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'The mad and the bad'

The mentally ill are often saddled with a double stigma, cycling through the justice system without getting treated for underlying disorders. As Dawn Walton reports, the prisons are full of people with mental problems, many of them so-called frequent fliers

From Thursday's Globe and Mail

EDMONTON — With her French-manicured nails, a dainty cross dangling around her neck and trendy eyeglass frames perched on her nose, Corry Grunsky looks every bit the woman she once was — a married mother of four with a career as a restaurant manager.

Then she points to her mug shot.

Her eyes are dour, her lips pursed, her skin is sallow and her short, brown hair is a mess. Her normally sturdy 5-foot-8 frame has been whittled down to a 123-pound stick figure.

The photo was taken on Dec. 27, 2001, when Ms. Grunsky's dual life as a methamphetamine junkie and successful dealer, trafficking the scourge of the Prairies to a network of two-bit dealers in small towns around Edmonton, would abruptly end. Drugs had become her crutch — and her livelihood — after she was diagnosed with depression, bipolar disorder and attention deficit hyperactivity disorder.

Police, who had been dogging her for years, used a battering ram to barge into her home. Prosecutors made drug charges stick. And Ms. Grunsky, with her addiction and multiple psychological demons, joined the growing legion of mentally ill Canadians for whom prison has become the new asylum.

"They should offer treatment programs because we're incarcerated anyway, so why don't we get a program that will help us cope?" said Ms. Grunsky, now 54 and, despite everything, sober and working through a college program in psychology and social work. "… My time in the federal penitentiary was a joke; it was a complete joke."

It is public-policy insanity, a justice system that cycles people through cops, courts and prisons without treating their underlying illnesses.

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. Many have diagnoses ranging from depression and schizophrenia to anti-social personality disorder and psychosis, and may also be addicted to alcohol or drugs.

"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."

The number of people in federal prisons with mental illnesses has nearly doubled in the past decade, according to the 2006/07 report of the Office of the Correctional Investigator, long-time federal Ombudsman Howard Sapers. 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.

Why the spike in mentally disturbed people behind bars?

Experts point to the well-intentioned deinstitutionalization trend in the 1970s aimed at getting the mentally ill back in the community, as well as deficit-reduction strategies of the 1990s, which saw cuts to social programs.

"The prison system is the only system in the entire state apparatus that can't say, 'Sorry, we're full,'" said Craig Jones, executive director of the John Howard Society, an advocacy group for male prisoners. "As a consequence, prisons become dumping grounds because other areas of the social-welfare network have either broken down or been downsized or downloaded to the provincial authorities that can't deal with it."

A MONTH'S WORTH OF PILLS

Ms. Grunsky was born an Air Force brat in Arvida, Que., and by the age of 8, her family had moved to Bon Accord, just north of Edmonton.

Despite a difficult adolescence, including heavy drug use, she went on to a sober, busy life as a wife and mother of four, working in the restaurant industry. But feeling down, she consulted psychiatrists who diagnosed her with depression and bipolar disorder and prescribed several drugs. By her early 40s, the anti-depressant Prozac made her feel "normal" and she figured she was cured — so she "took the whole bottle."

A month's worth of pills was pumped from her stomach. She left the hospital and slipped into old habits: booze, drugs and trouble. By the mid-1990s, her drug of choice was crystal meth, an addictive stimulant that produces 12-hour highs — and, unable to hold a job, she started dealing.

She ended up controlling the communities around Edmonton — Edson, Drayton Valley — selling five ounces to half a pound of crystal meth at a time to other dealers. She was pulling in thousands of dollars a day and splurged on vehicles, paintings and furnishings.

"I kept up with the Joneses except I was a drug dealer and the Joneses were working stiffs," Ms. Grunsky said.

Her neighbours were oblivious, even though community theft and break-and-enters were on the rise and shady characters milled around at all hours. But two city police officers — whom she now considers friends — were on to her.

"They did everything in their power to get me off the street because everywhere I lived was a nightmare for the community," she said. "I don't blame them at all. My houses were nightmares. They were drug magnets."

'GROWING CRISIS'

Police have become "psychiatrists in blue" — Canada's front-line workers dealing with the mentally ill. The Vancouver Police reported that 31 per cent of the 1,154 calls they received during a 16-day period in December, 2007, involved a mentally disturbed person. Some police forces are creating specialized mental-health units to deal with such cases.

During his 20 years treating offenders, Kenneth Hashman, a forensic psychiatrist in Calgary, has worked with everyone from a homeless schizophrenic who gets hungry and commits a dine-and-dash to a mother who killed her infant during a bout of postpartum depression. Mental illness can afflict the most marginalized and the most privileged, he says, but whether they break the law may depend on their genes, psychological makeup and social support.

"There are some pretty seriously ill people in prisons," Dr. Hashman said.

