Commentary

By Summer Hart

Criminal Justice in Canada

It comes as little surprise that Canada witnesses a gross over representation of individuals with mental illness in the criminal justice system (1). The pervasiveness of mental illness in corrections is significantly higher than in the general population and research has demonstrated a growing percentage of individuals with mental illness entering the criminal justice system (1). Consequently, Canadian correctional services have inadvertently become one of the largest providers of mental health services, despite often being ill-equipped as they lack the resources to address such topics (2). This system poses ethical, economic, and political challenges as the justice system is unable to effectively address the integration of mental illness with criminal justice intervention as this lies outside the scope of the law (2). In particular, there has been a growing call for occupational therapists (OTs) to establish a stronger partnership with the criminal justice system, a theoretical perspective that this paper will support (1, 2).

Mental Health Courts

To address this challenge, forensic mental health services in the form of mental health courts have emerged as an alternate avenue for rehabilitation. Mental health courts are a specialized court support service that integrates the mental health and criminal justice systems as they aim to address mental health concerns within the criminal justice process (3). In this system, convictions are addressed within a specialized court equipped to directly treat the offending behaviour and its association with mental health concerns (4). Mental health courts provide tailored and appropriate interventions by implementing court support and diversion programs where necessary for individuals with mental health concerns (4). Court support can include providing medical and community resources such as personal counselling and housing assistance, whereas diversion programs include incorporating creative solutions to divert individuals with a mental illness from entering the justice system (4).

Furthermore, one of the main objectives of mental health courts includes decreasing recidivism, which refers to an individual’s probability of reoffending (4). The presence of recidivism varies depending on how it is defined, however, a 2019 study by Statistics Canada found that 46% of individuals in the Ontario justice system had at least one re-contact with the police (5). This has vast implications for safety, as well as population and community health, as recidivism is associated with poor mental health outcomes and costs the Canadian economy millions of dollars per year (4). Research suggests that forensic mental health initiatives have been successful in reducing rates of recidivism for individuals with mental illness (2). Studies have also demonstrated improved scores on indices of addiction severity, psychiatric rating scales, and education and job outcomes (2).

RI_article_4_2 — August de Richelieu (Pexels)

Occupational Therapy

Mental health professionals such as social workers and psychiatrists have historically been involved in assessing and treating individuals who come in conflict with the law, especially in forensic mental health practice (6). Although occupational therapy (OT) is less known in this context, research has begun to explore the role of OT in forensic mental health and mental health courts (2). For those unfamiliar with the field, OT is a health profession concerned with enabling people to participate in the activities of everyday life (7). OTs work with people and communities to enhance their ability to engage in occupations, or daily activities, by modifying the task or the environment to better support occupational engagement (6). This approach to well-being is based on the notion that humans are occupational beings who require engagement and participation in occupations necessary to further human survival, health, and overall potential (2).

Expanding the Occupational Therapy Role

Recently, OT has begun to play a larger role in helping individuals in the justice system reintegrate into society. Although OT has been traditionally situated in hospitals, schools, and community organizations, forensic mental health is an emerging practice area where the role of OT is immensely valuable (2). In fact, a report by the Canadian Association of Occupational Therapists (CAOT) argues that it is important to demonstrate the need for OT across the continuum of health and social services (1). The report suggests that beyond providing mental health care, OT can prevent criminal justice involvement by addressing social determinants of health. This holistic outlook is crucial as it can bring about social change through the full participation of people with criminal justice involvement (1).

“Recently, OT has begun to play a larger role in helping individuals in the justice system reintegrate into society”

Research conducted by Priscilla Ferrazzi, a lawyer and researcher in rehabilitation science, suggests that OT’s growing influence in mental health rehabilitation positions itself as a critical player to meet the therapeutic goals of criminal court mental health initiatives (2). Similarly, studies demonstrate that engaging in meaningful occupations is an important determinant of health and well-being for individuals with mental illness (2). This is particularly relevant as individuals in the criminal justice system frequently find themselves with a lack of structured time, which has the effect of exacerbating barriers to rehabilitation and societal reintegration (2). Ferrazzi argues that the role of OT can be realized in this practice setting by ensuring that OTs promote occupational engagement in corrections, diversion programs, and post-court proceedings (2). OTs are also uniquely positioned to promote occupational engagement by supporting meaningful involvement in leisure, productivity, and self-care occupations within correctional services (6). As such, OTs can aid in problem-solving, stakeholder collaboration, and community reintegration. This strategy is especially important as barriers to engaging in everyday occupations are common among individuals with mental health concerns (2). Finally, OTs can help people identify meaningful occupations and roles outside of the criminal justice system and connect them “to opportunities in the communities where these roles can be practiced” (2).

