  and  can be admitted t o the  to  Within  established  I n s t i t u t e when c e r t i f i e d under the Mental  Naturally, of  has been  criteria  I n s t i t u t e , i n d i r e c t response t o facilities.  P s y c h i a t r i c I n s t i t u t e , there i s also a a r e of c i v i l  'Involuntary' s t a t u s .  In  - 27 simple  terms,  facility law,  not  but  Act.  this  is  only  chronically  under the c i v i l in  psychopharmacological  of  Forensic  Counsel  require  kept at  p r o v i s i o n s of the Mental  group  treatment, The  the  and  poorly  to  has  and  traditional  r e q u i r e a long p e r i o d of  alleged offences  which  Health  are g e n e r a l l y s e v e r e l y  t h a t brought them  system o r i g i n a l l y have been 'stayed'  office  rather  justice  than  system.  Riverview strict  by  the  agreed t h a t these i n d i v i d u a l s  Hospital. on  at  for  years,  the  expansion  transfer  have  or  the  criminal  As a r e s u l t ,  the F o r e n s i c P s y c h i a t r i c I n s t i t u t e , i n awaiting  list  a  transfer  to  Riverview  when the p a t i e n t i s not  f o r f e a r t h a t he or she w i l l  have  121  then,  increased  Forensic  While of  seen  the  that  movement. capacity  the  be  prematurely under the d e i n s t i t u t i o n a l i z a t i o n p o l i c y .  we  demands  through  does not accept them.  Indeed, there are o c c a s i o n s  discharged  within  criteria,  remains  cases  What  processed  Although t h i s group should be t r a n s f e r r e d t o  admission  placed  being  H o s p i t a l , t y p i c a l l y Riverview H o s p i t a l because of i t s  group  some  individuals  and would b e n e f i t from treatment f o r an extended p e r i o d  time  this  of  i l l , respond  treatment.  the  Crown  this  mentally  in-patient  group  because of the l e g a l requirements of the c r i m i n a l  Individuals  into  a  -  in  this  p a s t two  years,  f l e x i b i l i t y of admission  Psychiatric emerged  the  criteria  I n s t i t u t e i n response to  from  facility  the  the d e i n s t i t u t i o n a l i z a t i o n was  p a t i e n t s , i t has  r e l a t i v e l y s t a b l e c a p a c i t y of 145  i s the  designed f o r the maximum  been o p e r a t i n g  patients.  recently at a  -  The what  primary  the l e g a l  continue who  been  they  ambivalent  involved may  circumstances, them  they  i s t h a t r e g a r d l e s s of  used  alike,  individuals  w i t h the F o r e n s i c P s y c h i a t r i c system. with  their  experience and  a r e a l s o r e l u c t a n t t o work w i t h o r accept manner.  Services  i s often  see i t ,  towards m e n t a l l y i l l  sympathize  i n t h e same  Psychiatric  as I  s t a t u s may be, p r o f e s s i o n a l s and p u b l i c  to feel  have  While  It  problem,  28 -  will  T h i s group's h i s t o r y w i t h F o r e n s i c always  weigh h e a v i l y a g a i n s t them.  t o r a t i o n a l i z e f a i l u r e t o p r o v i d e them w i t h  much needed s e r v i c e s .  MUTWT.ailD REGIQHAL CQRBECTIQHBL CEHTRE  TnURW  The also  Lower  known  years  Mainland  as O a k a l l a ,  C o r r e c t i o n a l Centre  i n British  twelve  hundred  number  o f inmates  Columbia.  correctional  I t s maximum c a p a c i t y was  inmates per day d u r i n g the 1950's. i t houses c u r r e n t l y  f i v e hundred on a g i v e n day.  behaviors  a r e guided  (LMRCC),  was e s t a b l i s h e d i n 1914, and f o r many  i t was the o n l y p r o v i n c i a l maximum s e c u r i t y  institution  to  Regional  The average  (1990), i s between f o u r  W i t h i n the i n s t i t u t i o n ,  by t h e C o r r e c t i o n a l  Centre  inmate  Rules and  R e g u l a t i o n s of the C o r r e c t i o n s A c t .  The  Health  Correctional  Care  Centre  Centre  i s now a  located  within  maximum  c a p a c i t y i s approximately  o f Lower  Mainland  Regional  d i s t i n c t and separate b u i l d i n g  t h e c o n f i n e s of the c o r r e c t i o n a l grounds. I t s 65, although i t seldom houses  - 29 that  many  Care  Centre  rooms. are  there are not enough beds a v a i l a b l e . is  composed  Wards one  designed  broken the  as  of  and two,  for  the  six  floor  inmates who  with  and  two  Health  independent  which are l o c a t e d on the main f l o o r ,  l e g , h e a r t problem, e t c .  second  wards  The  the  have p h y s i c a l i l l n e s s ;  e.g.  Wards f i v e and s i x , l o c a t e d on  other  are  primarily for  inmates  who  are  mentally  inmates  who  are  p s y c h i a t r i c a l l y v u l n e r a b l e , but are g e n e r a l l y  higher  functioning  because  their  illnesses  than  illnesses  are  in  ill.  wards,  Wards t h r e e and f o u r c o n t a i n  inmates are  i n wards f i v e and s i x e i t h e r  less  remission.  severe  or  because  their  T h i s group appears to engage i n  fewer a c t i n g - o u t b e h a v i o r s .  Health  care  is  professionals,  most  sessional/contract one  p r o v i d e d by a c o n s t e l l a t i o n of h e a l t h care of  basis.  psychiatrist,  pharmacists,  one  dermatologist,  one  hour  Inmates  who  to  local  the  Health on-call  Care  Up  on  a  two  one  only  one d e n t a l h y g i e n i s t , and  until  seven  full-time  dentist,  August  1989,  r e g u l a r n u r s i n g s t a f f coverage. to  part-time  two medical d o c t o r s ,  psychologists,  optometrist,  twenty-four  back  employed  physiotherapist,  specialist.  cut  are  They i n c l u d e :  three  orthopaedic  been  whom  a.m.  there T h i s has  t o e l e v e n p.m.  one one was now  coverage.  r e q u i r e surgery or l a b o r a t o r y t e s t s are t r a n s f e r r e d acute Centre  psychiatrists  hospitals, for  and are o f t e n r e t u r n e d t o the  follow-up  available  f o r p s y c h i a t r i c emergencies.  in  care.  As w e l l , t h e r e are  the evenings  and weekends  - 30 Health  care  professionals  inmates  from  at  H e a l t h Care Centre, however.  the  medical  the  provide  doctor  Discretion  is  whole i n s t i t u t i o n .  the  to  finds  to  be  all  the seen  Many are seen by e i t h e r a  l e f t t o the inmates t o submit  staff  to  Not a l l inmates are  and/or nurse d u r i n g t h e i r d a i l y  correctional request  services  'sick  parades'.  a r e q u e s t , and  the  i n f o r m the h e a l t h c a r e p r o f e s s i o n a l s of  seen.  When the h e a l t h c a r e p r o f e s s i o n a l  i t a p p r o p r i a t e , he or she w i l l request t h a t the inmate be  t r a n s f e r r e d t o the H e a l t h Care Centre f o r c l o s e r m o n i t o r i n g .  Upon  admission,  classification inmate's court  officer.  history  of  inmate  with  information Inmates  who  may  the  Screening  offences,  'screened'  by  a  c o n s i s t s of r e v i e w i n g the  past  i n s t i t u t i o n a l behaviors,  inmate.  require  protective  is,  isolated  in  security  and s u i c i d e r i s k may  observation.  should  be  noted here t h a t  custody  admission.  due t o the nature of  are p e r c e i v e d t o be h o s t i l e , t h r e a t e n i n g ,  dangerous--that the  It  not be a v a i l a b l e at the time of the  o f f e n c e , or who  and/or  usually  is  recommendations, medical h i s t o r y , and conducting a d i r e c t  interview  their  each  Westgate  B  a  security  cell  block.  concern—are Inmates who  often are a  be p l a c e d i n South Wing f o r c l o s e  Inmates from Westgate B and South Wing O b s e r v a t i o n  receive  health  care  i n t h e i r c e l l s r a t h e r than b e i n g  t r a n s f e r r e d t o the H e a l t h Care Centre.  - 31 Inmates directly  to  exhibit their  who have a known p s y c h i a t r i c h i s t o r y a r e o f t e n sent the  signs  of  identified bizarre  of  space  as  earlier.  the  Centre,  particularly  i f they  o r b i z a r r e behaviors a t the time of  Naturally,  behaviors  with  Care  unusual  admission.  availability  in  Health  well  Inmates  this as  who  i s dependent  on the  the s e c u r i t y c l e a r a n c e as do  not e x h i b i t unusual or  a t the time of t h e i r admission may be p l a c e d  g e n e r a l p o p u l a t i o n u n t i l t h e r e a r e i n d i c a t i o n s of  mentally d i s t u r b e d behavior.  Inmates to  self  who  and/or  Health  Act  inmate  could  treatment the  by  at  Forensic  Health  Centre earlier, serving Forensic of  others two  either the  may be c e r t i f i e d under the B.C. Mental  physicians. voluntarily  Health  Psychiatric  application. the  become a c u t e l y p s y c h o t i c , and p r e s e n t a danger  Involuntary  In  these circumstances the  accept  psychopharmacological  Care Centre and/or be t r a n s f e r r e d t o Institute  via a  Temporary Absence  treatment can not be imposed s i n c e  Care Centre of Lower Mainland R e g i o n a l C o r r e c t i o n a l  i s not a d e s i g n a t e d p s y c h i a t r i c f a c i l i t y .  As mentioned  Riverview H o s p i t a l w i l l not accept i n d i v i d u a l s who are a  sentence  i n a correctional institution.  Transfer to  P s y c h i a t r i c I n s t i t u t e i s dependent on the a v a i l a b i l i t y  bed space.  On some o c c a s i o n s , inmates a r e r e l e a s e d i n t o the  community b e f o r e they can be t r a n s f e r r e d .  - 32 -  Each  inmate  correctional care is  of  the  staff  Health  member  management.  Care  Centre  is  The a c t u a l substance  member.  inmate  The  adapt  to  a  who i s r e s p o n s i b l e f o r the inmate's o f the case management  h i g h l y dependent on the inmate and the a s s i g n e d  staff  assigned  primary  focus  h i s period  is  correctional  p l a c e d on h e l p i n g the  of i n c a r c e r a t i o n r a t h e r than any  other k i n d of p l a n n i n g .  At  the recommendation of the c o r r e c t i o n a l s t a f f member/case  manager,  inmates  can be e l i g i b l e f o r the 'work program'.  This  program  b a s i c a l l y e n t a i l s j a n i t o r i a l d u t i e s , meals p r e p a r a t i o n ,  laundry  services,  small  sum  greater  of  the  (i.e.  inmates  considered Wards than is  money  degree  Within  in  maintenance.  return  Inmates r e c e i v e a  f o r t h e i r work, as w e l l as a  Care Centre, inmates from Wards one and two  with  first and  inmates  perceived  yard  of freedom and time t o spend i n the games room.  Health  three the  and  to  physical  illnesses  f o r the work program. four  are  only)  are u s u a l l y  S i m i l a r l y , inmates from  more e l i g i b l e f o r the work program  from Wards f i v e and s i x , as the former group be  more  s t a b l e and h i g h e r i n t h e i r l e v e l of  functioning.  There Care  Centre.  workshop an  is  a  woodworking area i n the basement of the H e a l t h  At one time t h i s was u t i l i z e d as a r e h a b i l i t a t i v e  f o r the m e n t a l l y i l l  Occupational Therapist.  inmates under the s u p e r v i s i o n of  During the p a s t year, t h i s area has  -  not  been  fiscal  used  at  a l l , p r i m a r i l y due t o s t a f f i n g shortage and  constraints.  Anonymous inmates  and  33 -  Finally,  Spiritual  there  Guidance  are regular  meetings  who choose t o a t t e n d , s u b j e c t  Alcoholics  available for a l l  t o s e c u r i t y management of  course.  When the  the p r i s o n  correctional  circumstances, could That  sentence imposed by the c o u r t has e x p i r e d ,  system  the  must  released  release  the  inmate.  psychiatrically  impaired  I n these inmate  remain i n the t r e a d m i l l of a k i n d of 'greyhound therapy'. i s , bouncing  ball'  between  back  and  forth,  almost l i k e a 'ping pong  the community, the mental h e a l t h  system, and the  c r i m i n a l j u s t i c e system.  ENTRY TO T H E SYSTEM Our  mental  voluntarily for  admit  a duration  permits  a  health him  or  family  impaired  mentally  the b e n e f i t The  complex to  say  to  I t also  group  ties.  individual  of h o s p i t a l i z a t i o n as deemed necessary.  for psychiatric  have  an  facility  admission of  enables  herself into a psychiatric  concerned  psychiatrically  system  ill  member  or  friend  individual  to  a  intervention.  t o e s c o r t the  hospital  and seek  However, t h e r e i s a  i n d i v i d u a l s i n our community who do not  of or enjoy c l o s e f a m i l i a l and i n t e r p e r s o n a l  reasons f o r t h i s 'disconnectedness' a r e m a n i f o l d and  and they w i l l not be addressed i n t h i s s e c t i o n . that  this  group  of  'disconnected'  Suffice  psychiatrically  - 34 impaired  individuals  for  necessary  the  result, a to  i s o f t e n unable or u n w i l l i n g  the  i n t h i s 'disconnected' group who  inappropriate  attention  of  law  enforcement  professionals.  caught  between the mental h e a l t h  In power  individual  to  take  facility the  I  of  official and jail.  to  the  have  the  found  the  is,  when  the  charges  h i s or her  system.  too  a  being  From my  own  l a t t e r i s dependent on  the  f e a s i b i l i t y of admission i n t o a  there  i s not  facilities  c h o i c e but  are  are no p s y c h i a t r i c beds  c e r t i f i a b l e under the  potentially  i s l e f t with l i t t l e remove  justice  to  i n d i v i d u a l i s deemed u n s u i t a b l e f o r  he or she is  pending  When a l l the p s y c h i a t r i c  when the  or  jail  t h a t the  o f f e n c e and  because Act  in  criminal  facility.  or,  apprehended  discretionary  or, a l t e r n a t i v e l y , t o l a y c r i m i n a l  the  "diversion"--that  available  the  individual  through  psychiatric  Health  system, the community, and  either  experience,  facility  brought  i n t h i s group f i n d themselves  the  processed  on  a  than mental  B r i t i s h Columbia, a p o l i c e o f f i c e r has  place  nature  As  j u s t i c e system.  psychiatric and  Individuals  officials  out  behave i n  manner are more l i k e l y t o be  health  criminal  t o reach  h e l p i n a s o c i a l l y a c c e p t a b l e manner.  individuals  socially  -  the  Mental  aggressive—the  police  to l a y c r i m i n a l  charges  i n d i v i d u a l from the community t o the  local  While seen  the  by  police  i n d i v i d u a l i s i n the  official.  medical  From  and  the  doctor  findings.  the  review  The  'Fitness  based  on  individual's  the  the  ability  important  to  to  remanded  that  and  court a  the  lengthier  assessment.  Individuals  who  processed  takes  An  who  Mental  Status  information,  the  clinical  'Fitness  to  i s a l e g a l term, and  is  be  l e g a l counsel. individual deemed  a  day of  t h a t the time  at  can  ' f i t to the  judicial  stand  individual the  comprehensive  the  be  physician be  Forensic  psychiatric  are deemed ' f i t ' by the  through  It is  presiding  system i n the same  impaired i n d i v i d u a l .  That i s ,  s e n t e n c i n g or  follows.  psychiatric to in  the  p l a c e , a v e r d i c t i s rendered, and  individual  returned  the  i s d e f e r r e d , and  a non-psychiatrically  acquittal  system  still  period for  trial  recommendation of  individual's  an  following  Institute  as  he  understanding of the c o u r t p r o c e s s  Psychiatric  are  be  available  i n s t r u c t h i s or her  impaired  in for  or she may  of  t o Stand T r i a l '  Oftentimes, the d e c i s i o n  recommends  a  results of the  recognize  psychiatrically trial'.  the  primary focus i s on the  Trial'.  manner  local j a i l ,  w i l l make recommendations based on the  Stand  judge  -  a m e d i c a l d o c t o r i f such was  Examination  and  35  who  is  remand  at  court  and  the  same  the  found  ' f i t ' following  Forensic Psychiatric  processed through the  of  Institute, is  criminal  manner as mentioned above.  i s found ' U n f i t t o Stand T r i a l '  a period  An  justice  individual  i s r e t u r n e d t o the  Forensic  - 36 Psychiatric court  Institute  when  i t  psychiatrist Stand  or  is  determined  the Review  Trial'.  through  f o r treatment and e v e n t u a l l y r e t u r n e d t o  Again,  the c r i m i n a l  by  Board  h i s or  that  her  attending  he o r she i s ' F i t t o  once ' F i t ' , the i n d i v i d u a l i s processed justice  system  as w i t h t h e case of any  other i n d i v i d u a l charged w i t h a c r i m i n a l o f f e n c e .  There  a r e many  sentencing  suspended  sentence,  fine,  combination period  of  of  When  officer.  appropriate  placed  in,  based  on  including  recommendations  of  individual,  transfers individual,  an i n d i v i d u a l i s sentenced t o a  he  and  may  and  and so  not  stage;  occur  of  or  she  offence,  past  i s reviewed  past  needs, on. be  of  by  a  the following  the p a s t  institutional  the c o u r t ,  history  classification  p r i s o n term and/or a  the a v a i l a b i l i t y  incarceration  information  a  of them a r e :  c o r r e c t i o n a l f a c i l i t y the i n d i v i d u a l should be  the nature  the  Some  The c l a s s i f i c a t i o n o f f i c e r determines  information:  psychiatric  probation,  incarceration,  classification the  these.  options.  and  h i s t o r y of  behaviors,  the  c u r r e n t medical and  the g e o g r a p h i c a l home base of I t should be noted t h a t a l l the  available  during  the  initial  and c e r t a i n l y , i n t e r - and i n t r a - f a c i l i t y  depending  on  the emerging  needs  of the  the a v a i l a b i l i t y of a d d i t i o n a l i n f o r m a t i o n , as  w e l l as i n s t i t u t i o n a l space and s e c u r i t y demands.  - 37 Perhaps  what  is  unique  -  about the Lower Mainland R e g i o n a l  Correctional  Centre i s t h a t , u n l i k e other r e g i o n a l c o r r e c t i o n a l  centres,  does  it  result,  inmates  attention often  have who  require  medical  t h a t can not be p r o v i d e d  transferred  Centre. Mental  a separate h e a l t h care f a c i l i t y .  to  Sometimes, Health  Psychiatric Regional  Act,  Lower an  Institute  awaiting  may  Correctional  at the host i n s t i t u t i o n ,  Mainland  is  find  Centre.  a  (including psychiatric)  Regional  i n d i v i d u a l who  and  As  Correctional  i s c e r t i f i e d under a  bed  himself  in  are  the  i n the  Forensic  Lower  Mainland  ( T h i s does not apply t o female  inmates  as  Lakeside  grounds  of  Lower Mainland R e g i o n a l C o r r e c t i o n a l Centre, i s the  only  female  Correctional  provincial  classification  process  population  there  be  as  transferred  psychiatric  correctional greatly  i s o n l y one  to  Forensic  intervention.)  returned  from  Regional  Correctional  only  the  if  is  Forensic  latter  Centre,  located within  facility.  simplified  facility.  Similarly,  The  f o r the  female  Female inmates  Psychiatric an  the  Institute  can for  i n d i v i d u a l may  be  P s y c h i a t r i c I n s t i t u t e t o Lower Mainland Centre  is  instead  of the host  institution  not equipped t o meet the needs of  the  inmate.  In  sum,  individual multitude and  how ends  an i n d i v i d u a l e n t e r s up  of f a c t o r s .  