November 18th Lecture and Readings Flashcards
How many ppl experience mental illness
1 in 5 ppl
How many people have mental health?
5 in 5 ppl
what is mental illness?
The reduced ability for a person to function effectively over a prolonged period of time
- Mental illness is not the same as feeling sad or distressed as a result of normal reactions to difficult or troubling situations
-a wide range of illnesses that affect mood, thinking and behavior
what age group of ppl is more likely to experinece mental illness?
young people are more likely to experience mental illness and or substance use disorders
what are ppl w substance use probs more likely to experience?
Ppl w substance use probs are up to 3x more likely to have an additional mental illness
Are mental and physical health related?
yes
risk factors of mental illness
- early life experiences
- genetics
- stressful life events
- environmental influences
- social, economic and educational status
what class is more likely to experience mental illness?
Ppl who are mentally ill might slide into lower class and lower class are more likely to have mental illness
symptoms of mental illness
- significant distress
- inability to function as needed over an extended period of time
- severity depends on a variety of factors
physical health effects of mental illness
- diabetes
- heart disease
- weight gain or loss
how can ppl be treated with mental illness?
Most of those living with mental illness can be treated effectively in the community, but some require hospitalization.
why may some ppl not access mental health care?
Stigma
what is the difference between men and women in sharing feelings ab mental health?
men and women may be diff in sharing experiences, women may share more and men do not really
how many ppl get help with mental illness?
Less than half of ppl suffering from MI do not get the help even if they know ab resources
how does mental health help look in Ontario?
Mental illness accounts for 10% of the burden of disease in Ontario, it receives only 7% of health care funding.
- underfunding by 1.5 billion dollars
- wait times can be long
what does the common experience of getting MH care look like?
- MH needs not fully met, lack of specialized care, long wait times for counselling & therapy, over-reliance on ED care
- As soon as police get involved it can become a criminal justice issue instead of MH issue
what does cost of disability leave from employment look like for MH compared to physical health?
Cost for a disability leave for mental illness is almost double that of a disability leave due to physical illness
what leads to positive return on investment for ppl struggling with MH?
promotion, prevention, early intervention
what does WHO do?
WHO works to improve mental health individuals and soc at large
- Deemed to be for the benefit of the human race- eugenics (mental defectives) that is why they sterilized and in 1937 they took out consent and in 1948 they broadened the standards for sterilization
what is one of Canada’s partners?
Canada is a party to the Convention on the Rights of Persons with Disabilities which affirms the rights of all individuals with disabilities.
prior to deinstitutionalization where were ppl living w mental illness?
Prior to deinstitutionalization, those living with mental illness often lived in hospitals (true for USA and Canada)
- Lamb & Weinberger says that while conditions weren’t great… they weren’t treated as criminals
why is institutionalization of those with MH issues attractive in the 19th century?
- it removes the undesirable or dangers from society
- less fam responsibility
- belief that isolation was beneficial for the community
- essential for rehab
- Patients were isolated from soc so if they escaped they would have to adapt all over again and that would be hard
- public pressure for deinstitutionalization and more into community care
what did the shift toward deinstitutionalization look like?
- global popularity began in 1960s
- late 1970s and 80s was the rise of disability rights and evidence of negative impacts on patients
- growing interest
- importance of social inclusion
- Institutionalizing and was a way to hide the prob or relocate it to another place
- Inclusion over isolation is essential for treatment and recovery
- all provinces tried to move toward this
what did Wolfensberger introduce?
the concept of normalization w regards to MH treatment
what was Rosenhan’s goal?
see the impact of labelling
what principles is independent living based on?
principle of the social inclusion of ppl w disabilities including mental illness
social inclusion
a systematic strategy that seeks to ensure that disenfranchised groups of people, including people with disabilities, have greater participation in decision making that affects their lives.
outcomes of deinstitutionalization
- community care has been successful for some
- issues regarding access to community supports, preventative care and emergency treatment
- led to many MH issues living in poverty, being homeless and criminalized
- funding shortage
- revolving door effect
Penrose’s law
as we increase reliance on CJS to deal w MI we reduce number of hospital beds and the more beds and resources we have for MI less ppl are incarcerated- hydraulic relationship as one goes up the other goes down
what can be done to better the future of those with MH issues?
- Reinforce prevention and promotion, community based services for common MH issues and specialized services for those living w severe mental illness
- action, prevention and promotion
- spending money on things like psychotherapy overall saves money
how did CAN immigration act impact people with mental and physical health issues?
Canada’s 1910 Immigration Act established “prohibited classes,” which referred to people with mental and physical disabilities.
- The 2001 Act’s “excessive demand” section allows refusal of entry to a person who is likely to add to wait lists.
- 1929 act categorized ppl w disabilities along w criminals
Hassan and Gordon’s review of mental and intellectual disabilities that impact contact with criminal justice system include what?
- Factors associated with increased risk for offending are also associated with increased risk for disabilities.
- Ppl living w mental disorders are more likely to be apprehended
- police tend to be harsher on these people
The Macrthur study of mental disorder and violence
- Violence risk assessment involving over 1000 psychiatric patients examining the relationship between 134 potential risk factors and subsequent violence.
