The Mentally Ill in Prison – A Reply to the Centre For Addiction and Mental Health

newer meBy Marvin Ross

The chief of forensic psychiatry at Toronto’s Centre for Addiction and Mental Health (CAMH) , Dr Sandy Simpson, gave his explanation as to why so many people with mental illness are in the correctional system in a blog earlier in December. I learned of it because a number of people contacted me upset by what he had to say.

He gave three main reasons for this phenomenon which you can read for yourselves. His first reason is the one that people found the most upsetting as he claims that “broken families, poverty, substance abuse in the home, physical and emotional abuse experience” are “problems that increase the risk of suffering a serious mental illness. Therefore people with problems of criminal behaviour may well also have problems of mental illness, but the illness is not the cause of their criminality.”

This sounded like family blaming to those who contacted me and it does. I asked him on Twitter if he was suggesting that mental illness is caused by bad families? And I added, “Your point 1. MI in jail because of lack of services and beds”. His Twitter reply was “Agreed to last point esp in US. Family one of many relevant factors for crime generally Family problems often social context driven”. I then asked if he thought that serious mental illnesses were caused by families and he replied “no” but he did not reply to my tweet that his blog could be taken the wrong way.

His suggestion that the lack of beds might be a problem but that it is worse in the US is an interesting comment. That may be the case but so what? Is our negligence mitigated because someone else might be even more negligent? Imagine an accused murderer saying to the judge, “but your honour, I only murdered one person. Joe Blow murdered three people”.

Now Doc Simpson works at CAMH and CAMH is notorious in my mind for refusing a court order to treat a mentally ill patient. In fact, they won a legal battle that prevents judges from ordering mentally ill offenders to be taken to a hospital for treatment. In 2010, Toronto judge Mary Hogan, was faced with a schizophrenic defendant before her on a minor offence. She ordered CAMH to stabilize him as she knew that the standard policy was that these individuals were rerouted to jail rather than hospital.

CAMH left him in the hall because they had no beds and initiated legal proceedings to prevent such orders. They won. Can anyone imagine refusing treatment to someone injured in a traumatic car crash because the hospital is busy? It would not happen.

Lack of adequate mental health services and beds is the main reason that so many with mental illness are in jail. According to a thesis submitted in 2011 to the University of Manitoba by Richard Mahé, it has been known since the 1970’s that the lack of community resources resulted in the criminal justice system replacing the psychiatric hospital. The Canadian Institute for Health Information reported that the shortage of psychiatric hospital beds is resulting in people being squeezed out of hospital too early.

This closing of beds was decried by the Schizophrenia Society of Canada. And the Public Health Agency of Canada pointed out that “the rise in the proportion of prison inmates with mental illness suggests that some have exchanged the psychiatric ward for the prison ward.”

Howard Sapers, the investigator for Corrections Canada, told the Tyee that “We’ve seen a big increase in the number of men and women being sent to federal penitentiaries with a mental health issue and many of them end up with diagnosed mental illnesses such as schizophrenia.” And, he added, it is difficult to even find qualified staff willing to work in the prison system.

In fact, a state of the art infirmary and 26 bed mental health unit in the Toronto South Detention Centre has never opened due to a staff shortage. Inmates are being held in solitary confinement instead. Andre Morin, Ontario’s Ombudsman, has threatened to intervene if the situation is not rectified.

So, Dr Simpson, there is a lot to talk about on the subject of mentally ill in jail that is a lot more crucial than speculating on the adequacy of families. And we have a lot of work to do to rectify that sad reality.

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10 thoughts on “The Mentally Ill in Prison – A Reply to the Centre For Addiction and Mental Health

  1. Right on

    He answered my mail saying that he did not want to hurt families he then asked me to explain why I was hurt…you are telling him much much better than I, and giving him the right reason.

    Let us see what he will now say.

    Thank you again Marvin for standing up for us

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    1. Sometimes it would seem that some physicians are still in the dark ages with attitudes that should have been buried long ago. We may not know the exact underpinning of these medical illnesses but that should not give psychiatrist latitude to deal in family blaming. Patricia Forsdyke.

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  2. .No doubt about it! There are some old-fashioned psychiatrists currently working in the mental illnesses system who seem never to have read a scientific journal.

    It looks like Dr. Simpson might be one of them with his never proved, unscientific assumptions about schizophrenia and criminality.

    As the mother of a 21 year old son whose schizophrenic voices eventually made him kill himself I resent his social-studies, ignorant assumptions about what we now know are infectious biological brain diseases.

    I know of no other serious illness where doctors like him are allowed to spew social study adages or as psychologist and author Steven Pinker calls them “the usual rat’s nest of confounded variables”.

    It’s as if witch doctors have been called into service for the mentally ill. Families are never sure if they are dealing with magical thinkers or science-informed psychiatrists.

    We have a right to demand proven expertise in our search for qualified professional help for our suffering offspring without being gob smacked by these old fashioned, out of date psychiatrists who depend on Freud and old social unscientific presumptions about family causation for mental illnesses..

    There ‘oughta’ be a law.

