Reieased under the Access to information Act! Divulg?(s) en vertu de ta Lei sur I?acces a I?informatien. The Mentally 111: How They Became Enmeshed in the Criminal Justice System and How We Might Get Them Outi Prepared by the Hon. Mr. Justice Richard D. Schneider For the Research and Statistics Division March, 2015 his report is a work product, and the ?ndings presented herein are not to be construed as an of?cial Department of Justice Canada position, unless they are designated as such by other authorized documents and the report is posted on the of?cial Department of Justice Canada Web site. a Department of Justice Minist?re de la Justice '1r 1 Canada Canada (Alldda 000022 Reieased under the Access to information Act! Divulg?(s) en vertu de 13 Loi sur I?aooes a I?information. Provocative Paper Series Contents 1. Background .. 2 2. The Manufacturing of a Forensic Patient .. 2 3.Abit of history .. 3 4. Adding to the Picture .. 6 5. The Numbers are Growing .. 7 6. Criminal Code is the Mental Health Act of Last Resort .. 9 7. What to do? .. 10 7.1 INVEST IN PROVINCIAL AND TERRITORIAL MENTAL HEALTH CARE .. 10 7.2 EXPAND DIVERSION PROGRAMS: MOVE THE NEW FORENSIC PATIENT BACK TO THE CIVIL SYSTEM QUICKLY ..11 7.3 A FEDERAL MENTAL HEALTH ACT .. 13 7.4 PART XX.1 OF THE CRIMINAL CODE .. 14 7.5 ENABLE THE CHANGE WITH FEDERAL LEGISLATION .. 15 000023 Released under the Access to information Act! Divulg?(s) en vertu de la Loi sur I?acces a I?information. Provocative Paper Series 1. Background That individuals with mental illness are over-represented in the criminal justice system is a reality beyond debate. The percentage of individuals in federal correctional institutes with self- reported mental health issues has more than doubled between 1997 and 2008. At the time of admission 65% of federal inmates were ?agged for mental health follow-up. A recent one day ?snapshot? indicated that 63% of female federal inmates are prescribed medication. From across the border, at present there are ?ve times as many mentally ill individuals in American jails and prisons as there are in American hospitals. And, while comparable statistics are not readily available for Canada there is no reason to expect that we are doing much betterthis state of transinstitutionalization?? Certainly, not by design. 2. The Manufacturing of a Forensic Patient [De?nitionz An individual with mental illness charged with, or convicted of, a criminal offence. And, in particular, those who have obtained verdicts of ?un?t to stand trial? (Un?t) or ?not criminally responsible? (NCR) on account of mental disorder.] Here is a fictitious but very realistic example of how the mentally ill can become enmeshed in the criminal justice system how they become ?forensic patients?: You and your family have been extremely frustrated because you can?t get your 18 year-old son any help. He hasn?t been taking his medications again. He continues to refuse medication because its poison. He has been holed-up in his room, making weird noises. He has become nocturnal. He has stopped bathing. He hears voices from the Martians. While he looks menacing, he has not actually been violent or overtly threatened violence. Your family physician is noticeably nervous when you ask that he be involuntarily hospitalized under the provincial Mental Health Act. You suspect that your physician is worried about his liability. You have tried to convince a Justice of the Peace that your son satisfies the criteria of the Mental Health Act but have been turned away because there is no clear evidence that he is dangerous to himself or others. You are exasperated with the civil mental health system. All you want is some help for your son. You say that the Mental Health Act has no teeth and that there are so few resources that even if he is admitted he will be discharged as soon as he can barely satisfy the Mental Health Act criteria. When he is admitted to hospital your son is discharged before he is stable. His condition deteriorates rapidly upon discharge. 000024 Released under the Access to information Act! Divulg?(s) en vertu de la Loi sur I?acc?s a I?information. Provocative Paper Series But, recently the news has improved. He has been charged with a criminal offence. Yes, he punched a police officer who came to the house at your request. He has been charged with assaulting the police officer. The really good news is that he was so disorganized at the time he appeared in the bail court that the Crown Attorney had serious doubts about his fitness to stand trial. You took perverse delight in the fact that he had been charged with a criminal offence because now, in the criminal justice system, he can get a comprehensive assessment. The court did indeed order an assessment to determine his ?tness. The assessment indicated that your son was, as you knew, schizophrenic, and unfit to stand trial. You were ecstatic. Ecstatic, because the court, with his new status of unfit to stand trial, was able to order that he receive involuntary treatment in a hospital for a period of 60 days. None of this had ever been accomplished with the civil mental health system. From your perspective things just kept getting better. He was eventually found fit to stand trial. But the court ordered that he be kept in a hospital until his trial had concluded so that he wouldn?t stop taking his medication and become unfit again. This was the longest time he had ever spent in a hospital and you were thrilled. Eventually, he had his trial and he was found to have been ?not criminally responsible? on account of mental disorder. As a result, he is now being supervised by the Ontario Review Board. After spending a little bit of time in the hospital the Review Board sent him back home to live with you but his case is still reviewed by the Review Board at least once a year. You feel much more comfortable because the Review Board is watching over him. The Provincial and Territorial Review Boards, operating pursuant to the provisions of the Criminal Code, look after all accused like your son who have been found by the criminal justice system to be either unfit to stand trial or not criminally responsible on account of mental disorder. Unfortunately, however, the greater percentage of individuals suffering from a mental disorder who, as a result, come into con?ict with the law end up in jails or correctional settings. With this their prognoses worsen, their probability of re-offending increases, and, as discussed later, at a greater cost. All of the above might have been captured with much less expensive intervention at first instance engaging civil mental health care. 3. A bit of history In the 1950s and 60s, detention in a mental hospital (civil) in Ontario was predicated on the presence of a disorder which required observation, care, and treatment. The 1967 Ontario Mental ealtli Act provided for the involuntary admission of a person to a 3 000025 Released under the Access to information Act! Divulg?(s) en vertu de la Loi sur I?aee?s a I?information. Provocative Paper Series facility if she was suffering from a mental disorder in the nature or degree so as to require hospitalization in the interests of his/her own safety or the safety of others and was not suitable for admission as an informal patient. A one month period of detention was In 1978, the Ontario Mental ealth Act was amended and criteria for involuntary hospitalization altered. The person must have threatened or have attempted to cause bodily harm to himself, behaved violently towards another, or caused another to fear bodily harm from him, or shown the lack of competence to care for himself and to be suffering from a mental disorder of a nature of quality that will likely result in serious bodily harm for the person and other persons, or imminent serious physical impairment of the person. The period of involuntary detention is 14 days. In the 1950s, involuntary hospitalization assumed treatment was the quid pro for state intervention. Post 1978, as the courts defined the need for an informed consent before treatment, the union of involuntary hospitalization and treatment was broken. There are two fundamentally different ways in which civil mental health legislation has responded to the treatment and hospitalization of the mentally ill. The 1967 Ontario Mental ealth Act predicates hospitalization upon a ?need to treat?. With this model mentally disordered individuals are hospitalized if there appears to be a need to treat them and they are not availing themselves of the necessary treatment voluntarily. This approach is a child of the state?s parens patrtae role as guardians of the in?rm. As this approach fell out of favour in the late sixties and seventies it was replaced in 1978 by the second model championed by the civil libertarians based upon dangerousness. Under the second model, we may only interfere with an individual?s freedom if he is perceived to be a danger to himself or others. If an individual is not seen as dangerous to himself or others he is free to roam the streets ?madder than a hatter?. This latter model is the most common in North America. What is the problem with the second model? Well, if a seriously mentally disordered person were to enter the room and he was talking to Martians and making weird noises, most of us would probably agree that there was a need to treat. Applying that test, if the individual was not prepared to come into the hospital on his own we would have him admitted on an involuntary basis. If we were to employ the second model, how many of us could feel con?dent concluding that he does or does not represent a danger to himself or others? The problem with this dangerousness-based legislation, some say, is that we are not able to determine with any degree of accuracy who should be detained and who should not. We make all sorts of mistakes; false positives and false negatives. That is, we make errors asserting that some individuals are 4 000026 Reieased under the Access to information Act! Divulg?(s) en vertu de {a Lei sur I?aee?s a I?information. Provocative Paper Series dangerous when, in fact, they are not', and, we make errors asserting that some individuals are not dangerous when, in fact, they are. As a result, the civil mental health system, quite apart from resource issues, is, with the rights-based model simply unable to reliably capture many mentally disordered individuals who are at risk for criminal activity. As long as this persists, the argument goes, you will inevitably and unavoidably have mentally disordered individuals leaking through the ?civil net? and slipping to be caught-up in the ?forensic net?. As many have observed, forensic patients are, for the most part, patients, as any others, of the civil mental health care who received inadequate supports and treatment. I respectfully submit that, while there are complexities, this is where the bulk of the problem lies. Aggravating all of the above, is that as governments have been cash strapped and have cut back spending on health care and social programs the mentally disordered are more likely to end-up in the forensic system. As there are fewer and fewer hospital beds per capita the greater the likelihood that individuals for whom there is no room in the civil system will end-up in the forensic system. If, for example, a hospital has ?fteen vacant beds and ten prospective new customers at the door there is a good chance that they will all be admitted if they satisfy the Mental ealth Act criteria or are presenting themselves as voluntary patients. They will all be looked after. If, on the other hand, there are only ?ve vacant beds and the same 10 prospective customers are at the door some hard choices will have to be made. Five will be admitted and ?ve will not. Five will, as a result, be left at risk for attracting the attention of the police and the criminal justice system if their odd behaviour results in the commission of a criminal offence?. Unfortunately, it often does. As a result of resource shortages, these customers who should have been accommodated by an adequately resourced civil mental health system have now become ?forensic patients?. With downsizing and/ or restructuring of the civil mental health care systems across Canada there was inevitably the promise that by reinvesting the money saved with the bed closures into less expensive out-patient community treatment the mental health care system would actually be better off. While super?cially attractive, I don?t know of any compelling support for this proposition. Some say that the ineffective shift to out-patient, community-based treatment may have something to do with the increases we are observing. Others say that, in any event, those saved dollars are never reinvested in alternative community-based care as advertised. I think that it is safe to say that many mentally ill individuals can be adequately supported through community treatment but that, at the same time, there are many who cannot be supported through community mental health care. Certainly, at the time of the transitioning it was an unproven alternative. 000027 Released under the Access to information Act! Divulg?(s) en vertu de la Loi sur I?acc?s a I?information. Provocative Paper Series There is probably no single explanation for the fantastic growth of the forensic population. It is undoubtedly a product of a multiplicity of factors which includes the ones cited above. 