economic  climate  in  the  the system, and where the  system are l a r g e l y dependent on  In a d d i t i o n , w h i l e the g e n e r a l influences  our  social  a  political  policies,  these  - 38 policies  i n turn,  caregivers  -  shape agency mandates, and  the parameters of p r o f e s s i o n a l  their discretionary  provide i n d i v i d u a l  activities,  including  powers.  CONCX.UDJLMG CCMMKBPT  For  the p a s t four y e a r s , I have been a c t i v e l y i n v o l v e d  mentally our  i l l offenders  provincial  attended  a  Mentally  the  institutions.  Disordered at  and  mentally  problems  ill'  that  number  repeatedly  arrested  symptomatic question service  cop"  manage again  of the most alarming and  into to  and  one us  mentally and  today.  Of  the  inherent  for  individuals community.  with  of  of  is  the  that  are  the  existing  a new  'career'  patients.  a "mental h e a l t h mental  illness  While some of these  community, o t h e r s r e t u r n  again  again.  As  and  Moreover, I began t o  s t a y i n the and  The  have been  offences  limitations  scenario:  I  demanding  concern to me,  s o c i a l systems are c r e a t i n g  following  the  'criminalization  i l l i n d i v i d u a l s who  incarcerated  in  provincial,  as  p s y c h i a t r i c a l l y impaired  the  speakers  i d e n t i f i e d the  of t h e i r p s y c h i a t r i c i l l n e s s .  directing  hospital  the  sectors,  agencies and  Picture  S p r i n g of 1987,  conference, from f e d e r a l and  of  whether  path f o r our  the  All  3  challenges  increasing  l o c a l community and  f i r s t of i t s k i n d , t i t l e d  Offender .  this  private  the  During  l o c a l conference, the  participants public  both w i t h i n  with  traffic  from  the  individuals  to the  hospital  the community becomes l e s s  - 39 tolerant  and  admission caught  system;  mentally  the  are  more r e s t r i c t i v e i n t h e i r  of our m e n t a l l y i l l p a t i e n t s who  only  system  subsequently  that  are  i n t o the c r i m i n a l  cannot say no.  These  l a b e l l e d and c a t e g o r i z e d i n t o the  i l l o f f e n d e r group and are l e d i n t o a 'career' o p t i o n  previously  not  enough,  with  some  become  the 'over-flow' are b e i n g detoured  individuals  not  hospitals  criteria,  in  justice  the  the  readily  we  available  t o them.  And as i f t h a t i s  f u r n i s h t h i s group of m e n t a l l y i l l i n d i v i d u a l s  context  t o s t a y w i t h i n t h e i r new  'career' and  little  hope f o r change.  Several years  are:  from  the  option  Is t h i s group of m e n t a l l y i l l o f f e n d e r s d i f f e r e n t 'generic'  of  mentally  entering  positively ill  i s s u e s t h a t have emerged f o r me d u r i n g the p a s t few  or  the  criminal  justice  Does t h i s  system  added  contribute  c o n s t r u c t i v e l y t o the w e l l b e i n g of the m e n t a l l y  individual?  criminalize  the  i l l population?  What  are  mentally improve  the n e g a t i v e consequences when we  i l l individual? or  alter  the  How  service  providers  current  affairs?  And f i n a l l y , where do we go from here?  can  we,  as  state  of  - 40 CHAPTER THE  This  study  concerns  and  chapter,  A  RESEARCH DESIGN  was needs  incarcerated  3  within  designed of  to  mentally  g a i n an understanding of  i l l o f f e n d e r s w h i l e they are  a correctional  institution.  In  this  I will:  1)  define  2)  d e s c r i b e the purpose of the r e s e a r c h  3)  i d e n t i f y the i s s u e s s e l e c t e d f o r the r e s e a r c h ;  4)  d e s c r i b e the r e s e a r c h methodology.  short  'mentally  summary  methodology w i l l  of  There  is  limitations  of  study;  the  and  d e s i g n and  the  consensus r e g a r d i n g the d e f i n i t i o n of  the  follow.  little  'mentally  i l l offender';  the  D K F I H I H G MEHTALLY U J .  term  the  OFFERDKRS  i l l offender'.  i d e n t i f i e d f o u r subgroups.  Monahan  and Steadman (1983)  These a r e :  1)  those who  are found Not  G u i l t y By Reason of  2)  those who  are found U n f i t To Stand  3)  mentally  4)  mentally  d i s o r d e r e d sex o f f e n d e r s ; disordered  inmates  who  Insanity;  Trial; and are t r a n s f e r r e d t o a  mental h o s p i t a l .  In (1987)  his  monograph The M e n t a l l y D i s o r d e r e d  makes  a d i s t i n c t i o n between the  Offender,  Halleck  "formally categorized  1  - 41 and  the  offender. subgroups  1  non-formally Basically,  Monahan  and  categorized' Halleck's f i r s t Steadman  mentally  disordered  group embodies the f o u r  identified.  Although  r e c o g n i z e s t h a t the second group "may share many characteristics with formally designated mentally disordered o f f e n d e r s . . . the two groups are managed q u i t e differently by the criminal justice system....[That is,]...if they are t r e a t e d the u s u a l purpose i s t o a l l e v i a t e their suffering or help them adjust to a particular environment. No s p e c i f i c l e g a l purpose u n d e r l i e s t h e i r treatment, such as restoring t h e i r competency or r e h a b i l i t a t i n g them, and those who treat them do not usually r e p o r t the p r o g r e s s to judicial agencies" (p.3). He f u r t h e r comments t h a t "The routine of prison life and in particular the degree of isolation i t imposes upon inmates allows seriously disordered o f f e n d e r s , i n c l u d i n g many who may be psychotic, to go undetected....My experience is not unique....If blatant p s y c h o s i s can be hidden or undetected i n prison, severe d e p r e s s i o n , which i s much easier to conceal, i s probably even more prevalent....If psychiatrists are a v a i l a b l e to examine i n d i v i d u a l s who f r e q u e n t l y occupy punitive segregation u n i t s , they u s u a l l y discover a high i n c i d e n c e of p s y c h o s i s and major affective d i s o r d e r . . . . the personal vulnerabilities of many of these inmates i n protective custody can be b e s t d e s c r i b e d as manifestations of serious mental disorders....The number of these i n d i v i d u a l s e v e n t u a l l y d e s i g n a t e d as m e n t a l l y d i s o r d e r e d o f f e n d e r s i s unknown, but probably many are not" [ s i c ] (pp.4-6).  Halleck  - 42 For  a  much broader d e f i n i t i o n , Jemelka, T r u p i n ,  (1989) use the term  'mentally  ill  offender'  and C h i l e s  t o mean  "Those i n d i v i d u a l s i n p r i s o n s and j a i l s who have a diagnosable major psychiatric disorder (schizophrenia, unipolar and bipolar d e p r e s s i o n o r o r g a n i c syndromes w i t h p s y c h o t i c f e a t u r e s ) " (p.482) (my emphasis).  The a  Community A c t i o n f o r the M e n t a l l y  111 Offender  (CAMIO),  n o n - p r o f i t o r g a n i z a t i o n i n S e a t t l e , Washington, d e s c r i b e s i t s  t a r g e t p o p u l a t i o n as "any i n d i v i d u a l who, by v i r t u e of a c h r o n i c mental illness, that i s , schizophrenia and/or a major a f f e c t i v e d i s o r d e r , i s unable to independently maintain law-abiding behavior. This i n c l u d e s those i n d i v i d u a l s who a r e i n pre- or p o s t - c o n v i c t i o n s t a t u s . . . e i t h e r i n c a r c e r a t e d o r i n the community".  For  the  offender Guilty  will By  Offenders in  the  health is  paper,  the  term  mentally  ill  of  Insanity,  Unfit  t o Stand T r i a l , or Sex  the  Psychiatric group by  the  system.  of  o f f i c i a l manual of nomenclature of the  Association. mentally  arresting  It  i s a l s o not concerned  i l l individuals police  officers  The group of m e n t a l l y  ill  who  into  offenders  have been the mental t h i s paper  r e f e r r i n g t o c o n s i s t s of i n d i v i d u a l s who have a major mental  disorder and  Reason  this  i n c l u d e those i n d i v i d u a l s who a r e found Not  DSM-III-R,  the  diverted  not  of  who do not have a major mental i l l n e s s t h a t i s l i s t e d  American with  purpose  t h a t i s found i n the A x i s I c a t e g o r y of the DSM-III-R,  are e i t h e r :  - 43 1)  discharged  psychiatric  in  with  coping  processed engaging 2)  the  p a t i e n t s who  have d i f f i c u l t i e s  community l i v i n g and are  through  the  criminal  consequently  justice  system  for  i n p r i m a r i l y minor p e t t y crimes;  emerging  Appendix  A)  mentally  ill,  Young who  Adult  Chronic  Patients  (See  are r e s i s t a n t t o b e i n g c a t e g o r i z e d as  and  health  are t h e r e f o r e , s i m i l a r l y treatment  and s o c i a l  resistant  to  mental  intervention.  As  a r e s u l t , they are r e s u r f a c i n g amongst the c r i m i n a l  s u b c u l t u r e s ; and/or 3)  offenders  who  become  psychiatrically  impaired w h i l e  i n c a r c e r a t e d or under community s u p e r v i s i o n . Indeed,  an  into  more  time,  as  individual than these  interested  in  with  a  major mental i l l n e s s can  'fit'  one of these groups a t any g i v e n time, or over groups this  are  not  mutually  exclusive.  I am  group because i t i s the group t h a t i s most  v u l n e r a b l e t o b e i n g l o s t i n the system.  PORPOSE  In  OF  1857,  B R S K u n r H  Edward J a r v i s , an American p s y c h i a t r i s t , d e s c r i b e s  the experience of a m e n t a l l y i l l  o f f e n d e r as f o l l o w s :  "[He]...has nowhere any home: no agency or n a t i o n has p r o v i d e d a p l a c e f o r him. He i s everywhere unwelcome and o b j e c t i o n a b l e . The prisons t h r u s t him out and the h o s p i t a l s are unwilling t o r e c e i v e him; the law w i l l not let him s t a y a t h i s house, and the p u b l i c will not permit him t o go abroad. And y e t humanity and justice, the sense of common danger, and a tender r e g a r d f o r a deeply degraded brother-man, a l l ,agree that  - 44  something should be H a l l e c k , 1987, p.11).  In  reference  criminologist,  to  done  Dr.  clinician,  Jarvis'  and  American c o n d i t i o n s i n 1987  -  for  him"  (cf.  comment,  administrator,  Halleck,  summarized  a the  as f o l l o w s :  "These words still apply to mentally disordered offenders today. We remain uncertain how to t r e a t them. We are unwilling to leave them alone, y e t most agencies seek t o a v o i d responsibility for their care. We c o n f i n e them t o p r i s o n s and to p r i s o n - l i k e h o s p i t a l s where they are sometimes treated worse than other offenders. They almost always r e c e i v e worse treatment than mental p a t i e n t s i n p u b l i c or p r i v a t e mental h o s p i t a l s " (p.12).  The  availability  of  documented i n f o r m a t i o n w i t h i n Canada,  and  s p e c i f i c a l l y B r i t i s h Columbia, r e g a r d i n g  and  with mentally  an  acute  care,  of  and  in  address been  services,  and  our the  local needs  In  an  Branch dated May  Yet, there i s health  of t h i s group of m e n t a l l y  particularly unpublished  by  increase  are emerging as a d i s t i n c t i v e  c r i m i n a l j u s t i c e system.  22nd, 1990,  of  c r i m i n a l j u s t i c e agencies of both  i l l i n d i v i d u a l s who  identified  Branch.  i s very l i m i t e d .  p r i v a t e s e c t o r s , t h a t there i s an apparent  mentally  group  offenders  awareness amongst the d i r e c t c a r e g i v e r s i n our  social  public  ill  the experiences  the  4  ill  The  urgency to  offenders  Provincial  has  Corrections  d i s c u s s i o n paper prepared f o r the  i t was  stated:  "it has become i n c r e a s i n g l y more common f o r correctional centre staff t o comment on an increase i n the number of MDOs [ M e n t a l l y Disordered Offenders] i n t h e i r i n s t i t u t i o n s .  - 45 Correctional S e r v i c e o f Canada (CSC) has also identified t h e MDO as an area f o r concern and s p e c i a l i z a t i o n . Corrimunity Corrections s t a f f are under growing p r e s s u r e to p r o v i d e programming a p p r o p r i a t e t o these o f f e n d e r s " (p.2).  Furthermore, "The Branch i s e x p e r i e n c i n g p r e s s u r e t o provide s e r v i c e s t o a group of o f f e n d e r s that i t f e e l s i l l equipped t o d e a l w i t h . I n l a r g e p a r t these o f f e n d e r s may be i n g a o l , not because o f e x t e n s i v e c r i m i n a l i t y , but because o f mental d i s o r d e r . I t , t h e r e f o r e , becomes difficult t o reconcile services which have been designed f o r the 'average' inmate w i t h the demands/requirements of the m e n t a l l y d i s o r d e r e d o f f e n d e r " (p.3).  ISSTJKS  SKT.RrTwn  In  their  PQR  review  RKSPBPPH  of the l i t e r a t u r e  on m e n t a l l y i l l  o f f e n d e r s , Jemelka, T r u p i n and C h i l e s (1989) p o i n t e d out t h a t : "Much more has been w r i t t e n about the l e g a l issues i n p r o v i d i n g p s y c h i a t r i c treatment i n jails and p r i s o n s than has been w r i t t e n about t h e treatment itself. Little i s available i n the l i t e r a t u r e t o guide decisions about designing treatment programs" (p.485).  Given  that  experiences  there  i s a d e a r t h of i n f o r m a t i o n r e g a r d i n g the  and needs of m e n t a l l y i l l o f f e n d e r s , t h i s r e s e a r c h  study i n t e n d s t o : 1)  explore  t h e experiences  who have been i n c a r c e r a t e d ;  of mentally i l l i n d i v i d u a l s  - 46 2)  explore  the  problems  professionals care  for  identify  confront  correctional  mentally  incarcerated; 3)  and  that  health  personnel who  i l l individuals  who  care  provide  have  been  and  the  needs  of  mentally  i l l offenders  as  p e r c e i v e d by themselves and t h e i r c a r e g i v e r s .  RESEARCH D E S I G N One  way  to  incarcerated complexity chosen.  determine the experiences  mentally of  this  and s e r v i c e needs of  i l l o f f e n d e r s i s t o ask them. topic  area,  a  qualitative  Given design  the was  Such a d e s i g n : "attempts to g a i n a f i r s t hand, h o l i s t i c understanding of the phenomenon of i n t e r e s t by means of a f l e x i b l e s t r a t e g y of problem f o r m u l a t i o n and data collection shaped as the investigation proceeds...understanding the system from the p e r s p e c t i v e s of the actors i n v o l v e d r a t h e r than through the i m p o s i t i o n of the researcher's t h e o r e t i c a l views" (Reid and Smith, 1981, pp.88-89).  In the  order  in  research  institution gain  i n f o r m a t i o n from the p o i n t of view of  v a r i o u s a c t o r s i n v o l v e d , the study must be n a t u r a l i s t i c  exploratory the  t o generate  nature. would  context;  an i n i t i a l  and  N a t u r a l i s t i c i n t h i s case meant t h a t be  conducted  exploratory  within  the  correctional  means t h a t the i n t e n t " i s t o  look at a p i e c e of r e a l i t y and t o promote ideas  about i t " (Reid & Smith, 1981,  p.67).  - 47 With  r e s p e c t t o data c o l l e c t i o n , the r e s e a r c h e r  f e l t i t was  important t o A)  g e t c l o s e enough t o be almost d i r e c t l y  B)  capture  and  record  what  involved;  actually  happens  in a  non-j udgemental manner; C)  r e c o r d e x t e n s i v e d e s c r i p t i o n s of events; and  D)  record 1980,  The  direct  of  program  Finally,  findings  the e x i s t i n g  planning  practical  w i l l be used t o i d e n t i f y t h e problem services,  that  concepts  and  to  facilitate  future  can be a p p l i e d i n s i m i l a r s e t t i n g s .  through the process by  and  and p o l i c y development, as w e l l as t o i d e n t i f y  knowledge  described  from a l l p a r t i c i p a n t s . (Patton,  p.36).  accumulated  areas  quotes  Glaser  and  hypotheses  of Constant Comparative Methods as  Strauss will  (1967), emerge  a  s e t of r e l a t e d  f o r future  research  studies.  By  design,  prevalence  rate  incarcerated.  this  study  of  mentally  This  does not address t h e i n c i d e n c e and i l l individuals  research  who  have been  design i s p r i m a r i l y exploratory  and r e t r o s p e c t i v e i n nature.  METHODOLOGY (i)  DATA COLLECTION Descriptive,  researcher  between  qualitative March  1989  data  was  and March  collected  by the  1990, by means of  - 48 participant  observation,  semi-structured the in  supplemented w i t h formal and i n f o r m a l  interviews.  (See Appendix B)  i n t e r v i e w s were tape recorded, writing  the  and  permission  The  an  used  informal  the  formal  interview  initial  specific  interview  and/or  p o i n t s made by some of  after  the  interviews  since  t o be recorded was not always g i v e n .  during  with  during  researcher  included  the r e s e a r c h e r had t o r e c o r d  summarize the important  participants  While some of  a  "phenomenological  unstructured  approach" which  conversational  phase of the r e s e a r c h study,  using  open  an  interview  ended  procedures  guide,  questions.  were  followed  i n t e r v i e w as w e l l as a guided  formal  -  interview  f o l l o w e d by a  and then c l o s i n g  In  essence then, two  an  initial  informal  interview.  ( i i ) SAMPLING The All  sampling  subjects  were  determine  their  selected,  by  would  strategy  represent  approached  interest  the  was p u r p o s e f u l , r a t h e r than random.  i n participation.  researcher,  the  i n person by the r e s e a r c h e r t o  various  based interest  a f f e c t e d by the c r i m i n a l i z a t i o n process  on the premise t h a t groups  mentally  i l l o f f e n d e r s , and  b)  service providers.  that  they  might be  of the m e n t a l l y i l l .  There are two d i f f e r e n t sampling p o p u l a t i o n s . a)  They were a l s o  They a r e :  -  Representatives Care as  from  both  49  -  groups a r e s e l e c t e d from the  Centre o f t h e Lower Mainland R e g i o n a l C o r r e c t i o n a l Centre, well  group whom  as  from  consisted were  Centre  t h e community. of  s i x male  of  the interviews,  of  t h e same f a c i l i t y .  consisted  of  health  personnel.  The  registered  correctional administrator,  care  health  personnel  The s e r v i c e p r o v i d e r s  professionals  care  nurses  and two o f whom were  p r o f e s s i o n a l group c o n s i s t e d of  and one p s y c h i a t r i c  group  consisted  one p r i n c i p a l  officer,  of  and two  correctional  Mainland R e g i o n a l C o r r e c t i o n a l Centre.  with  correctional Vancouver  o f whom were from the H e a l t h Care Centre o f  included  two  mentally i l l system,  The  correctional  Lower  familiar  nurse.  one  members—all  group  group  and c o r r e c t i o n a l  staff  sample  offenders  i n c a r c e r a t e d a t Lower Mainland R e g i o n a l C o r r e c t i o n a l  a t the time  three  The m e n t a l l y i l l  p s y c h i a t r i c p a t i e n t s -- four o f  ex-inmates  was  Health  In addition,  this  h e a l t h care p r o f e s s i o n a l s who were offenders  and two  population  correctional  as w e l l as t h e  o f f i c e r s from t h e  P r e - T r i a l Centre. (See Table 1) The t o t a l sample s i z e  eighteen.  -  50 -  TABLE 1 DISTRIBUTION OF PARTICIPANTS WHO WERE FORMALLY INTERVIEWED  IN LMRCC  IN COMMUNITY  TOTAL  M e n t a l l y 111 Offenders  4  2  6  Correctional  4  2  6  4  2  6  12  6  Personnel  H e a l t h Care P r o f e s s i o n a l s TOTAL  The  sample  mentally  was  i l l offender  researcher  began  inmates  at  mental  illness.  