Proceedings of the Standing Senate Committee on
Social Affairs, Science and Technology
Issue 30 - Evidence - March 25, 2015
OTTAWA, Wednesday, March 25, 2015
The Standing Senate Committee on Social Affairs, Science and Technology met this day at 4:15 p.m. to study Bill S- 208, An Act to establish the Canadian Commission on Mental Health and Justice.
Senator Kelvin Kenneth Ogilvie (Chair) in the chair.
[Translation]
The Chair: Welcome to the Standing Senate Committee on Social Affairs, Science and Technology.
[English]
I'm Kelvin Ogilvie, from Nova Scotia, chair of the committee. I'll ask my colleagues to introduce themselves, starting on my left.
Senator Eggleton: Art Eggleton from Toronto, deputy chair of the committee.
Senator Merchant: Pana Merchant from Saskatchewan.
[Translation]
Senator Chaput: Maria Chaput from Manitoba.
[English]
Senator Cowan: James Cowan from Nova Scotia.
Senator Nancy Ruth: Nancy Ruth from Ontario.
Senator Enverga: Tobias Enverga from Ontario.
Senator Raine: Senator Nancy Greene Raine from British Columbia.
Senator Seidman: Judith Seidman from Montreal, Quebec.
The Chair: Thank you, colleagues. Before I welcome our visitors today, I want to remind us that we are here studying Bill S-208, An Act to establish the Canadian Commission on Mental Health and Justice.
As per our previous meetings on this series, by agreement of the steering committee, we will be having you put the questions one at a time and in successive rounds. So when you make your question, if you want to be on the next round, signal immediately and you will go on the next round.
With that understanding, I am very pleased to welcome our visitors today. By earlier agreement, I will be introducing Terry Coleman, retired Chief of Police, who is here representing the Canadian Association of Chiefs of Police.
Terry Coleman, Chief of Police (Retired), Canadian Association of Chiefs of Police: The Canadian Association of Chiefs of Police expresses its sincere appreciation for the opportunity to speak here today and contribute to this important discussion.
I'm representing, as you heard, the Canadian Association of Chiefs of Police as a member of the CACP Human Resources and Learning Committee, where this subject is domiciled, as well as past co-chair of the subcommittee with respect to police and mental health. I've worked in policing for 38 years, including with the Calgary Police as well as the Chief of Police in Moose Jaw. I'm also the former Deputy Minister of Corrections, Public Safety and Policing for the Government of Saskatchewan.
I currently work as a public safety consultant primarily related to policing, mental health in policing, as well as mental health and corrections. In these capacities, I also work closely with the Mental Health Commission of Canada.
Senator Cowan, in introducing this bill, made reference to a number of statements and statistics, including those by our past president, Chief Constable Jim Chu, and the 20,000 calls a year experienced by the Toronto Police Service.
Our current president, Chief Clive Weighill of Saskatoon, very much regrets that he's unable to be here today. However, he shares the following:
CACP members and the public at large strongly feel that those suffering such illness most often need the health system rather than the justice system. This issue is on the mind of every police leader in Canada.
Mental illness represents one of the top five concerns of police agencies in Canada. We cannot understate the significance of this issue to policing but, more importantly, to the communities we serve. Police are de facto 24-7 first responders to mental health crises and other situations related to mental health and mental illness occurring in our communities.
The reality of contemporary policing in Canada is that it is not just about addressing crime. It is about addressing deficiencies in the broader social systems, including our health and social services. It is about working with symptoms of greater social issues.
Typically, only 20 per cent of police calls for service actually relate to crime. By far, the majority of remaining calls for service have roots in social issues, including mental illness, substance abuse and addiction.
A recent study by one British Columbia RCMP detachment found eight people in that detachment area with mental health needs were responsible for a staggering 1,500 calls for police service over four years.
While many prefer to focus on declining crime rates in our country, this is only one part of Canadian police responsibilities. Overall, police calls for service continue to increase and police interactions with people with mental illness and mental health problems appear to represent a significant component of these increased calls, which in turn requires a substantial commitment of resources.
In recognizing the dire need to address the issue of mental health in policing, the CACP has partnered with the Mental Health Commission on a number of projects in the last 10 years related to this issue, including the delivery of two key national conferences on this issue.
First, in March of 2014, 350 delegates representing criminal justice and mental health leaders, researchers and people with lived experience of mental illness met under the theme of "Moving from Crisis to Creating Fundamental Change: Improving Interactions between Police & Persons with Mental Illness." They discussed what works, what could be improved, promising practices, and sought to find innovative ways to answer the question: How can we make these interactions safe for the person with mental illness, police personnel and the communities in which we all live?
The conference highlighted the growing list of promising practices, including crisis intervention teams — that is, police and mental health workers — forming a joint response most often found in larger urban centres, as well as the HUB approach, which is very prevalent in Saskatchewan right now. This brings together a wide range of community services such as police, health, social services and education to act collaboratively as early intervenors when a person appears to be at risk.
The conference resulted in recommendations for a new national framework for police education and training for consideration by Canada's police services and the release of the TEMPO report, a blueprint for a comprehensive training and education curriculum which has been referred to within this committee, I believe, and was co-authored by myself and Dr. Dorothy Cotton. This was endorsed by the CACP and the Mental Health Commission in August of last year.
Last month, the CACP and the Mental Health Commission jointly sponsored a second successful conference with 250 attendees under the theme of "Mental Readiness — Strategies for Psychological Health and Safety in Police Organizations," in recognition that in order to best serve others we must also look after our own. A key outcome was a call to all Canadian police services as well as police governance authorities to ensure that a clear and coherent mental wellness strategy is in place for all personnel.
The CACP highly commends the intent of this bill and the recognition of the often undesirable impact when the mental health and justice systems interface. It is a complex issue.
Should the role of the Mental Health Commission of Canada be expanded, or should there be a newly formed Canadian commission on mental health and justice? We recognize and applaud the fact that the Mental Health Commission came into being as a result of this committee's efforts. With a 10-year mandate expiring in 2017, the CACP believes the MHCC needs a permanent and expanded mandate to more clearly include the intersection of mental health and the criminal justice system.
The intersection between mental health and the criminal justice system has been a significant focus of the Mental Health Commission to date. Much good work in terms of research, guidelines and knowledge dissemination has occurred through the commission.
The Mental Health Commission should not be left with an uncertain future. This future should also include a mandate to be a catalyst for the necessary research. This is something that is badly lacking in Canada, and I believe you already have received a submission from a group, of which the Mental Health Commission and I were part of, in setting a national research agenda on mental health, justice and safety.
Given the complexity of the issue, a strategic approach is necessary to make meaningful change. A systems approach is also necessary to ensure that the resources and funding necessary for our front-line mental health partners to improve outcomes for all parties involved in police interactions with persons with mental health problems are improved, not least of which are improved outcomes for those with lived experience of mental health problems.