4. Adding to the Picture Further to all of the above, in the wake of a landmark decision from the Supreme Court of Canada in 1991, Bill was proclaimed on February 5, 1992. Bill (An Act to Amend the Criminal Code (Mental Disorder)) forms for the most part what we now know as Part XX.1 of the Criminal Code of Canada and provides a relatively complete procedural code for dealing with the mentally disordered accused. A new jurisdictional threshold was established based upon ?signi?cant threat to the safety of the public? rather than upon ?substantial recovery?. All accused must be reviewed upon the verdict and thereafter within at least every twelve months. The Bill amendments also modernized some of the language which had been used in the Criminal Code for over 100 years. ?Not guilty by reason of insanity? was changed to ?not criminally responsible?. The terms ?natural imbecility? and ?disease of the mind? were removed (NB: nevertheless, ?mental disorder? is de?ned in s. 2 of the Code as ?disease of the mind?). Automatic ?strict custody? was eliminated. Instead, the court is now able to hold a disposition hearing immediately following the verdict and may make its own disposition for the accused. Court-made dispositions are all reviewed by the Review Board. It is fair to say that since the proclamation of Bill C-30, travelling down the path of ?not criminally responsible? has become a more attractive option for defence counsel and their clients. Certainly, when I first started practice as a criminal lawyer raising an insanity defence for anything but the most serious of offences was viewed as tantamount to negligence. You feared that your client would be tossed into a dungeon perhaps never to see the light of day again. He could spend decades locked in a hospital for the most minor of offences. This perception was based upon more fiction than fact. In reality the disposition options under the old legislation were virtually identical to the present scheme. The significant changes came with the mandatory creation of the Review Boards, the changed jurisdictional threshold [substantial recovery significant threat], and the time limit within which an accused must be reviewed ?post-verdict?. Nevertheless, the perception is that the ?new system? is less harsh - more ?defence friendly?. Therefore, this explanation has it that the new legislation is itself attracting more customers". Perhaps the most significant change in the Criminal Code so far as the bar is concerned relates to the jurisdictional threshold. While under the previous scheme (pre-1978) jurisdiction was 6 000028 Released under the Access to information Act! Divulg?(s) en vertu de la Loi sur I?acc?s a I?information. Provocative Paper Series ?recovery-based?, now it is maintained only so long as the accused remains a signi?cant threat to the safety of the public. Understandably, if ?recovery? was what was required to escape the clutches of the state one could expect that the stay at ?Her Maj esty?s Pleasure? could be particularly given that there are no cures for mental illness, only treatments that work to varying degrees in attenuating the most dramatic Recoveries would be few and far between. Maintenance of jurisdiction over an accused in the new schemeVi requires a positive finding that the individual is a signi?cant threat to the safety of the public. This bears no necessary relationship to ?recovery?. It is well known now that the mentally disordered are no more dangerous as a population than the general population. ?Significant threat? is obviously a more elevated concern than ?threat simpliciter?. Some say therefore, that one?s prospects for release are very much better under the new legislative scheme. There is a real probability that you may be released in a much shorter period of time than if you had been convicted and sentenced. 5. The Numbers are Growing While the impact of the various contributors is not precisely known, we do know that the numbers of mentally ill individuals in the criminal justice system is on the rise. Since the early 1990's this population has been growing at the alarming rate of up to 10% or more per yearVii. This is juxtaposed data which shows that from the early 1990's the actual number of arrests has steadily decreased. An early explanation has it that the humourless political climate with its zero tolerance, tough- on-crime - no matter how trivial attitude, is resulting in arrests for situations that might have been handled with police discretion in the past. Related to this is the explanation that the police with their heightened fear of liability and sense of accountability are more inclined to ?go by the book?. It is safer to lay a minor charge and have the mentally disordered individual processed like any other criminal than to stick your neck out and do something creative like take the individual to a emergency and forego the laying of a charge. As a result, now with the more attractive provisions contained in the Code, many more accused who have committed ?not so serious? nuisance offences are entering the criminal justice system being found un?t and raising the defence of not criminally responsible on account of mental There is less concern regarding disproportionate consequences. 000029 Released under the Access to information Act! Divulg?(s) en vertu de la Loi sur I?acc?s a I?information. Provocative Paper Series A signi?cant problem results when you have a collision course of decreasing resources and increasing numbers of mentally disordered accused with verdicts of NCR or un?t to accommodate. Here, we have also been caught by judicial decisions which exacerbate the problem. It is the obligation of the Review Board to, for each accused, taking into consideration the need to protect the public from dangerous persons, the mental condition of the accused, the reintegration of the accused into society and the other needs of the accused, make one of the following dispositions that is the least onerous and least restrictive to the accused?ix. That is the Review Board?s statutory mandate. The person in charge of the hospital where the accused is detained or is to attend is a party to our proceedings as is the Attorney General and, of course, the accused. Appeals have been successfully made by the hospitals against Review Board Dispositions based upon the contention that, for example, there is no room at the hospital to which we ordered the accused to attend. We have been told by the Courts that we must not make Dispositions unless we know that the disposition can be effected. What the Review Board is then left with is our statutory mandate to impose the ?least onerous and least restrictive disposition? compromised or limited by the resources with which the province has chosen to equip itself. Accordingly, if the Review Board is of the view that the least onerous and least restrictive disposition is that an accused be discharged conditionally to live in a place in the community approved by the administrator but the administrator says there is no such place, the disposition should not be made. The provincial governments are apparently free to defeat the statutory scheme set-out in the Criminal Code when they decide that money will not be spent on adequate resources for the mentally disordered accused. Hospital Administrators are able to defeat the scheme by indicating that the resources that are available are not appropriate. As a result, individuals who were ?rst of all not served well by the civil system are now, as forensic patients, not doing any better. This predicament causes some to wonder whether we are not creating a situation where we have parties to our proceedings of differing status; those who must comply with our orders - the mentally disordered accused', and, those who don?t need to comply with our orders - the hospitals or provincial ministries of health. We are also receiving word from the Courts that if the least onerous and least restrictive disposition is X, we must order X, and not order Y. This would appear to be at odds with the proscription against making dispositions unless we know that they can be effected. And ?nally, while we understand the problems associated with making de?nite assertions with respect to dangerousness, we must not maintain jurisdiction over an accused unless we can state positively 000030 Released under the Access to information Act! Divulg?(s) en vertu de la Loi sur I?acc?s a l?information. Provocative Paper Series that they are a signi?cant threat to the safety of the public. Some say that we are unable to make such an assertion except in the most extreme cases. 6. Criminal Code is the Mental Health Act of Last Resort The Criminal Cocle of Canada has emerged as the Mental ealtn Act of last resort. The provisions of the Criminal Cocle appear to be robust enough to provide a comprehensive system of care and supervision for the mentally disordered individuals who are entering the system at a disproportionate rate. The most pressing problem is that unless the forensic system is adequately resourced our legislative mandate cannot be implemented. How to return the mentally disordered accused to the status of ?patient?? Arguably, if the system had worked optimally for him at ?rst instance, he would never have lost patient status. In North America, American Express markets its credit card with a concept called ?Front of the Line?. Consumers wanting to either get the service quickly, or the best spot, at a theatre or similar such entertainment event, can use their American Express card to get to the ?front of the line?. That is, in fact, what the forensic system does. It moves people to the front of the line, to ensure that they are being monitored and supervised by some form of case manager or case management team. Entry into the community from the forensic system occurs only after the patient, who in the Criminal Cocle system we refer to as ?the accused?, has managed previous passes and liberties successfully. The scheme ultimately provides careful and gradual transition into the community with minimal risk to all. But it should be understood that although the forensic system ensures services, it is not cost effective. I do not know the ?gures, but one learned colleague suggested that up to 20 civil patients would have been accommodated and treated in the bed space time allocated to a single forensic patient. The development and expansion of the forensic system, while meeting a legitimate need, is a tribute to the saying ?necessity is the mother of invention?. The disempowerment of the civil mental health care system necessarily led to the forensic system?s growth. There developed an inverse relationship; as the Civil System became progressively de-energized, sacri?cing in particular, the custodial and social components of mental health care, the forensic system increased in strength and volume. The formula can be expressed this way. The mentally disordered offender, formerly known as a patient, forfeited his liberty in exchange for the certainty of better mental health care, and the public?s greater assuredness that its safety interests would be met. The civil system under the MHA had been originally constructed as a safety net for patients and the public, but the net needed repair and rather than ?xing it, a second net the forensic system was put in place - it is therefore the net under the 9 000031 Released under the Access to information Act! Divulg?(s) en vertu de la Lei sur l?acc?s a l?informatien. Provocative Paper Series net, or, the net further 7. What to do? The over-representation of individuals with mental illness in the criminal justice system is a situation that has arisen due to a complexity of factors. The solution, to my mind, must also be multi-faceted in order to be successful. It is recognized that health care is constitutionally a provincial/territorial domain but solutions, given that the problem of the over-representation of mentally ill individuals in the criminal justice system is largely one of "transinstitutionalization?, must involve main stream civil mental health care. 7.1 Invest in Provincial and Territorial Mental Health Care We know that the percentage of our population who suffer from mental illness will remain static over time and across cultures/jurisdictions. What accounts for differences, where they occur, is thought to be due to recognition or reporting of the disorders rather than actual incidence. Similarly, the percentage of that population who will present as a management problem for society will remain constant over time. What will change as a function of politics or unintended evolution is how we, as a society, choose to respond to the problem. Will the problem be addressed through new efforts in health care or will we allow the problem to continue to leak through that system and into the criminal justice system? It will be one or the other. I am of the view that we should not continue to expand the role of the courts and the criminal justice system as principal dispensers of mental health care. It is much less expensive, more humane, and more appropriate that this population be looked after properly at first instance by the civil mental health care system. The best prophylactic in avoiding the growth of mentally disordered accused in the Criminal Courts is an improved civil mental health care system across the provinces and territories. Therefore, the number one remedy to the problem is reinvestment in civil mental health care. It is the failures of this system that we are seeing in the criminal justice system. If one examines the cases of extreme violence the ?headline cases? - perpetrated by individuals with untreated mental disordersX it is a virtual certainty that the individual had had contact with the civil mental health system but that she was either discharged or evaded containment and or treatment. It is alarming to note, in many cases, contact with civil mental health care was within days of the very serious offending. Included in the concept of ?civil mental health care? is the necessity of housing with appropriate levels of support. Homelessness amongst this population is an enormous problem. Aid to provincial and municipal governments to provide this support will inevitably prove to have a good return on the investment in the form of fewer individuals suffering from mental illness 10 000032 Reieased under the Access to information Act! Divulg?