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A view from CAMH

I have been a psychiatrist for more than 20 years. In that time, we have come a long way in how we think about and offer services for people with mental health problems who come into contact with police and the legal system. When I started psychiatry, there were few court diversion programs; forensic psychiatry was not considered a specialty and poorly trained and monitored doctors offered treatment in Dickensian conditions.

We have come a long way, but not far enough. A new report, which was published just before we went to press, reveals some humbling findings. The study, prepared for the Mental Health Commission of Canada, underlined the significant role the police play in the mental health system. The study found that 40 per cent of people with mental illness have been arrested in their lifetime, and 30 per cent have had police involved in their care pathway. One in seven referrals to emergency psychiatric inpatient services involves the police, and five per cent of police dispatches or encounters involve people with mental health problems. Police initiate about 25 per cent of contacts; 15 per cent are made by the person and 20 per cent by family.

Half of these encounters lead to mental health services. In 40 per cent of cases, the encounter is resolved informally. The use of force is rare, but people with mental illness are over-represented in police shooting, stun gun incidents and fatalities. People with mental illness who are suspected of committing a criminal offence are also more likely to be arrested than people without mental illness.

Consumers and service providers, who were interviewed as part of the study, recommend better training of police officers, information sharing between mental health services and police and closer relationships between police and the mental health sector, for example, by ensuring that mental health services are involved in mental health emergency calls that police attend.

This issue of CrossCurrents shows how much work is already underway at the intersection between mental illness, addiction and the law. But a recent study has shown that most people with mental health problems who commit offences and end up in the legal and mental health systems are existing clients of mental health services. The worry is that failing to establish good mental health and support services leads to the criminalization of clients.

On a bit of a tangent, the open access journal PLoS Biology presents an interesting piece of research that identifies a centre in the brain that deals with justice (http://bit.ly/iGi6b5). It seems that ideas of right and wrong and fairness are hardwired.

Kwame McKenzie, MD, MRCPSYCH (UK)
Executive Editor, CrossCurrents;
Director of Social Aetiology of Mental Illness, CIHR Training Centre (SAMI);
Deputy director, Schizophrenia Program, CAMH;
Clinical director, Health Equity, CAMH;
Senior scientist, Social Equity and Health Research Section, CAMH;
Professor of psychiatry, University of Toronto

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