- The study concluded that, the propensity for violence is the result of the accumulation of risk factors, no one of which is either necessary or sufficient for a person to behave aggressively toward others. People will be violent by virtue of the presence or absence of different sets of risk factors. There is no single path in a person’s life that leads to an act of violence
what is needed from police to positively impact MH system?
- Need for more appropriate and adequate MH training for police and correctional officers
- more inclusion of ppl w lived experiences of MH are needed in the development of cirricula
- need to combat stigma
- anti stigma education
police interactions MHCC report recommendations
- inclusion of multiple experts in the learning process
- uniform inclusion of non physical intervention
- mobile crisis team- emerg services for MH
- est of policing standards
case study of ppl w autism and interactions w police
CAMH and Yorkk Uni research showed:
- Those living with autism face frequent interaction with police (16% had interaction)
- 19% of police interactions included physical restraint
- Suggested a need for vulnerable person registries
correctional and MH system- what does it look like?
- Rate of serious MI among persons in custody is up to 6 times higher than the general pop
- a system ill equipped to deal w MI
- many go w/o adequate treatment
- prisoners often end up in segregation
- corrections is not geared to deal w those w MI
- There is an under-emphasis on the role of mental illness in causing people to enter the CJS
- lack of attention paid to mentally ill patients that do not realize they are mentally ill
- we criminalize Mi bc stigma, ideal of what else do we do w them?
NCRMD: the McNaughten rule
to est a defense on the ground of insanity it must be proved that at the time of the committing of the act the party accused was laboring under such a defect of reason from disease of the mind as not to know the nature and quality of the act he was doing or if he did know that he did not know what he was doing was wrong
ex: In 1843 Danial McNaughten shot and killed PM’s secretary thinking it was PM Sir Robert Pee it was Edward but he could not be punished bc it was his delusions that made him act
NCRMD
not criminally responsible on account of mental disorder
- do not know the nature or quality of act
- did not know the act was wrong
- Sent to psychiatric facility until deemed no longer threat to public and they may be housed there for longer than a prison sentence
- No acquitted- may be held as long as they are a threat to the public
Case of Guy Turcotte
cardiologist in QB, he found out his wife (in process of divorce) was in relationship with someone else, drank 1L of washer fluid and doesn’t remember anything after, he stabbed his 3 and 5 year old 47 times, charged of first degree murder, was found NCR bc he was unaware of what he did, he called police on himself and hiding when police came, after going to facility for 18 months he was released in 2012 and it was appealed and then he went to jail (life, 17 years no parole)
Vincent Lee Case
suffering from paranoid schizo, and killed Tim McLain, he stabbed him, beheaded him and then tried to eat his body bc schizo told him Tim was the devil
- he received an absolute discharge in 2019
diseases paradigm
- address symptoms of MI
- effective treatment outside of an institutional setting requires:
1. a supportive fam network
2. an accepting community
3. adequate community resources
4. a place to live in the community
discrimination paradigm
try to resist stigmatization of MI
what should be at the heart of police training with MI?
- de escalation must be at the heart of all training probs w recruiting, police are not equipped to deal w MH issues
- Initiatives taken to mitigate tragic interactions between police and ppl w MI- de-escalation techniques, body cams, training police to not use lethal force or having them not even carry firearms like UK without formal consent, thoughtful assessment before lethal force is used, cop partnered w MH professional
Rosenhan experiment
- naturalistic observation and field experiment
- also known as the thud experiment
- Experiment was conducted to determine the reliability and validity of psychiatric diagnosis- it feigned hallucinations to enter psychiatric hospitals and acted normally afterward- they were diagnosed w psychiatric disorders and were given antipsychotic drugs
- Involved the use of healthy associated men and women including the researcher himself who feigned auditory hallucinations in an attempt to gain admission to 12 psychiatric hospitals in 5 states. All were admitted and diagnosed w psychiatric disorders. After admission the ppl acted normal and told staff they were fine and had no longer experienced any additional hallucinations. All were forced to admit having mental illness and had to agree to take antipsychotic drugs as a condition of their release. All but 1 were diagnosed with schizophrenia in remission before their release
- In the following weeks out of 250 new patients the staff identified 41 as potential participants w 2 of these receiving sus from at least one psychiatrist and one other staff member
- Rosenhan used experiment to test the reliability of psychiatric diagnoses
- Study concluded by saying it is clear that we cannot distinguish the same from the insane in psychiatric hospitals and also illustrated the dangers of dehumanization and labelling in psychiatric institutions
- It suggests the use of community mental health facilities which concentrated on specific probs and behaviors rather than psychiatric labels might be a solution
Details of Guy Turcotte case
- sentenced to life w no chance of parole for 17 yrs originally
- sentenced for killing his 2 children
- found guilty of 2nd degree murder in stabbing his kids to death
- Jury carries out automatic life sentence reflecting the nature of his crimes
- Crown asked he serve a minimum of 20 years while the defense argued he should be eligible to apply for parole after 10 yrs
- He had no previous convictions and was not considered a risk to society- Crown’s request was seen to be exaggerated
- At his first trial he was found not criminally responsible for killing his kids and the second trial ultimately ended in his 2nd degree murder conviction
- his legal team is appealing the guilty verdict
Details of Vincent Li’s case
- Li is a schizophrenic who was psychotic at the time of the event and he acc poses a low risk of reoffending and they say he will be closely monitored that if his mental health declines further it will be quickly detected and actions will be taken to rein in his freedoms
- The review board ruled Li could transfer to a psychiatric center at a Winnipeg hospital and will be allowed unsupervised visits to the Manitoba capital as long as he carries a phone
- Doc said he did not have hallucinations for over a year
- Li received a NCR designation after he killed Tim McLean on a bus
- Li said he heard the voice of God instructing him to kill McLean and repeatedly stabbed and mutilated the young man who was on the bus
- likelihood of reoffending for these ppl is rare
how likely is it for NCR individual to commit another crime?