researcher review invited know  chosen  the  the  as  follows.  population  18  With r e s p e c t t o the  w i t h i n the i n s t i t u t i o n , the  by a s k i n g the s t a f f members t o i d e n t i f y  H e a l t h Care Centre who might have a h i s t o r y of While  already, relevant  some  of  them  were  known  t o the  i n a l l cases t h e r e was the o p p o r t u n i t y t o files.  Following  t h i s , the r e s e a r c h e r  v a r i o u s p o t e n t i a l p a r t i c i p a n t s t o an i n d i v i d u a l each  individual  other' was  those  interview  informed see  with  verbally  Appendix  C)  the  and  the  researcher.  i n writing  purpose  'get t o Each  ( v i a the  consent  form,  of the r e s e a r c h  study.  Each p o t e n t i a l p a r t i c i p a n t was aware t h a t p a r t i c i p a t i o n  - 51 was  p u r e l y v o l u n t a r y , and would have no i n f l u e n c e whatsoever on  his  stay  in  Regional within  the  Correctional  Care  Centre  Centre.  of  the Lower  Several mentally i l l  Mainland offenders  the community f o r m e r l y known t o the r e s e a r c h e r were a l s o  asked  i n person  research  study.  verbally  and  in  Health  the  i f they were i n t e r e s t e d i n p a r t i c i p a t i n g i n the The purpose of the study was e x p l a i n e d t o them  i n writing.  community,  Arrangements were made t o meet them  and the i n t e r v i e w s took p l a c e i n the o f f i c e  where the r e s e a r c h e r had p r e v i o u s l y worked.  With the  respect  Health  Correctional time the to  to  the s e l e c t i o n of s e r v i c e p r o v i d e r s w i t h i n  Care  Centre  Centre,  the  of  the  Lower  Mainland  Regional  r e s e a r c h e r spent an i n i t i a l b l o c k of  j u s t t o get f a m i l i a r w i t h t h e i r r o l e s and the s t r u c t u r e of institution. identify  interested with  the  Informal d i s c u s s i o n s p r o v i d e d the o p p o r t u n i t y  those  staff  members  i n participating. correctional  be s u i t a b l e and  ( I n d i v i d u a l s who were u n f a m i l i a r  system  and/or  recently  the  H e a l t h Care  because  and/or  a u x i l i a r y s t a t u s were c o n s i d e r e d u n s u i t a b l e  hired,  temporary  Centre relief,  candidates.)  s t a f f member was informed v e r b a l l y and i n w r i t i n g ( v i a the  consent  form,  research  see  study.  voluntary, addition, within  were  might  either  Each  they  who  and  Appendix  D)  regarding  the purpose of the  Again, each was aware t h a t p a r t i c i p a t i o n was confidentiality  would  be  respected.  In  s e v e r a l c o r r e c t i o n a l o f f i c e r s and h e a l t h care workers  the  community  formerly  known  to  the r e s e a r c h e r were  asked  if  -  they were i n t e r e s t e d i n p a r t i c i p a t i n g i n the r e s e a r c h  study.  Arrangements  and  interviews  the  52  were made t o meet them i n the community, took  place  e i t h e r i n t h e i r o f f i c e or the  o f f i c e s where the r e s e a r c h e r p r e v i o u s l y worked.  (iii)  THE  An B)  INTERVIEW  open-ended s e m i - s t r u c t u r e d i n t e r v i e w guide  was  designed  general  topic  interviews. probing,  the  areas Such  and  attitudes, gathered  by  the  would a  the  be  guide  permits for  perception,  early  to  ensure t h a t the same  explored  opportunity  experiences, from  researcher  during  the  flexibility,  expressions and  interviews  (See Appendix  was  used  detailed  of  ideas.  formal  personal  Information to  ask  more  s u c c i n c t and p e r t i n e n t q u e s t i o n s i n the subsequent i n t e r v i e w s .  (iv)  DATA ANALYSIS The  raw  data  transcribed collected researcher, The basic with  consists  verbatim from  twelve  since  information concept  of:  by  the  s i x tape recorded i n t e r v i e w s researcher,  interviews,  permission collected  to  from  p r o c e s s , see Appendix E ) .  f  information  recorded i n w r i t i n g by record  these  by tape was interviews.was  i n d i c a t o r s and subsequently  the r e s t of the f i e l d notes.  and  the  refused. used as  used f o r comparisons  (For d e t a i l s of the  analytic  - 53 The  analytic  preferences the  of  opinion  tape  of  the  would  the  was  That  b e h a l f of the  the  and  sequential  may  data  as "In p r a c t i c e  employ s e v e r a l . . . s t r a t e g i e s or  qualitative  a r e l a t i v e l y uniform  researcher  m o d i f i e d v e r s i o n of  research  p.205). is  the  the i n d i v i d u a l i t y of the s u b j e c t s and  After a l l , ability  s t i l l be  to able  body of r e l e v a n t data. In s h o r t ,  c o n s i d e r s the data c o l l e c t i o n methods used were  research  and have y i e l d e d v a l i d  study  was  approved  Columbia Research Screening  Ministry  of  interviewed  at  on  approaches" (Patton, 1980, of  be  data.  ETHICS  British  they  t h a t a l l i n t e r v i e w s should  subjectivity  evaluation  of  researcher  This  and  In an i d e a l s i t u a t i o n , i t i s  not a 'pure type' i s a c c e p t a b l e  particular  gather  of  diminish.  strength  individual  memoing and a n a l y s i s would be maintained;  o p t i m a l f o r the circumstances,  (v)  the  T h i s would allow c l o s e r adherence to G l a s e r  greatly  accommodate to  researcher  coding,  combinations the  the  degree  collection any  accommodates  Constant Comparative Method where verbatim,  line-by-line and  used  the p a r t i c i p a n t s .  recorded.  Strauss'  process  were  Solicitor  General,  participants informed  chose,  of  were  destroyed.  the  U n i v e r s i t y of  Committee as w e l l as by  B.C.  C o r r e c t i o n s Branch.  the All  r e q u i r e d t o s i g n a consent form  t h e i r r i g h t to d e c l i n e p a r t i c i p a t i o n i f  as w e l l as withdraw t h e i r consent t o p a r t i c i p a t i o n  any time d u r i n g the i n t e r v i e w ( s ) .  confidential  by  and  all  identifying  T h e i r i d e n t i t i e s remained information  has  been  -  (vi)  54 -  DISCUSSION Some o f the l i m i t a t i o n s of t h i s study a r e as f o l l o w s : 1)  The  sample  size  generalizability sample  size,  'general also  population',  offenders,  limits  In a d d i t i o n t o a l a r g e r  data  from  ethnic  inmates  from  of the  m i n o r i t y groups who are  be  and  useful  ill  i n terms of i d e n t i f y i n g  d i f f e r e n c e s of s e r v i c e needs between  d i f f e r e n t groups. I n an i d e a l s i t u a t i o n ,  data  the  i l l o f f e n d e r s , and female m e n t a l l y  would  similarities  eighteen  of the data. obtaining  mentally  the  of  obtaining  h o s p i t a l i z e d p s y c h i a t r i c p a t i e n t s , again i n  comparing  the s i m i l a r i t i e s and d i f f e r e n c e s , would a l s o  be  illuminating.  guite  the  different  needs  data  presented  The use of comparison between  would  e l u c i d a t e the problems and  by m e n t a l l y  ill  o f f e n d e r s . The p u r s u i t  of such s t u d i e s i n the f u t u r e i s s t r o n g l y recommended.  2)  The  research  Care  study  Centre  of  was a  conducted  medium  and  maximum  security  correctional  institution  The  results  of the data a n a l y s i s apply t h e r e f o r e  to  this  setting,  and  different  setting,  rendering  only  i n generating  studies. because  The of  within  w i t h i n the H e a l t h  have  limited  hypotheses  conclusions  the conceptual  the Lower Mainland. only  utility  in a  the conclusions  useful  f o r future  a r e important  research primarily  significance, particularly  i n i d e n t i f y i n g s a l i e n t variables f o r future studies.  - 55 3)  One  of the extraneous v a r i a b l e s t h a t must not be  out, is  ruled  g i v e n the non-randomness of the sample s e l e c t i o n , the  is,  phenomenon  when  researchers  subjects  cues  about  (Kidder  and Judd,  subjects  "are  signals  and  setting"  "wittingly how  1986,  That  or u n w i t t i n g l y g i v e  they are supposed t o behave"  p.97).  particularly  Furthermore, likely  to  voluntary  respond  to  demands they p e r c e i v e i n the experimental  (p.97).  "potential  is  experiments"  Although the authors note t h a t the greater  in  (Ibid),  individuals  who  perspective  may  institutionalized either  of 'demand c h a r a c t e r i s t i c s ' .  randomized  the  have  a  issue  remains  different  that  attitude  decline to p a r t i c i p a t e . psychiatric  laboratory  patients  or  In a d d i t i o n , tend  to  be  eager t o p l e a s e or r e s i s t a n t when they i n t e r a c t  with  'system  how  much  r e p r e s e n t a t i v e s ' , l e a v i n g one wondering of  what  institutionalization. researcher hear.  what  As  one  they  say  In  other  thinks  he  is  a  words, or  she  function  of  telling  the  may  want t o  a r e s u l t , the s e l f - s e l e c t i v e process c o u l d  conceivably  skew  the  types of data o b t a i n e d , and not  r e p r e s e n t the f u l l r e a l i t y of the area of i n t e r e s t .  4)  At  the  time  Solicitor process  of  the  study,  the  B.C.  Ministry  of  General, C o r r e c t i o n s Branch, has been i n the of  d e c e n t r a l i z i n g the Lower Mainland R e g i o n a l  Correctional great  Centre.  deal  of  re-shuffling  staff  on  of  study,  the  new  Centre  social a  and  As  on  programs  were  ill  Spring  well,  some  had  general  of 1989,  her  of  program,  of  since  in  shortly after They  the' the  (the  were:  more  this  staff  members,  enduring  While some of  study  these  than o t h e r s , they a l l i n  I t may were  mentally  w e l l be t h a t the  more a r t i c u l a t e i n  i d e n t i f y i n g what they p e r c e i v e d the needs to those  programs the  still  programs  fresh i n their  might  influenced t h e i r perceptions regarding and  see  were  To  feasibility  and  brought i n  memories. have  a  Inter-Ministerial  impact on the i n s t i t u t i o n , the  in  the  r e s e a r c h e r h e r s e l f , a t the  o f f e n d e r s , and the s t a f f .  terms  had  context  interest  study.  behavior management.  an  participants  T h i s undoubtedly  study.  based  articles  part,  impending  group, an a l c o h o l and drug program,  community  of  the  started  skills  request  be  the  had  Project).  members.  the  programs were brought i n t o the H e a l t h Care  during  researcher  with  s t a f f morale, the p o l i t i c a l  p a r t i c i p a t i n g i n the  Several  a r e s u l t , there has been a  uncertainty  of  influence the  As  desirability  a c t u a l l y operating the  of implementing c e r t a i n  programs w i t h i n a c o r r e c t i o n a l s e t t i n g .  -  Notwithstanding decided  that  appropriate.  the  the  57  -  abovementioned  research  design  limitations, and  it  methodology  was were  -  58  -  C H A P T E R R E S E A R C H  As  stated  consisted  F I N D I N G S  in  of  F O U R  the  two  previous  AND  D I S C U S S I O N  chapter,  methodological  the data  processes  -  collection  the  informal  participant  observation  and  with  studies  a q u a l i t a t i v e nature  (See Appendix E ) ,  be  i n the c o n t e x t i n  other  the  findings  which  the  can  of  only  study  took  place  the formal guided i n t e r v i e w s .  f u l l y understood and  process by which the f i n d i n g s were  CHaRACTKRISTICS  OF THE  through  understanding  SAMPLE  formal  s i x m e n t a l l y i l l o f f e n d e r s p a r t i c i p a t e d i n the  data c o l l e c t i o n of t h i s study.  four  were  Care  Centre the  inmates  their  j a i l sentence  a t the H e a l t h  of  Centre  the study and two were ex-inmates of the same  who were r e s i d i n g i n the community a t the time of the  interviews . 5  this  serving  Of the s i x p a r t i c i p a n t s ,  of the Lower Mainland R e g i o n a l C o r r e c t i o n a l  time  facility,  of  clarification.  mentally i l l offenders  Altogether,  at  the  generated.  Readers should r e f e r t o Table 1 f o r f u r t h e r  (i)  As  It  group  interviews'.  should was  be noted t h a t none of the p a r t i c i p a n t s  acutely  psychotic  at  the  time  of  the  -  The  age  between have  range  of  mid-twenties  the and  1)  a  mentally  ill  o f f e n d e r group f a l l s  A l l are s i n g l e men,  who  S e v e r a l other commonalities t h a t  this  are:  diagnosis  of  N  -  mid-forties.  never been married.  sample group share  59  Axis  of  I  mental i l l n e s s i n the  and  Axis  II  as  per  categories  the  Diagnostic  S t a t i s t i c a l Manual, T h i r d E d i t i o n , R e v i s e d ; 6  2)  multiple  3)  multiple  psychiatric hospitalizations; contacts with p o l i c e o f f i c i a l s  provincial j a i l  a h i s t o r y of substance abuse;  5)  periodic  local  have  data  participants, care  community  mental  centres;  7)  been  receiving  and  Income A s s i s t a n c e f o r most,  a l l , of t h e i r a d u l t  lives.  providers.  Altogether,  health  with  a long h i s t o r y of unemployment;  service  formal  contacts  6)  i f not  (ii)  sentences;  4)  health  including  twelve  service  collection six  were  professionals.  of  providers this  correctional  participated in  study. personnel  Of  the and  the  twelve s i x were  (a)  60 -  c o r r e c t i o n a l personnel  Of were  the  s i x correctional  employed  Regional  at  facility  two  were  ranged  twenty f i v e y e a r s .  a  variety  including  the  correctional  The l e n g t h o f years i n  unit  within  custodial management,  t o the r e s e a r c h study  the c o r r e c t i o n a l work,  case  system,  management,  administration,  program  analysis.  s i x h e a l t h c a r e p r o f e s s i o n a l s , f o u r were employees  the H e a l t h  Correctional  Care  Centre  Centre at  of  the Lower  Mainland  the time of the study.  They  Regional comprised  two female r e g i s t e r e d nurses, one male r e g i s t e r e d nurse, and  one  female  health and  years  psychiatric  care  nurse.  As f o r the remaining two male  p r o f e s s i o n a l s , one was a p s y c h i a t r i s t on c o n t r a c t ,  the other was a community mental h e a l t h s o c i a l worker.  length  care  different  h e a l t h care p r o f e s s i o n a l s  Of  of  a  T h i s group brought  line  p l a n n i n g , and p o l i c y  of  at  a minimum of f i v e years t o the maximum  experiences  front  classification,  (b)  employed  from  of  of  Four  Centre a t the time of the study, and the  a t the time of the i n t e r v i e w s .  experience  a l l were male.  the H e a l t h Care Centre of the Lower Mainland  Correctional  remaining  personnel,  of to  years  i n experience  the maximum  of  p r o f e s s i o n a l s brought  ranged  t h i r t y years. to  The  from a minimum of nine T h i s group of h e a l t h  the r e s e a r c h study a range of  - 61 clinical  experiences  within  the  correctional,  medical,  and  mental h e a l t h systems.  All ill  the p a r t i c i p a n t s i n t h i s sub-group worked w i t h  offenders  either  during  their  period  of  mentally  incarceration  and/or when they were r e s i d i n g i n the community.  F I N D I N G S AMD  I.  DISCUSSION  Alienation A  primary f i n d i n g t h a t emerged from t h i s study i s the  sense  of a l i e n a t i o n shared by a l l the p a r t i c i p a n t s .  Alienation, Dictionary  as  is  the  separation. disconnect,  To and  environment.  defined  to  act  in  the  of  alienate  Webster's  withdrawal, is  to  feel  New  Collegiate  detachment,  and  estrangement,  to  d i s t a n c e from the s e l f and/or the  I t can be achieved  external  through i n s u l a t i o n by the  self  or i s o l a t i o n by the e x t e r n a l world.  (i)  mentally  ill  Individuals such the is  as DSM  offenders  who  s u f f e r from major c h r o n i c mental i l l n e s s e s  schizophrenia III-R)  because  and  affective disorders  o f t e n experience  mental  illness  (Axis I as  a form of displacement.  intrudes  upon  per This  the i n d i v i d u a l and  - 62 mounts  up  individual is  a  psychological  barricade  that  s e p a r a t e s the  from h i s or her own s e l f and the e x t e r n a l world.  indicated  individuals  in  are  the  following  oftentimes  examples,  As  mentally i l l  l e f t w i t h an e x i s t e n t i a l v o i d o r a  sense of emptiness. "I don't really know how I f e e l sometimes. It's like I can o n l y s t a r e you know. There's no thoughts going on i n my head." "I don't get the audio hallucinations anymore. I miss t h a t . I t was my l i f e . I t was what I b u i l t my l i f e around. Without t h a t , I don't have my l i f e anymore." In  the  same  vein,  a  health  care  professional  who  p a r t i c i p a t e d i n t h i s study made the f o l l o w i n g o b s e r v a t i o n : "The i m p r e s s i o n I get i s t h a t they a r e chronically n e u t r a l about e v e r y t h i n g . . . . I t ' s like they are fighting against this condition t h a t ' s a p s y c h o l o g i c a l vacuum t h a t sucks a l l the l i f e o u t " .  What more  emerges then, i s a sense of detachment,  isolated  forms.  and  withdrawn.  as one becomes  Withdrawal, assumes d i f f e r e n t  Take the f o l l o w i n g f o r example:  "I  used drugs a l o t t o escape from r e a l i t y " ;  "I've "I "It  c u t other people out of my  don't want t o s t e a l .  I'm not a t h i e f " ; and  became an excuse f o r me t o cop out".  Withdrawal, subculture,  life";  be  i t into  inevitably  drugs, one' s e l f , o r the c r i m i n a l leads  to  further  insulation,  -  estrangement, of  and  despair.  disconnectedness  individual self  feels  63  and  -  In  order t o cope w i t h t h e sense  helplessness,  increasingly  indifferent  and the e x t e r n a l environment.  the m e n t a l l y i l l towards him or her  T h i s i s b e s t i l l u s t r a t e d by  the f o l l o w i n g examples:  "I c o u l d n ' t do anything. I never t r i e d . an i n d i v i d u a l , I'm a f a i l u r e "  As  "Jails and h o s p i t a l s a r e p l a c e s f o r me t o hide. Hide from myself and other people....They become l i k e hotels....Being in jails and h o s p i t a l s broke up my time"; and "I can't e n v i s i o n anything d i f f e r e n t or what I want because i f there i s something I want, it may g i v e me the m o t i v a t i o n t o go out and get i t " .  As passive  p a r t and p a r c e l of the sense of h e l p l e s s n e s s , there i s a acceptance  unsatisfying  i t may  of  the  be.  external  world  r e g a r d l e s s of how  The l a c k of hope, d e s p a i r , and the  absolute p a s s i v i t y are e v i d e n t i n the f o l l o w i n g n a r r a t i o n s : "It was hard. I was t h e r e , being the end of my l i f e . T h i s i s what my l i f e had come t o . I thought i t was the end"; "Here, I get up and have b r e a k f a s t , and g e t back t o bed. I g e t up around t e n or ten-thirty, maybe have a shower, and then have lunch. Then I p l a y c a r d s , c r a s h out for awhile, get ready f o r d i n n e r , maybe read a b i t or w r i t e something down. J u s t phone numbers, make sure I don't l o s e them, t h a t ' s all" ; "I see the p s y c h i a t r i s t once a week or once every two weeks. A c t u a l l y , no, I see the psychologist. I don't know what you can get  -  64  -  out of a three minute c o n v e r s a t i o n , but i t seems t o be a l r i g h t . I walk i n t h e r e and he goes, How are you Mr. . I say fine. How d i d the m e d i c a t i o n go? O.K. W e l l , w e ' l l keep you t a k i n g the m e d i c a t i o n until you g e t out. That's i t ! Then he says next! And you j u s t go back u p s t a i r s again"; and "Well, i t ' s j u s t the way l i f e i s . I t ' s o n l y who you come i n t o c o n t a c t w i t h . W e l l , how people r e a c t t o you. Favourable o r not"..  