Newsletter of the Human Services and Justice Coordinating Committee
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Human Services
and Justice

December 2013

News from the Human Services and Justice Coordinating Committee

Message from the Provincial Co-Chairs

Although this year is coming to an end, the Local, Regional, and Provincial Human Services and Justice Co-ordinating Committees continue to plan for the future. Across the province, our colleagues have been creating and implementing programmes that will improve the delivery of services that span a range of health and justice sectors. Many of these initiatives were presented at our recent Provincial conference, “The Changing World from Youth to Elderly in Human Services and Justice”. As you may be aware, we had more than 400 registrants, who benefited from two-and-a-half days of diverse and thought-provoking workshops and keynote presentations. It was an outstanding conference, and the members of the organizing committee are to be commended for the tremendous amount of time and effort they committed to this event.

For those who wish to review the conference material, most of the keynote and concurrent presentations have been uploaded to the Provincial HSJCC site. You will notice that this is our new site. After many months of work, we now have a website that is more attractive, functional and navigable. It has a greatly increased capacity to store and deliver content. Although there are still a few “bugs” to work out, it is a significant improvement. Many thanks to our CKT Committee Chair, Trevor Tymchuk, who has tirelessly worked to ensure the integrity of our website content. His perseverance and attention to detail benefits us all!

One of the conference panel sessions provided the Provincial committee with the opportunity to present the second phase of our work on the “Police-ER Protocol”. The panel comprised police officers from three different communities, who discussed how protocols with their local hospitals has reduced the amount of time police officers spend in emergency rooms, and expedited the care of the individuals in their custody. As with our initial report on police-ER protocols, we will be offering a Webinar on this second phase in the future.

Recently, we received renewed “Communities of Interest (CoI)” funding, which allows us to provide additional webinars, in partnership with the Evidence Exchange Network for Mental Health and Addictions (EENet). On December 13, 2013, we held a webinar on the “Hamilton Anatomy of Risk Management (HARM)”, a risk assessment tool developed by the Forensic Research Group at St Joseph’s Health Care in Hamilton, Ontario. It was hosted by Provincial HSJCC Co-Chair, Sandie Leith. Our next webinar will explore the issue of “prisoner’s belongings” --- how to ensure that our incarcerated clients, upon release from custody, have immediate access to their keys, money, clothing and identification. This is a problem province-wide, and this webinar will examine how one community has attempted to solve it. We hope to offer the webinar in mid-to-late January.

As previously reported, members of the Provincial HSJCC met with a team from the Ministry of Attorney General’s Justice on Target team, to discuss how to improve the bail process. Last month, MAG’s “Bail Experts Table” released their final report. It contains 34 recommendations to improve the bail process and reduce court delays. Within these recommendations are opportunities for local and regional HSJCCs to assist in effecting positive change and ensuring that the needs of our clients are met.

Members of the Provincial HSJCC continue to be involved with the Justice Collaboratives, both at the local level, and in an advisory capacity.

As we wrap up another year, I want to thank my Co-Chair Sandie Leith for her diligence, insight, common sense, and Zen-like calm; Trevor Tymchuk for his critical eye, hard work and dry humour; Dorina Simeonov, for her ability to multi-task and produce excellent work simultaneously; and Jenna Hitchcox, for patiently organizing and documenting our many committees and meetings.

We wish everyone a safe, happy and restful holiday.

Katie Almond

Message from the Communications and Knowledge Transfer Committee

The Provincial HSJCC Conference was a great success. One the highlights of our conference was Howard Sapers, the Correctional Investigator of Canada. The day after he spoke to us, he presented his annual report to Parliament. We have linked to both his presentation and the annual report.

In fact, almost all of the presentations from the conference are now available on our website -

It's a brand-new design for our site, so there is still a bit of tweaking to do. If you encounter any problems with the site, please email me. And as you've noticed by now, we're trying a new format for this newsletter. In testing various newsletter formats, I have discovered that the more things you try to do with it, the more likely it is to cause errors with one or more of the myriad of email and browser software out there. I'm hoping the format works for the majority of readers. It's still available as a PDF, which is one of the only formats that works for (almost) everybody.