We all need to move from a point of crisis to preventing a crisis in the first place; that is, collectively collaborating and solving the problem instead of repeatedly trying to address the symptoms. This is not a problem to be solved within the criminal justice system alone, but rather by the criminal justice system in conjunction with the health care system and other social systems.
We thank you for raising this important issue, and I look forward in due course to responding to your questions. Thank you very much.
The Chair: Thank you very much, Mr. Coleman.
I now want to welcome Anita Szigeti, Chair of the Mental Disorder Portfolio for the Criminal Lawyers' Association.
Anita Szigeti, Chair, Mental Disorder Portfolio, Criminal Lawyers' Association: Thank you, senators, for the opportunity to comment on the bill to establish the Canadian commission on mental health and justice. I do appear today on behalf of the Criminal Lawyers' Association, whose Mental Disorder Portfolio I chair.
The CLA is one of Canada's largest specialty legal organizations, currently with more than 1,300 members. CLA has always taken a particular interest in mental disorder and criminal justice matters and has recognized expertise in this area. Our members represent clients with serious mental health issues in criminal courts and unfit and NCR accused before the provincial and territorial review boards every day. We represent clients on appeals in all levels of court.
I personally have represented more than 6,000 clients with serious mental disorders in a 23-year career. I have also participated in more than a dozen inquests involving deaths of mentally-ill individuals. At least five of those looked at why individuals took their own lives in a secure setting, whether custodial or in a psychiatric facility. The rest looked at deaths of individuals in crisis at the hands of police.
I will preface my remarks with three guiding principles our association endorses respecting the issues raised by Bill S-208.
CLA agrees that, generally speaking, seriously mentally ill individuals should be, number one, kept away from criminal justice where possible; number two, kept out of jail where possible; and number 3, kept out of psychiatric hospitals where possible. In other words, where possible, individuals with serious mental illness should be supported in the community with appropriate and necessary housing, income maintenance, vocational and educational supports. They should also be provided access to psychiatric care, observation and treatment if they desire it.
However, CLA wants to make one central point in all of this and it is this: Clients with mental illness are autonomous human beings whose own decisions should and must be respected. This means that lawyers acting for clients in criminal courts must take instruction from their clients at every step of the legal proceeding, from bail to a plea or whether or not an NCR verdict should be sought or conceded. The only exception to a client-instructed advocacy model is those few accused that have been found unfit.
The other important thing is that each individual is facing unique circumstances and requires an individualized, particular solution to the challenges they're confronting, particularly once they have come into contact with criminal justice.
I highlight these points because CLA worries that whenever there is suggestion of any systemic analysis proposed there is a tendency to veer toward therapeutic justice and to reworking the justice system into a more "medicalized" model with an emphasis on psychiatric medication equating to treatment, and things like early intervention too often meaning forced intervention.
That all being said, CLA is pleased to see many things in this particular bill recognizing the importance of social determinants of health rather than just focusing on the need for medication administration.
CLA supports the formation of a national commission on mental health and criminal justice for three reasons. One, we agree that the problems faced by mentally ill individuals in criminal justice are of epic proportions and need to be addressed comprehensively by people expert in the area. Two, we agree that a legislative mandate is required to ensure meaningful results. Three, we support the overall thrust of the bill as set out in the preamble which, on the whole, largely focuses the issues in a rights-based way and in a manner intended to reduce stigma and respect the autonomy and dignity of the individual at the centre of the controversy. We congratulate you for that.
We have a few concerns specifically arising from provisions in the bill, and they are as follows.
One, there's a suggestion that the advisory council should include either a client who has been involved in the criminal justice system or a family member of such an individual. We do not agree that this is an either/or proposition. CLA believes the commission must involve individuals who themselves have serious mental disorder and have been or are involved in criminal justice proceedings or have been under jurisdiction of a review board. The perspective of family members is not a reasonable facsimile for the experience of the individual him or herself.
Two, there's a suggestion that members of the advisory council would not be paid for their time. CLA believes that unless this is changed, the commission will not have the benefit of those with real experience and expertise in the area who cannot then afford to participate. This includes not only the clients, the consumers/survivors themselves, but often members of our own association who are not salaried individuals but practise law in a sole practice or small firm setting, working for this client group on a legal aid retainer, who would not have the ability to contribute. In this regard, we believe that involving defence lawyers who have vast experience and expertise in representing this extraordinarily vulnerable group of clients in the work of any commission on mental health and justice is critical. We believe our lawyers provide a perspective unique to our members and different from that of Crown attorneys or academics. We are very pleased to see the bill requires an equal balance of representation on the commission from health and justice, but we want to flag that defence lawyers are critically important to the work of this commission.
Finally, there's a suggestion that justice system participants should be educated on how to detect mental illness. Respectfully, CLA suggests that justice system participants be educated first on the law of mental disorder, particularly in the case of defence counsel. Major mental illness is not difficult to spot. The challenge for lawyers on the ground is not identifying who is mentally ill but rather representing the clients according to their instruction and respecting their wishes, as they would do with any other clients, as opposed to overstepping and starting to make best interest-based decisions for that person in their stead.
That and probably the greatest challenge our lawyers face in trying to represent this vulnerable population appropriately is the chronic underfunding of legal aid in this province and across the country. That is something we hope that this commission would address, recognizing that the work of lawyers who defend seriously mentally ill individuals is important and should be compensated in a way that permits lawyers to continue to provide the services long enough to build expertise in the area, to provide competent representation of clients who come into contact with the criminal justice system, recognizing that 99.9 per cent of clients with mental disorder in criminal justice are unable to retain counsel privately and must rely on a legal aid plan or lawyer if there is one.
To be clear, the purpose of these submissions is not a cash grab for the defence bar. We raise the issue because, in our view, the single greatest challenge mentally disordered offenders have in the criminal justice system, once they're in it, is they can't get a lawyer. They certainly can't get their counsel of choice to represent them on an instructed basis nearly often enough. Indeed, many senior members of the bar have stopped representing this clientele once cuts to legal aid were made and it became impossible to do so responsibly, professionally or ethically. The reality is that lawyers who do service this group spend at least three times as long as they would with any other client and end up providing nearly all of these services essentially pro bono, which over time becomes an insurmountable challenge for the bar.
In our view, these clients require expert and experienced counsel of choice to steer them away from criminal justice, to keep them out of jail, to champion their rights to liberty and trust, and more than anyone else in the criminal justice system they deserve the strongest representation with the utmost protection of their procedural rights because they are so vulnerable in every way. They also require a lawyer they choose to work with because building relationships with these clients takes a long time to gain their trust and to really understand their situation. Assigning duty counsel at random or a public defender model of service delivery is simply an injustice for these clients.
In closing, this brings me to the materials that we have asked to be distributed to you today, the G.A. inquest and CLA submissions to Legal Aid Ontario respecting their mental health strategy. Both documents underpin and underscore all that I have told you and illustrate all the many things wrong with what happens to mentally disordered clients in criminal justice.