The From  onset  o f mental i l l n e s s i s o f t e n an i n s i d i o u s p r o c e s s .  my c l i n i c a l experience, e a r l y warning s i g n s such as s o c i a l  withdrawal  and  interpersonal and  illicit  often  isolation,  relationships,  family,  words,  mentally  marginal.  In  through  poor alcohol  in  and/or  friends,  and  dismissed  social  network.  by  the  I n other  i l l i n d i v i d u a l s ' premorbid p s y c h o s o c i a l  retrospect,  may  be  considered  at  best  sum then, i n d i v i d u a l s w i t h mental i l l n e s s o f t e n l a c k the  skills  and  the  necessary  capacity  to  cope  to  develop  effectively.  the s o c i a l and l i f e They a l s o  experience  d i f f i c u l t i e s i n communicating w i t h t h e i r f a m i l y , f r i e n d s ,  social feelings  network, and c a r e g i v e r s .  The i n a b i l i t y t o express  their  and t h e i r needs can be s t r e s s f u l , and i n t u r n , c r e a t e s  estrangement social  skills,  T h i s i s f u r t h e r exacerbated by the d i s e a s e p r o c e s s .  motivation  great  self-medication  tolerated,  individual's  functioning,  coping  drug use, an i n a b i l i t y t o m a i n t a i n employment, a r e  overlooked,  many  poor  and  competence  encourages alienates  s o c i a l withdrawal. them  and  fosters  T h e i r l a c k of a  sense  of  - 65 helplessness them  all  which  the  illness.  compromises  more  All  t h e i r q u a l i t y of l i f e ,  vulnerable  the  to  mentally i l l  another  relapse  o f f e n d e r s who  leaving of  their  participated  in  t h i s study gave evidence of t h i s p r o c e s s .  (ii)  correctional  In  review  researcher's some  personnel  of the  identification  further  elaboration  p r o c e s s by which the  At  the  time  place within 1.  A  findings, of  to  the  alienation  as of the  conducted i s  a major  the  issue,  study and  the  required.  study, a number of changes were  the c o r r e c t i o n a l noticeable  p a r t i c u l a r l y i n view of  on the c o n t e x t  study was  of the  and  taking  facility.  l o s s of s e n i o r  provincial  c o r r e c t i o n a l s t a f f members  government's  early  retirement  program; r e s u l t i n g i n  2.  a high s t a f f turnover;  3.  an  increased  use  and  of a u x i l i a r y o n - c a l l a u x i l i a r y s t a f f  members. In  addition,  the  P r o v i n c i a l C o r r e c t i o n s Branch was  its  long term p l a n of  the  systematic  Regional  'regionalization'.  closing  Correctional  down Centre  of and  the the  working  Regionalization  on  meant  e x i s t i n g Lower Mainland development of  smaller  - 66 local  correctional centres.  informal  discussions  and  As w i t h any major r e - o r g a n i z a t i o n ,  'rumors' were rampant and t h e r e was  a  sense of u n c e r t a i n t y i n the a i r .  Although before, great  I  have  d e a l of time was It  management  (See  that  useful  study  of  as  the a  that  Care  Centre  the  staff  approval  from  t o c a r r y out the  t h a t I was In to  the  the  r e s e a r c h e r wore two  hats;  field. staff  The  'student'  members  The  researcher  to  role  share  their  'professional' role to  be  was  supportive  was and  some of the d i s t r u s t on the p a r t of Even  then, a l o t of e f f o r t  the s t a f f members of t h e i r anonymity.  was The  a S o c i a l Worker meant t h a t I remained a suspect order t o o b t a i n the data f o r my  some I  The  the o t h e r , of an i n d i v i d u a l w i t h  the  personnel.  assure  some.  in  minimized  correctional  occasions,  formal  r e q u i r e d i f I was  researcher.  allowed  which  to  and  encouraged  it  empathic,  required  a  a  E s s e n t i a l l y , the a u t h o r i z a t i o n  researcher.  student  with  as  concede  Health  w i t h the l e a s t amount of s u s p i c i o n and  expertise it  knowledge useful  apparent  Appendix F) was  to  professional  to  the  gave s t a f f members the formal p e r m i s s i o n t o d i s c l o s e  information  fact  at  spent on engaging the c o r r e c t i o n a l  degree of c o o p e r a t i o n .  memorandum  the  became  research  greatest  one  time  and the s t a f f had g e n e r a l l y been f r i e n d l y towards me,  members.  the  spent  was  i n t e r v i e w s without sworn  to  study, I had  a tape r e c o r d e r and on  to two  s e c r e c y and had t o promise t h a t I  would not share the i n f o r m a t i o n w i t h the  'nursing  staff.  - 67 The  physical  custodial their  structure  of  the nature of  work demand t h a t the c o r r e c t i o n a l p e r s o n n e l remain at  work  sites.  Therefore,  separated.  For example, one  front  two  gate,  office  the b u i l d i n g and  who  is  i n the  monitor  the  one  i n the basement who  of others who  What  became  correctional  information  and  sharing.  were  two,  two  the  adjoining upstairs  f o u r , f i v e and s i x , a couple  escorts.  apparent  and  i n the  monitors the work program, and  personnel  professionals,  f o r U n i t s one  inmates from U n i t s t h r e e ,  serve as  they  s t a f f member i s p o s i t i o n e d by  ' c o n t r o l c e n t r e ' , one  responsible  who  geographically,  the For  was from  t h a t the p h y s i c a l s e p a r a t i o n of one's  peers,  inmates, discouraged  the  health  communication  care and  example,  "Their f i l e s are s c a t t e r e d i n f o u r d i f f e r e n t places. I don't know what the problem i s " ; "Sometimes, an inmate would ask me about what's out there f o r them, I don't know what to t e l l them. I know t h e r e ' s a Red Book, and put together a resource book, but they're kept i n the n u r s i n g o f f i c e , I think. I haven't seen i t f o r a long time, we should have one up here"; and "We don't even have other between r e l i e f " .  In of  short,  the  experience  of  t o t a l k to each  the l a c k of r e c i p r o c a l exchange l e d , i n the case  correctional  psychological  time  personnel,  divisiveness, the  mentally  and ill.  to  the  alienation,  development not  What occurred  unlike was  that  of the the  - 68 correctional distance  personnel  withdrew  i n t o t h e i r own  allowed them t o become detached.  insulated  themselves  Regulations  of  the  by  strictly  facility.  'camp' and the  Some of them f u r t h e r  adhering  to  the Rules and  T h i s i s b e s t i l l u s t r a t e d by the  f o l l o w i n g comments: "Our p r i o r i t y i s s e c u r i t y " ;  and  "The correctional perspective i s the f i n a l p e r s p e c t i v e " ; and t o a l e s s e r degree, "It's a good t h i n g we have some d i s c r e t i o n , or e l s e every time we t u r n around t h e y ' l l be charged w i t h something".  In  the  personnel mentally were  process  can  be  and  withdrawal  then,  the  correctional  deemed t o have a l i e n a t e d themselves from the  i l l inmates.  fears  of  And as the 'gap' widened, what emerged  frustrations  sense of p o w e r l e s s n e s s .  towards  There are many  t h i s group as w e l l as a examples:  "I don't know enough t o know i f t h e y ' r e s i c k or i f t h e y ' r e cons....I can't t a l k t o them the same way". "I don't know what t o expect! can be q u i t e u n p r e d i c t a b l e " ; "This poor. area";  These guys  group's hygiene i s generally very They don't take care of t h e i r l i v i n g  "I'm not l i k e you, I don't know why t h e y ' r e the way they a r e " ; and "They make working here dangerous. I'm more concerned w i t h my own s a f e t y . As f a r as I'm concerned, the c o r r e c t i o n a l o f f i c e r s are put at r i s k " .  - 69 How  the  fears  and  frustrations  of  the  correctional  personnel  impact on the m e n t a l l y i l l inmates i s c a p t u r e d i n the  following  comment  made  by  one  of  the  participants  i n the  m e n t a l l y i l l o f f e n d e r group: "They make fun of me. People. They laugh at me a t O a k a l l a . I p r e f e r the o l d guards 'cos t h e y ' r e good t o me. They g i v e me tobacco, they leave me alone. The new guards, sometimes they make f u n of me. Is i t wrong t o hear v o i c e s ? "  by  Also,  some  their  sense  unable  to  of of  create  the c o r r e c t i o n a l p e r s o n n e l f e l t overwhelmed powerlessness positive  and  changes.  helplessness  and  felt  T h i s i s e v i d e n t i n the  following: "These guys don't belong here, but they keep coming back!"; "I'd l o v e t o be a b l e t o do more than j u s t this, but i f t h e r e ' s not enough s t a f f , i t ' s j u s t no way"; "I'd like to be involved with programming....I would enjoy i t but problem i s the l a c k of s t a f f " ;  the the  "I've asked f o r t r a i n i n g b e f o r e , but I won't do i t on my own time"; and "What you syndrome. before!"  Based that to  the the  on  the  see here i s the r e v o l v i n g door A l o t of guys have been here  information  I have gathered, i t i s apparent  t r a i n i n g of c o r r e c t i o n a l p e r s o n n e l i s l a r g e l y Rules  limited  and R e g u l a t i o n s of the C o r r e c t i o n s F a c i l i t y Act,  and  the  various  maintain issue  order  of  address  70  -  s e c u r i t y measures and procedures and  control.  psychopathology  a v a i l a b l e to  The b a s i c t r a i n i n g speaks t o the  t o a v e r y s m a l l e x t e n t , and does not  the nature of mental i l l n e s s , the s i g n s and symptoms of  mental  illness,  or  how  to  ill.  It  is  not  mentally knowledge  in  this  deal  more  effectively  with  the  s u r p r i s i n g then, t h a t the l a c k of  area  would  rapidly  lead  to  fears,  f r u s t r a t i o n s and disengagement.  Isolated, compelled routine  to  use  less  environment resistance learn  correctional  personnel  naturally  feel  what s k i l l s they do have t o make t h e i r  daily  threatening.  would  Moreover,  the  correctional  becomes f e r t i l e ground t o breed resentment, p a s s i v e and  more  alienation  information  or  when  expressions  to  try  out  of m o t i v a t i o n to  different skills  are  d i s c o u r a g e d or c u r t a i l e d .  ( i i i ) h e a l t h care p r o f e s s i o n a l s  Again, into  i n c o n s i d e r i n g the f i n d i n g s , i t i s necessary t o take  account  to generate  At occurred of  the  the  context  of  the  study and the p r o c e s s used  the d a t a .  time  of  the  study,  the  one  major  f o r the h e a l t h care p r o f e s s i o n a l s was  o p e r a t i o n were c u t back from a twenty-four  change t h a t  t h a t t h e i r hours hour s e r v i c e t o a  - 71 seven  a.m.  t o e l e v e n p.m.  schedule.  T h i s l o s s of working  hours  resulted i n :  In  1)  a cut-back of s t a f f i n g ;  2)  an i n c r e a s e i n work l o a d ; and  3)  fewer o p p o r t u n i t i e s f o r communication.  addition,  there  'regionalization' the  was  an  might  Provincial  anticipation  that  the  plan  of  mean t h a t the h e a l t h c a r e component of  Corrections  Branch  would  be  c o n t r a c t e d out.  Again, t h e r e was a sense of u n c e r t a i n t y i n the a i r .  My the  presence  perceived  They  were  able  such  as  to  me  aware  inmates,  were  was  H e a l t h Care Centre was g r e a t l y welcomed by  h e a l t h c a r e p r o f e s s i o n a l s f o r one primary reason.  they  ill  at  I  to  to  That i s ,  be a r e s o u r c e f o r them, and t h e i r  peer.  t h a t I was f a m i l i a r w i t h many of the m e n t a l l y was  a b l e t o share i n f o r m a t i o n w i t h them, they  consult  discharge  with  planning,  me f o r i d e a s on management i s s u e s community r e s o u r c e s , e t c . , and I  able t o spend time w i t h the inmates when they were not a b l e do  so.  activities  Whenever and  they  possible,  they  involved  me  i n their  paved the way t o make i t e a s i e r f o r me t o  conduct my r e s e a r c h .  The  nursing  building. both  of  activities  office  Adjacent which of  were the  to  is  located  on  the main f l o o r of the  t h i s i s the m e d i c a l examination  room,  q u i t e e n c l o s e d , away from the r e s t of the facility.  Contacts w i t h the c o r r e c t i o n a l  - 72  personnel  were l a r g e l y l i m i t e d t o a p u b l i c announcement system,  when  inmates  when  the  were e s c o r t e d t o and from the n u r s i n g o f f i c e ,  nursing  to dispense  While  there  is  from is  there  personnel  and  following  comment  who  s t a f f was  and  e s c o r t e d through the v a r i o u s u n i t s  medication.  professionals office,  -  no  p h y s i c a l s e p a r a t i o n of the h e a l t h care  their a  peers  as  there i s o n l y one n u r s i n g  p h y s i c a l s e p a r a t i o n from the c o r r e c t i o n a l  the inmates.  A case i n p o i n t i s p r o v i d e d i n the  made by one of the h e a l t h care p r o f e s s i o n a l s  participated i n this  study:  "I don't work w i t h the c o r r e c t i o n a l s t a f f . I have very l i t t l e d e a l i n g s w i t h them".  An one ill  even  more  participant  poignant who  was  example was  an o b s e r v a t i o n made by  working i n the community w i t h m e n t a l l y  o f f e n d e r s a t the time of the i n t e r v i e w s : "The o n l y a t t e n t i o n people get i s when they have medication, o r , i f they have a m e d i c a l problem. Otherwise they don't get any attention at a l l " .  Again, and  the  insulated  the d i s t a n c e turned i n t o a p s y c h o l o g i c a l detachment, health from  inmates.  In  withdraw  into  care p r o f e s s i o n a l s , as a group, can be seen the c o r r e c t i o n a l p e r s o n n e l and the m e n t a l l y the  process,  they  can  become  frustrated  as ill and  t h e i r framework of r e f e r e n c e , the medical model.  - 73 For example: "All  I do i s paper work, not p a t i e n t c a r e ! " ;  "I'd l o v e t o spend more time t a l k i n g to these guys, but I have too much paper work to do"; and "I work i n a p l a c e t h a t i s p h i l o s o p h i c a l l y against r e h a b i l i t a t i o n " .  Frustrations powerlessness.  turn This  into is  detachment illustrated  and in  a the  examples: "I was trained as a RN, not a p s y c h i a t r i c nurse...I don't know t h a t s t u f f very w e l l . I o n l y took one course i n p s y c h i a t r y and t h a t was a long time ago"; "I t h i n k the [ c o r r e c t i o n a l ] s t a f f who d e a l with these guys on a day t o day b a s i s should get more t r a i n i n g . They don't have any and some of the ways they handle these guys are, are abysmal! I take the time to t e l l them sometimes, but i t ' s not my job"; "There's no s o c i a l work s t a f f u n f o r t u n a t e l y who c o u l d c o o r d i n a t e d i s c h a r g e p l a n n i n g and so many other t h i n g s f o r the mentally ill...There should be o n - s i t e s o c i a l workers whom I can l i a i s e w i t h , h e l p f o r housing and f o l l o w - u p and s t u f f l i k e t h a t " ; "The impression I get i s t h a t they [the mentally i l l ] are c h r o n i c a l l y n e u t r a l about everything....It's like they are fighting against this condition that's a p s y c h o l o g i c a l vacuum t h a t sucks a l l the l i f e out"; and "sometimes when I see the way they [correctional s t a f f ] handle them [mentally ill inmates]...they treat them l i k e the other guys and they're not! And then they get upset because they don't respond the way they should".  sense  of  following  - 74 The  degree  health  care  explored  of  estrangement  professionals  and  and  alienation  between  the  the c o r r e c t i o n a l p e r s o n n e l was  by a s e n i o r c o r r e c t i o n a l s t a f f member who p a r t i c i p a t e d  i n t h i s study.  He s t a t e s :  "As a general statement, yes, there are t e n s i o n s between the c o r r e c t i o n a l s e c u r i t y officer's view of how t h i n g s should operate as compared t o the nurses.... i t does take awhile t o work through t h a t understanding, and basically the use of a u t h o r i t y and power...Until he or she has made t h a t accommodation to be a b l e t o use t h a t a u t h o r i t y w e l l , t h e r e may be an a c c e l e r a t i o n or an i n c r e a s e of those kinds of t e n s i o n s " .  Based the  amount  have  to  the  of  i n f o r m a t i o n I have gathered,  formal  i n the area  training a  on  took  varying  of  insulation,  and the  For  some, t h e i r  N a t u r a l l y , t h i s would l e a d t o  The o p p o r t u n i t y t o communicate and share  i s compromised  work,  varies.  of f e a r s , f r u s t r a t i o n s , and s t r i c t adherence  the m e d i c a l model.  paper  the h e a l t h care p r o f e s s i o n a l s  psychiatry  p l a c e on the j o b .  degree  information  training  i t appears t h a t  i n turn, sense  of  by  the demand  perpetuates  and the burden of  the d e t a c h m e n t ,  powerlessness,  and  the sense  the of  a l i e n a t i o n a l r e a d y remarked upon.  DISCUSSION In  summary  between  then, common threads of meaning were d i s c o v e r e d  the t h r e e  offenders, professionals.  groups  correctional  of  participants  personnel,  and  -  mentally i l l health  care  Through the process of content a n a l y s i s emerged  -  as  a  major  theme  estrangement,  and  precipitating what  is  process  alienation.  detachment,  insulation,  important  for  the  one  another;  -  A l i e n a t i o n i s c h a r a c t e r i z e d by  separation,  isolation.  factors,  with  75  and  is  which  t h r e e groups, in  Although  the  distance,  causes,  the  u l t i m a t e l y the s o l u t i o n s may vary,  that  we  withdrawal,  the  p e r s o n a l experiences and the  d e a l w i t h these e x p e r i e n c e s , are a l i k e and t h e r e f o r e can be presumed t o support  other  words,  to  r e i n f o r c e the p a t h o l o g i c a l  processes a l r e a d y a t work i n mental i l l n e s s .  I M B L I C A T I O H S OF T H E aLIEHATIOM FTHDIHG The  above  experienced personnel, in  this  findings  highlight  some  of  the  problems  by  the  mentally  and  the  h e a l t h c a r e p r o f e s s i o n a l s who p a r t i c i p a t e d  study.  The  i l l o f f e n d e r s , the c o r r e c t i o n a l  implications  with  respect  t o program  p l a n n i n g are many.  (i)  mentally i l l  Some to,  offenders  of the problems m e n t a l l y i l l  during,  and  subsequent  social  isolation,  denial  of  the  the  absence  inability  to  powerlessness  of  the  substance abuse, a m o t i v a t i o n ,  the l a c k of v o c a t i o n a l o p p o r t u n i t i e s ,  meaningful  obtain  prior  t o t h e i r term of imprisonment are  homelessness,  illness,  o f f e n d e r s encounter  interpersonal required  and a l i e n a t i o n .  