Legal Aid Ontario, an ex-officio member of the Provincial HSJCC, has released a discussion paper for their Mental Health Strategy. They're looking for feedback, and we've linked to the paper.

I want to thank Maurice Fortin for his contributions to the Communications and Knowledge Transfer Committee, and wish him well for the future. Which reminds me - we need volunteers for the CKT Committee. We meet, by teleconference, every month or two for no more than an hour. And, as always, if you have anything you'd like to contribute to the website or the newsletter, send it my way. Whether it's a news or journal article, or an article you've written about a project you're involved with, I'm happy to share it with our network of over 1400 people across Ontario.

Trevor Tymchuk, CKT Committee Chair

4th Biennial Human Services and Justice Coordinating Committee Conference

New Realities: The Changing World from Youth to Senior in Human Services and Justice

Over 400 participants from all sectors of human services and justice gathered Nov. 25 to 27, 2013 at the Toronto Eaton Centre Marriott for the biennial Human Services and Justice Coordinating Committee conference.

With sponsorship from the Ministry of Children and Youth Services, Ministry of Health and Long Term Care, Ministry of the Attorney General, Evidence Exchange Network, ConnexOntario and The Royal, the conference provided the opportunity for our community to share their learning and successes as we attempt to address the unique needs of youth and seniors.

Mr. Howard Sapers opened the conference with his keynote address; ‘Health’ in Federal Corrections: Key Challenges. The conference heard Mr. Sapers speak of the ongoing difficulties and gaps for the men and women held in the federal correctional system to access appropriate mental and physical health services, where and how he sees improvements can be made.

On Monday afternoon the panel presentation regarding Ontario Police Emergency Department Protocols: Reducing Emergency Wait Time for Police Officers & Accompanying Individuals Experiencing a Mental Health Crisis, showcased the incredible work done by the Provincial HSJCC and our policing partners.

Tuesday morning brought Dr. Wayne Hammond to the stage of the main ballroom for his keynote Mindful Resilience: The Human Curriculum for Thriving. Dr. Hammond had us laughing and crying. His presentation focused on strength based perspective and his examples of his work with youth were especially inspiring.

The film Not Criminally Responsible was shown on Tuesday afternoon. Facilitated by Steve Duffy from the Brockville Mental Health Centre, the film is a poignant story of both one man’s journey through the Forensic system and the journey of his victim and her family to forgiveness; reflecting the resiliency of the client and the victim. A panel of Alice Bellevance, Dr. Gary Chaimowitz, Justice Richard Schneider and Roy Bonadonna discussed their experiences working and living in the Forensic system and the planned amendments to the Criminal Code of Canada in respect to the Not Criminally Responsible legislation.

Megan Buisson closed the conference on Wednesday morning with her rhyming couplets and her perspective on her personal experience living with mental illness, diagnosis and labels. Breaking Barriers: Overcoming Obstacles and Finding Oneself. Again, the theme of resiliency was highlighted

The concurrent sessions covered everything you wanted to know about working with Youth, Adults and seniors in the community of mental health and justice. This writer had the good fortune to moderate several of the concurrent sessions, was and am inspired by the innovation and good work done by colleagues in all the service sectors.

Film night was Tuesday evening. Thanks go to Alice Bellevance for her recommendation and supply of: One of Two Minds; Three Voices: Discovery, Recovery; and We Were Children. With popcorn and drinks the films were well attended and very well received.

Aside from the excellent presentations, we were very pleased to be able to offer support to 15 people with lived experience to attend the conference this year. An amazing opportunity for those who have or are currently living within the mental health and justice system and for all of us who are working in the systems.

The food was terrific, the networking fabulous, the space was conducive to learning and sharing.

No conference can be a success without a phenomenal team working to plan and organize, this conference was no different. Sincere thanks and kudos go out to:

Vicky Heuhn, Alice Bellavance, Brian Smegal, Lin Sallay, Mandy Contois, Mark Graham, Marlo Jastak, Melanie Anderson, Melanie Lumsden, Paul Secord, Rob Adams, Sara Dias, Shelley Hatherly-Reichelt,


Sherry Sim, our event coordinator and her team who again this year made everything look effortless.