I'm happy to answer any questions regarding those documents or anything else. Thank you for your time.
The Chair: Thank you very much.
I will now open the floor to questions from my colleagues. I will remind us all that this session will end no later 5:15 and repeat that we will be doing one question at a time but multiple rounds of questioning. I will start with Senator Cowan.
Senator Cowan: Thank you for your contribution to this important discussion. I really have a question that is more a clarification I would seek from Mr. Coleman.
I take it from your comments on behalf of your association that you would agree with Ms. Szigeti that these issues that are addressed in the preamble to the bill do require a focused attention and do require a national focus or a national leadership, if I can put it that way, in this area. The question you have is whether or not a stand-alone, separate commission is the proper vehicle, or whether the appropriate vehicle would be an expanded mandate for the Mental Health Commission of Canada, a formal, longer-term mandate which, as you say, expires currently in 2017, and of course proper resources to do the job. We've heard from the Mental Health Commission that they are prepared to do these things, but obviously they haven't been able to do all of them because they're doing good work in so many other areas and they are coming up against their expiry date. Have I interpreted your position correctly, sir?
Mr. Coleman: Yes, you have. I would say not just a longer term, for example, for the Mental Health Commission, but one that's entrenched in legislation so that it doesn't come and go depending on the available resources and the will of the prevailing government.
Senator Cowan: Thank you.
Senator Eggleton: Ms. Szigeti, you were quite clear about the reasons why you think Bill S-208 should be supported and why it is a very clear focus on the issue and provides the kinds of resources needed, but then you talked about the need for a good lawyer and the fact that there are cutbacks in the legal aid system that make it difficult to get people who can properly represent people with mental illness. I take it most of that is a provincial responsibility in terms of the funds, but obviously a lot of these people will find themselves in federal institutions. If this committee wanted to make a recommendation to draw attention to that very issue, what would it be?
Ms. Szigeti: You can always recommend greater increases in federal contributions to provincial legal aid plans. There are federal contributions to provincial legal aid plans. The thing is that individuals in criminal justice with serious mental disorder will not have any access to justice unless they have competent expertise and a lawyer who can represent them according to their wishes. If you set up a commission that focuses entirely on mental health needs, social needs, other needs, and address that, you will still have people coming into criminal justice. When that happens and they show up in the courtroom and they're facing a charge, what they need in that moment is a lawyer who knows what needs to be done. What they need is someone to listen to them, and often the lawyer is the only person in the system who is going to respect their autonomy.
I don't know what you do about that. You recognize it. You ensure that there's funding. You ensure that there's training, because the bill contemplates that training be provided to justice system participants. You make sure that whatever lawyer in whatever system is ultimately assigned to these individuals is competent and able to navigate the justice system as it relates to mental disorder.
Senator Merchant: Thank you to both of you for being here and for representing the police and the lawyers' association.
Both in the police area and with the people who represent these clients, you have talked just now about training. When police train, do they receive some training to deal with these cases? Do lawyers receive some training while they're in law school or while they're articling? Where is the best place for them to train, and how then do you connect either with the Mental Health Association or with a body such as the one that this bill suggests, or amalgamation of the two? Can you describe it a little bit?
Mr. Coleman: Dr. Cotton and I have done a lot of work on behalf of the Mental Health Commission on this particular area. Our first study was in 2008, our second was 2010, and the more recent one is 2014 on this particular subject. It's on our website. I won't wax eloquently about what's in there. If you choose to, you can reference it.
I will tell you this. In 2008, we scanned all the police colleges and academies across Canada and we found that it was spotty about what was being delivered. At that time Newfoundland had gone through two crises that resulted in an inquiry. Newfoundland, in conjunction with Memorial University, had a 40-hour one-week program that was comprehensive and well done, whereas many other places in the country, colleges and academies, only offered at best half a day that was elementary and, in our opinion, insufficient.
In 2010, we surveyed the whole country to find out what was being delivered as in-service training for police personnel because it goes further than police officers. We have to properly train the people who take and dispatch the calls and victim services and the like.
We did that again and by 2010 there was some improvement, particularly in the in-service, but still some things were left to be desired. These were published and brought to the attention of the chiefs of police.
In 2014 we did this again and found there was substantial improvement. Some places still needed to pick it up a bit, but overall it was fairly well done.
That begs the question: What is the learning retention and how is that put into practice afterwards? The actual delivery of it and the fact that it is now better tailored to adult learners — there was a time when it was a straight lecture format, which was not effective — by using a variety of media to deliver learning makes it look more effective overall.
I talked about the TEMPO framework. That is what CACP and the Mental Health Commission of Canada have endorsed as the framework for learning of police personnel in Canada. It was built based on finding out what was happening across our country, on an international research review and on looking at what other countries were doing.
There is little primary research to determine the effectiveness of training of police personnel. One project that is a year and a half into a five-year study in the United States is trying to do that and we look forward to it.
To go back to the research I raised, there is a deficit of research around this subject and the criminal justice system. I speak in particular about policing and corrections.
Ms. Szigeti: I'll take a moment to comment on police training. I spent a year and a half back to back at police shooting inquests of mentally ill folks in crises. Part of the difficulty, for example, is that Toronto Police Service gets Cadillac training. When new recruits come in, they have consumer survivors — that is, people in crisis — providing training. They get fantastic training there. Part of the difficulty is that the local police service comes after the OPP. Some of the messaging of the OPP is completely contrary to when they come to TPS. They learn very different things. They learn the mentally ill are dangerous; then they learn they are not. Then we found through the process of the inquest that when the crisis is happening, our clients are still getting shot. They have a little knife or a little hammer.
Part of the message is lost at the divisional level. We think some good training is happening with new recruits, but it's got to be maintained and refreshed at the divisional level, because that's when the police culture takes over and people are out there if there is not mandatory re-messaging. I know more about training police than training lawyers, but not nearly as much as Terry Coleman obviously.
Regarding the training of lawyers, I don't know how else to put it other than it falls to me and my association, the Criminal Lawyers' Association. A couple of weeks ago two of my colleagues and I co-chaired a day of training on mental disorder law in criminal courts which was incredibly well received. We had 200 people and people were beside themselves, hungry for the education. It doesn't tend to happen unless we do it ourselves. There is nothing mandatory about it. They don't teach it in law school — they don't teach you anything in law school really, though — at least nothing of practical value.
I'll give a little plug for Legal Aid Ontario. To their credit, they do have a mental health strategy that they are working on. Albeit we have problems with it — we are lawyers; we have problems with everything. They want to ensure there is training for lawyers who take legal aid certificates in this area. Other than that, it falls to us. We do it for our members in the association. We can't make other people take it, but we think there is a huge need particularly for Crowns. There has to be a better sense across the board for Crown attorneys in terms of when to pursue NCR, when not to and what the consequences are. There is room for a ton of education. No offence to His Honour, who is coming up next, but judges could use some talking to, too.