relationships,  the  s e r v i c e s , and the sense of  Any  efforts  successfully quality  to  provide  re-integrate  of  life  programs.  would  Some  therefore  of  them  training,  awareness  management,  skills,  communications,  incorporates  the  relationships, development, name  a  occupational  programs,  resource substance  concept  money  seem t o demand a v a r i e t y of  are:  work  of  job  therapy,  search,  symptom  awareness and access, abuse  counselling  dual  diagnosis),  management,  recreation  assertiveness  few.  t h i s group w i t h the o p p o r t u n i t y t o  i n t o the community and improve t h e i r  pre-employment and  76 -  training,  life  (which  interpersonal and  leisure  and anger management, t o  Even more important however, i s t h a t the programs  must be designed: 1)  t o motivate;  2)  t o engage; and  3)  t o empower  this  group  rather  than  waiting  f o r them t o become motivated  spontaneously.  (ii)  service  Some  of  encounter access  providers  the  are:  problems a  information  geographical regarding  communication  amongst  peers,  approach  patient  care,  resources,  to  the  lack  the  group  of  service  separation, the  providers  the i n a b i l i t y t o  inmates,  the  lack  of  the l a c k of an i n t e r d i s c i p l i n a r y the  u n a v a i l a b i l i t y of  adequate  of knowledge base and t r a i n i n g , the sense  of i s o l a t i o n , and the l a c k of o r g a n i z a t i o n a l support.  - 77  Efforts expertise these  to and  central  the  intra-  approach  both  initial  address  contains  and where  and  work  effectively  social  would  of  the  to  be  and  Non-involvement  participants.  and  need f o r a  the  group  be  symptoms of personality  ill,  without  to  and how  to  compromising  wish t o c o n s i d e r  adding  A s o c i a l worker  c o n t r i b u t i o n s i n the areas of r e l e a s e  health  and  implementation,  and  the  care  professionals  and  the  Finally, successful, They  involved clearly  a  There must be  various  the m e n t a l l y  this  the  and  of mental i l l n e s s , how  and of  development  ownership.  helplessness  staff  t r a i n i n g t h a t would  t o the o r g a n i z a t i o n .  personnel.  implementation  the  p o s i t i v e and negative  with  position  program  correctional  resource  in-service  needs  significant  'bridging'  of  the  unique  work  planning,  sense  and  In a d d i t i o n , management may  offer  the  a l l the i n f o r m a t i o n r e g a r d i n g  illnesses  the  a  address  the nature  recognize  disorders,  security.  would  i n f o r m a t i o n can be shared.  mental  more  of  i n t e r - p r o f e s s i o n a l communication,  following:  major  use  c o u l d promote the development of a  This  orientation  the  identify  facility  that  team  optimum  For example, a r e d e s i g n of the p h y s i c a l  community.  area  inmates,  the  areas.  of  therapeutic  the  the development of job s a t i s f a c t i o n must address  problem  structure  facilitate  -  must and  be  for  changes  staff be  members  viewed  consulted  contributes  to  and  must have a  as an i n the the  program  important process.  feelings  d e s p a i r g r a p h i c a l l y d e s c r i b e d by the  of  research  - 78 II.  O r g a n i z a t i o n a l Commitment A  second major f i n d i n g t h a t emerged from t h i s study f o r the  researcher  is  the  evidence  commitment  in  providing  of  a  lack  services  for  of  organizational  the  mentally i l l  p o p u l a t i o n w i t h i n the c o r r e c t i o n a l h e a l t h care s e t t i n g .  Commitment, Dictionary, compelled  as  is to  engagement  defined  the do  state  of  programs  in were  conducted.  They group,  group,  an  study  of  an  the with  It  is  the  w i l l and  drug  'leaders'  who  inmates part  Collegiate emotionally  agreement  and  I t c o n t a i n s two  included  a  and  drug  the a c t .  work  (See Chapter 2 ) , a number  program,  treatment  case  an  group, and  management  program  of  treatment  who  was  alcoholics  a  skills  research from  the  t o l e a r n about  'mechanics' of these programs.  attended  were  the  equally  a v a i l a b l e d u r i n g the time when the study  as w e l l as the  and  addition,  being o b l i g a t e d and  an e a r l i e r chapter  intensive  researcher  the  The  New  E f f o r t s were made by the r e s e a r c h e r  the content  alcohol  Webster's  a s p i r i t u a l guidance program, a s o c i a l  alcohol  community.  The  the  t o assume a r e s p o n s i b i l i t y .  stated  anonymous  of  something.  important dimensions.  As  in  some of the s o c i a l s k i l l s , and groups.  Informal  interviews  i n v o l v e d as w e l l as formal attended  them  the i n f o r m a l and  were  the with  interviews  conducted.  formal i n t e r v i e w s w i t h  In the  - 79 service of  p r o v i d e r s focused on the d e s i r a b i l i t y and the  viability  these programs.  What the  became  'leaders'  evident of  agencies.  the  The  Corrections Regional  groups  contract  Branch  were  were  c o n t r a c t o r s from e x t e r n a l  agreements  Centre,  The  that  with  the  Provincial  intended f o r the whole Lower Mainland  Correctional  notwithstanding. with  from the i n f o r m a l i n t e r v i e w s was  the  Health  were  experienced i n working  offenders  or inmates w i t h mental  'leaders'  offenders/inmates,  not  Care  Centre  illness.  Informal to  interviews  with  the s e r v i c e p r o v i d e r s , i n d i c a t e d  the r e s e a r c h e r t h a t there was  programs.  This  knowledge when  of  they  inmates  could  occur,  only  and  attending.  these  awareness of these  demonstrated by the p a r t i c i p a n t s ' l a c k of  the groups'  were  although  is  very l i t t l e  programs  accommodate  e x i s t e n c e , t h e i r l a c k of knowledge of  their  lack  of  knowledge  Furthermore,  i t was  a consensus t h a t  might be u s e f u l f o r the inmates, the  inmates'  following  professional reality  of  who  observation,  participated  made  in  the  by  He  states:  a  study,  program d e s i g n and implementation  Care Centre q u i t e a c c u r a t e l y .  they  participation providing  t h e r e were enough s t a f f members a v a i l a b l e t o ensure  The  as t o which  security.  health  care  summarizes the  w i t h i n the H e a l t h  - 80 "every now and then, I t h i n k they have had programs...they seem t o be s p o r a d i c , no one is q u i t e sure when i t ' s gonna happen or i f they happen. They seem t o happen f o r a month or two and then they stop, and then they happen a g a i n a couple months l a t e r . I assume t h a t t h a t ' s because they c o n t r a c t these jobs out. T h e y ' l l work f o r awhile, and then t h e i r c o n t r a c t would run out. Then they'd start out a g a i n . Someone e l s e w i l l start another one. There doesn't seem t o be any s u s t a i n e d program, and the people are sitting t h e r e doing time, hour a f t e r hour, w i t h v e r y l i t t l e t o do".  To  be  revealed these  fair, a  interviews  relatively  programs.  with  positive  They  can  be  the  mentally  i l l inmates  a t t i t u d e and response towards summarized  by  the f o l l o w i n g  comments: "I was g l a d t o know t h a t people c a r e , and that other people had the same problems. Actually, I looked forward t o going...I wish it was longer. I t h i n k they should have more of t h a t , more programs l i k e t h a t " ; and "We need more programs t o h e l p us. Here's a lot of people who are i n a l o t of t r o u b l e t h a t want t o get s t r a i g h t e n e d out. They just need some h e l p . I t ' l l get the time go by f a s t e r t o o " .  The the  discrepancy  expressed  between the l a c k of s u s t a i n e d programs and  interest  in  participating  in  programs by the  mentally  i l l o f f e n d e r s can be b e t t e r understood i n the c o n t e x t  of  following  the  official  and  a  comments  senior  p a r t i c i p a t e d i n the study.  made  by  a  senior  correctional  h e a l t h c a r e p r o f e s s i o n a l , both of whom They are as f o l l o w s :  - 81 "The jail environment, over the l a s t y e a r s , have not been program development o r attempting to treat. So p r o v i d i n g the s t r u c t u r e program t h a t has treatment as one of the g o a l s , C o r r e c t i o n s j u s t hasn't been conducive t o t h a t " [ s i c ] ; " C o r r e c t i o n s do not see themselves as a hospital t r e a t i n g p s y c h i a t r i c p a t i e n t s . So, to say I want t o d e s i g n some s o r t of treatment program f o r p s y c h i a t r i c p a t i e n t s , I think, runs c o n t r a r y t o what they see themselves as"; and "I think i t i s philosophically an i s s u e . It's e i t h e r a prison or i t ' s a hospital....1 mean, we can get i n t o a whole p e r s o n a l view of rehabilitation t o b e g i n w i t h . I mean, I t h i n k i t c o s t s us thousands of d o l l a r s more than i t should because we don't p r o p e r l y train people. I don't see why we can't train people. They s i t i n t h e i r cells twenty three hours at a time, doing nothing. I t doesn't make any sense, i t ' s r i d i c u l o u s . . . So, i f you're not gonna t r a i n them, i f you're not gonna t r e a t them, i f you're not gonna h e l p them w i t h j o b f i n d i n g or anything l i k e t h a t , i t ' s so simple i n i t s concept! There're so many people I see who can b e n e f i t so much from some type of j o b program, some j o b s e a r c h , t h a t they can benefit from or look forward t o when they get out. Not everyone i n prison i s hopeless. Not i n our eyes anyways. I work in a place that i s p h i l o s o p h i c a l l y against rehabilitation".  In  summary  Mainland to  Regional  t h e i r inmates.  part the  then,  of  the  mentally  useful  and  the  Health  Correctional  Care  Centre  of  the Lower  Centre d i d o f f e r some programs  However, these programs were not an i n t e g r a l  f a c i l i t y , nor were they designed s p e c i f i c a l l y f o r i l l population.  were  appreciated  Although they were found t o be by the m e n t a l l y i l l  inmates, the  - 82 'ad  hoc  issues such  nature  1  f o r the programs  pervasive  sense  commitment the  needs  programs  r a i s e d some very  plays  alienation  the  important  The primary one was how the way  implemented of  of to  the  researcher.  are  participants  to  of  a r o l e i n f o s t e r i n g the  expressed  study.  Also,  by  the  the  various  organizational  the a c t of p r o v i d i n g s e r v i c e s t h a t a r e s e n s i t i v e of  the  mentally  i l l i s clearly  unsystematic,  haphazard, and v u l n e r a b l e .  DiscassiQH All Branch,  formal are  organizations  guided  by  statement  indicates  goal  conveys  and  provides over and  the the  such  B.C.  Corrections  t h e i r m i s s i o n statements.  The m i s s i o n  guiding  as  the  philosophy  organization's  or superordinate  overall  purposes.  It  a framework t h a t lends " c o n t i n u i t y t o the o r g a n i z a t i o n  time the  by s e r v i n g as a f o c a l p o i n t f o r s t r a t e g y application  of  individual  and  group  formulation  work e f f o r t s "  (Schermerhorn, 1984, p.150).  In  their  (Queen's  Printer,  identifies  one  sentences are  Beliefs,  based  on  the  purposes  1986),  and  Strategies  by  the courts. principles.  deterrence,  publication  the B.C. C o r r e c t i o n s Branch  i t s primary mandates as:  five  rehabilitation, For  revised  of  imposed  Goals,  to c a r r y out the  I t i s s t a t e d t h a t sentences They  are:  incapacitation,  and  retribution, reparation.  of t h i s paper, the f o l l o w i n g d i s c u s s i o n w i l l  focus on the p r i n c i p l e of r e h a b i l i t a t i o n  only.  - 83 As  stated  in  their  document, one of the mandates of  B.C.  C o r r e c t i o n s Branch i s t o p r o v i d e sentenced o f f e n d e r s : "reasonable opportunity f o r p o s i t i v e and constructive a c t i v i t i e s within operational and r e s o u r c e l i m i t a t i o n s and c o n s i d e r a t i o n for the protection of the public... correctional programs [should] provide opportunities for work, social, e d u c a t i o n a l , and r e c r e a t i o n a l a c t i v i t i e s and spiritual development. Offenders are  encouraged  to  take  advantage  of  these  opportunities....When o f f e n d e r s admitted t o c o r r e c t i o n a l programs r e q u i r e treatment f o r medical, physical, or psychological problems, the branch p r o v i d e s a p p r o p r i a t e treatment or makes community health resources available t o them. Although rehabilitation does occur within c o r r e c t i o n a l programs, the programs alone cannot rehabilitate offenders. While programs can encourage behavioral change,  rehabilitation  is  the  responsibility  offenders themselves"(my emphasis)(pp.5-6).  Opportunity, Dictionary, Chance or  as  is  is  a  of  d e f i n e d i n the L i v i n g Webster E n c y c l o p e d i c or f a v o r a b l e p o s i t i o n or chance.  convenient  d e f i n e d as an event o c c u r r i n g without apparent cause  control;  a  purposeless  cause  of unexpected happenings; a  possible or probable occurrence.  According rehabilitation by  the  titled  to  itself. influence  paper Works 1  Although on  (1989),  the  demise  of  the  concept w i t h i n c o r r e c t i o n a l s e r v i c e s was sparked  infamous Nothing  Cormier  the  written The  this Canadian  by  Robert  M a r t i n s o n i n 1974  t i t l e of t h i s a r t i c l e speaks f o r  was  an  American  Correctional  publication,  its  system was profound.  - 84 Thus,  Cormier  states:  -  " I r o n i c a l l y , Martinson's c o n t r o v e r s i a l  article  appeared at a time when r e h a b i l i t a t i o n was  b e g i n n i n g to  occupy  a  Penitentiary  Service"  stronger (Cormier,  Corrections  1989,  Agency  'rehabilitation model'.  position  in  p.7).  Task  model'  be  the By  Canadian  1977,  Force  the Canadian  recommended  replaced  by  the  Federal  that  the  'opportunities  That i s , the c o r r e c t i o n a l system would "provide c o r r e c t i o n a l o p p o r t u n i t i e s designed to a s s i s t the o f f e n d e r i n the development of daily l i v i n g s k i l l s , confidence to cope w i t h his p e r s o n a l problems and s o c i a l environment and the capacity to adopt more acceptable conduct norms" ( I b i d , p.30).  The policy, of  B.C.  Corrections  procedures,  values  Branch maintains t h a t t h e i r program,  and  and b e l i e f s .  s e r v i c e s rendered are guided by a s e t Included  i n t h e i r s e t of b e l i e f s i s the  p r o v i s i o n of "opportunities f o r inmate recreation, life-skills development t h a t  work, and  education, spiritual  a)  encourage responsible decision-making; and  b)  contribute positively to the individual's q u a l i t y of life, to the branch, and to the community" (p.10).  Furthermore, "availability comparable  to  it  of  responsible  medical,  those  emphasis) ( I b i d ) .  is  dental,  generally  for and  available  personal,  the assurance of psychiatric to  the  services  the p u b l i c "  (my  - 85 Essentially, model  had  l e d to  correctional initiative  the disenchantment a  shift  services. of  the  i n the g o a l s  Emphasis  individual  with  inmates  of our p r o v i n c i a l  i s placed to  rehabilitation  take  on t h e p e r s o n a l advantage  ofthe  o p p o r t u n i t i e s made a v a i l a b l e t o them.  As  observed  development within or  by s e v e r a l p a r t i c i p a n t s of t h i s study, program  f o r mentally  ill  o f f e n d e r s has not been a p r i o r i t y  the P r o v i n c i a l C o r r e c t i o n s Branch d u r i n g t h e p a s t decade  more.  Other  constraints; nature  of  mentally system;  contributing  the h e t e r o g e n e i t y mental  illness  i l l individuals a l l play  factors of  and  of  who  of  ill  may  offenders.  with  the m e n t a l l y  provided  with  the necessary  When  consulted  i n program  of  programs  reviewed  offenders.  and  programs  managed  by  outside  or may not be f u l l y o r i e n t e d t o the needs  interact  possibility  i n the c o r r e c t i o n a l  an a c t i v e r o l e i n d i s c o u r a g i n g t h e p r o v i s i o n  time-limited  contractors  not  that  a l l these f a c t o r s t r a n s l a t e i n t o the i n t r o d u c t i o n  sporadic,  mentally  the sentiment  not belong  of p s y c h i a t r i c s e r v i c e s t o m e n t a l l y i l l  Together,  as: the f i s c a l  the inmate p o p u l a t i o n ; the  itself; do  such  developing implemented  evaluated  When the e x i s t i n g s t a f f members who i l l offender  the most  are not  t r a i n i n g , a r e not i n v o l v e d and a r e development and implementation, t h e a  therapeutic m i l i e u i s precluded.  by  outside  contractors  a r e not  f o r t h e i r r e l e v a n c y , and e f f i c a c y , t h e  - 86 contractors in  place  a r e not h e l d accountable.  There are no safeguards  t o ensure t h a t the c o n t r a c t o r s d e l i v e r t h e i r  ethically.  services  Furthermore, t i m e - l i m i t e d c o n t r a c t s do not command  commitment on the p a r t of the c o n t r a c t o r s .  When  programs  non-accountable, Correctional  one  unavailable,  is  Services  'opportunities mentally  are  have  model'  to  i l l offenders  with  taken  a  substandard  structured  and  implemented.  comparable  to  t h e sense  very  and/or  that  the  c l e a r departure from the  'on the off-chance  have  of  those  left  an  advantage  inaccessible,  model', where  s l i g h t hope of even t a k i n g  programs  that  are  haphazardly  To imply t h a t these s e r v i c e s a r e  a v a i l a b l e t o the g e n e r a l p u b l i c i s r a t h e r  alarming.  m P L I C M I O H S O F T H E QRGAMXZATXCnMAT. e X I M M X T J M K B F T Given  that  predominant the  the  guiding  'opportunities  philosophy  model'  FJJMUJLMO  i s the  of the B.C. C o r r e c t i o n s  stated Branch,  f o l l o w i n g s e c t i o n w i l l examine how t h i s model i s a p p l i e d a t  the  Health  Care  Correctional the m e n t a l l y  To offender Centre  Centre, ill  begin has while  Centre  of  the Lower  Mainland  Regional  w i t h s p e c i f i c focus on i t s a p p l i c a t i o n t o  population.  with,  i t could  the o p p o r t u n i t y serving  be  said  t h a t the m e n t a l l y  t o be p l a c e d i n the H e a l t h  the d u r a t i o n  of  the sentence.  ill Care  This,  - 87 however,  depends  Availability general of  on  is  whether  dependent  p o p u l a t i o n who  functioning  of  on  may  the  there the  to  obtain  basis.  will  other  mentally  mentally  ill  level  o f f e n d e r s , and  the  individual.  i l l offender  psychopharmacological  and  is  remain  benefit  has the  treatment  on  opportunity a  of  unable or u n w i l l i n g t o consent  dangerous  medical facility  Institute.  