Since 2005, under persistent prodding from Mr. Sapers, the Ombudsman for the federal corrections system, Ottawa has announced millions in new funding for mental-health services during and after incarceration. Last year, Mr. Sapers called it "only a small fraction of what is required to deal with this growing crisis," and the federal government responded with an additional $16.6-million annually.

Still, federal and provincial facilities are feeling the pressure. This week, Mr. Sapers cited a lack of "adequate mental health services" as a contributing factor in the suicide of 19-year-old Ashley Smith in a federal prison in Ontario last fall. Quebec psychiatrists have threatened to refuse work in prisons, complaining the conditions for the mentally ill are inhumane. Unionized correctional workers in New Brunswick recently went on strike, citing chronic overcrowding and the influx of mentally ill prisoners, who are either ostracized or segregated for up to 23 hours a day.

A patchwork of initiatives is taking root across the country. These include mental-health courts, which started in Ontario a decade ago and are designed to divert the mentally ill out of the justice system and into treatment. Alberta is considering such courts, and is also working to better target funding to treatment of mentally ill offenders — who, they've come to realize, eventually return to the community.

As Judith Barlow, executive manager with Alberta's correctional health services, put it: "What happens behind prison walls doesn't stay behind prison walls."

A LIFE SENTENCE

During her downward spiral into mental illness and addiction, Ms. Grunsky lost her home, husband and grown children, who feared for the safety of their own kids.

On Sept. 2, 2003, she walked into an Edmonton courtroom and pleaded guilty to one count of trafficking methamphetamine, one count of possession for the purpose of trafficking and two breaches of recognizance. She was sentenced to 27 months in federal prison.

"There is no question that she has paid a price for involvement in the drug culture, and I think she recognizes that," said Mr. Justice R. Paul Belzil of the Alberta Court of Queen's Bench.

Ms. Grunsky had already spent months in the provincially run Fort Saskatchewan Correctional Centre. There, she took courses in anger management and relapse prevention. She learned how to design a résumé and picked up some job skills. Through trial and error, she also found an antidepressant that worked (and to which she remains faithful today).

She expected to get further help when she moved to the federal Edmonton Institution for Women, she says, but instead encountered scant programming and long delays. She had to request to see a psychiatrist and was stuck waiting on what inmates call the "idiot list." She says a common practice was to give prescriptions for methadone or a cocktail of other medications derisively dubbed "bug juice."

"They did that a lot in there with the women to control us, I think," she said. "… Many of the girls out there are on such high doses that they're just passing out at the table. It's absolutely ridiculous."

For the past two years, Ms. Grunsky has been working with Edmonton-based Clean Scene Network for Youth, an outreach program that talks to kids, some as young as 10, about the dangers of drug abuse. She considers it payback for what she did to her family and her community.

Her children have welcomed her back into their lives. Her 84-year-old mother lives with her. Her husband never came back. She is feeling "normal" again but is resigned to her life sentence with mental illness.

"I'm afraid to get off my medication. … I don't want to do drugs again and I don't want that lifestyle back," she said. "And that might happen; that's in the back of my mind."

THE RISK OF VIOLENCE

In Calgary last month, a young, educated father, suffering from delusions, killed his wife and children.

In Toronto, also last month, a pair of twentysomething reservists were sentenced for stomping to death a mentally ill, homeless man while he was sleeping on his favourite park bench.

These two cases highlight the complex issue of violence and mental illness. When people with mental illness commit violence, it is most often against family members. But they are far more likely to fall victim to violence themselves.

Some recent statistics:

  •  People with mental illness are 11 times more likely to be victims of violence than the general population, according to a U.S. study.
  • The same study found that rates of abuse were highest among people with the most severe illnesses, since they are most likely to be poor and lacking support systems.
  •  About 10 per cent of homicides in Canada are committed by people with a mental illness, according to E. Fuller Torrey, a U.S. psychiatrist who recently authored a book on the subject called The Insanity Offense.
  •  The vast majority of those cases involved people not receiving treatment, and who often had substance-abuse addiction, Dr. Torrey says. "If you've got someone with schizophrenia living next door and they're on medication," he said, "you've got no worries."

Erin Anderssen

BY THE NUMBERS

8 - Percentage of Canadian prisoners diagnosed with schizophrenia, according to one study, compared with 1 per cent of adults in society at large

57 - Percentage of incarcerated men, aged 18 to 44, who were found in an Edmonton study to have some sort of anti-social personality disorder, compared with an estimated 9 per cent in society at large

19 Percentage of incarcerated women suffering from major depression, compared with 8.1 per cent in society at large

29 Percentage of female prisoners with an anti-social personality disorder, compared with 1.2 per cent of Canadian women in general

Sources: Canadian Institute for Health Information; Correctional Service of Canada

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