Friday, 10 June 2016

Releasing mentally ill patients back into society

There is a defense asserted by a defendant in a criminal prosecution in which the defendant can avoid liability for the commission of a crime because at the time of the crime, the defendant did not appreciate the nature or quality or wrongfulness of the acts. In Canada, the verdict is called, Not Criminally Responsible (NCR). The defendant is then placed in a hospital for the criminally insane.

But are the members of society safe after that? That issue is the topic of this article.

Everyone deserves a second chance. Some people will say that violent criminals do not, but regardless of this, many are released from mental hospitals as cured and many of those who are released go on to disappear into obscurity. But alas, some of them, even if they were originally deemed to be insane, commit violent crimes again after they are released from the hospitals for the insane.

Richard Charles Vau Hawkins, 41, had been a patient in at the Capital & Coast District Health Board's Purehurehu secure inpatient unit at Porirua in New Zealand. He was there because he had killed one of his brothers in 2002. He had been self-managing his anti-psychotic medications, but stopped taking them months before he killed his brother. He was subsequently acquitted of murder on insanity grounds after the 2002 killing and declared a paranoid schizophrenic. 

After some years, he was allowed to live with his father in the community, and a degree of normality appeared to return, but that all changed when Richard again turned to violence. This time, he slashed a stranger's face at Waikanae train station in May 2015.  On March 3 this year, Richard, now 42, was found not guilty by reason of insanity of wounding with intent to cause grievous bodily harm. He has been back in Purehurehu since May of last year. Why did the psychiatrists believe that he was cured when in fact he wasn’t cured at all?

Shawn O’Neill of Toronto, Canada was freed from court-mandated psychiatric treatment for paranoid schizophrenia and substance abuse. He entered the system in 1996 when he was deemed “not criminally responsible” for the first time after brandishing a knife on Queen St. For more than 17 years, O’Neill was treated for mental illness, closely monitored by doctors and subject to annual hearings at the Ontario Review Board, a provincial body that oversees roughly 1,500 people deemed NCR by the legal system and some are kept in the Centre for Addiction and Mental Health in Toronto.

The Ontario Review Board annually reviews the status of every person who has been found to be not criminally responsible or unfit to stand trial for criminal offences on account of a mental disorder. The Ontario Review Board is established under the Criminal Code of Canada. The Board is made up of judges, lawyers, psychiatrists, psychologists and public members appointed by the Lieutenant Governor in Council.

After the board granted O’Neill’s absolute discharge in January 2014 — a move opposed by his family and doctors at the Centre for Addiction and Mental Health — he no longer had to visit the hospital every day. And no one could force him to take medicine.

O’Neill went into a spiral of drinking and weed smoking and stopped taking medication to control his psychotic symptoms. In late January 2015, while he was labouring under delusions that he needed to stop a murky conspiracy to abuse children, O’Neill grabbed a kitchen knife, went out to the street and stabbed four people he didn’t know.

The judge said that, while O’Neill won’t be criminally sentenced, he is expected to be institutionalized and forced into mental health treatment for a long time.

Justice Gary Trotter in his March 18th decision said, “This decision is made with the expectation that Mr. O’Neill will always be carefully monitored and supervised in the future.”

It is conceivable that had both of these men I have written about been taking their medicine after they were released, they wouldn’t have committed more violent crimes. The solution to this problem is requiring them to show up at a health clinic and be given the medicine there under the watchful eyes of those giving them their medicine.

Chris Murphy, a lawyer who represented O’Neill after the stabbings, said that, in retrospect, it was the wrong decision for the Ontario Review Board to relinquish oversight of his client. Though he had been living under supervision and tight conditions in the community for almost a decade, O’Neill repeatedly tested positive for drugs, sometimes broke the conditions of his treatment, and disappeared for days at a time. That is when he should have been returned to the mental hospital.

During the hearing before the Ontario Review Board, the hospital team expressed concern that, without any requirement of O’Neill to check into the hospital, he would start drinking and using drugs more heavily. They said that it could increase the chance that he would abandon his medication and his psychotic symptoms would return. They were right. Everything they forecasted actually occurred.

It is believed by many that according to Canadian law we can’t limit a person’s liberty forever. At some point in a person’s life, he or she is entitled to his or her unrestrained liberty. That is a fallacy. Persons who are convicted of first degree murder and are eventually released after serving twenty-five years in prison are on parole for the rest of their lives.  It follows that anyone who is released from a mental hospital and requires medicine to keep them normal should be required to take their medicine at a clinic when it is due for the rest of their lives. If you think this is too harsh, ask yourself as to whether you will feel that way after a family member is killed by a former mental patient who stopped taking his or her medicine.

The balance between an individual’s right to make his or her own decisions and the imperative to keep the public safe; something that the Ontario Review Board is tasked to do and has failed in making sure that those they release are taking their medicine.

Incidents like the O’Neill stabbing spree admittedly are rare, said Jennifer Chambers, executive director of the Empowerment Council, an organization that advocates for people deemed NCR. Research from a national project on mental health shows that only 1 per cent of NCR detainees given absolute discharge re-offend in a seriously violent manner in the three years after release.

But if one of them kills a stranger on the street, the 99% who don’t should still be required to take their medicine (if needed) in a clinic for the rest of their lives.

There’s really no way of predicting whether someone is going to be dangerous or not. It is pure guess work. I don’t care how qualified psychiatrists are; they cannot really read the minds of their patients.

It  was definitely the wrong decision for the Ontario Review Board to relinquish oversight of O’Neill. Though he had been living under supervision and tight conditions in the community for almost a decade, O’Neill repeatedly tested positive for drugs, sometimes broke the conditions of his treatment, and disappeared for days at a time. So much for his alleged supervision.   

Obviously O’Neill did pose a risk to the public. A significant factor in the Ontario Review Board O’Neill’s decision to discharge O’Neill was the lack of violent episodes and criminal activity in the 17 years after the 1996 knife incident.  That decision was flawed because he was institutionalized during those years and had been given his medicine on a regular basis.

Paul Berstein, a lawyer and former president of the Criminal Lawyers’ Association, said that, in some ways, NCR patients released on absolute discharge are “set up to fail.” He compared it to teaching a child to ride a bike without following them down the road as they wobble unsupervised into the distance. They (released patients) are set up for life in the community during treatment and then, abruptly, they’re on their own.

My proposal of making sure that they go to a medical clinic every day to get their medicine may very well solve this problem. If they fail to adhere to that regimen and they are considered as a danger to society, then they should he sent back to the hospital or alternatively, a penal institution that has psychiatric facilities available to them.  

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