Meanwhile,  opportunity  to  be  scrutiny  the  fellow  Health  by  Care Centre. time  engaging  is  to  self  voluntary  such the  as  until  the  to  inmates,  treatment,  transferred  Forensic  mentally  subjected  to  and/or o t h e r s without  intervention  psychiatric  this  number of inmates from the  However, i f he becomes f l o r i d l y p s y c h o t i c , d e l u s i o n a l ,  paranoid, he  the  space a v a i l a b l e .  r e q u i r e medical a t t e n t i o n , the  c r i m i n a l j u s t i c e h i s t o r y of the  Secondly,  i s a bed  staff,  to  a  Psychiatric  i l l offender  the  the  has  humiliation  of  the open  and v i s i t o r s of the  I t should be noted here t h a t the inmate a t  usually  semi-naked,  partially  shackled,  i n ' c r e a t i v e ' a c t i v i t i e s such as smearing f e c e s on  and the  wall.  For  the  quiet  individual  who  opportunity  to  isolation. vulnerable  is  clinically  experience  These to  psychotics,  the  individuals  or  the  passively  depressed,  withdrawn  there  is  the  l o n e l y d i s e a s e or d y s p h o r i a i n have  the  opportunity  abuse and be preyed upon by other inmates.  to  be This  - 88 group  i s easily  overlooked  since  they  are  non-disruptive;  u n l e s s they attempt s u i c i d e , o f course.  For  the  medication the  mentally  or  whose  opportunity  minute  to  staff  member  The  mentally  advantage  does  find assist  that  him  in  "have too much paper work t o do". also  the  the o p p o r t u n i t y t o take staff  members as a  responsibility  for  his  i s p o s s i b l y t h e r a p e u t i c and encouraging  i l l offender.  the  has  correctional  personal  This  mentally  out  t a l k t o the n u r s i n g s t a f f as long as  not  take  rehabilitation. the  or  utilizing  to  i l l n e s s i s i n remission, there i s  see the p s y c h o l o g i s t f o r a t l e a s t a "three  i l l offender  of  resource  o f f e n d e r who i s e i t h e r s t a b i l i z e d on  mental  conversation",  the  for  ill  only  That i s , the o p p o r t u n i t y t o  resource person  that i s a v a i l a b l e to  s e t t i n g up l i n k a g e s w i t h the community knows as  much, or l e s s , than he does.  This the by  group  'work the  also  the o p p o r t u n i t y t o take advantage of  program' p r o v i d i n g t h a t t h e r e a r e p o s i t i o n s u n f i l l e d  non-mentally i l l  'security  concern',  offenders  who  opportunity look  has  forward  do  to  o f f e n d e r s , and the i n d i v i d u a l i s not a  and not  seek  has  have  some b a s i c s k i l l s . the necessary  Mentally  ill  experience have the  asylum i n t h e i r c e l l s and e a t , s l e e p , and  t o r e t u r n i n g t o the community w i t h l e s s  i n t h e i r a b i l i t i e s t o s u r v i v e , and w a i t .  confidence  - 89 As  all  system  receive  opportunity be  sentenced a  to  involved  leave  the f a c i l i t y ,  sense  of  the  completing they  a l l inmates have the the programs they  may  have the o p p o r t u n i t y to  f o r example, on a long weekend, and have no  they can o b t a i n b a s i c food and l o d g i n g s when most  Unlike  mentally  on  without  correctional  the s e r v i c e s are not a v a i l a b l e , or "what happens t e n minutes  later".  the  the p r o v i n c i a l  sentence,  Furthermore,  leave  of  of  determinate  in.  how  inmates  patients  i l l offenders  Health an  the  have  in  a  psychiatric  the o p p o r t u n i t y not t o remain i n  Care Centre v o l u n t a r i l y , or completing  out-patient basis.  opportunity  and without  to  facility,  the programs  Instead, m e n t a l l y i l l o f f e n d e r s have  r e t u r n t o the community more i l l prepared,  the b e n e f i t of  'release planning'.  SUMMARY  The inmates  basic are  minimal  premise of the rational  encouragement  services,  and  take  rehabilitation. an  inmate  who  may  and  important  features  our  chronic  and  social  to  purposeful take  personal  beings who  advantage  of  responsibility  only require  the  available for  their  T h i s model does not apply w e l l to the needs of  cognitive  contacts.  and  ' o p p o r t u n i t i e s model' i s t h a t the  be p s y c h i a t r i c a l l y impaired, w i t h p o s s i b l e  social deficits. of  mentally competence Their  In f a c t , i t n e g l e c t s some v e r y  their illness.  The  r e a l i t y i s , many of  i l l p a t i e n t s l a c k the p e r s o n a l c a p a c i t y to  seek  impoverishment  out or i n i t i a t e i n t e r p e r s o n a l leads  to l i m i t e d b e h a v i o r a l  - 90 repertoires,  social  exacerbation  of  that,  left  unable  psychiatric  to  to  their  thrive  Programs  that  efficacy,  isolation  own  symptoms.  One  not  emphasize  availability, At  and f i n a l l y  and  least  not  are  ' o p p o r t u n i t i e s model'.  consistency,  continuity,  accessibility for  the  can o n l y surmise  devices, mentally i l l offenders  or f l o u r i s h under the do  opportunities.  and withdrawal,  the  are  not  chronic mentally i l l  population.  III.  Where Do They Belong? A  third  researcher  theme  is  that  from  this  study  for  the  the q u e s t i o n of whether m e n t a l l y i l l i n d i v i d u a l s  belong i n the c o r r e c t i o n a l  Belong,  emerged  as  facility.  defined  in  the  Webster's  New  Collegiate  D i c t i o n a r y , i s t o be s u i t a b l e , a p p r o p r i a t e , o r advantageous.  Although experiences providers Regional belongs  this of  within  research mentally the  Correctional in  this  study's  i n t e n t was  i l l offenders  the  their  service  H e a l t h Care Centre of the Lower  Mainland  Centre,  facility  and  to explore  the i s s u e of whether t h i s group  at a l l was  r a i s e d by s e v e r a l of the  participants  of the study.  In other words, i s the  facility  advantageous,  or s u i t a b l e or an a p p r o p r i a t e p l a c e  for  an  the m e n t a l l y  ill?  correctional  - 91 -  (i)  mentally i l l  Consistent offenders  passivity  earlier  the be  milieu  in they  i n part  findings, this  serving  Furthermore, a  some,  dependent  were  themselves  in.  ill  rather Their  t o the nature o f t h e i r  some f e l t t h a t i t was p r e f e r a b l e t o be  d e f i n i t e sentence i n s t e a d of an i n d e t e r m i n a t e p e r i o d  was on  participant  This  perceived their  i s because d e t e n t i o n i n a h o s p i t a l to  be a r b i t r a r y , a d e c i s i o n t h a t i s  progress  or l e v e l of f u n c t i o n i n g .  As one  stated:  "I p r e f e r O a k a l l a because you're gonna get o u t " .  you  know  when  c o r r e c t i o n a l personnel  According mental they  mentally  r a t h e r than w i t h the stigma of b e i n g p s y c h i a t r i c a l l y  hospitalization.  (ii)  study  found  attributed  the  and t h e i r p r e f e r e n c e t o be a s s o c i a t e d w i t h the c r i m i n a l  impaired.  for  the  participated  to can  subculture  of  with  who  indifferent  illness  offenders  to  illnesses present  evidently  a  further  one  of  "do  not belong" i n a c o r r e c t i o n a l s e t t i n g as  risk  to  the  the  supported  participants,  staff  by  one  members.  i n d i v i d u a l s with  T h i s view i s  of h i s peer who made the  f o l l o w i n g comment: "These guys don't belong here, but they keep coming back!"  - 92 However, health  care  t h i s sentiment was  not shared by a l l .  professional  p a r t i c i p a t e d i n t h i s study made  who  A community  the f o l l o w i n g o b s e r v a t i o n : "Every now and then you run i n t o a guard who seems r e a l l y tired and worn out, and seems to t h i n k t h a t they really shouldn't be dealing with these people, and i f only mental h e a l t h would do t h e i r j o b , then they wouldn't have t o . But most of these guys I've run i n t o have p r e t t y w e l l r e s i g n e d t o the fact t h a t they have these guys t h e r e that are mentally i l l who are their responsibility and they j u s t want t o know more about i t " .  (iii)  h e a l t h care p r o f e s s i o n a l s  Most this of  of  the  h e a l t h care p r o f e s s i o n a l s who  participated i n  study accepted the f a c t t h a t t h e r e i s an i n c r e a s i n g number mentally  i l l individuals  correctional  facility.  advantageous,  suitable  most  part,  pragmatism  This  group  tends  within  the  The  are  being  issue  of  or a p p r o p r i a t e was prevails,  housed whether  not r a i s e d .  in  the  this  is  For the  a l b e i t w i t h some d i s c o m f o r t .  t o focus on p r o v i d i n g the b e s t p o s s i b l e care  confines  frustration  of  correctional  system  p r o f e s s i o n a l who  who  of  having was  the  limited  mentally articulated  resource.  However, the  i l l individuals by  p a r t i c i p a t e d i n t h i s study.  in  the  a s e n i o r h e a l t h care He  states:  "Somehow, the system has broken down v i a the Criminal Code...if someone i s a r r e s t e d by the p o l i c e or a r r e s t i n g p e r s o n n e l , e i t h e r friends or f a m i l y who suggest t h a t something is wrong w i t h them m e n t a l l y , they're t o have a psychiatric examination. They should go  - 93 before the c o u r t so t h a t a judge can d e c i d e whether or not the person may be m e n t a l l y ill and should be remanded f o r t h i r t y days at a psychiatric facility l i k e FPI. Well sometimes t h a t process doesn't happen! And so, the patient who i s m e n t a l l y ill, probably not even competent t o i n s t r u c t c o u n s e l , has a duty c o u n s e l who doesn't even know them, ends up i n the system, s o r t of c r a z y out of t h e i r mind. They go t h e r e t o Oakalla. I'm sure a l o t of cases a r e missed in the system. So the whole system, the whole C r i m i n a l Code, the whole t h i n g doesn't work! And then, t h e r e a r e those who a r e remanded, i n custody, who a r e m e n t a l l y i l l , awaiting for trial, same t h i n g ! . . . I don't think prison i s a place f o r psychotic patients. And I t h i n k i t ' s r i d i c u l o u s t h a t they are t h e r e . I t ' s not f a i r t o them, not fair t o the s t a f f . They should be t r e a t e d in a h o s p i t a l , an a p p r o p r i a t e h o s p i t a l , not prison....Most of them who a r e p s y c h o t i c probably should be found Not G u i l t y By Reason of I n s a n i t y anyways. Or they should have a d i f f e r e n t k i n d of sentence, o r should be diverted....Why they end up t h e r e , w i t h lengthy sentences, being c h r o n i c a l l y i l l , i s a failure of the system. P a r t of the problem i s t h a t some of these people don't want to be found NGRI...Now, the new C r i m i n a l Code i s gonna change t h a t . You're gonna g e t a determinate sentence even i f you're found NGRI...It would be d i f f e r e n t . I t may p i c k up some of them. At l e a s t maybe some of the defence c o u n s e l w i l l use i t a bit more....But i t ' s a p h i l o s o p h i c a l t h i n g , the major mental i l l n e s s e s , as f a r as I'm concerned has no p l a c e i n p r i s o n . . . . B u t right now, what's even worse, FPI i s jammed to the r a f t e r s . I have v e r y s i c k p a t i e n t s . It's like a p a t i e n t w i t h an acute abdominal problem who cannot go t o the h o s p i t a l f o r surgery. I've got these p a t i e n t s who a r e p s y c h o t i c , who hears v o i c e s , d e l u s i o n a l , who are out of t h e i r minds, c e r t i f i e d and sitting i n O a k a l l a and I can't t r e a t them 'cos I don't have a mental h e a l t h f a c i l i t y . Some of them i t ' s OK t o t r e a t them, but a lot of them can't g i v e consent t o treatment, and I've got nowhere t o put them. So they stay there. I t ' s criminal!...I need h o s p i t a l beds!"  - 94 In  summary  facility the  mentally  i l l was  correctional unlikely  met  of  whether the c o r r e c t i o n a l  with  a v a r i e t y of responses.  that  this  some  study  passively  of  individuals they  service  some p r e f e r e n c e f o r the ' f i n i t e '  system.  While  In  The  group  the  feels  them  providers,  they  the  existence  facility,  begrudgingly.  of  i t is  belong anywhere. i n this  the m e n t a l l y i l l  t h e i r comments i n d i c a t e Finally,  some of the  both c o r r e c t i o n a l p e r s o n n e l and h e a l t h  felt  in a  that  s e r v i c e p r o v i d e r s who p a r t i c i p a t e d  accepted  accept  nature of the  view of the e a r l i e r f i n d i n g s ,  i n a correctional  professionals, belong  issue  i l l group f o r the most p a r t , was i n d i f f e r e n t although  d i d voice  that  the  i s an advantageous, s u i t a b l e , or a p p r o p r i a t e p l a c e f o r  mentally  they  then,  very strongly  correctional  care  t h a t the m e n t a l l y i l l do not  facility.  Their  reasons f o r t h i s ,  however,  differ.  mentally  i l l evoke f e a r and f r u s t r a t i o n s , as i l l u s t r a t e d i n the  previous  findings.  threatens their beliefs. 1)  us.  For some of the c o r r e c t i o n a l p e r s o n n e l , the  Like  With r e s p e c t t o the h e a l t h  convictions  are  founded  on  a  t o r e j e c t what  care  professionals,  s e t of  philosophical  They can be summarized as f o l l o w s : the  belief  that  should r e c e i v e 2)  a l l o f us, i t i s e a s i e r  the  individuals  with  mental  illnesses  the b e s t a v a i l a b l e m e d i c a l treatment;  b e l i e f t h a t an i n d i v i d u a l who i s not a b l e t o f u l l y  appreciate omission receive  the  nature  o f , as  a  of  h i s or her a c t ( s ) , or the  r e s u l t of a mental i l l n e s s  treatment r a t h e r  than punishment; and  should  -  3)  the  belief  that  95  -  individuals  with  mental  illnesses  should r e c e i v e humane c a r e .  DISCDSSIOM  The  fact  formally of  endorsed  Canada,  Mental  that  or  Health  each  of  the  above  mentioned b e l i e f s  are  a t a p o l i c y l e v e l e i t h e r i n the C r i m i n a l Code  in  the  Deinstitutionalization  System,  r a i s e s t h r e e important  policy  of the  questions.  They  are: 1)  Why  is  there  a  noticeable  i n c r e a s e of a r r e s t r a t e s  among the m e n t a l l y i l l p o p u l a t i o n ? ;  2)  Why  are  individuals  sentenced  to  designated the  begin  regarding  facility  illnesses  instead  of a  suitable,  and  appropriate  medical  and  with,  the  individuals  is  correctional  mental  Which system should be i s r e s p o n s i b l e f o r t h i s group?  To  meet  major  p s y c h i a t r i c f a c i l i t y where they can r e c e i v e  necessary,  treatment?;  3)  a  with  there  change  available  are in  at  no  specific  arrest  t h i s time.  the r i g o r of s c i e n t i f i c r e s e a r c h . ample  earlier  information chapter,  in  that  the  rates  of  mentally i l l  At l e a s t none t h a t would Having s a i d t h a t , there  literature,  discusses  formal documents  the  as  reviewed  phenomenon  of  i n an the  - 96 criminalization  o f the  an  increase  in  the c r i m i n a l  draw  from  mentally i l l ,  suggesting t h a t  i n the number of m e n t a l l y i l l j u s t i c e system.  this  individuals  observation  are  simply  A possible  is  i n d i v i d u a l s who i n f e r e n c e one  engaging  i n more c r i m i n a l  a more c o m p e l l i n g e x p l a n a t i o n i s one  by  experts  arrest a  rates  poorly  i n the  field.  of m e n t a l l y i l l  implemented  Furthermore,  the  could  that  That i s , the  activities. i s supported  increase i n  the  i n d i v i d u a l s i s a d i r e c t r e s u l t of  social  provisions  are  t h a t p s y c h i a t r i c a l l y impaired  However, many  there i s  policy, within  Deinstitutionalization. our  Criminal  Code  lend  support to t h i s c r i m i n a l i z a t i o n p r o c e s s .  IMPLICaTiaNS O F T H E BETWEEN  STATED  Whether of  psychiatric  large  SOCIAL  one argues  calculated a  FIMDIHG  POLICIES  community.  Many of these  for  themselves,  unable  in  socially  is  the  (1987)  note:  idealism or  r e a l i t y remains t h a t t h e r e i s  or u n w i l l i n g  necessary s e r v i c e s  inappropriate  police  residing  in  ' e x - p a t i e n t s ' are unable t o care  and  to seek treatment, unable support, and  behaviors  i s becoming i n c r e a s i n g l y  demanding  on n a i v e  of i l l - p r e p a r e d p s y c h i a t r i c p a t i e n t s  the  access  A M D ACTUM. P R A C T I C E S  was founded  f i s c a l pragmatism, the  to  TJUCUMGHUKNCIES  t h a t the d e i n s t i t u t i o n a l i z a t i o n p o l i c y  patients  body  community  OH THE  more  are  engaging  noticeably.  The  i n t o l e r a n t of t h i s group  intervention.  As P r o g r e b i n  and  and  Poole  " P o l i c e departments have become the most u t i l i z e d  agencies f o r p s y c h i a t r i c r e f e r r a l i n our  society"  (p.119).  - 97 Consistent admission often  with  to  the  when  are  their  (Borzecki often  the  placing  mentally in  in  place  individual. The  by  t h i s process,  1985)  especially clinicians.  Consequently, p o l i c e  i l l individuals  the  local  jail.  from It  is  the  officials' and  community  by  assumed t h a t  the  would address the needs of the m e n t a l l y  ill  However, as Lang (1986) p o i n t s out  F o l l y of  Police  o n l y recourse i s to l a y c r i m i n a l charges  them  'system'  policy,  time-consuming.  are d i s p u t e d by p s y c h i a t r i c  Wormith,  their  and  discouraged  judgements  feel  remove  cumbersome,  often  and  Deinstitutionalization  l o c a l or p r o v i n c i a l p s y c h i a t r i c f a c i l i t i e s i s  difficult,  officials  the  -  i n her  article  Fitness:  "Paradoxically, a d o c t r i n e which o s t e n s i b l y exists for the protection of the m e n t a l l y disordered accused often works to his disadvantage" (p.221).  The fraught  current with  the  focus  who  are  to  stand  problems.  will  be  the  is  for  found not trial  is  who  had  'incarcerated' for  twenty  found  Not  years,  also  individuals  committing  in  Code are  i t e f f e c t s mentally i l l  publicized  was  Criminal  discussion,  perceived  snatcher'  the  the purposes of t h i s  nature  g u i l t y by  Widely  facility  For  'indefinite'  unfair.  been  within  on how  accused  Basically, accused  provisions  non-capital  offences.  of the d i s p o s i t i o n i f the  reason of i n s a n i t y and/or u n f i t t o be  excessive, a r b i t r a r y ,  h o r r o r s t o r i e s such as the G u i l t y By Reason Of the  backwards  generate  of  'purse  Insanity a  and  and  psychiatric  g r e a t r e l u c t a n c e on  the  -  part  of the accused  suffering as  from  -  t o r a i s e the i s s u e of whether he or she was  a mental d i s o r d e r a t the time of t h e o f f e n c e so  t o be exempt from c r i m i n a l r e s p o n s i b i l i t y .  has  probably  charged to  stand  was  raising  them  was subsequently  stories  of an i n d i v i d u a l unfit  d e t a i n e d f o r t h r e e years that  t o even p l a c e him  serve t o d e t e r accused persons  from  i s s u e of whether they were s u f f e r i n g from a mental  that  encourages  f a r exceeds the s t a t e d maximum p o s s i b l e the m e n t a l l y i l l accused  to avoid Section  the C r i m i n a l Code even though i t was designed t o p r o t e c t criminal  individual sentenced  may  responsibility.  