Senator Enverga: Thank you for your presentations. Between the two of you there is a wealth of experience and knowledge. Have you worked with the Mental Health Commission of Canada before?
Ms. Szigeti: Thank you for the question. I was just saying to Mr. Coleman moments ago that, weirdly, the Mental Health Commission's justice subcommittee did not involve anyone from Ontario. We have a very vigorous legal and non-legal advocacy bar in Ontario. We're nearly 1,400 members strong. For whatever reason, legal and non-legal advocates from Ontario were not part of the mental health and justice subcommittee. There was a lot of focus out West and out East. We were not consulted and did not have any input into any of that stuff.
My colleague Archie Kaiser from Halifax did some tremendous work. He is a law professor who specializes in this area. But the mental health and justice subcommittee of the Mental Health Commission as it was structured was not focused on criminal justice, per se. It looked at civil legislation across the country and did some great work with policing issues. We did have the report from Anne Crocker which was helpful with statistics on NCR. Unfortunately we did not have any link and we are not necessarily particularly well-informed in terms of what was a practical result, other than I'm aware of Terry Coleman's work. We've given talks together before. He and Dorothy Cotton did some great work.
The simple answer to your question is I don't know why, but there was not a lot of inclusion of Ontario in the projects.
Senator Enverga: Have you tried to engage them? Has there been a need to engage them?
Ms. Szigeti: No. That's the short answer.
Senator Frum: I have an exact follow-up to that question. Knowing now that you were not consulted as someone from Ontario — I am also a representative from Ontario — I can tell you that when the vice-president of the Mental Health Commission gave her testimony, which you may have seen, she pointed out that they made corrections in justice one of their priorities. The measures they are calling for are measures to prevent and divert persons living with mental illness from the correctional system, to promote the rights of persons with mental illness within the justice and correctional system, to enhance policies and practices regarding persons with mental illness in the justice and correctional system, and to provide appropriate supports for those involved in the criminal justice system. As far as priorities go, I presume you find that all pretty reasonable.
Ms. Szigeti: It's mostly fine. When I prefaced my remarks, I said generally those are the goals, keeping in mind the autonomous decision making of the person.
There will be cases. It's not uncommon where diversion from criminal justice is not in the liberty interest of the accused person. Mental health diversion processes sometimes keep an accused person in the criminal justice system before the court for nine months to a year, when if they had plead guilty to something there would have been time served and they would have been gone. These things are a nuance, but generally, yes, we agree with those sentiments.
The difficulty is that in all the time the commission has been working, despite some excellent work — as I said, Anne Crocker's report and the statistics around reoffending post-sentence are really helpful — all those wonderful goals are left to be worked on.
I'm not fussy on who gets to work on it, but I do think that there has to be a statutory mandate. You can't have something that will expire and evaporate in a year or two. You have got to have some permanence to it and you have got to have some kind of process that ensures defence counsel are involved and consulted, and the people on the ground who are practically working with the clients are involved with it.
That all sounds good. Unfortunately, you've got a toothless tiger if you don't have the legislative component, and that's really problematic.
This issue is so important, pressing and so big, and I guess one option is to try to give that legislative mandate to the Mental Health Commission. If that's going to happen, then I would like to see it revamped in terms of its constitution so it includes the people I know who are incredibly expert at this stuff and have a direct link to the clients. The friends of clients themselves need to be involved, and I haven't seen that with respect to the commission, respectfully.
Senator Raine: Thank you very much, both of you. This is very interesting.
Mr. Coleman, could you expand a bit on what you said about the two different approaches of crisis intervention team? I think I understand that that's more in the urban centres, but if you could expand on that and especially the HUB approach, which you said might be more applicable to smaller communities in rural areas?
Mr. Coleman: There are several police response models. A police officer can respond to these situations alone or they can be part of a co-response model with mental health workers, whether that be mental health nurses, mental health social workers or the like.
Here in Ottawa they're fortunate that there is a psychiatrist from Royal Ottawa, and his interns ride with the police. It's a very successful program.
There are a variety of ways of co-response. Most of them across Canada now are joined up with a mental health worker, sometimes a psychologist or a mental health social worker, and these are proven to be effective.
In the terms of the HUB, the model originated in Glasgow and came together in Prince Albert and spread around Saskatchewan and has taken root in Ontario as we speak right now. That's a mechanism where all the social agencies — police, health, social services, applicable NGOs around addictions and mental health and the whole works — come together in routine meetings, usually weekly, to share information. They have specially designed information-sharing protocols to cover this off, because they are often working with the same clients, the same people. If they don't get together and talk about it, they're sometimes working at odds or not fully understanding what the other parties are doing.
Without going into a long story about it, it has proven to be very effective. It requires rigorous evaluation at some point, but I'm confident that rigorous evaluation will show that it's a really good way of doing business, and it's starting to take root across Canada.
Senator Cowan: In its presentation to this committee a week or so ago, the Mental Health Commission of Canada referred to its pre-budget submission as support for its position that it was ready, willing and able to take on this role and do the things intended to be done by this bill. Subsequently that was received and circulated to all committee members.
The only reference I could find in that pre-budget submission was the following paragraph under "a few more emerging issues we will engage around with our partners," and it talked about criminal justice and first responders:
First responders answer frequent calls involving persons with mental illness, and they must also deal with a high- stress workplace which can present personal mental health challenges. First responders need new avenues for personal support and increased training on how to deal with persons with mental illness.
I'm sure all of us would agree that that's an important issue. I was surprised that the focus was so narrow in the area that we're talking about, of the intersection between mental health and the criminal justice system.
Can either or both of you comment on the adequacy of that if a renewed mandate were provided to the commission and that was what they were seeking to do? Would you see that as fulfilling the needs proposed to be addressed in this bill?
Ms. Szigeti: That's a laudable objective: first responders' training and police interactions with the mentally ill. Huge problems with lethal outcomes. It's a narrow sliver of the broad-spectrum issues facing the clients in terms of criminal justice issues. We're looking at from the charge through to fitness through to mental health courts through to supports, diversion programs and not criminally responsible individuals.
You'll hear about the review board momentarily from His Honour, Mr. Justice Schneider. There is the need for training, funding and examination of social supports.
Police interactions with the mentally ill, although certainly a personal interest of mine — I've devoted the last couple of years to it — nonetheless there is the narrowest of slivers in terms of what we mean by these individuals in criminal justice.
Restricting a mandate to that is just about that. In fact, what you've just read, respectfully, is completely consistent with what my impressionistic understanding is of the incredibly good work done by the Mental Health Commission in respect of policing and the mentally ill, and by Terry Coleman and Dorothy Cotton in particular. That's what I understood was done in criminal justice, together with Anne Crocker's report.