Ppl held under an NCR are 5x less likely to commit a later crime than ppl who are sent to prison for crimes and are released after they serve their time
- Your chances are greater to get struck by lightning than being killed by an NCR person
why is receiving care important for NCR individuals over going to prison?
Ppl under NCR order receive the appropriate medical care and supervision unlike the penal system where ppl serve a set sentence in the NCR system ppl only attain more freedom when their doctors and their review board are convicted that they mentally fit into a threat to the public
- Ppl who go through the prison system have a 40% chance of re-offending within 3 yrs of release but for ppl who go through NCR system the rate is 7-9%
what kinds of crimes do NCR individuals commit if they do re-offend?
Ppl under NCR orders generally commit less serious crimes if they do re-offend such as public disturbances and homicide recidivism is very rare
how does the system for NCR ppl work if they go crazy again?
When ppl under the NCR order run afoul of the law the loosened bounds of the system quickly tighten again
often times how do ppl who are deemed NCR feel ab committing their crime?
- Ppl who commit serious crime while in the grips of psychosis are often so horrified by their actions that they are highly motivated to follow mandated medical regimen
- they often feel bad for their actions and this is then a motivation to change their life
- it is hard for ppl w schizophrenia to take their meds daily so this could be a reason for their actions
Hold your Fire Doc
Sahmi: was not mentally ill but was acting strange following ppl w a knife pl w a knife
Police: fired at him and then tasered him
O’Brien: O’Brien thought ppl were after him- putting microphone in his teeth
Police: O’Brien is walking around w a knife and police tell him to get on the ground and he runs away and he asked why to go on the ground and they did not answer and they shot him within 3 mins of coming into contact w him and he did not pose a real threat
Micheal: Micheal leaves hospital in gown and goes to store to get scissors and didn’t want to pay for them and hurt the worker
- Micheal suffered seizures from brain injury and he bolts out of door naked through neighborhood banging on car windows, picks up rocks and drops them then police show up and shoot Micheal 2x
Police: Micheal waving scissors around confused trying to get in ppls houses and police show up and kill him
Boyd: Boyd struggling w bipolar and shot by police- Paul was in successful career, smart- his mom diagnosed with ALS and his bipolar got more regularly, Paul called his dad 3 times that day and did not want to go to hospital
Police: eventually shot by police 2 mins after police entered scene, Boyd attacking officer with chain but Boyd was unarmed and crawling when shot was fired- officer who fired believed he was under threat- he was shot 9 times by officer- police were the cause of the violence
How police interact with the mentally ill and what they should be doing instead
What is going on:
- Canada keeps no record of police shootings but 72 ppl in crisis are shot and esp non white victims
- Toronto and other cities not keeping up w the demand of mental health crisis- should be treating them before crisis
- When ppl are obviously vulnerable police kill them
- Police are reluctant to back off
- Officer safety first- based on police training south of boarder
- police put under supervision after so many shootings
- Police do this as a fear factor
- Police are trained anything to cut your skin is a threat and hand to hand is not an option
- Police in a rush to fill positions- they take chances with candidates
what they should be doing:
- Police should try de-escalation instead of using violence
- Over time more ppl ended up in hospital for crisis instead of police killing them
- Response to increase of ppl in crisis police now use teams of mental health professional w officer- they divert ppl from the CJS or hospital and talk w mental health official and they put them up with counselling
- 21 foot rule required to react and deliver to move out of attackers path- got into officers heads
- We need to teach how police are taught- point is for police to back up to buy more time so there is no harm done
- Body cams to record interactions w public- 60% of reduction in violence, increase communication skills to talk to individual instead
- Cant let emotion or fear take over and remember the person in crisis can be a person you love
How does UK deal with ppl struggling w MI versus in other areas?
- UK a man has a Michetti and give him room to move and handcuffed eventually- he would not of survived in North America
- in the UK only small groups handle firearms for training purposes
- UK police went in w shields on person seeing things- she got his eye contact and talked to him
- Police and UK don’t even have fire arms often times
- In UK the issue is ill ppl in system instead of care