(s) en vertu de ia Lei sur I?aee?s a i?informatien. Provocative Paper Series entering the criminal justice system. This is not only a health concern it also engages ministries responsible for public safety, law enforcement, and criminal justice. There is a strong business case for the federal government?s investing in provincial/territorial civil mental health care. It is, as mentioned above, really all about what mechanisms should most appropriately be engaged to look after this population. To the extent that the provinces/territories are able to manage mental illness before it blooms into something that engages the criminal justice system, money has been saved, prognoses improved, and the potential for re-offending reduced. Hence, consistent with the Federal Govemment?s published objectives, the streets and communities will be safer as a result and, the enhanced safety will come at a lower cost. 7.2 Expand Diversion Programs: Move the New Forensic Patient back to the Civil System Quickly Various jurisdictions in CanadaXi have created ?diversion programs? in an effort to facilitate the diversion or transfer of mentally disordered offenders from the criminal justice system to civil mental health services. Diversion from the criminal justice system into the mental health care system can be accomplished where the offense is within the minor to mid-range and is the direct result of a mental disorder. Certain further criteria must be met, including that the safety of the public must not be compromised, the mental disorder must be amenable to treatment, and the proposed mental health care facility or practitioner must agree to accept the accused. Diversion can occur at a number of junctures in the proceedings, including prior to the accused?s initial court appearance, after the first appearance, after a bail hearing, or after a ?tness evaluation and hearing. As well, the police have always had ?pre-arrest diversion? available to them. Considerable discretion rests with any police officer who observes an apparently mentally ill individual act in a disorderly or inappropriate manner, to take that individual to a facility for evaluation pursuant to the Mental ealth Act, rather than laying charges. There has certainly not been universal reliance on this option. The efforts of well-meaning police officers have often been frustrated by the necessity of having to wait, potentially for hours, until the individual is assessed, as they are obligated to do until actual custody can be relinquished to the facility. Some officers have been further demoralized by knowing that the patient that they brought to hospital was released only a short while later, to repeat the behaviour, presumably because the hospital was not able to satisfy itself as to the level of the patient?s dangerousness so as to detain him involuntarily. Diversion programs are clearly aimed in the right direction, but would be fruitless endeavours in the 11 000033 Released under the Access to information Act! Divulg?(s) en vertu de la Loi sur I?acc?s a I?information. Provocative Paper Series absence of funds and services to support them. Conventional supervision and services are often insufficient but those can often be energized with the support of the teams involved with diversion programs and mental health courts. Clinicians and mental health workers could easily collaborate and create a prescription for intensive community services for the chronically mentally ill, predominantly the schizophrenics, that would meet their medical, mental health and needs. Programs like this include in their repertoire of interventions, medical and therapeutic services, assistance with money management and dealing with social services, housing and related support services, and close case management that may involve daily reporting and monitoring. The incentive for the client may first of all be the avoidance of penal consequences and greater constraints on their liberty, but more importantly, the patient/end-user is offered an opportunity to become reconnected to a caring environment, and in particular, to individuals who are able to deal with the numerous vexing concerns that the chronically mind experiences as an irritating distraction, if not a threat. Mental Health Courts and Diversion programs are not part of the ?system? in all parts of Canada. They should be. ?Graduates? from diversion programs reoffend less often and re-offend less violently. A recent Canadian meta-analysis demonstrated that Mental Health Courts have a 17% reduction in recidivism as compared with traditional courts. Graduates maintain housing, employment, and health care more consistently. They have fewer contacts with the police?. The Federal Government should become formally involved in promoting these programs as, mentioned above, there is a strong business case for doing so. Perhaps Grants to initiate mental health courts and/or diversion programs could be considered by the Federal Government. Prosecutions obviated result in fewer individuals with mental illness entering correctional systems. Meanwhile, the provisions pertaining to ?Alternative Measures? contained in the Criminal Coalemf should be amended to specifically advert to individuals who suffer from mental illness as was done in ss. 718.2(e) which deals with ?aboriginal offenders?Xi" . particular attention to the circumstances of offenders suffering from mental illness?). Similar amendments should be made to ss.718.2. Inclusion of these amendments (both with respect to sentencing principles and alternative measures) will serve to sensitize the bench and bar as to the importance of considering alternatives for individuals suffering from mental illness even where ?diversion? is not a formal program in that particular jurisdiction. Where convicted of an offence the courts must be mindful of the relative ineffectiveness of ?specific? and ?general deterrence? and the appropriate case law dealing with sentencing mentally ill offenders?. It must be recognized that the criminal justice system, with its traditional approach, as a response to behaviour driven by mental illness that is problematic for society, typically aggravates 12 000034 Released under the Access to information Act! Divulg?(s) en vertu de la Loi sur l?ace?s a l?information. Provocative Paper Series the situation and worsens prognoses. The principles of therapeutic jurisprudence should be formally adopted by the Federal Government and injected into s.718 of the Code so that meaningful dispositions are obtained elsewhere than in the specialty courts. The so-called ?statutory minimums? which stipulate mandatory minimum penalties should be, for the most part, discretionary where the accused suffers from a mental disorder. 7.3 A Federal Mental Health Act Because the civil mental health acts for each province and territory are different there are, effectively, different criminal justice responses in every province and territory as a result of how they interact with the criminal justice system. There are some glaring differences. For example, in Ontario it is possible to hospitalize (lock up in a hospital) an individual who suffers from a mental illness yet not treat that individual if they are ?capable? of consenting to treatment. In British Columbia, all individuals subject to the jurisdiction of the provincial Review Board are deemed to consent to treatment. The provincial/territorial civil mental health legislation unavoidably intersects with the Criminal Code either implicitly or, as with the legislation in Ontario, explicitly, as it provides jurisdiction for the ordering of assessments in the criminal courts?. As a result, Ontario is the only jurisdiction where the criminal trial court can order an assessment to assist with sentencing or judicial interim release. The Mental ealtn Act acts as a supplement to s.672. ll of the Code. It would be better to have, at least where civil mental health legislation and the Code do intersect, uniformity across Canada. This could be accomplished with a Federal Mental Health Act which intrudes into (from a division of powers perspective) the provincial health care domain only to the extent that is necessary to make the criminal law uniform across Canada. There are examples of intrusions of this sort by the criminal justice system', for example, the ability of the criminal courts to order un?t accused to undergo involuntary treatment. While it may not be accomplished easily, it would be of bene?t, for the reasons discussed above, if hospitalization was based upon illness and lack of insight (as well as, or perhaps instead of dangerousness). Most would agree that a system of intervention based upon dangerousness is theoretically very attractive. Why interfere with an individual?s freedom unless they are ?dangerous?? However, the theory makes the assumption that determining who is and who is not dangerous is within the range of abilities possessed by mental health professionals. The determination of dangerousness is something that cannot be done accurately. Some would say that despite an industry devoted to this enterprise, predictions with respect to individuals rather than groups is no better than chance. Of course, when someone who is actually not dangerous is detained upon the mistaken assessment that they are in fact dangerous the error is very difficult to detect. The converse is all too 13 000035 Released under the Access to information Act! Divulg?(s) en vertu de la Loi sur I?aee?s a I?information. Provocative Paper Series apparent. There are 3 main reasons why civil mental health systems fail to adequately address a patient?s needs: 1) Dangerousness based entry threshold, 2) Inability to involuntarily treat those who are hospitalized but who are ?capable?. (These two events should be merged.) 3) Discharge from hospital is pre-mature. Patients are discharged as soon as statutory criteria are barely met but before the patient has sufficient stability/insight required to maintain treatment and stability. It is widely recognized that these deficiencies create a rather ?leaky? civil net that is bound to send many mentally ill individuals into the criminal justice system. A corrective attempt with respect to the jurisdictional threshold for state intervention is a move that would be politically charged and legally difficult. On the other hand, if we want to see the numbers of mentally ill people in the criminal justice system decrease we must have a system that will adequately deal with the issue within the provincial/territorial health care systems. As mentioned above, the population must be looked after by one system or the other. The provinces and territories may require funds in order to improve their mental health care systems. Improvements need to be made both with respect to resources and legislation. It is unclear the extent to which shifts in legislation can be connected to funding. 7.4 Part XX.1 of the Criminal Code Where an individual commits a crime as a result of an untreated mental illness it is generally better to have that person self-identify and seek out, where appropriate, a rehabilitative response by way of an NCR verdict. The outcomes for individuals travelling down this path are, from a public safety perspective, much better than for those who remain in the regular prosecutorial stream. Their reintegration into the community is gradual, monitored, supported, and moves only as it is safe to do so. Where the same individual comes to ?warrant expiry? after completing a sentence in the regular prosecutorial stream there is none of that and the probability of reoffending is considerably greater. Whether or not to avail oneself of an NCR verdict is decidedly tactical and driven in part as a result of the likely outcome. That is, as between the Review Board system and the regular prosecutorial system (along with jails, corrections, parole, etc.) which route will be optimal? We know that counsel 14 000036 Released under the Access to information Act! Divulg?