Mr. Coleman: I don't disagree with what my colleague is saying about expanding the mandate. I think the Mental Health Commission has been more involved in the criminal justice system than perhaps would appear, certainly from the presentation you had there.
I represent the Mental Health Commission on the federal-provincial-territorial heads of corrections mental health committee. That's where I've been all week. I left there this afternoon to come here. We put together a national strategy for corrections in Canada, in the not-too-distant past. I asked the question of the delegates this week. There are 14 corrections jurisdictions, so you can't mandate that across the country, as you well know. Actually, I found that the people at the meeting today have been using this as a reference point to doing work in their own provinces. That was gratifying.
So the Mental Health Commission has been involved perhaps more than some would realize, but I don't disagree with what my colleague said. I think the mandate could be expanded and perhaps the composition of the people involved could be changed. I wouldn't disagree with that.
Senator Eggleton: I will focus for a minute on the guts of this bill, whether or not it's carried out by a special commission or whether the mandate of the Mental Health Commission is expanded to include it. It has a lot of meat in it.
The other thing I want to mention is the horrible statistics we keep hearing about the large percentage of people with mental health problems in our jails, not only going in with them but a lot of them developing them while they are in there, or matters becoming worse, not getting proper treatment. The suicide rates are through the roof, particularly for those people held in segregation.
This particular quote I want to mention is all the more apropos because it deals with the policing end of things, Mr. Coleman. This comes from the Deputy Commissioner of the RCMP. He says he often thinks of policing in terms of a river. The police are kind of the last net in many respects. The more intervention there is upstream earlier on, the fewer the issues caught in the net further downstream.
In terms of the meat or the guts of this thing, whether it's the Mental Health Commission or the special commission that Senator Cowan proposes, how will that help provide for more upstream solutions? That's where it seems to me a lot of this needs to be stopped.
Mr. Coleman: Well, you're absolutely right. The current situation is blamed by some on deinstitutionalization many years ago. It happened a long time ago. Unfortunately, at least for quite some time, there were insufficient community mental health supports for people who otherwise were institutionalized. I'm not advocating returning to institutionalization. Believe me, I'm not.
The police ended up increasingly being the agency of last resort. In fact — this is somewhat poor humour — it was often the gold card for people to get into the mental health system.
If the police could reduce their workload, for want of a better word, in their interactions with people with mental illness, and if there were greater mental health services in the community — and I have seen in the last 10 years an increase in those. Part of that is assisted by the joint response teams, where mental health personnel work with a police officer, very often for minor offences. Then the client is diverted, with the assistance of the mental health worker working with the police officer, to some other agency or place of safety or where they can get the help they require, rather than being charged with a criminal offence and finding their way through the system and ending up in corrections. I don't have any numbers on it, but anecdotally, talking to people across the country, it's done a lot.
Ms. Szigeti: Because of a lack of community resources — and we completely agree on that — of supported housing and those kinds of resources, people tend to fall through the cracks. The involvement of police is exponentially increased by misapprehension on behalf usually of families, that by calling police they're going to ensure that the individual is going to get to treatment, to hospital, to medical help. So families call 911. There are all kinds of calls to police that needn't be directed in that way if there were services, education and information getting out to families on how to access services.
The further difficulty is that the forensic mental health system — so the review board system, when people come in NCR and unfit — is perceived to be quite the Cadillac service provider, and it is. It's richly resourced. So people actually push for our clients to become criminalized and "forensicized" in order to access this better-resourced mental health care system. There's an awful lot of unnecessary police contact, and the more numbers of contacts, the more likelihood of lethal and adverse outcomes.
There are a lot of ways to reduce all that — education, information and stopping people from dialing 911 when they really don't need to.
Senator Raine: I'm having a hard time kind of wrapping my head around something. We have the Mental Health Commission of Canada, which is relatively new. It needs to have its mandate extended, for sure, but I'm not sure that I see the need for a second organization. We can see the needs and the people falling through the cracks and all the problems and challenges that are out there, but it sounds to me that through the policing association and through also criminal law you're already dealing with this, and maybe it should be resourced directly instead of adding one more layer. I just wondered if you could comment on that.
Mr. Coleman: On behalf of the chiefs' association, and I've had conversations with Chief Weighill and his board of directors on this particular matter, they acknowledge that these issues need to be addressed. They like the concept of the bill here. They feel that it could be achieved through a new mandate — not a new mandate, but entrenching the Mental Health Commission into legislation and giving it a mandate that would include what we're talking about over here, rather than creating another commission. That's the perspective of the chiefs' association.
Ms. Szigeti: Our perspective is slightly different. In our view, mental health and criminal justice is, as Senator Cowan pointed out in his initial speech, this enormous thing that itself leads to a lot of death and dying and violence and murder and suicide and loss of lives and misery and seclusion and segregation. There's so much that's pressing that directly impacts on liberties. It's on a different order.
There are tons of things that the Mental Health Commission has done right, and its mandate should be expanded. The Homes First stuff should definitely continue. They've done really well at homelessness and housing and those kinds of social determinants of health. But criminal law and mental health is its own animal. It's just an enormous and frankly, respectfully, national embarrassment, how we're treating these individuals. It's an emergency.
If the Mental Health Commission in its current formation can assure us that it can act quickly and with some power and would have legislative backing to it, great. But simply extending what it currently has without the legislative backbone, without further resources, without involving people on the ground and sort of a greater structure to it?
I like the ambit of this bill because it is comprehensive but it's focused. With the legislative mandate, it would stand real chance of real success.
Senator Seidman: I would like to make an observation and perhaps a comment that you might respond to. With direct response to Senator Cowan's question on the pre-budget brief, where you presented that there might just be one item directly related to criminal justice, Mr. Coleman, you said in fact you thought there were more than that because there was an action plan that you were aware of. Indeed, if I look back at my briefing note from Jennifer Vornbrock of the Mental Health Commission of Canada, when she was here, she presented to us a list of their initiatives. In this list, she said that the MHCC is currently creating a mental health action plan for Canada in consultation with a lot of stakeholders in the hopes that it will guide the next mandate of the MHCC. Based on the feedback so far, they anticipate this mandate will continue to include activities related to the justice system and mental illness.
Then she lists, and I really don't want to read it all because it's quite extensive, but there are eight items here, including police training and interactions; trusted adviser to federal, provincial and territorial governments about issues related to mental health and justice; informing the future mental health indicators for Canada, which is a report they're working on that will release a set of 63 indicators in 2015; their national trajectory project, which is examining the ability of the Criminal Code to balance the need to protect the rights of individuals living with mental illness and the need to protect public safety; their at-home study on homelessness; their knowledge exchange centre. They even say at the end that the organizational structure and governance of the MHCC is very similar to what's proposed for the commission in Bill S-208.
That's a broad overview of all the items that have been listed that presumably will be part of their ongoing mandate if they're renewed, which is of course an important issue. All that to say that this is in full support of the point you made when you said that you were convinced that there was indeed a large action plan that included mental health and criminal justice issues.