Now that this team made it all look so easy, we hope to have more volunteers for our 2015 conference!

Joan Dervin, Conference Co-Chair

Media Items and Press Releases

Shameful Profiling of the Mentally Ill
New York Times
A Canadian woman was denied entry to the United States last month because she had been hospitalized for depression in 2012. Ellen Richardson could not visit, she was told, unless she obtained “medical clearance” from one of three Toronto doctors approved by the Department of Homeland Security. Endorsement by her own psychiatrist, which she could presumably have obtained more efficiently, “would not suffice.” She had been en route to New York, where she had intended to board a cruise to the Caribbean.

$325M lawsuit filed over 'shameful' Elgin-Middlesex Detention Centre conditions
The London Free Press
A class-action lawsuit filed Monday on behalf of two former inmates at the Elgin-Middlesex Detention Centre over violence, overcrowding and living conditions at the troubled London jail is seeking $325 million in damages from the province.
The statement of claim describes a jail rotting under the pressure of jammed and unsanitary ranges, abusive or negligent guards and management, brutal cellblock overlords, improper medical treatment and a provincial government turning a blind eye to the situation.

Legal Aid Ontario’s Mental Health Strategy consultations begin with release of paper
Legal Aid Ontario
Legal Aid Ontario (LAO) released a paper today setting out a set of first principles and key issues that LAO believes are important to developing its Mental Health Strategy.
“LAO plays a crucial role in empowering clients in the mental health system,” says John McCamus, Chair of LAO. “Our Mental Health Strategy aims to improve access for a client group that is disproportionately criminalized, incarcerated, impoverished and under-housed.”

People with mental disabilities fear police
Toronto Star
Not a single hand went up when Peter Bruer, the manager of conflict resolution at St. Stephen’s Community House, asked the 40 or so people in the drop-in centre how many would call 911 for help in a crisis.
Most of the participants at the lunch-hour forum on policing and mental health issues knew from personal experience how Toronto police respond to EDP (emotionally distressed person) calls. None wanted to go through it again.
“I once called the police,” Heidi said. “Three came. They handcuffed me. I was terrified. They didn’t believe me. I would never call 911 again.”

Prison life steeped in myths
Toronto Star
Locked doors and barred institutions breed suspicion and myth.
Some Canadians believe jails are “country clubs” that coddle criminals. Others think they are medieval dungeons that strip inmates of their humanity and hope. Most people have never set foot in one.
The John Howard Society has worked inside Canada’s penal institutions for 146 years. It has helped inmates deal with the problems that brought them into the justice system, ex-prisoners reintegrate and troubled young people stay out of custody.
The charity doesn’t have the power to throw open the prison doors and give Canadians a look. But it is doing the next best thing. This month its Ontario branch is running a public education campaign called Counter Point designed to give outsiders a glimpse of life in the province’s 29 jails.

Myth Busting the Not-Criminally-Responsible Defense
The Trauma & Mental Health Report
“I thought he must die. He had no future, nothing good. I thought I was saving the child.” Nerlin Sarmiento had expressed disturbing thoughts about her children long before tragedy struck her small family of four. On many occasions the 32-year-old Edmonton mother had confessed to doctors and family members that she had thoughts of harming herself and her children.
Precautions were taken: Sarmiento was admitted to hospital several times, prescribed psychiatric medication, discharged, and had her mother move in to help care for the children.

With the Right Amendments, the Not Criminally Responsible Reform Act Can Support All
Schizophrenia Society of Canada
The Government of Canada announced yesterday that it will re-instate Bill C-54 (now re-numbered Bill C-14), the Not Criminally Responsible Reform Act, in the Senate of Canada. As a coalition of 12 national health organizations, we are optimistic that the government will work with us to amend the Bill so it supports victims without perpetuating the stigma and discrimination of mental illness.