(s) en vertu ole la Loi sur l?acc?s a l?information. Provocative Paper Series will steer their clients away from NCR verdicts where the consequences are potentially harsh. To the extent that this happens our streets and communities become less safe. With the proclamation of Bill C-14 (The Not Criminally Responsible Act that came into force in July, 2014) the potential for harsh consequences has been injected into the Criminal Code thereby increasing the probability that mentally ill offenders will avoid those rehabilitative provisions and end up in the jails and correctional facilities rather than in hospitalXVii. We know very well from the likes of the Ashley Smith inquest, and as mentioned several times above, mentally ill individuals do particularly poorly in jails. Their conditions worsen and their prospects for rehabilitation deteriorate while the probability for future difficulties increases. The irony is that with Bill C-14 the ?over-representation of individuals with mental illness in the criminal justice system? is likely to get worse. 7.5 Enable the Change with Effective Federal Legislation While the Mental Health Commission of Canada has done some wonderful work, it has been, to date, ?aspirational? in nature. It has funded some very research and has prepared strategy papers. The current commission is a funded project which lapses in 2017. Presently, its future is uncertain with respect to 1) its future existence, 2) its mandate, and 3) its funding. As a result, the commission is not easily able to engage in any meaningful long term commitments. A ?xed-term project is by de?nition hobbled during its final days. It is recommended, as set out in Bill 8?208 (Second Session, Forty-First Parliament, 62 Elizabeth II, 2013), that a commission (?Canadian Commission on Mental Health and Justice?) be established with a mandate to not only fund research and generate strategies but to actually become involved in effecting change on the ground. The next generation of efforts in this area needs to move strategy to implementation. This could include advisory roles, links to other government agencies, and the development of evidence-based action plans that could be overseen by or partnered with the Commission. All in an effort to create systems that reduce the probability of mentally ill individuals becoming enmeshed in the criminal justice system. i Prepared at the request of the Government of Canada, Department of Justice. ii Transintitutionalization is the migration of a particular population from one system to another. The mentally ill may be moved out of the health care system with the closure of hospitals but they only reappear in another setting which is all too often the correctional system. Part of the inconsistency across Canada with respect to the plight of the mentally ill in the Criminal Justice system is that each Province and Territory has its own mental health legislation. This can create some big differences. 15 000037 Reieased under the Access to information Act! Divulg?(s) en vertu de {a Loi sur I?acc?s a I?information. Provocative Paper Series i" It is a poorly kept secret that, given the choice, the cooperative prospective patient will be taken over the unruly, unkempt, uncooperative prospective patient. Across Canada the number of mentally disordered individuals entering the criminal justice system has been steadily increasing over the past two decades. At present, there appears to be a ??attening? of the curve but it is too early to know whether this is a trend or a ?blip?. "i It?s not really that ?new? at this point but is the ?newest? substantial change. And still, even though the number of individuals subject to the review board system has grown dramatically, the bulk of those suffering from a mental disorder charged with a criminal offence end up in the jails and penitentiaries. See Note iv, above. This, while the arrest rates for other criminal activity appear to be on the decline. ix With the proclamation of Bill C-14 on July 11*, 2014, the phrase ?least onerous and least restrictive? was replaced by the phrase ?necessary and appropriate? however, the Minister of Justice in testimony before the Senate has indicated that the phrases mean the same thing and that the new wording was only introduced to ?add clarity?. As a result, the Review Boards have been treating the phrases as synonymous. It must, at the same time, be recognized that statistically speaking individuals suffering from mental disorder are no more violent than others. Their potential escalates when untreated and when substance abuse is in the mix. "i The first Diversion Program in Canada was started in Ontario in 1994. xii As to the efficacy of these programs: see also, for example Special Issue: Mental Health Courts and Diversion Programs, International Journal of Law and V0133 (4), 2010. ?ii The provisions pertaining to Alternative Measures are set out below. 716. In this Part, ?accused? includes a defendant', ?alternative measures? means measures other than judicial proceedings under this Act used to deal with a person who is eighteen years of age or over and alleged to have committed an offence', ?court? means a superior court of criminal jurisdiction, a court of criminal jurisdiction, a justice or provincial court judge acting as a summary conviction court under Part XXVJI, or a court that hears an appeal', ?fine? includes a pecuniary penalty or other sum of money, but does not include restitution. R.S., 1985, c. C-46, s. 716', R.S., 1985, c. 27 (1st Supp), s. 154', 1995, c. 22, s. 1999, c. 5, s. Alternative Measures 717. (1) Alternative measures may be used to deal with a person alleged to have committed an offence only if it is not inconsistent with the protection of society and the following conditions are met: the measures are part of a program of alternative measures authorized by the Attorney General or the Attorney General?s delegate or authorized by a person, or a person within a class of persons, designated by the lieutenant governor in council of a provli?ce', 000038 Released under the Access to information Act! Divulg?(s) en vertu de {a Loi sur I?aec?s a I?information. Provocative Paper Series the person who is considering Whether to use the measures is satisfied that they would be appropriate, having regard to the needs of the person alleged to have committed the offence and the interests of society and of the victim', the person, having been informed of the alternative measures, fully and freely consents to participate therein', the person has, before consenting to participate in the alternative measures, been advised of the right to be represented by counsel', the person accepts responsibility for the act or omission that forms the basis of the offence that the person is alleged to have committed', there is, in the opinion of the Attorney General or the Attorney General?s agent, sufficient evidence to proceed with the prosecution of the offence', and the prosecution of the offence is not in any way barred at law. (2) Alternative measures shall not be used to deal with a person alleged to have committed an offence if the person denies participation or involvement in the commission of the offence', or expresses the Wish to have any charge against the person dealt with by the court. (3) No admission, confession or statement accepting responsibility for a given act or omission made by a person alleged to have committed an offence as a condition of the person being dealt with by alternative measures is admissible in evidence against that person in any civil or criminal proceedings. (4) The use of alternative measures in respect of a person alleged to have committed an offence is not a bar to proceedings against the person under this Act, but, if a charge is laid against that person in respect of that offence, Where the court is satisfied on a balance of probabilities that the person has totally complied with the terms and conditions of the alternative measures, the court shall dismiss the charge', and Where the court is satisfied on a balance of probabilities that the person has partially complied with the terms and conditions of the alternative measures, the court may dismiss the charge if, in the opinion of the court, the prosecution of the charge would be unfair, having regard to the circumstances and that person?s perfc13r7m ance 000039 Released under the Access to information Act! Divulg?(s) en vertu de la Loi sur I?aee?s a I?information. Provocative Paper Series with respect to the alternative measures. (5) Subject to subsection (4), nothing in this section shall be construed as preventing any person from laying an information, obtaining the issue or confirmation of any process, or proceeding with the prosecution of any offence, in accordance with law. RS, 1985, c. C-46, s. 717', 1995, c. 22, s. 6. 717.1 Sections 717.2 to 717.4 apply only in respect of persons who have been dealt with by alternative measures, regardless of the degree of their compliance with the terms and conditions of the alternative measures. Xi" s.718 pertaining to Sentencing Principles should be similarly amended so as to encourage more thoughtful responses to people who offend while suffering from a mental disorder who might not have been found NCR. See for example: Bloom, H. and Schneider, R. Mental Disorder and the Law: A primer for Legal and Mental Health Professionals, Irwin Law, Toronto, 2006, Chapter 9. mMenlal Health Act, R.S.O. 1990, as amended, ss.21,22. ?ii There has been much debate around the proclamation of this very controversial Bill which needn?t be repeated here. Suffice it to say, the Bill was criticized widely and vociferously by medical and mental health professionals. There was apparently no empirical support for the changes made and the experts who weighed-in warned that the Bill would have precisely the opposite effect (ie. make the streets and communities less safe). 18 000040 Reieased under the Access to information Act! Divulg?(s) en vertu de {a Lei sur I?acces a I?informatien. Les personnes atteintes de maladie mentale Comment elles se sent retrouv?es dans le systeme de justice p?nale et comment nous pourrions les sortir de 1a R?dig? par le juge Richard D. Schneider pour la Division de la recherche et de la statistique Mars 2015 Le present rapport est un travail preparatoire. Les conclusions qui sontpresentees ne doivent pas etre considerees cornrne une position o?icielle du rninistere de la Justice du Canada, a rnoins qu ?elles ne soient designees ainsi dans ?autres documents autorises et que le rapport ne soitpublie sur le site Web o?iciel du inistere. a Department of Justice Minist?re de la Justice '1r 1 Canada Canada (Alldda 000001 Reieased under the Access to information Act! Divulg?(s) en vertu de ia Lei sur I?acces a i?informatien. S?rz'e d6 documents susciranr la r??axion Table des mati?res 1. Contexte .. 2 2. La fabrication d?un patient n?cessitant des services de l?gale .. 2 3. Un peu d?histoire .. 4 4. Autres mesures .. 6 5. Augmentation du nombre de personnes atteintes de maladie mentale .. 8 6. Le Code criminel est la loi sur la sant? mentale de dernier recours .. 10 7. Que faire? .. 11 7.1 INVESTIR DANS LES SOINS DE SANTE MENTALE PROVINCIAUX ET TERRITORIAUX .. 11 7.2 ELARGIR LA PORTEE DES PROGRAMMES DE DEJUDICIARISATION RENVOYER RAPIDEMENT LE NOUVEAU PATIENT NECESSITANT DES SOINS DE LEGALE DANS LE SYSTEME CIVIL 12 7.3 UNE LOI EEDERALE SUR LA SANTE MENTALE .. 14 7.4 PARTIE XX.1 DU CODE CRIMINEL .. 16 7.5 PERMETTRE LE CHANGEMENT EN ADOPTANT UNE LOI EEDERALE .. 17 1 000002 Released under the Access to information Act! Divulg?(s) en vertu cle ia Loi sur I?aee?s a i?information. S?rz'e d6 documean susciranr la r??axion 1. Co ntexte Personne ne peut eontester le fait que les personnes atteintes de maladie mentale sont surrepresentees dans le systeme de justice penale. La proportion de personnes detenues dans un etablissement eorreetionnel federal qui ont fait etat de problemes de maladie mentale a plus que double entre 1997 et 2008. Au moment de l?admission, une note a inserite dans 65 des dossiers des detenus federaux a?n que eeuX-ei fassent l?obj et d?un suiVi en matiere de sant? mentale. Selon un portrait recent pris un jour donne, 63 des femmes detenues dans un etablissement federal s?etaient vu preserire des medicaments Aux Etats-Unis, il a aetuellement einq fois plus de personnes atteintes de maladie mentale dans les prisons et les etablissements eorreetionnels que dans les hopitaux et, bien que des statistiques eomparables ne soient pas facilement aeoessibles au Canada, il n?y a aueune raison de penser que nous faisons mieuX. Comment en sommes-nous arrives a eette situation de transinstitutionnalisation?? Certainement pas intentionnellement. 2. La fabrication d?un patient necessitant des services de legale [De?nition La personne atteinte de maladie mentale qui est accus?e ou reconnue coupable d?une infraction criminelle et, en particulier, la personne qui a obtenu un verdict inaptitude a subir un proc?s (ISP) ou de non?responsabilit? criminelle (NRC) pour cause de troubles mentaux.] Voiei un exemple ?etif, mais tres realiste, de la fagon dont les personnes atteintes de maladie mentale peuvent se retrouver dans le systeme de justice p?nale de la fagon dont elles deviennent des patients n?eessitant des services de legale Vous et votre famille ?tes devenus extr?mement eontraries paree que vous ne pouviez pas obtenir de l?aide pour votre ?ls de 18 ans. Celui-ei ne prenait plus ses m?dieaments. Il eontinuait de refuser de les prendre paree que o?etait du poison. Il passait toute la journee elo?itre dans sa ehambre a faire des bruits bizarres. Il Vivait la nuit et dormait le jour. Il ne prenait plus de bain. Il entend des voiX de Martiens. 