He did not know it at the time, but it was the best thing that ever happened to him.
In 2007, Mike Williams was transferred to the Forensic Psychiatric Hospital in Coquitlam, B.C., from a medium-security prison where he was serving a four-year sentence for running a marijuana grow-op, because of his frequent aggressive and angry outbursts. The forensic hospital is a secure facility that treats people who have been found not criminally responsible for a crime, unfit to stand trial due to a mental illness or, for those like Mike, who have been transferred from a prison for treatment.
While in treatment, Williams spoke to his mother on the phone. “I have someone who wants to ask you something,” his mother said. There was a momentary pause before Williams heard “the cutest little voice.” It was John, Williams’ five-year-old son, who asked, “Dad, will you be in my life?” Williams, who was 40 years old at the time, cried as he promised his son that he would be. Williams says that call triggered something inside of him that he refers to as a “God moment.” He kept that promise to his son with the support of a team of psychiatric professionals at the forensic hospital. “She said I had so much po-ten-tial,” he says of the psychiatrist who worked closely with him, enunciating every syllable in a thick Newfoundland accent. He recalls the psychiatrist saying that he was not the type of person that would commit violent crimes time and time again. “That just changed everything.”
“I’ve got a record as long as my arm,” he says, gesturing to his pale forearm covered in black tattoos, many of which he acquired in prison.
Williams, now 53, spent over 20 years of his life in jail, starting at age 17. “I’ve got a record as long as my arm,” he says, gesturing to his pale forearm covered in black tattoos, many of which he acquired in prison. He sips a coffee at a Starbucks in his Scarborough neighbourhood, where he shares a home with his fiancée and his daughter from a previous relationship. Williams seems tough—his hair is buzzed short, with a clean-shaven face. His arms, muscled and sinewy from years of working out in prison, poke out from his red Roots T-shirt. Williams would be an imposing figure if it weren’t for the softness of his blue eyes.
Williams has seen the inside of more cells than he remembers, from St. John’s, N.L., to Coquitlam, B.C. But while the names of the institutions are not important to him, each had a lasting effect. He recounts the different moments that landed him in prison, from robbery to drug dealing, to assault with a weapon. But the moment that stands out for him the most is when he realized his life needed to change, not only for himself, but for his family.
With the help of his social worker, he got sober. He got treatment for his mental illnesses. And three-and-a-half years later, he left prison for the last time to be reunited with his son. “I am 10 years out and it is because I dealt with my mental illness, I dealt with the under causing [issues] of my criminal activity and my drug addiction and where it all stemmed from, the root of the problem, why I was the way I was,” he says. By addressing his mental health issues, including his diagnosis of bipolar disorder, ADHD, addiction and post-traumatic stress disorder from living on the streets and in prison, he has not re-offended.
While it was that push from his son that got Williams started on the road to recovery, getting sober and seeking psychiatric help was what helped Williams end his cyclical pattern of re-offending.
Williams is vocal on social media, using his Facebook and Youtube platforms to talk about drug addiction and the prison system. In a video posted in November, Williams referred to his years as an addict. “What kind of dad was I really smoking crack…neglecting my children?…As an addict, you are going to ruin your life. You are going to ruin your kids’ lives.” While it was that push from his son that got Williams started on the road to recovery, getting sober and seeking psychiatric help was what helped Williams end his cyclical pattern of re-offending.
While inspirational, Williams’s story is not unique. There is a correlation between mental illness and recidivism, which results in the overrepresentation of people with mental illness among Canada’s prison population. It is impossible to say if one causes the other, but addressing mental health problems may help to reduce the number of repeat offenders in Canadian jails. However, the resources that inmates require to be successful in this struggle are not always available.