Lack of Gladue report writers in northwest a 'crisis'
CBC News
Nishnawbe Aski Legal Services is calling for more justice workers in the northwest.
The law requires courts to consider special circumstances when sentencing Aboriginal offenders, but there are no workers to do the research on what are called Gladue reports.
The head of Nishnawbe Aski Legal Services said she considers the situation a crisis.

Federal prisons more crowded, violent under Tories, ombudsman says
Globe and Mail
Canada’s ombudsman for federal inmates says prisons have become more crowded, violent and worse at rehabilitation under the Conservative government, despite a budget increase of 40 per cent in the past five years.
In a speech heavily critical of the Conservative government’s tough-on-crime policies, Howard Sapers criticized “mass incarceration,” “arbitrary and abusive conditions of detention,” and the victims’ rights agenda that Justice Minister Peter MacKay has placed at the centre of his program.
The idea that “punishment with no apparent limits is justified stands many of the principles underlying our democracy and our criminal-justice system on their head,” Mr. Sapers told 150 people at a Toronto church on Sunday.

CMHA Ontario/Provincial HJSCC feedback reflected in Ministry of Attorney General bail recommendations
Canadian Mental Health Association, Ontario Division
CMHA Ontario and its partner, the Provincial Human Service and Justice Coordinating Committee (HSJCC), is pleased that feedback provided to the Ministry of the Attorney General (MAG) is reflected in new, key recommendations to improve the provincial bail system.

Criminals running the show behind bars, say critics
The London Free Press
More prisoners, more gang members, more mentally ill, more women, more Natives, more blacks, more addicts.
The population in Canada's federal prisons and provincial jails is growing, its face changing dramatically.
That's making life behind bars more dangerous and more costly, guards, politicians, researchers and prisoners themselves all warn.
Worse, if we don't adapt to those changes, they warn, life on our side of the bars is going get more dangerous.

Health Canada, Stop Rewarding Companies for Worsening the Opioid Addiction Problem
The Huffington Post
There's nothing surprising about two physicians who specialize in addiction, writing about opioid addiction. That's because it's a major public health crisis with over 200,000 Canadians addicted to prescription pain killers. And just as distressing, Canadians are the second largest consumers of prescription opioids worldwide, with drug overdoses from prescription pain opioids rising at an alarming rate.
The sheer magnitude of this issue warrants us writing about it, talking about it and taking action.

OPP efforts pro-actively address mental health issues highlighted in quarterly report to Ombudsman
Ontario Provincial Police
In the year since receiving the Ombudsman's recommendations, the Ontario Provincial Police (OPP) continues to surpass project milestones to pro-actively address operational stress injuries (OSI). That progress is now highlighted in the OPP's fourth quarterly report to the Office of the Ontario Ombudsman.

'Disturbing' doc takes an inside look at Sean Clifton and the perpetrator’s experience
The Globe and Mail
It is a fact that an effective way for one politician to attack another is by declaring that the opponent is “soft on crime.” We live in that kind of country now. Even the cats and dogs on the street are probably aware that the federal government is tough on crime, building more prisons and talking up the importance of victims’ rights. Look out, criminals. Lock ’em up and throw away the key. That kind of thing.
In this context, the importance and greatness of NCR: Not Criminally Responsible (CBC, 9 p.m. on Doc Zone) cannot be overstated. John Kastner’s fine and vividly illuminating documentary caused something of a sensation at the Hot Docs festival and has already been screened and much discussed in Britain. “Disturbing,” “controversial” and “provocative” are the adjectives used to describe it. I prefer “illuminating.”

Vancouver Mental Health Crisis Has Limited Resources, Experts Say
Canadian Press
A man wielding a knife threatens to kill passersby, another man says he'll burn down an apartment building and kill everyone inside, and a third man is taken to hospital after trying to throw himself off a bridge for the second time in one night.
The incidents happened within one week last month, and Vancouver Police say they're part of the shocking statistics that show a dramatic spike in such scenarios over three years involving the mentally ill and their subsequent contact with law enforcement and the city's hospitals.
Police say 21 per cent of their calls involve someone who is mentally ill, and apprehensions under the Mental Health Act have risen 16 per cent between 2010 and 2012.