RI_article_4_3 — Youssef Naddam (Unsplash)

Current Limitations

Despite the importance of integrating the field of OT as a central component of mental health courts and corrections, there are limitations to the efficacy of this goal. Most importantly, the “dual mandates of care and custody” can blur professional boundaries and perpetuate ethical distress among clinicians, as they may feel tied between conflicting mandates to both the system and individuals in conflict with the law (1). In addition, the prevalence of stress and burnout among forensic mental health professionals remains very high, with a significant percentage reporting high levels of work-related stress and burnout (8). To confound this challenge, there is currently no professional practice network in Canada dedicated to supporting OTs in forensic mental health. While the CAOT supports a variety of practice areas, a specific forensic mental health network has yet to be established. As such, the expansion of this emerging area of practice should be formulated in tandem with a dedicated practice network to support OTs, exchange knowledge, and advocate for a greater leadership role in this scope of practice.

Ultimately, the goal of justice is to pursue restoration work toward more peaceful communities, a skill that is uniquely suited for OT (2, 9). As several diverse sources of research have indicated the growing need for OTs in criminal justice settings, it is my hope that these limitations can be addressed to ensure that both OT and the criminal justice system benefit from a stronger partnership toward rehabilitation.

Acknowledgements

Featured image by Sasun Bughdaryan (Unsplash)

To refer to this article, it can be cited as:

Hart S. The Role of Occupational Therapy in Forensic Mental Health. rehabINK. 2022:13. Available from: https://rehabinkmag.com

References

1. Canadian Association of Occupational Therapists. Report of the professional issues forum on occupational therapy in the criminal justice system [Internet]. 2013 [cited 2021 Nov 20]. Available from: https://caot.ca/document/3739/2013%20Criminal%20Justice%20System.pdf
1. Ferrazzi P. Occupational therapy and criminal court mental health initiatives: an important emerging practice setting. Occupational Therapy in Mental Health. 2019;35(3):238–61.
1. Centre for Addiction and Mental Health. Mental health and criminal justice policy framework [Internet]. 2020 [cited 2021 Nov 20]. Available from: https://www.camh.ca/-/media/files/pdfs—public-policy-submissions/camh-cj-framework-2020-pdf.pdf
1. Human Services and Justice Coordinating Committee. Mental health courts in Ontario: a review of the initiation and operation of mental health courts across the province [Internet]. 2017 [cited 2021 Nov 20]. Available from: https://ontario.cmha.ca/wp-content/uploads/2017/11/Mental-Health-Courts-in-Ontario-1.pdf
1. Research and Statistics Division. Recidivism in the criminal justice system [Internet]. 2020. Available from: https://www.securitepublique.gouv.qc.ca/fileadmin/Documents/services_correctionnels/publications/enquete-recidive-reprise/rapport-
1. Bettridge Shannon, Barbaree H, Centre for Addiction and Mental Health. The forensic mental health system in ontario : an information guide [Internet]. Centre for Addiction and Mental Health; 2012 [cited 2021 Nov 20]. Available from: https://www.camh.ca/-/media/files/guides-and-publications/forensic-guide-en.pdf
1. World Federation of Occupational Therapists. Definitions of occupational therapy from member organizations [Internet]. 2017 [cited 2022 Mar 25]. Available from: https://www.wfot.org/checkout/1213/22040
1. Brown D, Igoumenou A, Mortlock A, Gupta N, Das M. Work-related stress in forensic mental health professionals: a systematic review. The Journal of Forensic Practice. 2017.
1. Zehr H, Mika H. Fundamental concepts in restorative justice. Contemporary Justice Review. 1998;1.