Mental illness is the most prevalent health problem in Canada, according to a report by the Centre for Addiction and Mental Health (CAMH). By age 40, about half of Canadians will have experienced one or more mental health issues. The correlation between mental illness and substance abuse is striking no matter how it’s framed: People suffering from a mental illness are twice as likely to have substance-use problems as those without a mental disorder. Alternatively, people with substance use problems are three times more likely to suffer from a mental illness, compared to those without an addiction. As a result, a mental illness and substance-use disorder tend to be co-occurring, which is the clinical term for multiple illnesses that occur simultaneously.
People in prison are four to seven times more likely to have a mental illness than the general population. While clinicians recognize the complex relationship between addiction, mental illness and criminality, the criminal justice system lags far behind when it comes to treating addiction as a mental illness; this creates a disjunction between the criminal courts and mental health institutions. While the Diagnostic and Statistical Manual of Mental Disorders recognizes substance-use disorder as an illness, Canada’s criminal justice system is predicated on a belief that, since a person plays an active role in consuming drugs or alcohol, addiction cannot be used as a defence. According to Dr. Sumeeta Chatterjee, a forensic psychiatrist at CAMH in Toronto, substance-use disorder is what is known as a co-occurring illness. “We will see a significant percentage of our population have a major mental illness but they also have an addictive disorder that is just as much a priority for us to treat as their illness,” says Chatterjee. She further emphasizes that it is critical to understand how a mental disorder, like substance-use disorder, is defined clinically versus how it is defined in a legal setting. In a clinical setting, addiction is defined as a pattern of using a substance that causes significant issues in someone’s life. “It’s got to have biological and psychological roots and…that any individual compulsively engages in substance use in spite of all of the detrimental consequences to themselves, their functioning and other aspects of their life,” says Chatterjee. Alternatively, she says that the courts define addiction as a deliberate behaviour. “Courts have long held that an individual is accountable for their actions, even if under the influence of a substance, by virtue of the fact that they knowingly consumed that substance,” she says. Therefore, being intoxicated or having a substance-use disorder is rarely considered a defence to a criminal charge.
“Many people who end up in the criminal justice system are there because they have fallen through the cracks of other systems.”
Amber Kellen
Amber Kellen is the director of community initiatives, policy and research at The John Howard Society of Toronto, a Canadian non-profit that advocates for change in the criminal justice system. She says that while there are mental health facilities — like secure psychiatric facilities — for people who have committed crimes, many people go undiagnosed and therefore do not receive the treatment they need. As a result, these people continue to re-offend in a cyclical fashion and the criminalization of those with mental illnesses remains a major problem. “Many people who end up in the criminal justice system are there because they have fallen through the cracks of other systems,” says Kellen. “And so what that means in many cases is that people who have mental health issues are not always diagnosed.” As a result, those who are mentally ill have more difficulty participating in traditional court processes and adjusting to life in prison than someone without a mental illness. “I think there’s this tendency to see the prison population as having individuals in it that either have or don’t have mental health issues,” says Kellen. “Whereas I would argue that everyone who ends up inside jail does, to some extent, struggle with mental health.”
Ontario’s first mental health court opened more than 20 years ago to address the relationship between mental illnesses and criminal activity. A mental health court, while largely similar to a traditional criminal court, is staffed by people who have a deeper understanding of, and sensitivity to, the plight of accused persons who are experiencing mental illness. They are limited to resolving less serious crimes only, and often do so with less formality than traditional courts. Mental health courts often use diversion to resolve criminal matters without a trial or guilty plea—in many cases, offenders may receive a conditional discharge if they commit to getting treatment and keeping the peace.
Katalin Kirec is a Crown attorney who has worked extensively in Toronto’s mental health court over her 20-year career. Her fiery red hair is fastened in a low ponytail at the nape of her neck. She is wearing black trousers, a black blouse and a speckled grey cardigan. But her favourite accessory is her shoes—her black leather heels were specifically made for the performers of the Toronto Symphony Orchestra. She jokes that she definitely is not skilled to be part of that group, but when she saw them in a cobbler’s store, she knew she had to have them.
