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Val Villeneuve talks about mental illness and prisons

Psychiatric nursing and forensic expert takes your questions on mental illness and the prison system

Globe and Mail Update

Canada's provincial jails and federal prisons are home to a burgeoning number of offenders with mental disorders, many of them repeat offenders — so-called frequent fliers, Dawn Walton writes in Thursday's Globe and Mail. Many have diagnoses ranging from depression and schizophrenia to anti-social personality disorder and psychosis, and may also be addicted to alcohol or drugs, she writes.

"What we're seeing is a criminalization of the mentally ill," said Val Villeneuve, director of forensic psychiatry services in southern Alberta, who has been working with offenders for 30 years. "It's not a sexy topic. People don't want to hear about these crazies and criminals. It's a double stigma to be a criminal and mentally ill — the mad and the bad."

A 2006/07 report from the Office of the Correctional Investigator, long-time federal Ombudsman Howard Sapers, said the number of people in federal prisons with mental illnesses has nearly doubled in the past decade, while according over that same period, the incarceration rate has barely budged.

Twelve per cent of federally imprisoned men had a mental disorder in 2007, up from 7 per cent in 1997. Meanwhile, 21 per cent of incarcerated women were mentally ill, up from 13 per cent over the same period. And while stats are scant for provincial jails, experts say the mental-illness rates there are likely much higher.

How should the system treat people with mental illness who run afoul of the law? Are there solutions? What do you think? We're pleased to have Ms. Villeneuve joining us now for a discussion on mental illness and the justice system. Send your questions now and join us then to read her answers, which will appear at the bottom of this page.

Val Villeneuve is the director of the Calgary Health Region Forensic Mental Health Services, which encompass all inpatient and outpatient clinics in Southern Alberta.

Ms. Villeneuve has 30 years of psychiatric nursing and forensic experience. She has been awarded three Provincial Psychiatric Nursing awards in the past 10 years for excellence in the profession.

Editor's Note: globeandmail.com editors will read and allow or reject each question/comment. Comments/questions may be edited for length or clarity. HTML is not allowed. We will not publish questions/comments that include personal attacks on participants in these discussions, that make false or unsubstantiated allegations, that purport to quote people or reports where the purported quote or fact cannot be easily verified, or questions/comments that include vulgar language or libellous statements. Preference will be given to readers who submit questions/comments using their full name and home town, rather than a pseudonym.

Dawn Walton, globeandmail.com writes: Hello Ms. Villeneuve and thanks for joining us today. I had a couple of questions before we get to those from our readers.

To start, once an offender is referred to you, what kind of treatment is available to help them with their underlying mental health issues? With the number of mentally ill offenders ever rising, how do you measure success?

Val Villeneuve: It is important to know that I deal with provincial forensic services, when patients (offenders) are referred to our service it is for assessment of their mental health and if it affects their ability to understand the justice system.

Our services will observe, gather information and formulate recommendations to the courts prior to a plea being entered or for the purpose of a pre-sentence report. Treatment is also provided to the patient if they are show symptoms of mental illness (i.e. Bipolar or Schizophrenia).

We tend to measure success by seeing improvement in a patient's mental status and to overall functioning while attending our inpatient or outpatient departments. Keeping track of recidivisms both in the justice system and mental health admissions also assist us in measurement.

Dawn Walton writes: Can you suggest better ways for the justice system to deal with mentally ill offenders once they come into conflict with the law?

Val Villeneuve: This is a different question as each community may deal very differently with the acceptance and non-acceptance of mentally ill offenders. In Southern Alberta, many stakeholders are involved in trying to ensure patients receive proper access and treatment. Example - The Calgary Health Region forensic services work closely with the Calgary Remand Centre and Young Offender Centre to ensure persons suffering from mental illness see a psychiatrist and/or other mental Health professionals. One suggestion I have is increased collaboration of mental health professionals is sought to reduce the stigma of a patient who has come into conflict with the law. As well, Calgary has developed successful diversion program that assists in diverting low risk minor offenders experiencing mental illness to be assisted in the community as apposed to the correctional system.

walter hall from France writes: Mental health is a very wide and encompassing category. When it refers to schizophrenia, a clear cut bipolar disorder, dementia, there is little debate about the 'disease', medical aspect of it, along with the medicolegal implications of responsibility and accountability. But how about the underdiagnosed personality disorders, (the antisocials, the psychopaths, the borderlines, etc.), and the drug induced disorders? They are often misdiagnosed as an axis I disorder and included in the 'mental health' category with the social and legal implications. The medical and the legal system was not intended to address personality disorders as 'medical illnesses', and probably rightfully so, but they are generally included in the 'mental health' overinclusiveness drive

Val Villeneuve writes: Thanks Walter. Very often in our forensic mental health system in Alberta we see people who have the personality disorders that you have listed. These people are entitled to service and they have a psychiatric diagnosis; thus we make attempts to ensure they are assessed and treated accordingly to our professional standards.

dee vancouver writes: ms villeneuve....... i am thankful to you and the globe and mail for giving so many people more insight into the problems faced by the mentally ill. i would like to ask, as in my case, part of my problem is a family member who is having a lot of personal problems and how they generate to me. as long as that member cannot help herself and i myself feel helpless to do anything, i am in constant anxiety. others tell me 'there is nothing you can do about it , so forget it. as you know that is easier said than done. do you have any advice for this sleepless in vancouver, weary old lady?

Val Villeneuve writes: One of the most difficult things to deal with is being the support system of a family member who may be experiencing personal and/or mental health issues. Please ensure that you have your own support system and be in touch with the local mental health associations such as Canadian Mental Heal Association. Continue asking questions to mental health professional as to what can be done for yourself and your family member.

Emma Hawthorne from Canada writes: I have been told that sometimes the homeless and mentally ill commit minor crimes, especially as the weather grows cold, to acquire a warm cell, three square meals, campanionship, tv viewing and even medical and psychiatric care. Is this true? If so, wouldn't supportive housng with on-site mental health assistance be far more helpful and much less costly?

Val Villeneuve writes: Thanks Emma. I have also heard those types of comments, but I have no reality to base them on. I do know community resources for the homeless and/or mentally ill must be increased and strengthened. In a previous response, I spoke about the Calgary Diversion Service which was initiated to ensure the mentally ill are not jailed, but given appropriate support to help keep them functioning in the community.

Christine Diemert, globeandmail.com: Ms. Villeneuve, Do you think there should be special courts and/or special prosecutors and police departments that deal with people who have mental health issues?

Val Villeneuve writes: I believe the correctional and justice systems need to increase partnership with the mental health community to assist in breaking down the silo's that have been built in the past. If these silos's can be broken we will all benefit from a much more coordinated community response. The introduction of mental health courts and police assisted mobile response teams are excellent first steps. Further education and improved communication by all parties will assist in reaching better solutions.

Christine Diemert writes: Thanks for joining us today Ms. Villeneuve. Before we close the discussion, I'd like to ask a question based somewhat on the comment from a reader who said the justice system existed "...to protect the citizenry from the criminals, not to make life easier for the criminals."

What I'd like to know is, if some of those so-called criminals are there because of a mental illness, who should protect them?

Val Villeneuve writes: The forensic services assist in giving recommendations to the courts that protect the patient and public at large. In offering our forensic services we will assess dangerous offenders and long term offenders to assist the courts in disposition. There certainly are offenders with mental illness who must be kept in jail due to the seriousness of their offense, and it is up to those of us working in the various systems to protect and offer quality support and/or treatment to these inmates.

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