New Toronto jail includes mental health, aboriginal programs
CBC News
The largest correctional facility in Ontario is set to open in the next few weeks in Toronto, and will have features including programs dealing with mental health issues as well as spaces for aboriginal ceremonies.
The Toronto South Detention Centre will accommodate up to 1,650 inmates, including those awaiting trial and individuals sentenced to provincial terms of under two years.

Federal inmates go on strike to protest pay cuts
CBC News
Inmates in several federal prisons across Canada have gone on strike to protest against a 30 per cent cut in their pay that took effect this week.
The government began deducting the money from prisoners’ paycheques as part of a move to recover costs under the federal government’s Deficit Reduction Action Plan. The move was first announced in May 2012 by Public Safety Minister Vic Toews.
Until now, the top pay an inmate could earn was $6.90 a day, but only a small percentage of inmates received that. The average is $3 a day.

Review of the Local Health System Integration Act, and the regulations made under it, as provided for in Section 39 of that Act
Standing Committee on Social Policy
The Standing Committee on Social Policy will meet to review the Local Health System Integration Act, and the regulations made under it, as provided for in Section 39 of that Act.
The Committee intends to hold public hearings in Fort Erie, Hamilton, London, Kitchener-Waterloo and Windsor during the week of January 27, 2014; in Sudbury and Thunder Bay during the week of February 3, 2014; and in Kingston and Champlain during the week of February 10, 2014.

Police board approves new mental health crisis teams
Toronto Star
The police services board has created new resources to deal with mental health crises in the city’s east end — an expansion in service prompting both praise and renewed criticism.
The board approved a partnership between Toronto East General Hospital and the police service to create two mobile crisis intervention teams (MCITs), each made up of a police constable and mental health nurse in 54 and 55 divisions.

Ashley Smith's poems, journal moved psychologist
CBC News
Four specialized psychiatrists testifying at the coroner's inquest looking into the death of Ashley Smith offered more suggestions on how to make changes to the treatment of inmates dealing with mental health issues.
The psychiatrists took the stand Tuesday for a second day at the inquest, which is probing the death of Smith, a Moncton teen who died in Oct. 2007 at the Grand Valley Institution for Women in Kitchener, Ont., after tying a piece of cloth around her neck. The guards who stood outside her cell and watched, say they had been ordered not to intervene.

Hamilton police flooded with thousands of emails ‘honest cops’ very polite arrest of flailing woman
National Post
Hamilton police say they’re “overwhelmed by the thousands of emails” after nearly a million people tuned in to watch officers make a difficult arrest.
The video, titled “honest cops” and posted on YouTube on Wednesday, shows two Hamilton police officers subduing a screaming woman. Throughout the arrest, the male officer uses his size to hold her to the ground, placing handcuffs on the woman before ushering her to the back of a police cruiser.
After she’s in the car, the officer politely explains the level of force used.
“I’m doing my best, ma’am, not to hurt that girl,” officer Mark Morelli explains to several people who filmed the arrest.

CMHA Ontario among experts at community safety forum
Canadian Mental Health Association, Ontario Branch
CMHA Ontario was among more than three dozen participants from many sectors across the province to share knowledge about comprehensive approaches to community safety during a special forum hosted by the Law Commission of Ontario (LCO).
The Nov. 22, 2013 event, Interactive Expert Forum on Integrated Approaches to Community Safety, was attended by 40 experts from education, justice, policing, health and academia. The day was lead by Joanna Birenbaum, a research lawyer from LCO, who composed the background paper that was the basis of the small group discussions held throughout the forum.

Meet Thamsanqa Jantjie — the schizophrenic with a violent past who ‘signed’ next to Obama at memorial
National Post
The man accused of faking sign interpretation while standing alongside world leaders like U.S. President Barack Obama at Nelson Mandela’s memorial service said Thursday he hallucinated that angels were entering the stadium, suffers from schizophrenia and has been violent in the past.
Thamsanqa Jantjie said in a 45-minute interview with The Associated Press that his hallucinations began while he was interpreting and that he tried not to panic because there were “armed policemen around me.” He added that he was once hospitalized in a mental health facility for more than one year.
A South African deputy Cabinet minister, Hendrietta Bogopane-Zulu, later held a news conference to announce that “a mistake happened” in the hiring of Jantjie.