She pushes open the heavy courtroom door. Her heels click on the floor as she walks down an aisle flanked with three rows of wooden benches. She explains that the carpet that used to cover the floor of the courtroom was removed after too many people urinated on it. In front of the benches are two wooden desks, one for the Crown attorney and the other for a police officer’s use (the defence lawyers occasionally share this desk, but more often stand beside their clients to support them). The judge’s bench sits at the highest point of the room, facing the lawyers and the public gallery. Above the judge’s left shoulder is a video monitor used to conference in any accused person who is too ill to attend court in person. To the right of the judge is a door that leads to offices for the various resources available at the courthouse, including mental health support workers, Legal Aid Ontario duty counsel and a psychiatrist who is on-site five days a week to assess an accused person’s fitness to stand trial.
Brandy Skinner is familiar with this courtroom. When she was 33, she was diagnosed with generalized anxiety disorder and bipolar disorder. She lost her job of seven years after missing too much work, but was denied social assistance. As a result, Skinner was on the brink of homelessness and struggling to feed her 14-year-old son and seven-year-old daughter. She started abusing alcohol. For Skinner, these additional stressors exacerbated her mental illness, and she was arrested in 2014 for uttering threats.
Shortly after being arrested, Skinner was hospitalized for her mental illness, and it was while she was in hospital that she first heard about the mental health court system. During her next appearance in court, Skinner explained what she was going through, and her case was referred to one of Toronto’s mental health courts. After her initial assessment, she was connected with a psychiatrist who, according to Skinner, was a vital part of her recovery. “Not only did she talk to me open-heartedly, [but] I did feel good about seeing a woman of colour, who had understood the issues that I was facing and what I was dealing with,” says Skinner, who is Black. The psychiatrist helped Skinner apply for the Ontario Disability Support Program, which allowed her to keep her home and care for her children. Over the next 18 months, Skinner was required to appear in mental health court a dozen or more times; the court required Skinner to attend counselling, take her medication and stay out of trouble. Ultimately, she was granted a conditional discharge.
“If I would have been criminalized in a regular system and faced jail time…it would not have linked me to the support that I needed that helped change my condition,” says Skinner.
Brandy Skinner
The mental health court was pivotal in helping Skinner get better and avoid re-offending. “If I would have been criminalized in a regular system and faced jail time…it would not have linked me to the support that I needed that helped change my condition,” says Skinner. “If I didn’t get the help, if I didn’t have access to therapy and someone to speak with…I definitely would have re-offended because there would have been nothing to prevent me from continuing in that crisis mode.” Mental health court didn’t just help Skinner avoid a criminal record—it also gave her insight into the complexities of her mental illness. “My life is better in a sense where I’m more well aware of the moving parts to mental health,” she says.
Skinner’s experience illustrates the ripple effect poor mental health can have on all facets of an individual’s life. The many different social determinants of health that play a role in mental illness can increase the risk that a person with a psychiatric disorder will end up in the criminal justice system, according to Dr. Michaela Beder, a Toronto psychiatrist. “There are ways that being homeless and living in poverty heighten the chances that somebody is going to have that intersection with the criminal justice system,” says Beder. “If you look like you’re visibly experiencing homelessness, if you are racialized and if you’re acting erratically, each of those things will heighten the chance that police would actually seek you out.” Understanding the root of a person’s problem, whether that be a diagnosed disorder or homelessness, for example, can help address the various components of their mental wellbeing.
In 2018, the country’s crime rate and the severity of crimes recorded increased for the fourth consecutive year. The number of mentally ill individuals in the criminal justice system has been growing at a rate of about 10 percentage points each year since 1990. Richard Schneider, a judge in Toronto’s mental health court and a former clinical psychologist, wrote a report for the federal Department of Justice entitled “The Mentally Ill: How They Became Enmeshed in the Criminal Justice System and How We Might Get Them Out.” He writes that “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.” Police, he argues, tend to err on the side of caution and are more likely to “go by the book” by treating a person with mental illness like any other criminal. “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 psychiatric emergency [department] and forego the laying of a charge,” says Schneider.