11 a l?air dangereux, mais il n?a jamais ?te Violent et n?a jamais profere de menaees ouvertement. Votre medeein de famille est Visiblement nerveuX lorsque vous lui demandez d?hospitaliser votre ?ls eontre son gre en vertu de la loi provinciale sur la sant? mentale. Vous soupgonnez que votre medeein eraint d?engager sa responsabilite. Vous avez 2 000003 Released under the Access to information Act! Divulg?(s) en vertu de la Loi sur I?ace?s a I?information. S?rz'e d6 documean susciranr la r??axz'on essaye de convaincre un juge de paix que votre ?ls satisfaisait aux criteres de la loi sur la sant? mentale, mais il a rejete vos arguments parce que la preuve n?etablissait pas clairement que votre ?ls representait un risque pour lui-m?me ou pour autrui. Vous ?tes exaspere par le systeme civil de sant? mentale. Tout ce que vous voulez, c?est de l?aide pour votre ?ls. Vous dites que la loi sur la sant? mentale n?est pas ef?cace et qu?il a tellement peu de ressources que, meme si votre ?ls est admis dans un hopital, il en sortira des le moment ou il satisfera aux criteres de cette loi. Lorsqu?il est admis a l?hopital, votre ?ls obtient l?autorisation d?en sortir avant que son etat ne soit stabilise. Son etat se deteriore rapidement des sa sortie. Les dernieres nouvelles sont meilleures, cependant. Votre ?ls a ete accuse d?une infraction criminelle. Oui, il a frappe un policier qui s?etait rendu chez vous a votre demande. 11 a ete accuse de voies de fait en consequence. La bonne nouvelle est que son comportement etait tellement anormal lorsqu?il s?est presente devant le tribunal des cautionnements que le procureur de la Couronne a eu de serieux doutes au suj et de son aptitude a subir un proces. Vous avez pris un plaisir pervers a voir qu?il etait accuse d?une infraction criminelle parce que, maintenant qu?il est entr? dans le systeme de justice penale, il pourra faire l?obj et d?une evaluation complete. Le tribunal a d?ailleurs ordonne une evaluation Visant a determiner s?il etait apte a subir un proces. L?evaluation a con?rme ce que vous saviez deja votre ?ls est schizophrene et il etait inapte a subir un proces. Vous etiez fou de joie parce que, compte tenu du nouveau statut d?inapte a subir un proces de votre ?ls, le tribunal pouvait ordonner qu?il se soumette a un traitement contre son gre dans un hopital pendant 6O jours. Aucune de ces mesures n?avait jamais ete obtenue dans le cadre du systeme civil de sant? mentale. Selon vous, les choses s?amelioraient. Votre ?ls a ensuite ete juge apte a subir un proces. Le tribunal a toutefois ordonne qu?il soit detenu a l?hopital jusqu?a la ?n de son proces a?n de faire en sorte qu?il continue de prendre ses medicaments et ne deVienne pas inapte a nouveau. Il n?etait jamais reste aussi longtemps a l?hopital et vous etiez ravi. Votre ?ls a ?nalement eu son proces. 11 a ete declare non criminellement responsable pour cause de troubles mentaux. En consequence, il est maintenant surveille par la Commission ontarienne d?examen. Apres avoir passe un peu de temps a l?h?pital, il a ete renvoye chez vous par la Commission, laquelle examine cependant touj ours son dossier au moins une fois par annee. Vous vous sentez beaucoup mieux parce que la Commission garde un oeil sur votre ?ls. Sous le regime du Code criminal, les commissions d?examen provinciales et territoriales surveillent tous les accuses qui, comme votre ?ls, ont ete juges inaptes a subir un proces ou non criminellement responsables pour cause de troubles mentaux par le systeme de justice penale. 000004 Released under the Access to information Act! Divulg?(s) en vertu de la Loi sur I?ace?s a I?information. S?rz'e d6 documean susciranr la r??axion Malheureusement cependant, une plus grande proportion des personnes qui, a cause de leur maladie mentale, ont des demeles avec la justice se retrouvent dans une prison ou un etablissement correctionnel, ce qui aggrave leur pronostic, augmente le risque de recidive et, comme il en sera question plus loin, accro?it les co?ts. En fait, il en aurait coute beaucoup moins cher si le systeme civil de sant? mentale etait intervenu des le depart. 3. Un peu d?histoire Dans les annees 1950 et 1960, la detention d?une personne dans un hopital (civil) en Ontario etait fondee sur la presence d?un trouble mental qui exigeait observation, soins et traitement. La loi sur la sant? mentale de l?Ontario de 1967 prevoyait la possibilite d?admettre une personne dans un etablissement contre son gre si elle souffrait d?un trouble mental qui, a cause de sa nature ou de sa gravite, exigeait que cette personne soit hospitalisee pour sa propre securite ou pour la s?curit? d?autrui et si son admission a titre de malade en cure facultative ne convenait pas. Une periode de detention d?un mois etait En 1978, la loi sur la sant? mentale de l?Ontario a ete modi?ee, notamment les criteres d?hospitalisation involontaire. La personne doit avoir menace ou tente de s?in?iger des lesions corporelles, s??tre comportee avec violence envers une autre personne ou de maniere a lui faire craindre qu?elle lui causera des lesions corporelles ou avoir fait preuve de son incapacite de prendre soin d?elle-meme et souffrir d?un trouble mental d?une nature ou d?un caractere qui aura probablement l?une des consequences suivantes elle s?in?igera des lesions corporelles graves, elle in?igera des lesions corporelles graves a une autre personne ou elle souffrira d?un affaiblissement physique grave. La periode de detention involontaire est de 14 jours. Dans les annees 1950, l?intervention de l?Etat prenait la forme du traitement qui devait etre donne en cas d?hospitalisation involontaire. Apres 1978, les tribunauX ont statue qu?un consentement eclaire devait ?tre obtenu avant le traitement, ce qui a rompu le lien qui existait entre hospitalisation involontaire et traitement. Les lois civiles sur la sant? mentale regissent de deuX facons fondamentalement differentes le traitement et l?hospitalisation des personnes atteintes de maladie mentale. Dans la loi sur la sant? mentale de l?Ontario de 1967, l?hospitalisation est fondee sur la necessite de traiter. Les personnes atteintes de troubles mentauX sont hospitalisees si elles semblent avoir besoin d?un traitement et qu?elles ne demandent pas elles-memes le traitement necessaire. Cette approche decoule du role de parens patriae joue par l?Etat en tant que tuteurs des in?rmes. Delaissee a partir de la ?n des annees 1960, elle a ete remplacee en 1978 par le deuXieme modele fonde sur 4 000005 Released under the Access to information Act! Divulg?(s) en vertu de la Loi sur I?acc?s a I?information. S?rz'e d6 documean susciranr la r??axz'on le risque qui etait privilegie par les libertariens civils. Dans le cadre de ce modele, nous ne pouvons entraver la liberte d?une personne que si celle-ci est consideree comme representant un risque pour elle-meme ou pour autrui. Une personne qui n?est pas consideree comme etant dangereuse pour elle-meme ou pour autrui est libre de trainer dans les rues meme si elle est atteinte de troubles mentaux graves. C?est ce demier modele qui est le plus courant en Am?rique du Nord. Quel est le probleme du deuxieme modele? Si une personne atteinte de troubles mentaux graves entrait dans la piece, parlait aux Martiens et faisait des bruits etranges, la plupart d?entre nous conviendraient probablement que cette personne a besoin d??tre soignee. Selon ce critere, si la personne n?etait pas disposee a se rendre a l?hopital par elle-meme, nous l?aurions admise contre son gre. Si nous devions employer le deuxieme modele, combien d?entre nous pourraient conclure avec assurance que cette personne represente ou ne represente pas un risque pour elle-meme ou pour autrui? Selon certaines personnes, cette loi fondee sur le risque ne nous permet pas de determiner avec un certain degre d?exactitude qui devrait ?tre detenu et qui ne le devrait pas. Nous commettons toutes sortes d?erreurs; des faux positifs et des faux negatifs. En d?autres termes, nous commettons des erreurs en af?rmant que des personnes sont dangereuses alors qu?en fait elles ne le sont pas ou en af?rmant que des personnes ne sont pas dangereuses alors qu?en fait elles le sont. Il s?ensuit que, quels que soient les problemes de ressources, le systeme civil de sant? mentale est, selon le modele fonde sur les droits, incapable de retenir de maniere ?able un grand nombre de personnes atteintes de troubles mentaux qui risquent de commettre une infraction criminelle. Tant et aussi longtemps qu?il en sera ainsi, des personnes atteintes de troubles mentaux passeront inevitablement dans les mailles du ?let civil et seront recuperees par le ?let de legale Comme de nombreuses personnes l?ont fait remarquer, la plupart des patients necessitant des services de legale sont des patients comme tous les autres du systeme civil de sant? mentale qui ont recu un soutien et un traitement inadequats. A mon avis, bien qu?il ait des complexites, c?est la que se situe le noeud du probleme. La situation est aggravee par le fait que, comme les gouvernements manquent d?argent et ont reduit les depenses relatives aux soins de sant? et aux programmes sociaux, les personnes atteintes de troubles mentaux sont plus susceptibles de se retrouver dans le systeme de legale. Moins il a de lits par habitant dans les departements de des hopitaux, plus les personnes qui ne peuvent ?tre admises a cause du manque de places dans le systeme civil sont susceptibles d?aboutir dans le systeme de legale. Si, par exemple, il a 15 lits vacants dans un hopital et dix nouveaux clients eventuels, il a de bonnes chances que ceux-ci soient 5 000006 Released under the Access to information Act! Divulg?(s) en vertu de la Loi sur I?acc?s a I?information. S?rie d6 documean susciranr la r??exion tous admis s?ils satisfont aux criteres de la loi sur la sant? mentale ou s?ils se presentent de leur plein gre. Ils seront tous pris en charge. Si, par contre, il a seulement cinq lits vacants et les memes dix clients eventuels, des choix di?iciles devront ?tre faits. Cinq patients seulement seront admis. Les cinq autres courront alors le risque d?attirer l?attention de la police et du systeme de justice penale s?ils commettent une infraction criminelle a cause de leur comportement etrangei". Malheureusement, c?est souvent ce qui arrive. En raison de la penurie de ressources, les clients qui auraient d? recevoir l?aide d?un systeme civil de sant? mentale disposant de ressources su?isantes sont maintenant devenus des patients necessitant des services de legale La reduction et/ou la restructuration des systemes civils de sant? mentale en place au Canada a inevitablement permis de croire que, en reinvestissant dans des traitements communautaires moins chers offerts en clinique externe l?argent economise grace a la fermeture de lits, le systeme de sant? mentale serait plus ef?cace. Bien que cette idee soit interessante a premiere vue, je ne connais aucun argument en con?rmant le bien-fonde. Selon certaines personnes, l?ine?icacite de cette mesure est peut-etre l?une des causes des augmentations que nous observons. D?autres personnes disent que, de toute facon, les dollars economises ne sont jamais reinvestis dans des soins communautaires de rechange, contrairement a ce qui est annonce. Je pense qu?on peut a?irmer sans risque d?erreur qu?un traitement communautaire peut aider un grand nombre de personnes atteintes de maladie mentale, mais aussi que les soins de sant? mentale communautaires peuvent se reveler inutiles dans de nombreux cas. Il s?agissait cependant a l?epoque d?une solution de rechange qui n?avait pas encore fait ses preuves. 11 a probablement plus d?une raison qui explique la croissance extraordinaire de la population necessitant des services de legale. Cette augmentation decoule indubitablement d?une multiplicite de facteurs, notamment ceux mentionnes plus haut. 4. Autres mesures A la suite d?un arr?t de principe rendu par la Cour supreme du Canada en 1991, le proj et de loi C-3O (Loi modifiam 26 Code criminal (troubles meniauxD a ete proclame le 5 fevrier 1992. Ce projet de loi, qui forme la plus grande partie de ce que nous connaissons maintenant comme la partie XX.1 du Code criminal du Canada, etablit un code de procedure relativement complet qui s?applique aux affaires concernant un accuse atteint de troubles mentaux. Un nouveau critere de competence fonde sur le risque important pour la s?curit? du public pluth que sur le retablissement appreciable a ete etabli. Tous les accuses doivent faire l?obj et 6 000007 Released under the Access to information Act! Divulg?