Mr. Coleman: Fortunately, when the commission was stood up, seven advisory committees were created, this being one of them, mental health and the law. They were stood down, with the exception of perhaps one, five years later. In the meantime, there was a lot of work done. I speak for the committee I was on. There was money for research and quite a bit of research. Ann Crocker's project started under that committee, as did the work that Dorothy and I did. A lot happened there.
Since the committees have been stood down, some of that work has continued. I work on contract for the Mental Health Commission now on some of these projects, such as the corrections project that I talked about earlier on, but it could be more robust. It has probably lost a bit of impetus since the committees were stood down five years after it started, in 2012.
Senator Cowan: I just wanted to clarify that point. I wasn't in any way impugning the good work that the Mental Health Commission had done. Both of you have made the point that this is a huge area. The whole of mental health is a large enough area in and of its own, and they're doing good work. But probably for very good reasons they have not done sufficient work in this area, and that's why we either need an expanded, properly resourced function for that commission or a new commission.
Mr. Coleman: I agree completely.
The Chair: Thank you both for being very clear with us and bringing a great deal of experience in this critical area to us. I want to thank you on behalf of the committee for your presence here and your responses to us, and once again to my colleagues on the committee for the questions they've raised that will help elucidate this important issue.
Honourable colleagues, we'll welcome our next two panellists in a moment. I will remind you that the one question per round remains, and this session will end no later than 6:15 p.m.
With that, and because there's no prior discussion of whether they had fought one another to a draw on who will present first, I will call them in the order they were listed, unless there is a violent reaction at the other end of the table. That would mean that I'm very pleased to welcome the Honourable Mr. Justice Richard Schneider, Chair of the Ontario Review Board, to present to us first.
Hon. Mr. Justice Richard D. Schneider, Chair, Ontario Review Board: Thank you, Mr. Chair. As you indicated, I'm Chairman of the Ontario Review Board. The Ontario Review Board is a quasi-judicial administrative tribunal which obtains its jurisdiction pursuant to the provisions of the Criminal Code of Canada. We maintain jurisdiction over all individuals who have been found either unfit to stand trial or not criminally responsible on account of mental disorder. If I use the abbreviations "unfits" and "NCR" for economy, I trust everyone will stick with me on that.
We have about 170 board members who carry out our hearings. The board members are made up of judges, lawyers, psychiatrists, psychologists and public members. In Ontario, we hold over 2,200 hearings a year in respect to approximately 600 accused, and issue dispositions or orders that bind both the accused and the parties to the proceedings, in order to effect what we call the least onerous and least restrictive disposition.
These are, for the most part, individuals whose untreated or inadequately treated mental illness has brought them into conflict with the law. Nevertheless, only a small percentage of offenders who suffer from a mental illness actually obtain these verdicts and make it into the review board system. Most of them still do end up in jails or correctional facilities of one sort or another.
Of great significance — and there was a great article in The Toronto Star last week — most individuals who come into our system have had previous contact with the civil mental health care system prior to the offending that led to the verdict of unfit to stand trial or not criminally responsible. Senators, there's a tantalizing inference that had the civil mental health care system been more responsive to these individuals at first instance, they would perhaps not have become enmeshed in the criminal justice system. This would be a net, as Senator Eggleton referred to it, further upstream. A well-resourced and potent civil mental health care system is the best prophylactic we have to the problem that we're currently facing with the overrepresentation of mentally ill individuals in the criminal justice system.
The Ontario Review Board, for the most part — in fact I can think of very little we would depart on — would entirely endorse the submissions made by Ms. Szigeti and Mr. Coleman.
We are most interested in and support the objectives set out in Bill S-208 and would heartily support its implementation. We are most interested, as you might guess, in all efforts that have the potential of reducing the numbers of individuals with mental illness who come into conflict with the law. Also, we are most interested in reducing the numbers of people with mental illness who end up in the jails. Jails are very bad places for these individuals, as we repeatedly hear, most recently through the recommendations of the Ashley Smith inquest.
The Ontario Review Board agrees entirely with the state of the nation, if I can put it that way, as depicted in the preamble to Bill S-208.
There has been some debate in the earlier sessions as to an expanding of the mandate of the current commission or the creation of a new one with a statutory basis. I'd be quick to also observe that the Mental Health Commission of Canada has done some wonderful work, and that's been alluded to. However, I would submit that the commission, to date at least, has been for the most part aspirational in nature, if I can put it that way. It has formulated strategies. It has done some research. It's a recommendation-maker and it has done some wonderful work. It is common ground that its mandate is about to lapse in two years. With that, as with any body that has a limited lifespan, as it comes toward the end of that, it essentially finds itself at irons in that it's not practical to make long-term or even possible long-term commitments with other agencies or bodies that might be possible had that commission had a statutory backing.
While I agree with all of the objectives set out in the preamble, I think it's critical — and I think I'm gleaning the intention of the bill; I think it is more or less explicitly stated in some spots — to have a body with the objectives set out in the preamble but that goes beyond the simple making of recommendations, that's actually able to get onto the ground and help to implement or effect some of these policies, to assist jurisdictions with projects and offer guidance with projects that would actually go to reducing the probability of individuals with mental illness becoming enmeshed in the criminal justice system.
I think that takes me to my five minutes, and I'd be happy to answer any questions you might have.
The Chair: Thank you very much.
Now I will turn to Dr. Alexander Simpson, Vice-president, Canadian Academy of Psychiatry and the Law.
Dr. Alexander (Sandy) Simpson, Vice-president, Canadian Academy of Psychiatry and the Law: Thank you very much for inviting us here to submit on this bill. I speak on behalf of the Canadian Academy of Psychiatry and the Law, which is the organization that represents psychiatrists working in the area of forensic psychiatry and is involved in training and assisting the Royal College with the standard setting in forensic psychiatry. I also come with the approval of the Canadian Psychiatric Association, who also endorse the paper that I've given to you, and the content of that.
Both organizations welcome this bill. As Justice Schneider has said, we agree absolutely with the things that are set out in the preamble to it and share the sense that a statutory structure would give greater focus to the complex intersectoral issues that we've been talking about.
In the paper that I've given to you, you will see on pages 2 and 3 that I've set out eight major areas of public policy where we are struggling at the moment and that contribute to the problems that have been talked about already.
Although I am a fisherman, I'm not fond of the fishing analogy in this situation. One has to think of a pathway by which people get from being okay to getting increasingly troubled and what are, as one model describes, the intercepts that might work to stop people going down bad pathways and help them stay on better ones.
First is the social structure around vulnerable people that in many ways our social policies are failing. We've heard about housing, social support, work opportunities and so on.