Judy Gabriel-Virgo, a program manager for Toronto’s mental health court diversion program, strongly believes in the necessity of these specialized courthouses. “I think that mental health court is just more sensitive to the needs of people with mental health issues and understands the complexities,” says Gabriel-Virgo. “The judicial system is not really equipped to be able to take hold of people’s real issues.” Mental health courts are successful, according to Gabriel-Virgo, since they seek to understand why individuals commit crimes, which assists in developing a specific and individualized treatment plan and limit re-offending in the future.
In the mental health courts, the definition of success is much different than in traditional courts, and each case needs to be dealt with accordingly.
In the mental health courts, the definition of success is much different than in traditional courts, and each case needs to be dealt with accordingly. “Some people are going to be perfectly fine in three months and we’ll never see them again,” says Kirec. However, she says that others may take longer and are frequently seen in the courthouse. “Fine is different for everybody.”
Rather than being a system that forces those accused into it, like a traditional criminal court, these specialized courthouses have flexible procedures to fit the needs of the individual accused person’s illness and circumstances. Kirec says it is important to acknowledge that what may be trivial for someone without a mental illness can be extremely taxing for someone with a mental illness. Treating these as accomplishments rather than minor tasks gives that person a sense of pride. “So you might still be living out on the street homeless, but we know where you live,” says Kirec. Community treatment teams bring many of the services available through CAMH to mental health consumers, whether they are in their home or on the street, to assist in a person’s mental health recovery while living in the community. These teams are crucial to one’s recovery. “Your team sees you regularly, you do actually get your medication or your injection regularly because they take it to you on the street,” says Kirec. “You are not trying to avoid them, you found a way to do it that keeps you from re-offending even though the rest of the stuff isn’t fixed in the way that you might like to see it.”
Ted Kelly has been a judge for six years but before that, he was a lawyer who worked closely with Kirec at the mental health court. He emphasizes that the success of people whose cases end up in mental health courts is not always linear. Progress can be measured by a decrease in the severity of crimes, the frequency of the crimes or the person’s knowledge about how the system works improves, says Kelly. “You learn to look for little victories, small victories,” he says. “And those are not to be underestimated when you consider them in the context of the lives of the people who have those victories, they can be inspiring things.” While he believes the courts have come a long way in terms of how they deal with and understand mental health, there is still more that can be done to support those in need of assistance, specifically with the transition from the justice system and back into the community.
It took Williams 20 years in jail to change his life, but he eventually stopped his offending patterns, a victory he is incredibly proud of. Williams is from Gander, N.L., a community with a population of just under 12,000 people. In a community so small, changing his tainted reputation was nearly impossible, says Williams. People knew him as a “bad boy” and were not open to seeing him change. “I couldn’t have a job. I couldn’t get a girlfriend. Nobody would even date me…They wouldn’t socialize with me or date me or give me a job,” says Williams. If he stayed, he knew he would end up falling back into his old pattern of using and selling drugs. In 2001, Williams moved to Toronto to separate himself from the people and environment that supported his old behaviour.
For some people, the question of “why turn your life around if you still will be stigmatized?” is daunting and impedes them from changing. CAMH treats patients referred by the Ontario Review Board who have been found unfit to stand trial or not criminally responsible on account of a mental disorder. “The population that we deal with here is facing double stigma,” says Chatterjee. “They not only have the stigma of having a major mental illness but they have the stigma now of having engaged in criminal behaviour.” Chatterjee emphasizes that providing resources, specifically mental health support, to all offenders to help reintegrate into society is vital to reducing recidivism. “We can talk about doing all of these things for underserved and marginalized populations but unless we really address the issue with stigma, we are not going to get anywhere with it,” she says.