(s) en vertu de la Loi sur I?aee?s a I?information. S?rz'e de documents susciranr la r??exz'on d?un examen au moment du verdict et tous les 12 mois par la suite. De plus, les modi?cations apportees par le proj et de loi C-3O ont modernise certains termes et expressions employes dans le Code criminel depuis plus de 100 ans. Le verdict de non-culpabilite pour cause d?alienation mentale a ete remplace par celui de non-responsabilite criminelle Les expressions imbecillite naturelle et maladie mentale ont ete supprimees (remarque l?expression ?troubles mentaux est neanmoins de?nie a l?article 2 du Code comme etant une maladie mentale La garde stricte automatique a ete eliminee, et le tribunal peut maintenant plut?t tenir une audition pour determiner la decision a rendre immediatement apres le verdict et il peut rendre sa propre decision concemant l?accuse. Toutes les decisions judiciaires sont examinees par la commission d?examen. Il est juste de dire que, depuis la proclamation du proj et de loi C-30, il est devenu plus interessant pour les avocats de la d?fense et leurs clients d?emprunter la voie menant au verdict de non-responsabilite criminelle Lorsque j?ai commence a travailler comme avocat specialise en droit penal, invoquer la d?fense d?alienation mentale dans des cas ne concemant pas les infractions les plus graves etait considere de la negligence. Vous craigniez que votre client soit jete dans un donjon sans peut-etre ne jamais revoir la lumiere du jour. Il pouvait passer des decennies enferme dans un hopital alors qu?il etait accuse d?infractions mineures. Cette perception reposait davantage sur une ?ction que sur des faits. En realite, les decisions pouvant etre rendues sous le regime de l?ancienne loi et sous le regime actuel sont presque identiques. Les modi?cations importantes qui ont ete apportees concemaient la creation obligatoire des commissions d?examen, le nouveau critere de competence [retablissement appreciable/risque important] et le delai dans lequel un accuse doit faire l?obj et d?un examen apres le prononce du verdict. Le nouveau systeme est neanmoins percu comme etant moins severe plus amical a l?egard de la d?fense, ce qui explique que la nouvelle loi attire plus de clients". Dans la mesure ou le barreau est concerne, le changement peut-etre le plus important apporte au Code criminel jusqu?a maintenant a trait au critere de competence. Alors que la competence etait basee sur le retablissement dans l?ancien regime (avant 1978), elle peut maintenant etre exercee seulement tant que l?accuse represente un risque important pour la s?curit? du public. On peut naturellement penser que, si un accuse devait etre retabli pour echapper aux grilles de l?Etat, l?hospitalisation selon le bon plaisir de Sa Majeste etait susceptible d?etre plus longue, etant donne en particulier qu?il n?existe aucun remede pour la maladie mentale, mais seulement des 000008 Released under the Access to information Act! Divulg?(s) en vertu de la Loi sur I?acc?s a I?information. S?rz'e d6 documean susciranr la r??axion traitements qui en attenuent a differents degres les les plus graves. Les retablissements seraient tres rares. Pour que la competence continue d?eXister a l?egard d?un accuse sous le nouveau regime?, il faut que cette personne represente un risque important pour la s?curit? du public. Ce critere n?a aucun lien avec le retablissement. Il est bien connu maintenant que les personnes atteintes de troubles mentauX ne forment pas une population plus dangereuse que la population en general. Par ailleurs, le critere du risque important est manifestement plus exigeant que celui de la simple menace, ce qui amene certaines personnes a dire qu?un accuse a beaucoup plus de chances d??tre libere depuis que le nouveau regime legislatif est en place. 11 existe une reelle possibilite que vous soyez libere beaucoup plus rapidement que si vous aviez ete declare coupable et condamne a une peine. 5. Augmentation du nombre de personnes atteintes de maladie mentale Bien que l?effet des differents facteurs ne soit pas connu avec precision, nous savons que le nombre de personnes atteintes de maladie mentale dans le systeme de justice penale est en hausse. En effet, cette population augmente a un tauX alarmant atteignant jusqu?a lO ou plus chaque annee depuis le debut des annees 1990??. D?autres donnees indiquent toutefois que le nombre reel d?arrestations a diminu? regulierement pendant la meme periode. Differentes raisons eXpliquent ce phenomene. D?abord, le climat politique denue d?humour, axe sur la tolerance zero et la lutte contre la criminalite peu importe a quel point le comportement est anodin entraine des arrestations dans des situations ou les policiers auraient pu exercer leur pouvoir discretionnaire dans le passe. 11 a aussi le fait que la police a plus tendance a respecter strictement les regles parce que son sens des responsabilites s?est accru et qu?elle craint davantage d?engager sa responsabilite. Il est plus prudent de deposer une accusation mineure et de voir l?accuse atteint de troubles mentauX ?tre traite comme tout autre criminel que de prendre des risques, de faire preuve de creativite, par exemple en conduisant la personne a l?urgence d?un hopital et d?abandonner l?idee de deposer une accusation. En consequence, compte tenu du fait que les dispositions contenues maintenant dans le Code sont plus attrayantes, beaucoup plus d?accuses ayant commis des infractions de nuisance qui ne sont pas si graves entrent dans le systeme de justice penale en etant declares inaptes et en soulevant la d?fense de non-responsabilite criminelle pour cause de troubles Les consequences disproportionnees soulevent alors moins de questions. 000009 Released under the Access to information Act! Divulg?(s) en vertu de la Loi sur I?acc?s a I?information. S?rz'e d6 documean susciranr la r??axion Un probleme grave survient lorsque les ressources sont reduites pendant que le nombre d?21ccuses 21tteints de troubles ment21uX recev21nt un verdict de NRC ou augmente. Il f21ut 21ussi tenir compte des decisions judiciaires qui aggravent ce probleme. L21 commission d?examen 21 l?obligation de rend[re] la d?cision la moins s?v?re et la moins privative de libert? parmi celles qui suivent, compte tenu de la n?cessit? de prot?ger le public face aux personnes dangereuses, de l??tat mental de l?accus? et de ses besoins, notamment de la n?cessit? de sa r?insertion sociale ?ix. Il s?agit du m21nd21t con?e par la loi 2?1 121 commission d?eX21men. Le respons21ble de l?h?pital ou l?21ccuse est detenu ou doit ?tre soigne est p21rtie 2?1 notre procedure, tout comme le procureur general et, bien entendu, l?21ccuse. Des 21ppels interj etes par des hopitaux 2?1 l?encontre des decisions d?une commission d?examen 21u motif, p21r exemple, qu?il n?y 21v21it pas de ch21mbre disponible pour l?21ccuse, ont ete 21ccueillis. Les tribun21uX nous ont dit que nous ne devions rendre une decision que si nous s21vons que celle-ci pouv21it ?tre appliquee. L21 commission d?examen doit 2110rs tenir compte du f21it que les ressources dont l21 province 21 choisi de se doter pourr21ient nous emp?cher de bien nous 21cquitter du m21nd21t que la loi nous confie, qui consiste 2?1 rendre 121 decision l21 moins severe et la moins priv21tive de liberte En consequence, si 121 commission d?examen est d?21vis que la decision l21 moins severe et la moins priv21tive de liberte consiste 2?1 21ccorder une 21bsolution conditionnelle 2?1 l?21ccuse 21fin qu?il vive dans un endroit dans la collectivite qui est 21pprouve p21r l?21dministr21teur, m21is que celui-ci af?rme qu?un tel endroit n?eXiste p21s, l21 decision ne devr21it pas ?tre rendue. Les gouvernements provinciaux sont 21pp21remment libres de dej ouer le regime prevu par le Code criminal lorsqu?ils decident que des sommes ne seront pas depensees 21fin que les ressources cons21crees 21uX accuses 21tteints de troubles ment21uX soient suf?santes. Les 21dministr21teurs d?hopital sont en mesure de contrec21rrer le regime en indiqu21nt que les ressources disponibles ne sont pas suf?santes. En consequence, les personnes qui n?ont pas recu de services 21d?qu21ts dans le cadre du systeme civil n?en recoivent pas plus m21inten21nt en t21nt que p21tients n?cessit21nt des services de legale. Ce probleme 21mene cert21ines personnes 2?1 se demander si nous ne creons pas une situ21tion ou les parties 2?1 nos procedures ont des st21tuts differents d?une part, les parties qui doivent se conformer 2?1 nos ordonn21nces les accuses 21tteints de troubles ment21uX et, d?21utre part, les parties qui ne sont pas tenues de se conformer 2?1 nos ordonn21nces les hopitaux ou les ministeres provinciaux de la Sant?. Les tribun21uX nous disent 21ussi que nous devons rendre l21 decision l21 moins severe et la moins priv21tive de liberte et 21ucune 21utre, ce qui semble aller 2?1 l?encontre de l?interdiction de rendre une decision s21ns s21voir si elle peut ?tre mise en oeuvre. Enfin, bien que nous comprenions les 9 000010 Released under the Access to information Act! Divulg?(s) en vertu de la Loi sur I?acc?s a I?information. S?rie d6 documean susciranr la r??axion problemes lies a la formulation d?observations precises concernant le risque, nous ne devons exercer notre competence a l?egard d?un accuse que si nous pouvons a?irmer qu?il represente un risque important pour la s?curit? du public. Or, selon certaines personnes, nous sommes incapables d?a?irmer une telle chose, sauf dans les cas les plus extremes. 6. Le Code criminel est la loi sur la sant? mentale de dernier recours Le Code criminal du Canada est devenu la loi sur la sant? mentale de dernier recours. Ses dispositions semblent ?tre su?isamment solides pour creer un systeme complet de soins et de surveillance pour les personnes atteintes de troubles mentauX qui sont admises dans le systeme a un tauX disproportionne. Le probleme le plus urgent est le fait que, a moins que le systeme de legale ne dispose de ressources su?isantes, nous ne pouvons pas nous acquitter du mandat que la loi nous con?e. Comment redonner a l?accuse atteint de troubles mentauX le statut de patient On peut soutenir que, si le systeme avait fonctionne de maniere optimale des le depart, cet accuse n?aurait jamais perdu son statut de patient. En Am?rique du Nord, American Express a lance sa carte de credit Avant-premiere qui permet aux clients d?avoir de meilleures places dans un theatre ou lors d?un spectacle ou d?obtenir le service plus rapidement. C?est ce que fait le systeme de legale. Ce systeme place les personnes en t?te de ?le a?n qu?elles soient surveillees par un gestionnaire des cas ou une equipe de gestion des cas. Le retour dans la collectivite du patient, appele accuse dans le ode criminal, qui a bene?cie de services de legale ne survient qu?apres que celui-ci a obtenu des laissez-passer et des libert?s. Le regime assure au bout du compte un retour methodique et graduel dans la collectivite, la population ne courant qu?un risque minimal. 11 faut toutefois comprendre que le systeme de legale fournit des services, mais qu?il n?est pas rentable. ne connais pas les chiffres, mais un eminent collegue a laisse entendre que jusqu?a 20 patients civils peuvent ?tre accueillis et traites en milieu hospitalier pendant la periode allou?e pour un seul patient necessitant des services de l?gale. La creation et l?elargissement du systeme de l?gale, meme s?ils repondent a un besoin legitime, con?rment que la necessite est la mere de l?invention L?incapacite d?agir du systeme civil de sant? mentale a necessairement mene a la croissance du systeme de legale et une relation inverse s?est developpee. Ainsi, au fur et a mesure que le systeme civil perdait de son dynamisme, sacri?ant en particulier les aspects relatifs a la detention et les aspects sociauX des 10 000011 Released under the Access to information Act! Divulg?(s) en vertu de la Loi sur I?acc?s a I?information. S?rz'e d6 documean susciranr la r??axion soins de sant? mentale, le systeme de legale s?est etendu et a acquis de la force. La formule peut ?tre exprimee de la facon suivante. Le delinquant atteint de troubles mentauX, auparavant appele un patient, a renonce a sa liberte en echange de la certitude de recevoir de meilleurs soins de sant? mentale et d?une meilleure protection, aux yeuX de la population, de sa securite. Le systeme civil cree par la loi sur la sant? mentale constituait a l?origine un ?let social pour les patients et le public, mais, au lieu que soient apportees les reparations requises au ?let, un deuXieme ?let le systeme de legale a ete mis en place, ce deuXieme ?let constituant un ?let sous le ?let ou un ?let en aval. 7. Que faire? La surrepresentation des personnes atteintes de maladie mentale dans le systeme de justice p?nale est attribuable a une multitude de facteurs. A mon avis, la solution doit aussi comporter de multiples facettes pour ?tre e?icace. Il est reconnu que, selon la Constitution, les soins de sant? relevent des provinces et des territoires, mais, etant donn? que le probleme de la surrepresentation des personnes atteintes de maladie mentale dans le systeme de justice p?nale concerne largement la transinstitutionnalisation les solutions doivent aussi faire appel au systeme civil de sant? mentale ordinaire. 7.1 Investir dans les soins de sant? mentale provinciaux et territoriaux Nous savons que la proportion de notre population qui est atteinte de maladie mentale restera stable au cours des prochaines annees, peu importe les cultures et les administrations. Lorsqu?elles surviennent, les differences sont attribuables a la reconnaissance ou au signalement des troubles pluth qu?a leur existence reelle. De meme, la proportion de cette population qui posera des problemes de gestion a la soci?t? restera constante au ?l des annees. Ce qui changera en raison des politiques ou d?une evolution non souhait?e est la maniere dont, en tant que societe, nous choisissons de repondre au probleme. Le probleme sera-t-il regle si de nouveauX efforts sont deployes en matiere de soins de sant? ou laisserons-nous le probleme continuer de se repandre dans ce systeme et dans le systeme de justice penale? Il faudm trancher. suis d?avis que nous ne devrions pas continuer d?elargir le role de principauX foumisseurs de soins de sant? mentale des tribunauX et du systeme de justice penale. 