REPRESENTING MENTALLY DISABLED PERSONS IN THE CRIMINAL JUSTICE SYSTEM Chapter 13: Mentally Disabled Persons in Prisons and Jails TABLE OF CONTENTS I. INTRODUCTION ........................................................................................................................................... 3 II. DEFINITION: WHAT IS MENTAL ILLNESS? .................................................................................................... 3 III. PRISON POPULATION ................................................................................................................................ 5 A. FEMALE OFFENDERS..................................................................................................................................... 5 B. GENDER DIFFERENCES WITH RESPECT TO MENTAL HEALTH ...................................................................................... 6 C. INDIGENOUS PEOPLES AND THE PRISONS ............................................................................................................ 7 Indigenous Female Offenders ............................................................................................................................ 8 D. OLDER OFFENDERS ...................................................................................................................................... 9 IV. FEDERAL PENITENTIARIES AND PROVINCIAL CORRECTIONAL FACILITIES ..................................................10 V. PREVALENCE OF MENTAL DISABILITY IN PRISON AND JAIL ........................................................................16 A. FEDERAL CORRECTIONAL INSTITUTIONS ............................................................................................................16 B. PROVINCIAL JAILS .......................................................................................................................................19 C. MENTALLY HANDICAPPED PRISONERS ..............................................................................................................20 VI. MENTALLY DISABLED PERSONS IN PENITENTIARIES AND CORRECTIONAL FACILITIES ...............................22 A. GENERAL—CONDITIONS IN PENITENTIARIES AND CORRECTIONAL FACILITIES .............................................................22 B. MENTALLY DISABLED PRISONERS ....................................................................................................................24 1. Problems Encountered in the Regular Population ...............................................................................25 (a) Mentally Handicapped Prisoners ..................................................................................................................25 (b) Mentally Ill Prisoners ...................................................................................................................................27 2. Special Handling Units and Administrative Segregation......................................................................30 (a) Current Practices in Administrative Segregation ...........................................................................................31 (b) Drivers of Change in Administrative Segregation Practices ............................................................................32 (c) Administrative Segregation’s Application to Mentally Ill................................................................................35 C. OBLIGATION OF PRISON OFFICIALS TO PROTECT MENTALLY DISABLED INMATES .........................................................37 VII. TRANSFERS OF MENTALLY DISABLED PRISONERS ....................................................................................39 VIII. RIGHT TO TREATMENT IN PRISON AND JAIL ...........................................................................................44 A. INTRODUCTION ..........................................................................................................................................44 B. CORRECTIONS LEGISLATION AND THE RIGHT TO TREATMENT..................................................................................45 C. COMMON LAW RIGHTS TO TREATMENT ...........................................................................................................47 D. BARRIERS TO EXERCISING THE RIGHT TO TREATMENT ..........................................................................................51 E. THE AMERICAN BAR ASSOCIATION'S POSITION ON THE RIGHT TO TREATMENT AND MENTALLY DISABLED PRISONERS ..........53 IX. RIGHT TO REFUSE TREATMENT IN PRISON AND JAIL.................................................................................54 A. INTRODUCTION ..........................................................................................................................................54 B. CONSENT TO TREATMENT .............................................................................................................................55 1. Informed Consent ..............................................................................................................................55 2. Exceptions to the Rules ......................................................................................................................57 (a) Emergency ..................................................................................................................................................57 (b) Best Interests of the Patient ........................................................................................................................58 (c) Incapacity ....................................................................................................................................................58 Alberta Civil Liberties Research Centre Current to April 2018 Page 1 REPRESENTING MENTALLY DISABLED PERSONS IN THE CRIMINAL JUSTICE SYSTEM 3. Capacity to Consent to Treatment......................................................................................................61 4. Assessing Capacity to Consent to Treatment ......................................................................................63 5. Voluntariness and Consent—The “Captive” Patient ............................................................................67 C. RIGHT TO REFUSE TREATMENT, FEDERAL CORRECTIONS LEGISLATION AND PROVINCIAL LAW .........................................68 X. TREATMENT IN MENTAL HEALTH FACILITIES..............................................................................................70 A. THE ALBERTA MENTAL HEALTH ACT................................................................................................................70 1. General .............................................................................................................................................70 2. Persons Not Criminally Responsible on Account of Mental Disorder ....................................................73 3. Persons Found Unfit to Stand Trial .....................................................................................................74 B. CHARTER OF RIGHTS IMPLICATIONS ON THE RIGHT TO REFUSE TREATMENT ...............................................................76 XI. ROLE OF CORRECTIONAL INVESTIGATOR AND PROVINCIAL OMBUDSMAN ..............................................80 XII. RECIDIVISM AND MENTALLY DISABLED PRISONERS ................................................................................81 XIII. CONCLUSION – RECOMMENDATIONS AND STRATEGIES WITH RESPECT TO MENTALLY ILL OFFENDERS .84 BIBLIOGRAPHY ..............................................................................................................................................88 Alberta Civil Liberties Research Centre Current to April 2018 Page 2 REPRESENTING MENTALLY DISABLED PERSONS IN THE CRIMINAL JUSTICE SYSTEM I. Introduction This chapter discusses various aspects of imprisonment and its effect on mentally disabled offenders. It examines the prevalence of mental illness in incarcerated persons and the difficulties faced by these prisoners. It also outlines various human rights issues, the right to treatment and the right to refuse treatment while incarcerated. Finally, the chapter discusses the role of the Correctional Investigator and the provincial Ombudsman in assisting mentally disabled prisoners. II. Definition: what is mental illness? The term “Mental Disorders”, as discussed here, may include bipolar disorder or schizophrenia, Fetal Alcohol Spectrum Disorders,1 Alzheimer’s Disease, Attention Deficit Hyperactivity Disorder (ADHD), personality disorders, and problems resulting from traumatic head injuries and other disorders that influence the functioning of an individual.2 It is estimated that up to fifty per cent of prisoners in the criminal justice system have an anti-social personality disorder referred as to psychopathy.3 Mental illness is a health issue rather than a criminal law matter.4 As a result, the criminal justice system has proven ill-equipped to deal with people who suffer from mental illness. For centuries, persons with a mental illness have been systematically isolated, segregated from the mainstream of society, devalued, ridiculed, and excluded from participation in ordinary social and political processes.5 The criminal justice system is based on a set of assumptions, such as that people act in a voluntary manner that is determined 1 Beverly Spencer, “A Different Kind of Justice” 20 The Canadian Bar Association: National 5 (July-August 2011).