In Ontario, the use of background checks for hiring purposes is becoming more prevalent. As a result, those who have committed crimes and have a mental illness are additionally stigmatized because of their criminal records. Beder believes that “once you have been charged with something, it’s really hard to get out of that loop.” The inability to work because of a criminal record increases the risk of homelessness, which can make a person more likely to commit crimes. Senator Kim Pate, a prison-reform advocate, recently introduced a bill that, if passed, would help those who no longer commit crimes to move past that time of their life. The bill calls for an expiration date on criminal records of people who have managed to not re-offend so that they can separate themselves from their record, reducing the stigma that surrounds them. This would benefit many other aspects of a former offender’s life aside from employment, including access to housing, all of which contributes to mental wellbeing.
“The really important stuff is happening the moment that person leaves the courtroom…That’s what’s important. What happens in court, it’s not that important.”
Ted Kelly
As a judge, Kelly takes the implications of sentencing seriously. He says that a person with a mental illness requires a different sentence than someone who is mentally fit because the nature of their crime is critically personal. But Kelly emphasizes that what happens outside of the courtroom is even more significant. “I have to realize, my God, like [my decision] was nothing compared to what is happening as soon as that person either walks out of the courtroom or gets out of jail,” says Kelly. “The really important stuff is happening the moment that person leaves the courtroom…That’s what’s important. What happens in court, it’s not that important.”
Dr. Fiona Kouyoumdjian teaches in the medical school at McMaster University; she’s also a researcher with the Centre for Urban Health Solutions at St. Michael’s Hospital and she’s worked at a provincial jail in Hamilton. While all correctional facilities are required to have mental health resources of some kind, Kouyoumdjian says the quality varies. “This area has improved a lot over the last 10 years that I’ve been working in terms of better screening for mental health issues,” she says. “But there are still inconsistencies in terms of the access to care and quality of care within institutions, and then across institutions.” However, her main concern is how inadequately prepared inmates are when they leave prison. In the detention centre she works at, there is no process to connect an inmate who is being released with healthcare professionals, including mental health practitioners, or provide them with the prescriptions for their required medications, including those to manage their mental illness. “So if you’re leaving, you got to go sort out your relationships with your family, your housing situation, your job, whatever the things are that you have to do, you have to go see your probation parole officer. And you also need to try to go find a prescription for your antipsychotic medication,” says Kouyoumdjian.
According to Pate, the government is not doing nearly enough to help mentally ill people who are arrested and incarcerated. In addition to the bill she introduced to allow for the expiration of criminal records, she has also proposed a bill that will outlaw mandatory minimum sentences. Pate argues that by imposing mandatory minimum sentences, those who committed a crime as a result of their mental illness but are not deemed to be not criminally responsible are forced to spend time in jail when other methods of treatment would be more beneficial in rehabilitating them. ”When you think of equality you have to think of, does everybody start at the same place? Are all the circumstances the same? Are all the situations? Does the whatever behaviour impact everybody equally?” she asks. “And it doesn’t, obviously.”
There’s no shortage of advocates like Pate who argue that people with mental illness who commit crimes should be sent to secure mental health facilities where a stay is imposed, rather than warehoused in prisons. While their arguments are compelling, the economic feasibility is challenging. There are significant cost differences between placing mentally ill offenders in jail versus in a psychiatric facility. Prison is a cost-effective way for the government to punish wrongdoers and segregate them from the general population; however, traditional prisons should not be the go-to answer when someone commits a crime. “Over the last 20 or 30 years, is an increasing recognition that criminal records can be very detrimental to future success,” says Kelly. “And that attempts should be made to avoid or divert vulnerable people from criminal prosecution.”
Almost two-thirds of imprisoned adolescents have two or more diagnosed mental illnesses, according to a report by the George Hull Centre for Children and Families. The cost to incarcerate a federal offender is just over $300 per day, according to the Office of the Correctional Investigator’s 2017-2018 Annual Report. The daily cost to stay in a psychiatric hospital in 2017-2018 is close to $100 more, according to the Health System Resources for Mental Health and Addictions Care in Canada. Since every person requires an individualized plan to determine the length of stay they would need in a mental health facility, it is difficult to say exactly how much more the government would spend to ensure mentally ill offenders get the help they need. However, if placing a youth offender in a mental health facility at an early age would reduce re-offending, investing in their mental health may be reframed as a strategic economic investment.