11 en co?te beaucoup moins cher, est plus humain et est plus approprie de faire en sorte que les personnes atteintes de maladie mentale soient prises en charge a la premiere occasion par le systeme civil de sant? mentale. La meilleure facon d?eviter que le nombre d?accuses atteints de troubles mentauX dans les tribunauX criminels augmente consiste a ameliorer le systeme civil de sant? mentale dans les provinces et les territoires. La principale solution au probleme est donc un reinvestissement dans ce systeme. Ce sont les defaillances de ce systeme que nous constatons 11 000012 Released under the Access to information Act! Divulg?(s) en vertu de ia Lei sur I?aee?s a i?information. S?rz'e d6 documean susciranr la r??exz'on dans le systeme de justice penale. Dans les affaires concernant des actes d?une extreme violence les affaires qui font la manchette commis par des personnes dont les troubles mentaux n?ont jamais fait l?obj et d?un traitementx, il est presque certain que ces personnes ont eu des contacts avec le systeme civil de sant? mentale, mais qu?elles ont ete autorisees a sortir de l?hopital ou qu?elles se sont enfuies de l?hopital. Il est alarmant de noter que, dans de nombreux cas, les rapports avec le systeme civil de sant? mentale ont eu lieu quelques jours avant que l?infraction tres grave soit commise. La notion de systeme civil de sant? mentale inclut l?obligation d?heberger les personnes atteintes de maladie mentale et de leur offrir le soutien dont elles ont besoin. Le sans-abrisme au sein de cette population est un enorme probleme. L?aide apportee aux gouvemements provinciaux et aux administrations municipales a?n qu?ils soient en mesure d?assurer ce soutien entrainera inevitablement un bon taux de rendement du capital investi, soit moins de personnes atteintes de maladie mentale entrant dans le systeme de justice penale. Cet enj eu ne concerne pas seulement le systeme de sant?, mais aussi les ministeres responsables de la s?curit? publique, de l?application de la loi et de lajustice penale. Le gouvernement federal a de bonnes raisons sur le plan de la rentabilite d?investir dans les systemes civils de sant? mentale des provinces et des territoires. Comme il a ete mentionne precedemment, il faut determiner quels mecanismes conviennent le mieux pour surveiller cette population. Des sommes d?argent sont economisees, les pronostics s?ameliorent et le risque de recidive est moins important si les provinces et les territoires peuvent gerer la maladie mentale avant qu?elle se transforme en quelque chose qui exige l?intervention du systeme de justice penale. Les rues et les communautes seront ainsi plus sures, conformement aux objectifs publies par le gouvemement federal, er il en co?tera moins cher pour accro?itre la s?curit?. 7.2 Elargir la port?e des programmes de d?judiciarisation renvoyer rapidement le nouveau patient n?cessitant des soins de l?gale dans le syst?me civil Differentes administrations au CanadaXi ont cree des programmes de dejudiciarisation dans le but de favoriser la dejudiciarisation ou le transfert des delinquants atteints de troubles mentaux du systeme de justice penale aux services civils de sant? mentale. Il peut avoir dejudiciarisation lorsque l?infraction est de gravite mineure a moyenne et est le resultat direct d?un trouble mental. Certains autres criteres doivent ?tre remplis, notamment le fait que la s?curit? du public n?est pas compromise, que le trouble mental se pr?te a un traitement et que l?etablissement de sant? mentale ou le medecin proposes s?engagent a accepter l?accuse. La dejudiciarisation peut survenir a differents moments pendant les procedures, notamment avant la premiere comparution de l?accuse devant le tribunal, apres cette comparution, apres l?enqu?te sur le cautionnement ou apres une evaluation de l?aptitude a subir un proces et une audience. 12 000013 Released under the Access to information Act! Divulg?(s) en vertu de la Loi sur I?acc?s a I?information. S?rz'e d6 documean susciranr la r??axz'on Pour leur part, les policiers ont touj ours eu la possibilite de proceder a une dejudiciarisation avant l?arrestation Tout policier dispose d?un vaste pouvoir discretionnaire lui permettant de conduire une personne atteinte de maladie mentale qu?il voie agir d?une facon desordonnee ou inappropriee dans un etablissement a?n qu?elle fasse l?obj et d?une evaluation sous le regime de la loi sur la sant? mentale, au lieu de porter des accusations. Cette option n?a certes pas ete utilisee dans tous les cas. Les efforts de policiers bien intentionnes ont souvent ete contrecarres par le fait qu?ils devaient attendre, peut-?tre pendant des heures, que la personne soit evaluee les policiers ont l?obligation de demeurer sur place jusqu?a ce que la personne puisse ?tre laissee aux soins de l?etablissement Certains policiers ont ete encore plus demoralises lorsqu?ils ont appris que le patient qu?ils avaient amene a l?h?pital avait ete autorise a en sortir peu de temps apres, vraisemblablement parce que l?h?pital n?etait pas en mesure d?etablir le niveau de risque du patient afin de le detenir contre son gre. Les programmes de dejudiciarisation visent clairement les obj ectifs appropries, mais ils ne donneront aucun resultat en l?absence de fonds et de services pour les appuyer. La surveillance et les services conventionnels sont souvent insuffisants, mais il est souvent possible de les dynamiser avec l?aide d?equipes s?occupant de programmes de dejudiciarisation et de tribunaux de sant? mentale. Les medecins cliniciens et les travailleurs en sante mentale pourraient facilement collaborer et prescrire le recours a des services communautaires intensifs pour les personnes atteintes de maladie mentale chronique, en particulier les schizophrenes, qui repondraient a leurs besoins medicaux, et en matiere de sant? mentale. Les programmes de ce genre offrent notamment des services medicaux et therapeutiques, de l?aide en matiere de gestion du budget et de rapports avec les services sociaux, des services de logement et des services de soutien connexes ainsi que des services de gestion des dossiers fermes qui peuvent comprendre une surveillance quotidienne et l?obligation, pour le patient, de se presenter aux autorites tous les jours. Le client peut choisir de participer a un tel programme d?abord et avant tout parce que cela lui permet d?echapper aux consequences penales de ses actes et a une plus grande privation de liberte, mais, plus important encore, il a la possibilite d??tre de nouveau en contact avec un environnement ou il pourra obtenir des soins et, en particulier, avec des personnes qui sont en mesure de gerer les nombreux aspects desagreables que les chroniques considerent comme des irritants, voire comme des menaces. Les tribunaux de sant? mentale et les programmes de dejudiciarisation ne font pas partie du systeme dans toutes les regions du Canada. Ils le devraient pourtant. Les personnes qui ont participe avec succes a un programme de dejudiciarisation recidivent moins souvent et de facon moins violente. Une meta-analyse canadienne recente a demontre que la recidive a ete reduite de 17 lorsque les tribunaux de sant? mentale etaient intervenus au lieu des tribunaux traditionnels. Les 13 000014 Released under the Access to information Act! Divulg?(s) en vertu de la Loi sur I?aee?s a I?information. S?rz'e d6 documean susciranr la r??axz'on personnes concernees changent moins souvent de logement et d?emploi et recoivent des soins de sant? plus regulierement. De plus, elles ont moins de rapports avec la policeXii. Le gouvemement federal devrait participer en bonne et due forme a la promotion de ces programmes, car, comme il a ete mentionne precedemment, il est tres rentable de le faire. Il pourrait peut-?tre envisager de verser des subventions pour la creation de tribunaux de sant? mentale ou de programmes de dejudiciarisation. Moins de personnes atteintes de maladie mentale seront admises dans le systeme correctionnel si des poursuites sont evitees. Entre temps, les dispositions du Code criminal relatives aux mesures de rechange >9?ii devraient ?tre modi?ees a?n de faire expressement reference aux personnes atteintes de maladie mentale comme le fait l?alinea 718.26), qui mentionne les delinquants autochtones >9?v ex. . plus particulierement en ce qui concerne les delinquants autochtones atteints de maladie mentale Des modi?cations similaires devraient ?tre apportees a l?article 718.2. Ces modi?cations (concernant les principes de determination de la peine et les mesures de rechange) serviront a sensibiliser les juges et les avocats a l?importance d?envisager la prise de mesures alternatives a l?egard des personnes atteintes de maladie mentale, meme s?il n?existe pas de programme of?ciel de dejudiciarisation dans l?administration concernee. Lorsque les tribunaux rendent un verdit de culpabilite, ils doivent ?tre conscients de l?ine?icacite relative de la dissuasion generale et de la dissuasion speci?que et de la jurisprudence traitant de la determination de la peine au regard des delinquants atteints de maladie mentale?. Il faut reconna?itre que, en regle generale, le systeme de justice penale aggrave la situation et le pronostic en raison de son approche traditionnelle a l?egard des comportements causes par une maladie mentale qui sont problematiques pour la soci?t?. Les principes des decisions judiciaires rendues en matiere de soins devraient ?tre adoptes en bonne et due forme par le gouvemement federal et ?tre enonces a l?article 718 du Code, de facon que des decisions constructives soient rendues par d?autres instances que les tribunaux specialises. La plupart des peines minimales obligatoires devraient ?tre discretionnaires lorsque l?accuse souffre d?un trouble mental. 7.3 Une loi f?d?rale sur la sant? mentale Comme chaque province ou territoire a sa propre loi de nature civile sur la sant? mentale, les mesures prevues par la justice penale a l?egard de l?application de ces lois varient d?une province ou d?un territoire a l?autre. 11 a certaines differences evidentes. Par exemple, il est possible en Ontario d?hospitaliser (interner dans un hopital) une personne atteinte de maladie mentale sans toutefois la traiter si elle a la capacite requise pour consentir au traitement. En Colombie-Britannique, toutes les personnes assuj etties a la competence de la commission d?examen provinciale sont reputees consentir 14 000015 Reieased under the Access to information Act! Divulg?(s) en vertu de {a Loi sur I?acc?s a I?information. S?rz'e d6 documean susciranr la r??exion au traitement. Les lois provinciales et territoriales de nature civile sur la sant? mentale recoupent inevitablement 1e Code criminal soit implicitement, soit, comme en Ontario, explicitement, car elles conferent aux tribunauX criminels 1a competence necessaire pour ordonner une evaluation L?Ontario est ainsi 1a seule administration ou un tribunal criminel de premiere instance peut ordonner une evaluation Visant a l?aider a determiner 1a peine qu?il convient d?in?iger ou a decider s?il a lieu de mettre l?accuse en liberte provisoire. La [of sur la same mentale complete l?article 672.11 du Code. 11 serait preferable, a tout le moins lorsque la loi en matiere civile sur la sant? mentale et le Code se recoupent, d?avoir une certaine uniformite au Canada, par exemple en adoptant une loi federale sur la sant? mentale qui s?appliquerait dans le domaine des soins de sant?, lequel releve de la province (selon 1a Constitution), uniquement dans la mesure necessaire pour rendre 1e droit penal uniforme a l?echelle du Canada. 11 existe des exemples d?empietement de ce genre par le systeme de justice penale, notamment 1e fait que les tribunauX criminels peuvent ordonner a un accuse inapte a subir un proces de se soumettre a un traitement contre son gre. Il serait utile, pour les raisons exposees ci-dessus, que l?hospitalisation soit fondee sur la maladie et sur l?absence de prise de conscience (et aussi sur le risque ou, peut-etre, pluth que sur le risque), bien que cela ne puisse peut-?tre pas se faire facilement. La plupart des personnes reconna?itraient qu?un systeme d?interventions fonde sur le risque est tres interessant en theorie. En effet, pourquoi porter atteinte a la liberte d?une personne si celle-ci n?est pas dangereuse? Or, 1a theorie fait en sorte que la question de savoir qui est dangereux et qui ne l?est pas releve de la competence des professionnels de la sant? mentale. Il est impossible d?etablir 1e risque avec certitude. Selon certaines personnes, malgre l?eXistence d?une industrie qui se consacre a cette entreprise, les predictions formulees a l?egard de personnes pluth que de groupes ne reposent que sur la chance. Bien entendu, lorsqu?une personne qui ne represente en fait aucun risque est detenue a cause d?une evaluation erronee selon laquelle elle repr?sente un risque dans les faits, l?erreur est tres dif?cile a detecter. Le contraire est bien trop evident. 11 a principalement trois raisons qui expliquent pourquoi les systemes civils de sant? mentale ne repondent pas adequatement aux besoins d?un patient 1) 1e critere fonde sur le risque', 2) l?incapacite de traiter contre leur gre les personnes qui sont hospitalisees, mais qui sont saines d?esprit', (ces deuX raisons devraient ?tre fusionnees) 3) 1a sortie de l?hopital est autorisee trop tot. Les patients sont autorises a quitter l?hopital des que les criteres prevus par la loi sont remplis, mais avant que leur etat 15 000016 Released under the Access to information Act! Divulg?