Toronto woman with bipolar disorder refused entry into U.S. for being a ‘flight risk’
Toronto Star
While she was standing in front of a U.S. Customs and Border Protection agent, Box says he looked at his computer screen “and he said something about ‘mental health issues.’ Then he said, ‘Yeah, you’re really crazy.’ ’’
Box said he told her that she wasn’t being allowed to enter the U.S. and that she needed more documentation because she was considered a “flight risk. They said I might try and stay,’’ said Box, who felt upset and humiliated and shocked that someone in that position could be so rude.

B.C. study calls for needle exchange, HIV treatment for inmates
Globe and Mail
Needle-exchange programs and increased access to HIV treatment are essential to curb infection rates among Canadian prisoners, says the lead author of a new study calling for immediate action.
Dr. M-J Milloy of the B.C. Centre for Excellence in HIV/AIDS said other jurisdictions, including some American states, have reduced HIV rates among inmates and protected public health in the communities they return to when they’re released.
“We are really in favour of collaborating with the prison system to try and find better ways to deliver harm reduction – whether that’s supervised injection, a needle exchange, improved access to methadone,” Milloy said on Monday.
“We think scientifically there’s a good argument for these sorts of things and what happens next, I think, is a political question and a question that should best be answered by the people who are in charge of our prison system.”

Journal Articles, Research, and Presentations

Annual Report of the Office of the Correctional Investigator 2012-2013
Office of the Correctional Investigator
40th Annual Report of the Correctional Investigator to the Parliament of Canada

Risky Business - An Investigation of the Treatment and Management of Chronic Self-Injury Among Federally Sentenced Women
Office of the Correctional Investigator
The death of 19-year-old Ashley Smith in a federal women’s correctional facility in October 2007 underscored the importance of developing effective, evidence-based management and treatment strategies for complex self-injury cases.
Since Ashley Smith’s death, the number of self-injury incidents in federal penitentiaries has more than tripled. In 2012-13, there were 901 incidents of recorded prison self-injury involving 264 offenders.
Last year, a relatively small number of federally sentenced women offenders (37 of 264 total) disproportionately accounted for just over 35% of all reported self-injury incidents.
The frequency and severity of self-injury is particularly concerning among Aboriginal women offenders. 45% of all incidents of self-injury among federally incarcerated women involved Aboriginal offenders.

Mental Health Strategy Consultation Paper
Legal Aid Ontario
This consultation paper considers how LAO can expand access to justice for legal aid clients with mental health and addiction issues. It is designed to provide greater clarity about LAO’s early thinking about the objectives and plans for developing a Mental Health Strategy. It is also designed to encourage participation in the development of that Strategy by clients, lawyers, agencies, legal organizations, governments, and any other individuals or organizations who are concerned about legal services to persons with mental illness. This paper follows earlier LAO papers on clinic law services and refugee legal aid. LAO anticipates releasing discussion papers on family and criminal legal aid in 2014.

Science of Adolescent Development Continues to Inform Juvenile Justice System
CSG Justice Center
Over the past decade, state and local jurisdictions have been actively developing strategies to reduce both recidivism and spending in their juvenile justice systems. Many also seek to ensure that every youth who comes in contact with the system is met with procedural fairness at every stage of the justice system. To help accomplish these goals, juvenile justice leaders are examining and applying research and recommendations outlined in Reforming Juvenile Justice: A Developmental Approach, a seminal report released by National Research Council in 2012. This report provides an extensive review of decades of research on juvenile justice programs and practices. It also delineates how the adolescent development field can serve as a framework for developing strategies across the justice system continuum that promotes positive outcomes for youth involved with the juvenile justice system.