One that's not quite so politically correct to say but I think is really important to say is that it's not only the resourcing of and the access to high-quality mental health services; it's also another health technology called civil commitment, or mental health law that often does not work in a manner that allows timely, appropriate and sufficiently thorough addressing of people's care. So it is fine to have services, but if you do not have mental health law that fits with the needs of people and to ensure people's needs of treatment are adequately addressed, then that will be not a crack that people will fall through, but it will be an engineered gap in services that results in the decline in function of people.
Third, and related to that, is the need for a recovery focus throughout what we do, including when we have to take control in areas such as civil commitment. We're not well developed in our thinking in those areas, but what one sees over time with people, if there's been a lot of police involvement and a lot of frequent short-term but largely ineffective use of civil commitment, is that people get increasingly alienated and avoidant of care, which accelerates their pathway down the wrong direction. So we need to have a lot more sophisticated thinking in those areas.
We've heard a lot of the positive work that's gone on with police involvement. I won't add anything to what Terry Coleman has already said. Indeed, in the discussions with the previous Mental Health Commission, I think that's been one of their areas of real strength.
But once you then get involved in the criminal justice system, what are the mechanisms that should be present in our communities to help people? How do we intercept people at the court level?
We hear much talk of mental health courts and their models. They are very little evaluated and we have very little knowledge as to how well effective mental health court models are available across our communities. If I have a mental illness and I offend, and I wind up in the court, what are the chances I will get before Justice Schneider's 102 court in Toronto or simply in a mainstream court where the Crown, the defence counsel and the judges are inexperienced in dealing with mental health issues? What's my likelihood of getting access to a diversion program that will help me get redirected onto better, more effective pathways? Of course, you have to have something to divert into. You have to have those high-quality, well-resourced, accessible and good linkages with civil commitment-related community mental health services to provide structure and care around for those people. Do we know about the extent and the range of those services? No, we don't.
There's been much talk about correctional services provincially and federally. That is an area of huge need. Our model of health service delivery to those facilities is not as effective as we would like to see. Correctionally-run health services generally don't work as well as in-reach mental health services from local community mental health services, where you get benchmarked against community quality rather than get isolated in a parallel universe.
We also have to think about the mental health impacts of our criminal justice practices and laws. If we bring in things like mandatory minimum sentencing, like a retributive culture throughout what occurs, then we are likely, especially for minor offenders, to increase their risk of recidivism. We've already heard mention of issues in criminal justice such as the overuse of segregation, which can also have negative health impacts, so we need to be able to critique what we're doing in that way with a mental health lens.
Finally, at the parole stage of people exiting from correctional facilities, the integration with mental health services there is often very difficult. Services are unwilling to pick those people up. There are often delays with getting health cards and access to treatment, so people get doubly more likely to fall over.
I mentioned briefly, and will be happy to talk about more, the special issues about populations — First Nations, Inuit and Metis populations — and their rapid rise in this area at a worrying rate, particularly for women.
The mechanism of the commission, per se, and the proposal that's put forward, as other speakers have said, both CAPL and the CPA are supportive of the Mental Health Commission continuing its mandate. We note the areas where it has been effective. But looking at the overall situation, at the complexity of the intersection between these various agencies, the prospect of a commission with a mandate such as is proposed in this legislation as a statutory body is one that is of great appeal. Although we don't want to take away anything from the likelihood of the Mental Health Commission getting a renewed mandate, we do strongly support the statutory basis of the commission that's laid out here and would be happy to endorse and participate in any way we could in such a commission were it to be established.
The Chair: Thank you.
I'll now open up the floor to my colleagues, and I will begin with Senator Cowan.
Senator Cowan: Thank you for your contributions to the discussion.
Dr. Simpson, I wasn't aware, until I read your notes that you sent around the other day, that the Mental Health and the Law Advisory Committee of the MHCC had been wound up. That was alluded to by the previous panel. I think the evidence was it was five years into their ten-year mandate. Can you tell us why that was done? What does that say about the commission's commitment or, to use Justice Schneider's term, aspirations with respect to this area of concern of mental health and the criminal justice system?
Dr. Simpson: I don't know in detail as to why that decision was made. As I understand, most of their advisory boards were wound up at the same time. So there wasn't any sense that this particular board or sector was being picked on in any way but, rather, it was a strategic shift for the commission in terms of how it saw the contribution it could make in the work and the manner in which it was going to influence that. The priorities they've set out in their strategic direction are ones that are supported. Clearly, the criminal justice and mental health interface is one that they mention.
But in terms of new policy directions or new focus on the issues of concern for us, the commission is clearly in an uncertain future at this point and is unsure how it will influence those things. I wouldn't think that in any way they were avoiding the problems of the sector but, rather, it was a shift in the use of the commission itself. A statutory commission focused on these areas would clearly not do that.
Senator Frum: Thank you both for your presentations.
Dr. Simpson, I want to ask you about something that is in your presentation but you didn't say in your testimony. You write here:
As a matter of public policy it does not make sense to duplicate existing structures, but we are by no means assured of the continuance of the MHCC.
I appreciate the sentiment and I think it is the sentiment of everyone around this table and practically every witness we've heard that they wish to see a continuance of the MHCC. But in terms of the phrase "As a matter of public policy it does not make sense to duplicate existing structures," can you comment on that thought further?
Dr. Simpson: It would obviously be odd to have two commissions was overlapping mandates — one statutory and one not. Clearly if this legislation passes and this commission is established, then the Mental Health Commission of Canada, should it get a continuance in its mandate, might shift its focus to other areas and work in partnership with a commission such as this that would take leadership in the mental health and criminal justice interface. It would make sense that there would be some shift in the mandates to accommodate that so we're not working in any way in competition with each other but working in an integrated way.
Were this legislation to pass and the commission to get its mandate, then I would see the need for the two organizations to work out how they would manage their interface and who would be responsible for policy in which area.
Senator Frum: As you know, the commission has a whole package approach, and so to carve off this section of mental health from the Mental Health Commission, the Mental Health Commission would not be hampered by that in any way in terms of its whole approach?
Dr. Simpson: It would be awkward I think, clearly. It would not be insurmountable. There are some things that the commission has been advocating and providing leadership on that would span the whole mental health area — principles of recovery and approaches to how services should be delivered. All of that would apply clearly very much within our area as well. But the specific work around policy of input on issues around indicators and interfaces between general mental health and forensic services, between general services and mental health services and corrections, police and so on, there would have to be some way of dividing that up in a way that was coherent.
Senator Eggleton: Let me pick up on what Senator Frum has just said because we've had a lot of discussion back and forth.
We love the Mental Health Commission of Canada; it was created by a recommendation of this committee. But, Justice Schneider, you said that a lot of the things they talk about doing are really more aspirational in this particular context of the criminal justice system. Can you expand on that?
Mr. Schneider: Again, I was not a member of the commission, so I'm not privy to anything in particular. It's based more on observations that their work has been mostly in the area of strategies, recommendations, research, which is of course extremely valuable.