prefer  to  to a correctional  There  can  individual primary  appropriate ill  story  r e t u r n e d t o the c o u r t when i t was determined  time  from  The  the  I n b r i e f , the f e a r t h a t one c o u l d be d e t a i n e d f o r a  of  of  and  Such  the  sentence  by  not s u f f i c i e n t a d m i s s i b l e evidence  disorder. period  generated  Equal r e l u c t a n c e  b r e a k i n g and e n t e r i n g o f f e n c e , was found  trial  trial.  16  a  being  there on  been  with  before  to  98  be  who  many  be  and  found  guilty  and  facility.  disadvantages  i s diverted  one  tried  Instead, the mentally i l l  f o r the m e n t a l l y i l l  i n t o the c r i m i n a l j u s t i c e system.  i s the l a c k of o p p o r t u n i t y f o r access t o the  and necessary treatment.  A l s o , the l a b e l  'mentally  o f f e n d e r ' weighs h e a v i l y a g a i n s t the i n d i v i d u a l , and access mental  difficult. more  health The  vulnerable,  process.  and  social  mentally  services  becomes  increasingly  i l l i n d i v i d u a l i s then l e f t a l l the  which i n t u r n perpetuates  the c r i m i n a l i z a t i o n  - 99 Understandably, received  much  practical  criticism  one  could  psychiatrically  can  that  a l l individuals  incarcerated regardless  on  one's  and  who are  not be processed through the  Instead,  who  and  philosophical  a l l individuals  they should be h o s p i t a l i z e d  r e c e i v e m e d i c a l treatment. behave  Others c o u l d argue  'illegally'  should  be  r e c e i v e the same o p p o r t u n i t i e s as a l l inmates  of t h e i r p s y c h i a t r i c impairment.  us  that  two  extreme b e l i e f s .  must  that  should  system.  they  i n i t s philosophical  Depending  impaired  justice  both  argue  where  It  -  implications.  beliefs,  criminal  the j u x t a p o s i t i o n of law and p s y c h i a t r y has  the best  Common sense t e l l s  s o l u t i o n can be found i n the balance of the  would  appear t h a t a reasonable and r e s p o n s i b l e s o l u t i o n  include  the p r o t e c t i o n of the p u b l i c and the p r o v i s i o n of  treatment  and  humane  care  debilitating  effects  documented.  Incarceration  skills  development  of  has  f o r the m e n t a l l y  incarceration without  no  any  therapeutic  have  i l l .  The  been  well  r e a l opportunity f o r value; but r a t h e r , i t  impedes the p o t e n t i a l f o r s u c c e s s f u l community r e i n t e g r a t i o n .  Part  of  the  libertarians  and  imprisonment  on  responsible clients.  and When  problem  defence behalf  counsel  i n the f a c t  that  civil  f r e q u e n t l y p r e f e r a term of  of t h e i r c l i e n t s r a t h e r than demanding  appropriate one  lies  examines  treatment  f o r t h e i r mentally i l l  the experiences of m e n t a l l y i l l  - 100 offenders  -  which  include  trans-institutionalization,  - i t i s evident  the  and  with  mental  Without  revolving  door  and  t h a t t h i s group i s not r e c e i v i n g  should  treatment  syndrome,  psychosocial  support t h a t meet t h e i r needs.  illnesses  such  the  homelessness,  impoverishment treatment  -  have  they  will  a  right  remain  Individuals  to  treatment.  disconnected  and  alienated.  We and  can a l l be p a r t of the s o l u t i o n . ethical  responsibility and  society  requires  as  as  well  accountability.  c i v i l i t y i s how  SUMMARY  AMD  This  the  of  began  personal  a l l , the  most important s i g n of  by  COHMEHT  presenting  a  brief  review  of  the  community  mental  policy.  health For  movement  and  many of our m e n t a l l y  its ill  d e i n s t i t u t i o n a l i z a t i o n meant the a d d i t i o n a l burden of  with  asylum.  assume  the North American mental h e a l t h system t h a t l e d t o  Deinstitutionalization  coping  we  demand a c o l l e c t i v e r e s p o n s i b i l i t y  After  COMCI.13DXBW3  current  patients,  that  a s o c i e t y t r e a t s i t s marginal members.  paper  history  A r e s p o n s i b l e , humane,  socio-economical  The  impoverishment  criminalization  of  the  and  mentally  the l a c k of ill  has  been  i d e n t i f i e d as a d i s t i n c t problem t h a t i s worthy of r e c o g n i t i o n .  A  study  experiences  was  undertaken  of  mentally  by  the r e s e a r c h e r  i l l offenders  and  t o look a t their  the  service  - 101 providers.  I t was  motivated  service  program  needs  and  correctional  setting.  by  the  for this  I t was  interest  to identify  s p e c i f i c group w i t h i n a  determined  that a q u a l i t a t i v e  r e s e a r c h d e s i g n would be most a p p r o p r i a t e t o achieve t h i s g o a l .  Three  primary  alienation,  themes emerged from the f i n d i n g s .  lack  incongruencies  of  between  organizational the  stated  commitment,  They are: and the  s o c i a l p o l i c i e s and a c t u a l  practices.  Efforts  the  of these t h r e e themes and a n a l y s i s of them l e d the  origins  were made by the r e s e a r c h e r t o understand  r e s e a r c h e r t o conclude  Although  some  hesitancy  to  the  that  fear  Information of  t h a t t h e problems are inter-dependent.  concrete  make  alternatives  were  presented, the  s p e c i f i c program recommendations stems from  the c e n t r a l i s s u e may g e t l o s t i n the p r o c e s s .  on programs t h a t a r e s e n s i t i v e t o the v a r y i n g needs  the m e n t a l l y i l l  are r e a d i l y a v a i l a b l e .  I t i s not necessary  t o r e - i n v e n t the wheel.  During our  the p a s t  local  collaboration mentally  few y e a r s , a number of i n d i v i d u a l s w i t h i n  agencies with  i l l offenders institutions.  efforts  are being Services,  organizations  have  worked  in  each o t h e r t o develop s p e c i f i c programs f o r  various  Health  and  -  both  i n the community and i n the  (See Appendix G)  In addition, d i s t i n c t  made i n t h e reform of the P r o v i n c i a l  Mental  the B.C. Mental H e a l t h A c t , and the C r i m i n a l  -  Code  of  Canada.  experienced these  by  All the  initiatives  programs  appear  the  actual  excellence  utmost  that  based  society  nothing  are  not  ill. more  changes would be  highly  our  policy  if  there  open  seduced  i s t h a t i n our p u r s u i t f o r  by  'quick  fixes'.  values  I t would  A v i s i o n that  of human d i g n i t y , mutual  to  t o the abandonment of  an  put  an end  obviously,  a  v i s i o n t h a t would g i v e  vision  academic e x e r c i s e . and  and  collaborative a  is explicit  A  makers  with  makers.  partnership.  Very than  continuous,  undertaken.  these  endure  really,  fundamental  courage  policy  actions  importance,  active  the  strengthen  only  of  of  effect  While  a c t i v e o r g a n i z a t i o n a l support.  the  and  mentally  policy  commitment  can  the  what i s l a c k i n g i s a common v i s i o n .  on  respect,  for  we  i l l population.  encouraging,  on  solutions,  is  mentally  anticipated  p o l i t i c a l w i l l and  appear  chronic  the  Individual  -  i n response to the i d e n t i f i e d problems  and  dependent  Of  102  service vigilant efforts.  critical  A f t e r a l l , we  without a c t i o n i s  What i s r e q u i r e d i s  providers consultative In  evaluative  our  to  engage  in  processes  to  conjunction, component  are a l l r e s p o n s i b l e .  concrete must  be  - 103  -  FOOTNOTES  For example, see Hobbs, (1977); and Grob, (1983).  (1964); F o u c a l t , (1965); S c u l l ,  Province of B r i t i s h Columbia, M i n i s t r y of H e a l t h , Mental Health Branch, Annual Report, 1967-1968. Queen's P r i n t e r : Victoria. The Mentally 111 Disordered Offender. May, 1987. Conference Sponsored by Simon F r a s e r U n i v e r s i t y , F o r e n s i c Psychiatric S e r v i c e s , B.C. C o r r e c t i o n s , and Mental H e a l t h S e r v i c e s . Vancouver, B.C. Ibid. An e x p l o r a t o r y study was conducted by the r e s e a r c h e r as part of a course requirement of the S o c i a l Work 551 i n the Spring of 1989. As a r e s u l t of t h i s study, one of the recommendations i n the student paper was to include non-incarcerated mentally i l l o f f e n d e r s , and service p r o v i d e r s who are not employed at the said f a c i l i t y . " T h i s would b r i n g i n r e l e v a n t d a t a t h a t would e i t h e r confirm the identified themes and/or allow the emergence of d i f f e r e n t r e a l i t i e s from the p e r s p e c t i v e s of other key actors. In p a r t i c u l a r , i s the r e t r o s p e c t i v e data of non-incarcerated mentally i l l o f f e n d e r s , and how t h e i r past experiences of i n c a r c e r a t i o n impact on t h e i r c u r r e n t experiences, and what they p e r c e i v e as perhaps b e n e f i c i a l now. The i n c l u s i o n of a v a r i e d sample d i s t r i b u t i o n would provide a r i c h e r p e r s p e c t i v e f o r the understanding of the s e r v i c e needs f o r m e n t a l l y i l l o f f e n d e r s " (p.48). Axis I of the DSM-III-R c o n s i s t s of major mental i l l n e s s e s such as schizophrenia, a f f e c t i v e disorders, organic b r a i n syndromes, e t c . 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V o l . 6, pp. 22-49.  - 113 A P P E N D I X Y O U N G  The  A D U L T  Young  Adult  identified  as  relatively  little  and  social  1981,  p.  disorder, brain  to  has  been  and 35 who have "spent  This  group  disorder, mental  caregivers...who  are  impaired, so s e r i o u s l y t h a t  they  clients  agencies  affective  of mental h e a l t h and  over a p e r i o d of y e a r s " carries  a  disorder,  substance  retardation,  syndrome, e t c .  abuser,  learning  (Lamb,  variety  of l a b e l s :  behavior  disorder,  attention  deficit  disability,  organic  Regardless of t h e i r c l i n i c a l  differences,  the  one  the  onset  the  e r a o f d e i n s t i t u t i o n a l i z a t i o n " (Caton, 1981, p. 475).  group  main  18  Population  community  recurrently  service  463).  personality  Patient  between  socially  or  schizophrenia,  P A T I E N T S  time i n h o s p i t a l s but who p r e s e n t p e r s i s t e n t  and  continually  other  Chronic  problems  psychiatrically are  C H R O N I C  individuals  frustrating  A  commonality t h a t t h i s group shares i s t h a t  of t h e i r i l l n e s s . . . [ t h e y ] . . . h a v e  i s socially  impulsive,  isolated,  victimized,  characterized  by  psychopathology,  lack  and  been t r e a t e d  perpetrators  "assaultive  of  behavior,  crime. severe  of i n t e r n a l c o n t r o l s , r e l u c t a n c e  medications,  addition  t h e i r psychoses and i n some cases s e l f  behavior"  during This  t r a n s i e n t , homeless, disengaged,  psychotropic to  "from  problems  (Lamb, 1982, pp. 466-467).  with  They are overt t o take  drugs and a l c o h o l i n destructive  According t o Finlayson e t  - 114 al  (1984)  this  occurrences  four  additionally, (p.638). mental group  commit Whereas,  a  is  young  and  Criminals, crime.  being  incompetence.  in  initial  They a  police  population,  a d u l t c h r o n i c p a t i e n t , admission t o  admission  medicates  subculture.  "involved  had m u l t i p l e r e p o r t e d c o n t a c t s w i t h p o l i c e "  the  illness  are  times more o f t e n than the g e n e r a l  most  For  self  group  -  mental  to  failure.  becomes at are  Consequently, t h i s  i n v o l v e d w i t h the c r i m i n a l  least,  are  competent  enough to  unlucky because they get caught.  patient  is  a  clear  i n d i c a t i o n of  - 115 A P P E N D I X  I N T E R V I E W  B  G U I D E  I: Inmate/Patient Nature of Offence D i a g n o s i s Given and One's Understanding  of Such  D u r a t i o n of Stay Experience w i t h the C r i m i n a l J u s t i c e System Other H o s p i t a l i z a t i o n s and/or I n s t i t u t i o n a l i z a t i o n s Community Involvement w i t h  Agencies  Expectations Experiences Type of Care C u r r e n t l y R e c e i v i n g Type of Care Received  Elsewhere  Type of Care t h a t i s D e s i r e d What would be most u s e f u l f o r o p t i m i z i n g the c u r r e n t stay? What would be most u s e f u l w h i l e out i n community? Types of Concerns w h i l e I n c a r c e r a t e d Types of Concerns w h i l e i n the Community  II:  Staff  Length of Employment Experience w i t h the M e n t a l l y 111 Offender Impact on one's r o l e , and r e l a t i o n s h i p w i t h other c o l l e a g u e s What would be most u s e f u l f o r one as a s e r v i c e p r o v i d e r ? What would be most u s e f u l f o r the m e n t a l l y i l l  offenders?  Types of Concerns i n working w i t h the M e n t a l l y 111 Offender What a r e the s t r e n g t h s and l i m i t a t i o n s of the c u r r e n t system?  - 117  -  Your s i g n a t u r e below on t h i s page i n d i c a t e s t h a t you have received a copy of the consent form t h a t e x p l a i n s the purpose and procedures of the study t i t l e d , S e r v i c e s f o r M e n t a l l y 111 Offender: An Exploratory Study. I t a l s o i n d i c a t e s your voluntary agreement to p a r t i c i p a t e i n t h i s r e s e a r c h study. If you would l i k e t o r e c e i v e a f r e e summary of the r e s u l t s of t h i s study when i t i s a v a i l a b l e ( l i k e l y S p r i n g 1990) p l e a s e a l s o p r i n t your m a i l i n g address i n the space p r o v i d e d .  I understand t h a t I am under no o b l i g a t i o n t o complete t h i s consent form. No d e c i s i o n s r e g a r d i n g my s t a y i n the H e a l t h Care Centre of Lower Mainland R e g i o n a l C o r r e c t i o n a l Centre would be i n f l u e n c e d by my d e c i s i o n to p a r t i c i p a t e or not participate in this research study. My involvement w i l l be used f o r r e s e a r c h purposes o n l y . My r i g h t s t o p r i v a c y and confidentiality will be f u l l y respected. I have the r i g h t t o decline to p a r t i c i p a t e i n t h i s research study. I have the right to withdraw from the r e s e a r c h a t any time. I understand that I do not have t o be tape recorded d u r i n g the i n t e r v i e w ( s ) if I do not choose t o . I know t h a t the l e n g t h and number of i n t e r v i e w s w i l l be dependent on me.  I have read and understood the purpose and procedure of t h i s research study. I understand t h a t the i n f o r m a t i o n gathered will be used to assist the co-investigator, L i l y , in identifying the s e r v i c e needs of m e n t a l l y i l l o f f e n d e r s . I have read the above statement of my r i g h t s and v o l u n t a r y consent t o p a r t i c i p a t e i n the r e s e a r c h study by completing the following:  Signature Name (Please P r i n t ) Address City,  Province  P o s t a l Code  - 119  -  Your s i g n a t u r e below on t h i s page i n d i c a t e s t h a t you have received a copy of the consent form t h a t e x p l a i n s the purpose and procedures of the study t i t l e d , S e r v i c e s f o r M e n t a l l y 111 Offender: An Exploratory Study. I t a l s o i n d i c a t e s your voluntary agreement to p a r t i c i p a t e i n t h i s r e s e a r c h study. If you would l i k e t o r e c e i v e a f r e e summary of the r e s u l t s of t h i s study when i t i s a v a i l a b l e ( l i k e l y S p r i n g 1990) p l e a s e a l s o p r i n t your m a i l i n g address i n the space p r o v i d e d .  I understand t h a t I am under no o b l i g a t i o n to complete t h i s consent form. No decisions regarding my employment i n the Health Care Centre of Lower Mainland R e g i o n a l C o r r e c t i o n a l Centre would be i n f l u e n c e d by my d e c i s i o n to p a r t i c i p a t e or not participate in this research study. My involvement w i l l be used f o r r e s e a r c h purposes o n l y . My r i g h t s t o p r i v a c y and confidentiality will be f u l l y respected. I have the r i g h t t o decline to p a r t i c i p a t e i n t h i s research study. I have the right to withdraw from the r e s e a r c h a t any time. I understand that I do not have to be tape recorded d u r i n g the i n t e r v i e w ( s ) if I do not choose t o . I know t h a t the l e n g t h and number of i n t e r v i e w s w i l l be dependent on me.  I have read and understood the purpose and procedure of t h i s research study. I understand t h a t the i n f o r m a t i o n gathered will be used to assist the co-investigator, L i l y , in identifying the s e r v i c e needs of m e n t a l l y i l l o f f e n d e r s . I have read the above statement of my r i g h t s and v o l u n t a r y consent t o p a r t i c i p a t e i n the r e s e a r c h study by completing the following:  Signature Name (Please P r i n t ) Address City,  Province  P o s t a l Code  - 120 A P P E N D X X D A T A  The  plan  qualitative  f o r data  A N A L Y S I S  analysis  methodology.  E  i s seen  as c o n s i s t e n t w i t h  In the process of g a t h e r i n g data, one  constantly  looks f o r p a t t e r n s , themes, or o r g a n i z i n g c o n s t r u c t s  which,  they  This  as  emerge,  framework  hypotheses the  may  which,  ongoing  involve  collection  and  until  satisfactory  this of  point  form  of  T h i s process of s e q u e n t i a l  focused  the accumulated reflection,  and  data.  data  collection  continues  grasp of the phenomenon i s achieved.  qualitative  collection  the c o n s t r u c t i o n of c a t e g o r i e s or  of  increasingly  systematic  a t e n t a t i v e a n a l y t i c framework.  i n t u r n , guide, and a r e f u r t h e r m o d i f i e d by,  analysis a  form  data i s s u b j e c t e d t o a f i n a l p e r i o d a n a l y s i s , and i n t e r p r e t a t i o n .  analysis  analysis  At  of  is a  data,  system  with  of  these  This  concurrent  two processes  s e q u e n t i a l l y i n f l u e n c i n g and m o d i f y i n g each o t h e r .  The method  specific (C.C.M.)  analysis  stresses  collection,  coding  systematic  obtained  data.  differences assessing  was  the constant  comparative  d e s c r i b e d by G l a s e r and S t r a u s s (1967).  methodology  of  used  that  this  joint/sequential  Their  process  of  and a n a l y s i s i s e s s e n t i a l t o the g e n e r a t i o n  theory  -  t h e o r y which i s t r u l y grounded i n the  A c o n s t a n t comparison of both s i m i l a r i t i e s and  i s made.  Thus,  the  researcher  i s continually  the degree of f i t , o r i n c o m p a t a b i l i t y , as the data i s  - 121 assigned within  to  categories  significant form  various categories.  the  i s assessed  groupings  The degree of f i t between and i n order t o begin t o sense the  and t h e i r p o t e n t i a l r e l a t i o n s h i p s .  These  b a s i s of themes and, e v e n t u a l l y , of the g e n e r a t i o n of  theory which i s the o b j e c t i v e of t h i s r e s e a r c h .  The Strauss  Constant is a  collection,  from  notes.  