(s) en vertu de la Loi sur I?aee?s a I?information. S?rz'e d6 documean susciranr la r??axz'on soit su?isamment stabilise ou qu?ils aient su?isamment pris conscience de ce qu?ils ont fait pour que le traitement et la stabilite soient assures. Il est largement reconnu que ces defaillances creent un ?let civil qui est plutot suj et aux fuites a cause desquelles un grand nombre de personnes atteintes de maladie mentale sont envoyees dans le systeme de justice penale. Des mesures visant a corriger le critere de competence seraient lourdes de consequences sur le plan politique et seraient problematiques sur le plan juridique. Par ailleurs, si nous voulons que le nombre de personnes atteintes de maladie mentale qui se retrouvent dans le systeme de justice penale diminue, nous devons avoir des systemes de sant? provinciaux et territoriaux qui traitent adequatement ces personnes. Comme il a ete mentionne precedemment, la population doit ?tre prise en charge par l?un ou l?autre systeme. Les provinces et les territoires peuvent avoir besoin de fonds pour ameliorer leurs systemes de sant? mentale, a la fois en ce qui touche aux ressources et aux dispositions legislatives. On ignore dans quelle mesure les modi?cations legislatives peuvent ?tre liees au ?nancement. 7.4 Partie XX.1 du Code criminel Lorsqu?une personne commet un crime parce que sa maladie mentale n?a pas ete traitee, il est generalement preferable que, en plaidant la NRC, elle demande la mesure de readaptation qu?elle veut obtenir. Les personnes qui agissent de la sorte obtiennent, du point de vue de la s?curit? publique, des r?sultats beaucoup plus grands que celles qui continuent de faire l?objet de poursuites. Leur reinsertion dans la communaut? est graduelle et surveillee', ces personnes obtiennent du soutien et le processus est marque par la prudence. 11 en est tout autrement lorsqu?une personne a purge sa peine dans le systeme regulier des poursuites et que le mandat expire. En outre, le risque de recidive est alors beaucoup plus grand. La question de savoir si une personne devrait se prevaloir d?un verdict de NRC releve nettement de la strategie et depend notamment de l?issue probable des poursuites. En d?autres termes, quelle voie celle offerte par le systeme des commissions d?examen ou celle offerte par le systeme regulier des poursuites (prisons, services correctionnels, liberation conditionnelle, etc.) sera la plus optimale? Nous savons que les avocats detoumeront leurs clients des verdicts de NRC lorsque les consequences pourraient ?tre dramatiques. Dans la mesure ou cela se produit, nos rues et nos communautes deviennent moins sures. Par suite de la proclamation du proj et de loi C-l4 (Loz' sur la r?forme de la non?responsabilir? Grimmelle, qui est entree en vigueur en juillet 2014), la possibilite de consequences dramatiques decoule du Code criminal, ce qui augmente la probabilite que les 16 000017 Released under the Access to information Act! Divulg?(s) en vertu de la Loi sur I?aoo?s a I?information. S?rz'e d6 documean suscz'ranr la r??axion delinquants atteints de maladie mentale echappent a l?application des dispositions d?autrefois sur la readaptation et se retrouvent dans les prisons et les etablissements correctionnels pluth que dans les hopitauXXVii. Differentes enqu?tes, notamment celle sur Ashley Smith, ont demontre que la Vie en prison des personnes atteintes de maladie mentale est particulierement dif?cile, comme il a ete mentionne plusieurs fois ci-dessus. En effet, l?etat de ces personnes s?aggrave et leurs chances de readaptation diminuent, alors que la probabilite qu?elles aient des dif?cultes dans l?avenir augmente. Il est ironique de penser que, par suite de l?adoption du proj et de loi C-l4, la surrepresentation des personnes atteintes de maladie mentale dans le systeme de justice penale pourrait s?aggraver. 7.5 Permettre le changement en adoptant une loi f?d?rale efficace La Commission de la sant? mentale du Canada a merveilleusement bien travaille, mais elle s?est bornee a enoncer des ideauX. Elle a ?nance des recherches tres utiles et a redige des documents strategiques. La commission actuelle est un projet ?nance qui prendra ?n en 2017. A l?heure actuelle, son avenir est incertain en ce qui touche l) a son existence, 2) a son mandat et 3) a son ?nancement. En consequence, il lui est dif?cile de prendre des engagements signi?catifs a long terme. Par de?nition, la realisation d?un proj et d?une duree determinee cesse de se derouler rondement lorsque sa date d?eXpiration approche. Il est recommande, comme le prevoit le proj et de loi 8-208 (26 session, 416 legislature, 62 Elizabeth II, 2013), que soit constituee une commission (la Commission canadienne de la sant? mentale et de la justice qui aurait le mandat non seulement de ?nancer la recherche et de generer des strategies, mais aussi de jouer un role dans la mise en oeuvre des changements sur le terrain. La prochaine serie d?efforts doit servir a mettre en oeuvre les strategies, notamment en donnant des conseils, en creant des liens avec d?autres organismes gouvernementauX et en elaborant des plans d?action fondes sur des donn?es probantes qui pourraient ?tre surveilles par la Commission ou mis en oeuvre en collaboration avec elle. Toutes ces mesures Visent a creer des systemes qui reduisent le risque que des personnes atteintes de maladie mentale se retrouvent dans le systeme de justice penale. iR?dige a la demande du gouvernement du Canada, ministere de la Justice. La transinstitutionnalisation est le deplacement d?une population particuliere d?un systeme a un autre. Les personnes atteintes de maladie mentale peuvent sortir du systeme de soins de sant? en raison de la fermeture d?h?pitaux, mais elles reapparaissent touj ours ensuite dans un autre etablissement qui est bien trop souvent un etablissement correctionnel. Les incoherences concernant la situation difficile des personnes atteintes de maladie mentale au sein du systeme de justice penale au Canada sont attribuables en partie au fait que chaque province ou territoire a sa propre loi sur la sant? mentale, ce qui peut entrainer des differences considerables. 17 000018 Released under the Access to information Act! Divulg?(s) en vertu de la Loi sur I?aee?s a I?information. S?rte d6 documents suscttant la r??axton i" C?est un secret mal garde que, en raison du choix, le patient cooperatif eventuel sera prefere au patient indiscipline, neglige et non cooperatif. Le nombre de personnes atteintes de troubles mentaux qui sont entrees dans le systeme de justice penale a augmente de facon reguliere au Canada au cours des deux dernieres decennies. La courbe de croissance semble s??tre aplanie, mais il est trop tot pour savoir s?il s?agit d?une tendance ou d?un phenomene temporaire. ?1 Il ne s?agit pas reellement d?un nouveau regime, mais plutot de la modification importante la plus recente. ?1 Meme si le nombre de personnes assujetties au systeme des commissions d?examen a augmente considerablement, la plupart des accuses atteints de troubles mentaux se retrouvent dans les prisons et les penitenciers. Voir la note iv, ci-dessus. Malgre la baisse apparente des taux d?arrestation pour d?autres activites criminelles. ix Par suite de la proclamation du proj et de loi C-l4 le 11 juillet 2014, l?expression la moins severe et la moins privative de liberte a ete remplacee par l?expression necessaire et indiquee Le ministre de la Justice a toutefois declare, au cours de son temoignage devant le S?nat, que les expressions avaient le m?me sens et que le nouveau libelle avait seulement pour but de clarifier la disposition. Les commissions d?examen considerent donc les deux expressions comme des synonymes. 11 faut aussi reconnaitre cependant que, selon les statistiques, les personnes atteintes de troubles mentaux ne sont pas plus violentes que les autres. Le risque qu?elles representent augmente lorsqu?elles ne sont pas traitees et lorsqu?elles consomment de l?alcool ou des drogues de facon abusive. Xi Le premier programme de dejudiciarisation au Canada a debute en Ontario en 1994. xii Au sujet de l?efficacite de ces programmes, voir aussi, par exemple, Special Issue: Mental Health Courts and Diversion Programs International Journal OfLaw and vol. 33 (4), 2010. Les dispositions relatives aux mesures de rechange sont reproduites ci-dessous. 716. Les definitions qui suivent s?appliquent a la presente partie. accuse Est assimile a l?accuse le defendeur. amende Peine pecuniaire ou autre somme d?argent, a l?exclusion du dedommagement. mesures de rechange Mesures prises a l?endroit d?une personne de dix-huit ans et plus a qui une infraction est imputee plutot que le recours aux procedures judiciaires prevues par la presente loi. tribunal a) Une cour sup?rieure de juridiction criminelle; b) une cour de juridiction criminelle; c) unjuge ale patx 0n unjuge ?une cour provinciale agtssant a titre ale cour ales poursuttes sommatres en vertu ale la partie d) an tribunal qui entenal an appel. LR. (1985), ch. C-46, art. 716; LR. (1985), ch. 27 (ler suppl.), art. 154; 1995, ch. 22, art. 6; 1999, ch. 5, art. Measures ale rechange 717. (1) Compte tenu de l?inter?t de la soci?t?, le recours a des mesures de rechange a l?endroit d?une personne a qui une infraction est imputee plutot qu?aux procedures judiciaires prevues par la presente loi peut se faire si les conditions suivantes sont r?unies a) ces mesures font partie d?un programme de mesures de rechange autorise soit par le procureur general ou son delegue, soit par une personne appartenant a une categorit 8e personnes designee par le lieutenant-gouverneur en 000019 Released under the Access to information Act! Divulg?(s) en vertu de {a Loi sur I?acc?s a I?information. S?rz'e d6 documean susciranr la r??axion conseil d?une province; 29) la personne qui envisage de recourir a ces mesures est convaincue qu?elles sont appropriees, compte tenu des besoins du suspect et de l?inter?t de la soci?t? et de la victime', 0) le suspect, informe des mesures de rechange, a librement manifeste sa ferme volonte de collaborer a leur mise en oeuvre; le suspect, avant de manifester sa volonte de collaborer a leur mise en oeuvre, a ete avise de son droit aux services d?un avocat', e) le suspect se reconna'it responsable de l?acte ou de l?omission a l?origine de l?infraction qui lui est imputee', f) le procureur general ou son representant estiment qu?il a des preuves suffisantes justifiant des poursuites relatives a l?infraction', g) aucune regle de droit ne fait obstacle a la mise en oeuvre de poursuites relatives a l?infraction. (2) Le suspect ne peut faire l?objet de mesures de rechange dans les cas suivants a) il a me toute participation a la perpetration de l?infraction', 29) 2'2 a mam?fesr? le d?sir de voir d?f?rer au ua'buual route accusation po??e contre lui. (3) Les aveux de culpabilite ou les declarations par lesquels le suspect se reconna'it responsable d?un acte ou d?une omission determines ne sont pas, lorsqu?il les a faits pour pouvoir beneficier de mesures de rechange, admissibles en preuve dans les actions civiles ou les poursuites penales dirigees contre lui. (4) Le recours aux mesures de rechange a l?endroit d?une personne a qui une infraction est imputee n?emp?che pas la mise en oeuvre de poursuites dans le cadre de la presente loi', toutefois, dans le cas ou une accusation est portee contre elle pour cette infraction et lorsque le tribunal est convaincu, selon la preponderance des probabilites, que cette personne a) a entierement accompli les modalites des mesures de rechange, il rejette l?accusation', b) a par?ellemeur accompli les modalir?s des mesures de rechauge, 2'2 peur, ?27 esame que la poursuire est injusre eu ?gard aux circousrauces, rejerer ?accusau'ou; le tribunal peur, avaur de reudre d?cz'sz'ou, reuir compre du compo?emeur de cette personne darts l?applicaaou des mesures de rechauge. A-68 (5) Sous reserve du paragraphe (4), le present article n?a pas pour effet d?emp?cher quiconque de faire une denonciation, d?obtenir un acte judiciaire ou la confirmation d?un tel acte ou de continuer des poursuites, conformement a la loi. LR. (1985), ch. C-46, art. 717', 1995, ch. 22, art. 6. 717.1 Les articles 717.2 a 717.4 ne s?appliquent qu?aux personnes qui ont fait l?obj et de mesures de rechange, peu importe qu?elles observent ou non les modalites de ces mesures. 19 000020 Released under the Access to information Act! Divulg?(s) en vertu de la Loi sur I?aoe?s a I?information. S?rte ale documents suscttant la r??exton Xi" L?article 718, qui a trait aux principes de determination de la peine, devrait ?tre modifie de la m?me facon afin d?encourager la prise de mesures plus judicieuses a l?egard des delinquants qui sont atteints d?un trouble mental et qui n?ont peut-?tre pas obtenu un verdict de NRC. Voir, par exemple, Bloom, H. et Schneider, R. Mental Disorder and the Law: A primer for Legal and Mental Health Professionals, Irwin Law, Toronto, 2006, chapitre 9. ?i Lot sur la sant? mentale, L.R.O. 1990, et ses modifications, articles 21 et 22. ?ii La proclamation de ce proj et de loi tres controverse a fait l?obj et d?intenses debats qu?il n?est pas necessaire de repeter ici. Il suffit de dire que le proj et de loi a ete critique largement et avec force par des medecins et des professionnels de la sant? mentale. Les modifications qu?il renfermait n?etaient apparemment fondees sur aucune donnee empirique et les experts qui sont intervenus ont signale que le proj et de loi aurait exactement l?effet contraire rendre les rues et les communautes motns sures). 20 000021