Improving Outcomes for Youth in the Juvenile Justice System
CSG Justice Center
The Center for Juvenile Justice Reform (CJJR) at the Georgetown University’s McCourt School of Public Policy, the Council of State Governments Justice Center, the Missouri Department of Social Services’ Division of Youth Services, and the Office of Juvenile Justice and Delinquency Prevention’s National Center for Youth in Custody co-founded the Youth in Custody Certificate Program. The program is an intensive learning opportunity at Georgetown University for juvenile justice leaders and their partners. It consists of a curriculum composed of instruction modules in areas such as culture change and leadership; assessment; treatment, services, and reentry; and family and youth engagement. Specifically, it shines a brighter light on the high-risk, high-needs juvenile offender population, and helps leaders to develop capacity, effectuate change, and sustain and accelerate system improvements to improve outcomes for youth in custody.

Bail Experts Table Recommendations
Justice on Target - Ministry of the Attorney General
This committee has made recommendations to improve the efficiency and effectiveness of the bail phase while balancing the principles embodied in the Canadian Charter of Rights and Freedoms and the Criminal Code. These recommendations are focused on streamlining processes and enabling effective and efficient decision-making; they do not seek to restrict the exercise of discretion by justice participants. They address the whole bail phase – from he point of arrest to the determination of an accused person’s bail status.

Study protocol Efficacy of immediate patient feedback in emergency psychiatry: a randomized controlled trial in a crisis intervention & brief therapy team
BMC Psychiatry
This study looks at the effect of immediate session-by-session feedback using short questionnaires for evaluating outcome of and alliance in the therapy. Research data strongly suggests that using this feedback informed treatment improves the outcome of therapy. However, until now, this method of Miller and Duncan has only been examined in clients (generally students) with mild problems and in partner counselling. The question addressed by this study is whether immediate feedback is also effective when applied during crisis intervention and subsequent brief therapy in a psychiatric patient population in emergency situations. It also looks at whether 'feedback-informed treatment' affects the quality of the alliance.

Mental illness stigma in health care settings a barrier to care
People with mental health problems still experience “some of the most deeply felt stigma” from health care professionals, according to the Mental Health Commission of Canada.
Although “often unintentional,” such discrimination remains a major barrier to quality care, treatment and recovery, the commission reveals in the Opening Minds Interim Report.

eLearning course may shorten the duration of mechanical restraint among psychiatric inpatients: A cluster-randomized trial
Nordic Journal of Psychiatry
The management of psychiatric inpatients exhibiting severely disturbed and aggressive behaviour is an important educational topic. Well structured, IT-based educational programmes (eLearning) often ensure quality and may make training more affordable and accessible. The aim of this study was to explore the impact of an eLearning course for personnel on the rates and duration of seclusion and mechanical restraint among psychiatric inpatients.

Self-Cutters May Be Seeking Pain Relief
Scientific American
“You don't feel like you're hurting yourself when you're cutting. You feel like this is the only way to take care of yourself,” a young woman we will call Alice told journalist Marilee Strong for her 1998 book, A Bright Red Scream: Self-Mutilation and the Language of Pain. As with many adolescents and young adults, Alice habitually harmed herself by cutting her arms and wrists.

Oregon Judges Participate in Live Mental Health and Criminal Justice Training
CSG Justice Center
On October 22, 2013, about 200 Oregon judges took part in the training module Judicial Work at the Interface of Mental Health & Criminal Justice, in Gleneden Beach, Oregon. Organized by the Oregon Judicial Department, the training was part of a half-day program devoted to criminal justice and mental health. The program included a presentation by mental health advocate and author Pete Earley, followed by the training module, which was led by Judge Steven Leifman of Miami-Dade County, FL, and Dr. Fred Osher, Director of Health Systems and Services Policy at the CSG Justice Center. The event marked the debut of a new set of skill-building video case studies that are now part of the Judicial Work at the Interface of Mental Health & Criminal Justice training module.

How Mental Illness Loses Out in the NHS
The Centre for Economic Performance’s Mental Health Policy Group
Mental illness accounts for a massive share of the total burden of disease. Even when we include the burden of premature death mental illness accounts for 23% of the total burden of disease. Yet, despite the existence of cost-effective treatments, it receives only 13% of NHS health expenditure. The under-treatment of people with crippling mental illnesses is the most glaring case of health inequality in our country.