To  an  data  unit  Strauss's  Method  system  of  Glaser  and  which s t r e s s e s t h e s e q u e n t i a l process of and  analysis  of data; where t h i s data i s  l i n e - b y - l i n e coding of the r e s e a r c h e r ' s  elaborate,  observer's  primary  a  with  obtained  method  coding,  obtained  primarily  Comparative  the C.C.M. procedure  participant  observation  field  has been employed  studies  i n which the  take the form of t h e c o n c i s e summarizations field  notes.  These summarizations  from  became the  of a n a l y s i s and were then coded u s i n g G l a s s e r and  open-coding:  ...the g o a l of the a n a l y s t i s t o generate an emergent set of categories and t h e i r p r o p e r t i e s which f i t , work, and a r e r e l e v a n t for integrating into a t h e o r y . To achieve this goal, the a n a l y s t b e g i n s . . . [ b y ] . . . coding the data i n every way p o s s i b l e . . . [he]...codes f o r as many c a t e g o r i e s t h a t might f i t ; he codes d i f f e r e n t i n c i d e n t s i n t o as many c a t e g o r i e s as p o s s i b l e .  During compare  the coding process the a n a l y s t sought t o c o n t i n u a l l y  both the s i m i l a r i t i e s and the d i f f e r e n c e s between these  u n i t s of a n a l y s i s as they were b e i n g assigned t o c a t e g o r i e s .  - 122 This  provides  each  piece  an  of Such  reflections  and  of the degree of f i t of  an  a s s i g n m e n t / a n a l y s i s process generates  interpretations  the  (memos) which i n t u r n p r o v i d e  o r g a n i z a t i o n a l c o n s t r u c t s and t e n t a t i v e a n a l y t i c framework  from  which  This  process  truly  assessment  data as i t i s b e i n g c o n s i d e r e d f o r a p a r t i c u l a r  category.  the  ongoing  -  the b a s i c themes and theory g e n e r a t i o n w i l l emerge.  grounded  is  e s s e n t i a l t o the emergence of t h e o r y which i s  in  the  the p r i n c i p l e s of C.C.M.  data, and thus remains c o n s i s t e n t w i t h  - 124  -  A P P K N D I X I  N  I  T  As  I  A  a  there  T  I  V  E  S  A  consequence  has  been  psychiatric Columbia,  a  N  in  O  an  O  K  T O  T  increase  the  health  H  and  in  E  F  professionals with  the  increase  the  community.  policy  criteria to  L  significant  deinstitutionalization  contributed  A  U  T  U  R  E  of the community mental h e a l t h movement,  patients mental  admission  D  G  Within believe  its  patient  of  British that  strict  rights  of m e n t a l l y  number  the  hospital  movement  have  i l l i n d i v i d u a l s being  processed  through the c r i m i n a l j u s t i c e system.  This  has  echoed  i l l individuals  in  been the  community.  the  local  and  are  Act,  being  distinct  and  apparent and  the  In  direct  efforts  in  the of  problem  will  response to t h i s problem. the  reform  reform of the B.C. the be  Criminal  future if  of  there  the  Mental  is  Health  Code of Canada t o  presented.  mentally  In  of the P r o v i n c i a l  What becomes  t h a t the i n d i v i d u a l commitments are there  encouraging a c t and  in  amendments  this  is  o r g a n i z a t i o n a l e f f o r t s t h a t have been  Services,  the to  and  made  Health  respond  In the f o l l o w i n g , I w i l l i d e n t i f y some of  agencies  addition, Mental  i n the l i t e r a t u r e on m e n t a l l y  conclusion  i l l  can  already, be  quite  p o l i t i c a l and o r g a n i z a t i o n a l w i l l  to  l e n d support t o i n d i v i d u a l e f f o r t s .  1984,  provincial  a  group  of  representatives  government m i n i s t r i e s and  from d i f f e r e n t  l o c a l p r i v a t e agencies  B.C. met  - 125 to ill  discuss  the  management  -  problems of multi-problem m e n t a l l y  i n d i v i d u a l s . (Buckley e t a l . , 1991)  I t was  agreed t h a t  deinstitutionalization  policy  had  contributed  criminalization  mentally  ill.  I t was  participants  the  that  individuals hospitals,  of  were  group  health  forensic  institutions,  of  to  the  apparent to a l l  multi-problem  mentally i l l  being c y c l e d through v a r i o u s s e r v i c e s  mental  programs,  a  the  such as  centres,  a l c o h o l and  drug treatment  psychiatric  services,  correctional  community  corrections,  and  other  private  agencies.  In  1985,  agreement  following  was  coordination  a s e r i e s of i n t e r - a g e n c i e s  reached  program  to  jointly  meetings,  establish  a  an  service  s p e c i f i c a l l y f o r the s e r v i c e p r o v i d e r s of  multi-problem  mentally  Part  of  the  mandate of t h i s program i s a l s o t o develop a data  base  of  information  the  system.  the  first  the  problems  Mental purpose  in  of  s i g n i f i c a n c e i s the effort  mentally i l l  v a r i o u s systems of  1985,  f a c t t h a t t h i s program i s  undertaken l o c a l l y to address  mental  health  and  i n d i v i d u a l s was  are b e i n g  cycled  care.  p r o c e s s was  i n i t i a t e d by  D i v i s i o n of the M i n i s t r y of H e a l t h .  t o review the p r o v i n c e ' s s t r a t e g y  of  1991)  t o i d e n t i f y the gaps i n  i n d i v i d u a l s who  a consultative  Health Services was  i n d i v i d u a l s . (Buckley e t a l . ,  on t h i s group and  collaborative  through our  Also  Of  ill  services.  f o r the  the The  provision  P a r t i c i p a t i o n from i n t e r e s t groups  r e l a t i v e l y widespread.  - 126 In the  1987,  the  consultative  blueprint Reform  for of  Mental  H e a l t h C o n s u l t a t i o n Report, based  p r o c e s s , was  the  future  the  -  of  provincial  completed. the  B.C.  Mental  I t was  viewed as the  mental h e a l t h Health  on  system.  Act  was  also  Services,  the  B.C.  anticipated.  In  1987,  Corrections Services the  the  Forensic  Branch,  Society,  above  and  assertive  case  of  were simple.  They were:  Vancouver Mental H e a l t h  the s i x sponsoring agencies from implemented  management  mentally  program  community-based  specifically  i l l individuals.  2)  t o engage multi-problem m e n t a l l y i l l i n d i v i d u a l s ;  3)  t o improve  budgets  unique allocated,  shared  paper.  what  This  mandate  in  and little  program  this  and  life.  program  was  t h a t t h e r e were  consequently everyone begged and  no  stole  r e s o u r c e s they had i n c l u d i n g pens and has  effectively  achieved  i t s primary  t h a t the s e n i o r managements of these t h r e e agencies  continued  services.  collaboration;  t h e i r q u a l i t y of about  for  The i n i t i a l mandates  t o encourage  was  multi-agency  a  1)  What  have  Greater  program)  multi-problem  and  the  (three  mentioned  Psychiatric  to  work  collaboratively  More i m p o r t a n t l y , the ' c l i e n t s *  no longer l o s t t o the  system.  in  a l l areas of the  of t h i s program are  - 127 In  1988,  research  programs  discharged Fraser with It  Riverview  into  mentally  agencies.  The  likely and  who  were  Greater Vancouver Area program was  u l t i m a t e l y disbanded.  t h a t t h i s r e s u l t was  collaborative  met  due  efforts  t o the l a c k of  with  the  other  Although the mandates of the program were s i m i l a r to  the  assertive  the  research  the  'clients' is  outreach  the Greater Vancouver Area as w e l l as i n t o the  most  consultation  assertive  i l l individuals  g r e a t d e a l of r e s i s t a n c e , and was  seems  here  H o s p i t a l p i l o t e d two  for  V a l l e y Area. a  -  case  management program r e f e r r e d t o p r e v i o u s l y ,  component  overwhelmed  remained  that  the  collaboratively  the s e r v i c e component  underserved.  lack  together  of was  and  A l e s s o n t o be  learned  commitment t o c o n s u l t and  t o work  met  with  failure  regardless of  the  s t a t e d mandates.  In  the  Committee from  on  Mental  Social  summer  1990,  the  A s s i s t a n t Deputy M i n i s t e r ' s  Deinstitutionalization invited Health  Services  Corrections  of  Services, and  Branch,  Police  Department  review  the  to  The  Psychiatric Services,  Alcohol  and  Drug  Programs,  C r i m i n a l J u s t i c e Branch, and the Vancouver  effects  J u s t i c e System.  Housing,  Forensic  representatives  p a r t i c i p a t e i n a subcommittee t h a t would of  multi-problem  persons on the  Criminal  terms of r e f e r e n c e g i v e n were t o :  1)  review the management and treatment problems;  2)  monitor  current  mentally  d i s o r d e r e d multi-problem persons;  issues  related  t o the management of  - 128 3)  review r e l e v a n t p r o v i n c i a l and f e d e r a l  4)  monitor  the  impact  of  legislation;  d e i n s t i t u t i o n a l i z a t i o n on the  c r i m i n a l j u s t i c e system; and 5)  suggest  strategies  to  c o o r d i n a t i o n of treatment It  was  agreed  interministerial year), were  would  the  guidelines  treatment  as  the  between  f o r t h i s group.  first various  and the  services.  establishment  of  province-wide  (completed by November of the same  be an a p p r o p r i a t e p o l i c y response.  viewed  cooperation  that  improve  step  in  The p r o t o c o l s  the p r o c e s s of improving  agencies who share r e s p o n s i b i l i t y  Of s i g n i f i c a n c e here i s the f o l l o w i n g comment:  "Governments which have the r e s p o n s i b i l i t y of e n s u r i n g the p r o t e c t i o n of the g e n e r a l public a l s o have the moral and e t h i c a l responsibility to prevent p r i s o n s from becoming the r e p o s i t o r y f o r multi-problem m e n t a l l y i l l persons. One response t o t h i s growing s o c i a l problem i n B r i t i s h Columbia is government p o l i c y - m a k i n g which s t r e s s e s increasing interministerial cooperation i n service delivery in order t o develop strategies that provide appropriate comprehensive assistance to mentally disordered offenders. The a c t i o n s of government are not always viewed in a favourable light, but here i s an example where government i n t e r v e n t i o n may have a beneficial effect on an u n f o r t u n a t e and d e s e r v i n g group i n s o c i e t y caught up i n a p r e v i o u s l y unsympathetic p r o c e s s " (Hightower and Eaves, 1991, p . 7 ) .  In  1990,  Provincial that:  the  Cabinet.  Mental H e a l t h I n i t i a t i v e was approved by the The I n i t i a t i v e was based on the p h i l o s o p h y  - 129 1)  treatment  and  settings  rehabilitation  should  be  provided i n  t h a t are most a p p r o p r i a t e t o the needs of the  individual; 2)  -  services  and should  work  to  facilitate  the  community  adopted.  They are:  r e - i n t e g r a t i o n process. In  addition,  a  set  of  comprehensiveness, availability  that  the  accessibility,  the  then  "provincial  existing  mental  (February  26th,  t h a t the B.C.  were  coordination,  and  importantly,  principles  Health  continuity and  of  care,  accountability.  Minister  More  John Jansen announced  government i s committed t o improving  health 1990;  care  press  system  in  release).  Mental H e a l t h I n i t i a t i v e  British  the  Columbia"  Moreover, Jansen s a i d  was:  "a model of p a r t i c i p a t o r y p o l i c y development producing a w o r l d - c l a s s v i s i o n f o r the care of the m e n t a l l y ill. The government i s d e d i c a t e d t o c o n t i n u i n g p a r t n e r s h i p s as we work together t o r e a l i z e our commitment t o the m e n t a l l y i l l " ( I b i d ) .  Also  in  established  1990, to  individuals.  p r o v i d e s e r v i c e s f o r multi-problem For  Lookout  Emergency  Mental  Patient  management Regional management plans  s e v e r a l l o c a l community-based programs were  example, Services Society  component. Correctional program  for  mentally  ill  the S t . James S o c i a l S e r v i c e s and Case  Management P r o j e c t s , and  Courtworker  The  newly  Centre their  has  Program  established a  mentally  added  a  case  Fraser V a l l e y  community-based ill  the  inmates.  case  Similar  are i n the making f o r the Vancouver P r e - t r i a l Centre,  the  - 130 Surrey  Correctional  Centre and  for  In  B.C.  The  efforts  it  should  and  be  illness  Currently  for  Regional  Correctional  process i n c l u d e s the  local  consultation  mental  health  Forensic P s y c h i a t r i c Services.  noted t h a t s e v e r a l months ago  P r e - t r i a l Centre i n i t i a t e d s t a f f t r a i n i n g i n the  mental  the  the  between  as  w e l l as an o c c u p a t i o n a l  f o r p s y c h i a t r i c a l l y impaired  by  and  planning  Corrections,  addition,  Vancouver of  Women.  collaborative  centres,  Centre,  -  various  reform  of  area  therapy program  remanded i n d i v i d u a l s .  mental h e a l t h agencies have been i n v i t e d  M i n i s t r y of H e a l t h  the  the  the  t o review and Provincial  submit recommendations  Mental  Health  Act.  The  submission  deadline  i s June, 1991.  reform  the  Mental H e a l t h Act w i l l become a r e a l i t y i n  the the  of  near  B.C.  future.  Forensic  encouraging.  Some of the recommendations put  Psychiatric For  I t i s anticipated that  Services  appear  to  forward be  the  by  quite  example:  "That the Act should be p a t i e n t - c e n t r e d . . . should meet the guarantees p r o v i d e d by the Charter of Rights and Freedoms...that i t should reflect a 'need for treatment model'...an acute or emergency situation,[should] be met w i t h a minimum of administrative interference...recognition [should include the] patient's r i g h t s to receive information regarding treatment" ( F o r e n s i c P s y c h i a t r i c S e r v i c e s , 1991).  Furthermore, criminalization were made:  of  with  respect  the  mentally  to ill,  the  issue  of  the  the f o l l o w i n g comments  - 131  -  "At present, too often we see that appropriate psychiatric care is not forthcoming...Individuals are l e f t u n t r e a t e d until their i l l n e s s r e s u l t s i n actions that compel the i n t e r v e n t i o n of the criminal justice system...We are concerned t h a t a 'pure detention model' of mental health s t a t u t e w i l l aggravate r a t h e r than a l l e v i a t e this problem...patients falling w i t h i n the admission criteria should be given p r i o r i t y " . (Ibid)  As w e l l , "It i s the Committee's view t h a t the duty of mental, h e a l t h s e r v i c e s continues past an individual's release...there i s the f u r t h e r need to provide for his or her r e - i n t e g r a t i o n back i n t o the community. The new Act should acknowledge the s i g n i f i c a n c e of this duty by p r o v i d i n g adequate time f o r discharge planning t o meet the c o n t i n u i n g needs of the p a t i e n t " . ( I b i d ) Finally, "Some form of administrative review i s necessary, but should be keyed to the protection of and respect for patient's rights and to a r e c o g n i t i o n t h a t i n d i v i d u a l s suffering a mental disorder are often amongst the most v u l n e r a b l e members of society. Indeed, these person's very vulnerability r a i s e s the l e g a l standard of care required of medical and clinical staff. These f a c t o r s must be foremost i n ensuring substantive fairness and conscientious conduct in the clinical decision-making process enshrined i n mental health l e g i s l a t i o n " . (Ibid)  During circulated  the a  past  five  years,  number of p r o p o s a l s  the  F e d e r a l Government  t o reform the c r i m i n a l law  has in  - 132 relation  to  control  the defense  and  The  Providing Criminal  i n s a n i t y and the o p t i o n s f o r the  treatment of persons found not g u i l t y by reason of  insanity. considering  of  a  House  of  sixteenth  that  these  Commons  draft  of  of  Canada  is  the proposed  recommendations  currently  amendments.  a r e accepted, a r e v i s e d  Code would address such i s s u e s a s :  1)  maximum  duration  of  disposition  made  following  a  v e r d i c t o f Not G u i l t y By Reason of I n s a n i t y ; 2)  what  to  do where a prima f a c i e case f o r committal f o r  t r i a l cannot be made; 3)  appeal  process  following  a d i s p o s i t i o n i n r e s p e c t of  insanity; 4)  duties  and  powers  of  the Review  Board f o r persons  deemed  U n f i t To Stand T r i a l or Not G u i l t y By Reason of  I n s a n i t y ; and 5)  burden  of  proof  i n cases where c r i m i n a l  insanity i s  raised.  On  May 2nd of t h i s year (1991), the Supreme Court of Canada  handed  down  verses  Regina)  of  a  ruled  individuals that  fundamental detained)  on the case of Owen Swain. (See Swain  B a s i c a l l y , the Court had s t r u c k down s. 614(2)  the C r i m i n a l  for  decision  Code, which p r o v i d e d automatic s t r i c t found  Not  Guilty  By Reason of I n s a n i t y .  s. 614(2) v i o l a t e d s e c t i o n justice) of  custody  seven  It  (the p r i n c i p l e s of  and n i n e (the r i g h t not t o be a r b i t r a r i l y  the C h a r t e r of R i g h t s and Freedoms.  A s i x month  - 133 'transitional  period'  Government  enable  meet  the  certainly the  to  facilitate  judgement  been  enactment  requirements  C r i m i n a l Code.  Swain  has  of  the  granted  to  the  Federal  of new l e g i s l a t i o n t h a t would Charter.  T h i s d e c i s i o n should  or " f a s t - t r a c k " the complete amendment of At a minimum, the amendments r e f l e c t i n g the  will  likely  be  presented  f o r Parliamentary  approval w i t h i n the next s i x months.  The will  anticipated  include  consequences  of  the  proposed amendments  t h r e e new k i n d s of p s y c h i a t r i c assessments.  They  are: 1)  assessment t o determine a p p r o p r i a t e d i s p o s i t i o n ;  2)  assessment  to  determine  the person's  mental s t a t e a t  the time of the o f f e n c e ; and 3)  assessment  to  determine  if a  hospital  order  is  appropriate. In  most  cases,  incarceration, Governor  in  proposed  a  particularly determination  Council  amendments  maximum  within  for  NGRI's  continued  must be made by the L i e u t e n a n t  thirty  include  the  days.  procedural  Finally, safeguards  as the such  as  d u r a t i o n of the d i s p o s i t i o n , the need f o r a prima f a c i e  case  to  be made, and c o n t i n u i n g review,  that  the m e n t a l l y i l l  exempt  from  criminal  result  would  would  receive  be  i t i s also anticipated  accused would r a i s e the i s s u e so as t o be responsibility  more  readily.  of course, t h a t more m e n t a l l y i l l the  necessary  psychiatric  The end  individuals  treatment  i n an  -  appropriate where  facility  the p r o t e c t i o n  their  being  correctional  an  meet  the  sensitive  to  t h e i r needs, and  of t h e i r r i g h t s i s guaranteed, r a t h e r additional  that  committed  consultation  is  -  burden  on  an  than  ill-prepared  facility.  Assuming is  that  134  the P r o v i n c i a l Mental H e a l t h S e r v i c e s Branch  to and  five  decrease  of  criminal  justice  the  provision  collaboration, stated  mentally  of  and  quality  care,  active  programs are designed t o  p r i n c i p l e s , what we would see then i s a i l l i n d i v i d u a l s b e i n g d e p o s i t e d i n t o the  system  or being r e c y c l e d  r e s o u r c e s w i t h no p l a c e t o go.  through the v a r i o u s  

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