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  3. Most of us look up to doctors for good reason. My doctor works hard for her patients and really does make a difference. That is why I am alarmed at Dr. Simpson’s words “….the problems in a person’s development that are associated with offending (broken families, poverty, substance abuse in the home, physical and emotional abuse experience) are also problems that increase the risk of suffering a serious mental illness.” I would suggest that Dr. Simpson has put the cart before the horse for the most part. Untreated serious mental illness can cause family break up, poverty, substance abuse and physical and emotional abuse. Family break up possibly could be prevented if family caregivers got support and education from the medical/healthcare provider instead of off putting remarks like this which is a reflection of discrimination, in my opinion. Both the 2006 Michael Kirby Senate Committee Report “Out of the Shadows at Last” and the 2012 Report from the Ontario Human Rights Tribunal document the discrimination felt by patients/families that has come from the healthcare system. The recent EUFAMI survey has documented that close to half of family caregivers are not getting the support that they need, which if they did get it, would result in better patient outcomes. 78% of these caregivers are women and the average age is 61 which would suggest that sexism and ageism factor into this situation. The “contextual issues” that families deal with are attitudes like Dr. Simpson’s. For example, when my son was at CAMH in 2005, the psychiatrist made reference to being reluctant to talk to families before we began our family meeting. My son did not get the adequate follow up care that his psychotic condition warranted, in my opinion. Plus, I did not get any education in how to care for him. Research (Dixon L. et al, 2001) has demonstrated the link between positive outcomes and the caregiver getting clinical guidance. In addition, the 2014 EUFAMI press release notes a 2012 report which states that when caregivers are supported the rate of relapse is 40% compared to 70% for those caregivers who were not supported.
    Compare the current neglect of caregivers’ needs to that with physical illness. My aunt received information from the hospital on nutrition when her husband was diagnosed with a heart condition.
    Recently an elderly friend appealed to me to help get her son to see a psychiatrist. I referred her to a GP who was taking on new patients to get a referral to a psychiatrist. Her son had been an alcoholic all his life as it turned out he was self-medicating his undiagnosed schizophrenia. After seeing her son, the GP entered the waiting room and loudly addressed my elderly friend and her husband in front of other waiting patients, stating that “he was not a specialist” and “he was doing them a favor” by referring their son to a psychiatrist. My friend came to me in tears as the experience was devastating for her. The son did see a psychiatrist and was put on appropriate medication, but why did she and her husband have to be publicly humiliated like that. This attitude of some medical/healthcare providers constitutes a health hazard because it discourages families from seeking help for their ill relative. It would seem that the attitude expressed in Dr. Simpson’s unfortunate remarks is pervasive in the health care system and it will take an incensed public to create meaningful change. Any resident in psychiatry should be required to attend family support groups and get an idea of the emotional and financial costs of supporting an ill relative. Better still they should be required to live in the homes where a psychotic person lives and see first-hand how one’s relative’s engagement with what is happening around him/her is restricted and how this in turn puts restrictions of the relationship between he/she and the family care-giver. It is easy for Dr. Simpson to throw his stones. Most of the medical community do not know the experience of families and will accept his statement based upon his status in the community.

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    1. however not to say mind you, families hesitate to talk about their ill members’ abusive or dangerous behaviour in fear of attracting the attention of the law.
      How many families have been told to press charges in order to get treatment for the agitated family member, only to regret ever doing so !!! As treatment did not materialize but conflict with the law did !!!
      Families are sitting ducks,

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      1. This is what happens too often. The current law is too blunt an instrument and the healthcare system fails so often the untreated seriously mentally ill. The detention centres are full of some very neglected seriously ill people. Their families watching this awful neglect suffer and are powerless to effect change. Patricia Forsdyke.

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  4. I have come through what at one time was schizo affective.. with ptsd severe. Now it looks like i went to jail. Had dirty cops think.i was a skinhead because i shaved my head due to illness and i always felt safe in boots. I had no idea i was in a state of psychosis. Throw me in.jail..little to they care to know why i was scared of nazis… gangs… child abuse.. alot of trauma and was thrown in jail after being cavity searched. In a cell alone. For i have no idea why but i just sat in a piss soaked cell.. hallucinations happening and no one gave a shit. Not at the jail and no one believed me cause there were no showing bruising. I dunno some i know wasnt possobly real but i still remember to this day. I remember faces of women who had done some scary things. I thougjt my.neighbour was abusing her child so to save him or so.i thought.. and i grabbed a butcher knife… went to.the door. I just thoughr her son was being hurt.i.loved those kids.i hacked the hallway by her door.. but i never hurt her.. sent.me where i thought was a station for the kkk to hide me..i.have no.idea why… so i woudnt talk.. i was afraid of being beaten again.they left me homeless.. after losing my whole world. Now im looking at a diagnoses of psychotic episode triggered her severe PTSD. Im doing volunteer work..im taking part in committees in the community. I want to do so much but because of all the trauma i.lived through.. i was taking a psychology course and was severely triggering to me. Everything gone including my.mind as well as be eaten alive by.bed bugs…i was even moore traumatized.by what i saw and went through at the shelter. Those are soecial people that work there. YWCA saved my.life and had a.lot of good workers supporting me.there. now im.goving back..

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