Schizophrenia: an integrated sociodevelopmental-cognitive model
The Lancet
Schizophrenia remains a major burden on patients and society. The dopamine hypothesis attempts to explain the pathogenic mechanisms of the disorder, and the neurodevelopmental hypothesis the origins. In the past 10 years an alternative, the cognitive model, has gained popularity. However, the first two theories have not been satisfactorily integrated, and the most influential iteration of the cognitive model makes no mention of dopamine, neurodevelopment, or indeed the brain. In this Review we show that developmental alterations secondary to variant genes, early hazards to the brain, and childhood adversity sensitise the dopamine system, and result in excessive presynaptic dopamine synthesis and release. Social adversity biases the cognitive schema that the individual uses to interpret experiences towards paranoid interpretations. Subsequent stress results in dysregulated dopamine release, causing the misattribution of salience to stimuli, which are then misinterpreted by the biased cognitive processes. The resulting paranoia and hallucinations in turn cause further stress, and eventually repeated dopamine dysregulation hardwires the psychotic beliefs. Finally, we consider the implications of this model for understanding and treatment of schizophrenia.

New Release: “Guidelines for the Successful Transition of People with Behavioral Health Disorders from Jail and Prison”
CSG Justice Center
Developed in collaboration with the Council of State Governments Justice Center and with support from SAMHSA and the Bureau of Justice Assistance, the guidelines promote the criminal justice partnerships that are necessary to develop successful approaches for identifying individuals in need of services, determining what services those individuals need, and addressing these needs during transition from incarceration to community-based treatment and supervision.

Upcoming Events

Harm Reduction in Prison Workshop
System Overview, Specific Populations, HIV/HCV Prevention Education, Agency Accessibility for Prisoners/Ex-prisoners, Communication Basics
January 28, 2014 - Toronto

Suicide Prevention, Intervention and Postvention Strategies
To address the issue of suicide, a broad and diverse approach is needed. The first day of this workshop will teach caregivers the skills needed to identify and assist those at risk of suicide. The second day focuses on providing caregivers with tools to minimize the impact of a suicide on survivors. Participants will gain valuable insights into why suicide postvention is also suicide prevention. Also, a guide for how to develop a comprehensive suicide prevention plan will be presented, with emphasis on addressing the root risk factors that lead to suicide.
January 30 - 31, 2014 - Toronto

Tenth World Congress on Brain Injury
Held biennially, IBIA World Congress is the largest gathering of international professionals working in the field of brain injury. Delegates are comprised of physicians, psychologists and neuropsychologists, therapists, social workers, nurses, case managers, legal professionals, advocates and all others working in the field of brain injury
March 19 - 22, 2014 - San Francisco, California

Balancing Individual Safety, Community Safety and Quality of Life
A Conference to Improve Interactions with Persons with Mental Illness. Presented by the Canadian Association of Chiefs of Police and the Mental Health Commission of Canada
March 25 - 26, 2014 - Toronto

14th Annual Meeting of the International Association of Forensic Mental Health Services
Trauma, Violence and Recovery: Risk and Resilience Across the Lifespan
June 19 - 22, 2014 - Toronto

Useful Links

ConnexOntario Health Services Information
ConnexOntario provides free and confidential health services information for people experiencing problems with alcohol, drugs, mental health or gambling

Evidence Exchange Network (EENet) is a mental health and addictions knowledge exchange network that connects stakeholders across Ontario

The Royal
The Royal is one of Canada’s foremost mental health care and academic health science centres. Our mandate is simple: to get more people living with mental illness into recovery faster

NCR: Not Criminally Responsible
Directed by John Kastner, this feature documentary about violence, mental illness, and the rights of victims tells the story of a troubled young man who stabbed a complete stranger 6 times in a crowded shopping mall while gripped by psychosis. Twelve years later, his victim, who miraculously survived, is terrified to learn that he’s out, living in the community under supervision. He’s applying for an absolute discharge, and if he succeeds, he’ll no longer be required to take the anti-psychotic drugs that control his mental illness. With unprecedented access to the patient, the victim, and the mental institution, the film looks at both sides of the debate and puts a human face on the complex ethical issues raised.

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