Using Policy to Manage Recidivism and Persons with Serious Mental Illness: Voices from Human Services and Justice Co-ordinating Committees

The debate regarding the tensions between the lack of an integrated system of community based mental health care, compulsory care, and individual rights and freedoms in the context of serious and persistent mental illness, is not new. lt contains a delicate and changing balance of rights and obligations. Valid arguments can be made on both sides of the protection balance - protection of a common sense of the social good and protection of the rights of individuals needing mental health treatment. The evolution of the Ontario Mental Health Act (R.S.O. 1990) (MHA) is discussed and situated in the Canadian context to illustrate how our current mental health system came to exist and unwell forensic clients reside in communities. Deficiencies are highlighted in applying mental health legislation to situations of persons with persistent psychosis, who are chronically interacting with the criminal justice system, treatment non-collaborative, and lack insight into their own behaviour and its consequences -- a symptom often associated with psychosis. The Government of Ontario has funded initiatives to attempt to monitor the safety/risk of forensic clients. An inter-ministerial initiative - Human Services and Justice Coordinating Committees (HSJCC) is the focus of research. This unique convergence of healthcare, the criminal justice system, community service providers, and stakeholders have been mandated to meet to discuss their common forensic clients with a mission toward prevention, system designs, crisis and community intervention planning, court assessments, and case management. Latent consequences of the diverse convergence of policies guiding individual HSJCC members are discussed. Confusion about the protocols for sharing needed information within meetings and with identified community stakeholders to plan for client management and potential Committee member self-preservation were the primary findings. The potential impacts of the findings and how these might impede HSJCCs from realizing their potential are highlighted. Promotion of simplified education in privacy policies to enhance the important work of the Committees is proposed.

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