Katie Almond is a probation and parole officer who works with mentally ill clients in high-need, high-risk areas of Toronto. She describes many of her clients as “frequent flyers”—people who are in and out of the criminal justice system. While they may be recognized as having one or more mental illnesses, they are often not in jail long enough to receive the help they need to get better. As a result, they continue to re-offend. “So the longer [your sentence], the better your chances of getting help,” says Almond. “But for the shorter [sentence]…they’re in and out of jail [and] because they’re in and out so quickly, they may be assessed as having issues, but those issues may not be addressed, because they’re not there for that long.”
In Ontario, the criminalization of mental illness results in the overrepresentation of mentally ill offenders in the justice system, according to The John Howard Society of Ontario. During the late 20th century, there was a decrease in institutionalizing mentally ill people in psychiatric hospitals based on the belief that they would benefit more from being treated in the community. The idea that people with mental illnesses will be better served outside a hospital or prison has sparked a pilot project of four community justice centres in Ontario. These centres provide the services and resources an individual would need to be successful and function in a normal society, including mental health support, doctors and dentists, says Almond. Rather than being sent to prison, offenders would be diverted into this alternative rehabilitation system. “It’s all about what can we do to care for you to try to keep you out of the justice system and [others have] had tremendous success,” says Almond.
He ended up being one of those criminal justice “frequent flyers” from a young age.
Ryan Beardy has used knowledge gained from his years in prison to help other people. He was raised by parents who were residential school survivors and as a result, he says he lived in “a very cold home.” He ended up being one of those criminal justice “frequent flyers” from a young age. “Youth [detention] centre at 13, three years of incarceration as a youth, several years of incarceration as an adult, in and out of the criminal justice system,” says Beardy. He recognizes that there is an overrepresentation of Indigenous people in Canada’s prisons and he has witnessed first hand the overwhelming number of offenders with mental health problems and how prisons are not qualified to deal with these issues. “And I saw this exact same situation across the board, to many, many Indigenous men. That historically, since we were children, we’re told to man up, we’re told to tough it out, pretty much not have feelings and to bottle it up essentially.”
Beardy wanted to give Indigenous offenders in Winnipeg the chance to speak openly about the root causes of their criminality by starting the Healing Together sharing circle. Every Sunday evening, Beardy and a small group of men meet at the Circle of Life Thunderbird House, an Indegenious community centre, to talk and to listen. “Socializ[ing] is one of the important aspects, being able to socialize with each other. You have men coming in and hugging each other and shaking hands and getting coffee and sitting down for a bite to eat,” says Beardy. Then the meeting starts with a smudge, a ceremony to purify the body and clarify the area they are in. The discussion that follows often explores topics like toxic masculinity, abuse, trauma and grief. “It’s just sharing, you’re able to share as much as you want, as little as you want,” says Beardy. Members sign a confidentiality agreement so the circle remains a free and safe space. Beardy concludes with a ceremony to rid their bodies of negativity.
Beardy credits the support he received from his peers as the reason he ended his criminal behaviour, and he hopes that the group’s supportive environment helps the other members avoid re-offending. “We all have problems,” he says. “We all need to vent and we all need people to support us and we all would like to ask for help and get that help.”
While having a support system is crucial, society’s fundamental ideas regarding mental illnesses and the associated stigmas remains a prevalent issue, especially when it comes to committing crimes. “If you had a tumor in your brain that was causing this, and we removed the tumor, people don’t have a problem understanding that you’re no longer a danger,” says Kirec. “But you cannot remove the mental illness. You can treat it but you have to keep that person on meds. And sometimes those meds are going to have to change and it’s more nebulous and it’s something you can’t see like a tumor and some people can’t get their heads around it.”