The way that I see Bill S-208 extending that is the suggestion that the commission actually get its hands dirty and get into the business of supporting projects on the ground and assisting with affecting the change that comes from the sorts of recommendations that the commission has made and, of course, that's part of the work recommended in Bill S-208 as well.
Did I capture all of that?
Senator Eggleton: Yes, I got you.
[Translation]
Senator Chaput: Dr. Simpson, Bill S-208 calls for the development of mental health and criminal justice policies. Obviously, policies must be based on analysis and evidence, which in turn requires in-depth and good research by recognized stakeholders in different disciplines, such as criminology or psychiatry.
To your knowledge, is there research being conducted that could help with the development of policies? If yes, who are the authors? Would you see the commission or another body working together with existing entities?
[English]
Dr. Simpson: Thank you for the question. Yes, there is some research being done in this area. I believe the committee has been provided with the results of the workshop we had in Montreal during the winter to try and set an agenda for research in this area. I'm one of the co-authors of that. Anne Crocker's group led that. So there is an attempt to set an agenda in that area.
The National Trajectory Project, which the committee has heard about, is a very nice piece of work in terms of a population cohort of NCR people. But those people were found NCR between 2000 and 2005, so we need that type of research to be continuous because a lot changes over periods of time. We've had Bill C-14, which may well change the rate at which NCR dispositions are being used. We are very aware in Ontario, in research we are doing together with the Ontario Review Board, that the number of people coming under the ORB is decreasing rapidly. So the public regime doesn't stand still.
There is some good research going on within the correctional area, but we still know way too little about the needs of women and First Nations, Inuit and Metis people coming into the prisons. We know little about their pathways and what our policies should be. There are some very good criminology, psychology, social science and psychiatry researchers working in the area.
But as an overall prioritized research program for this area no, it is piecemeal. There's some good work, but it's piecemeal. To some degree that strategy that I believe Anne Crocker provided the committee is an attempt to say, "Here is a range of areas where we have holes."
The other concern is when we do come up with results how much the evidence is listened to in the way in which public policy is made. In fairness, we've been dismayed at the non-evidence-based approach to public policy in legislation in this area, and that's a problematic conversation.
Senator Stewart Olsen: Thank you, gentlemen, for your presentations. I'm most interested in Mr. Justice Schneider's outlook on commissions getting their hands dirty. That's not what commissions do, in my experience. Is there another way?
I'm a front-line proponent as well. This is a personal feeling, but I would like to see more done at the front lines. I'd like suggestions from both of you of perhaps another way rather than striking commissions to actually get to the heart of the matter on the ground level, which is maybe where we need to go.
Mr. Schneider: Well, I think that the DNA for any project or any business of getting one's hands dirty has to start with some research, it has to be evidence-based and it probably will come from some aspirational paper of some sort. But I think too often they sit on shelves and gather dust. If you had a body that was able to then take those and not perhaps itself get its hands dirty but at least assist those people on the ground with implementing and effecting some of the key bits that have been recommended, that what I'm thinking of, which would be the next generation or perhaps even third generation of the current commission.
Senator Cowan: Justice Schneider, you were a participant in the meeting held in November of last year funded by the Mental Health Commission of Canada and the Canadian Institutes for Health Research that produced the agenda we've all been speaking about over these hearings. Dr. Crocker led the team that produced the National Trajectory Project, and she provided this committee with a copy of the report. Unfortunately, we're not able to fit her in as a witness before us, but in her written submission she said this, and I'll ask for your comments on it.
It directly follows our recommendations in the report on Setting a National Agenda for Research on Mental Health, Justice and Safety that a Commission on Mental Health and Justice is needed in Canada. It would ensure that the issues pertaining to justice-involved persons with a mental illness would be appropriately and systematically addressed at a national level in order to promote evidence-based policy decision-making and training as well as knowledge dissemination and public education in matters of mental health, justice and safety.
I take it you'd support that position. Do you have anything to add to that comment?
Mr. Justice Schneider: No, and I think I am repeating myself, but I would fully endorse what Dr. Crocker has said there. I have participated in countless efforts of this sort, and they produce wonderful recommendations that go nowhere. Again, I would like to see something, and I hope I'm not over gleaning in my read of Bill S-208, that would go a little farther down the road.
Senator Eggleton: Dr. Simpson, in your presentation you talked about eight public policy priorities. I don't know if you've done an analysis of those versus what is in the legislation, but do you think the legislation provides a framework under which those policies could be adequately dealt with?
Dr. Simpson: Yes, I think so. I think it has set a broad range of concerns that cover that area.
The one area that I mention in the submission that is not emphasized there is the area of youth forensics. Clearly, to use the fishing analogy that I don't like but keep coming back to — one of my many character flaws — I think we need to get to some of things earlier on in the life course. But there is very good evidence around conduct disorder treatment interventions, and the co-occurrence of mental illness and conduct disorder is very high. That's a complex area as well in terms of multiple agencies funding it. I would like to see an emphasis on that area as well, explicitly, but that's the only other point I would add.
Senator Cowan: I have a question of clarification for Dr. Simpson following on a point that Senator Frum made earlier. She read to you the first sentence of a paragraph in your submission, which has been circulated to the committee, dated March 26. So that it could be seen in context, I thought I would read the whole paragraph and see if you have comment. The part that she put to you was:
As a matter of public policy it does not make sense to duplicate existing structures, but we are by no means assured of the continuance of the MHCC.
The two sentences which she didn't put to you were:
Further, we are not clear that without explicit direction the issues of concern noted above will be addressed in a generic mental health commission. We support the explicit mandate that a Commission must address the particular concerns at the interface of mental health and justice, and therefore welcome the Bill and the directions that it proposes.
You covered that in your previous testimony, but I would invite you, now that the sentence Senator Frum put to you is in the context of the whole paragraph, to clarify.
Dr. Simpson: At first glance, why have a new commission, particularly a new commission when the old commission has a lot of support in the sector? I think the other points in that paragraph set out why.
The explicit agenda that's set out in this legislation is strong and is welcomed, and the statutory basis would give much more confidence that it would grapple with the complex cross-jurisdictional and departmental issues in the sector. For that reason, whilst it looks a bit odd to have two, that's why we're supporting the bill.
Senator Frum: Supplemental to that, in the event that the Mental Health Commission was renewed and got a renewed mandate, there is nothing preventing the new mandate from containing the same emphasis?
Dr. Simpson: In a non-statutory way, clearly that could be drafted in a mandate, yes, but it would lack the statutory function that this legislation has.
The Chair: Thank you very much, colleagues.
I want to thank our witnesses today. You've added a rounding dimension to the testimony we've received with regard to this bill. I think all committee members are now very much aware of the issues and the ideas that surround this, the issues that we need to face in making our decisions with regard to the future in this very critical area. You've both been very helpful to us today in giving us information that is important to us.
Once again, I want to thank my colleagues for their questions that helped elucidate these additional areas.
(The committee adjourned.)