At the outset, let me also echo the sentiments expressed by the chair to Mr. Ehsassi regarding the unfortunate situation that happened in Willowdale. All of our thoughts and prayers are with the ones who lost their lives and those in the process of recovery. We commend the great work of our first responders, and also of Mr. Ehsassi, who went to the riding to be there for the people.
On that note, good afternoon, members and colleagues. It is a privilege to be here before this committee today.
Let me start by saying that one in five Canadians will directly face a mental health issue at some point in their life. Four out of five will indirectly be impacted. The economic impact of mental health-related issues is estimated at $50 billion a year, and it continues to rise. While there are vulnerable populations across Canada, mental illness will affect all Canadians regardless of age, sex, or background. Accordingly, there is an overwhelming desire for real change across a broad range of stakeholders.
This bill reflects what I've heard on the ground in my constituency, testimony from various groups championing mental health, such as the CMHC, CMHA, and CMHI, and my own research and expertise as chair of the mental health caucus. I also considered the testimonies of front-line workers, research organizations, and most importantly our experience on our visit to the Ray of Hope youth facility and the Grand Valley Institution for Women last year.
As highlighted earlier, this also reflects the priority of my constituents in Richmond Hill, who have, since I took office, often shared their concerns regarding the dynamics between the criminal justice system and mental health.
In Canada, 10% of the population reports symptoms consistent with mental illness. Among our youth, 25% will experience a mental health issue as they navigate through their adulthood, particularly in the vulnerable transition period between ages 18 and 24. This vulnerable population is profoundly overrepresented in our prison system, and studies have shown that the majority of young inmates demonstrate a mental health issue.
According to the Mental Health Commission of Canada, only a fraction—20% of youth—have access to the mental health services they need. We must be very clear on that fact. Mental health services are as much needed as any necessary medical services. To be forced to go without them is to invite life-altering consequences.
The correctional investigator's 2012 annual report found that 36% of offenders at federal penitentiaries were identified as requiring psychiatric or psychological follow-up. Forty percent of male inmates and 69% of female inmates were treated for mental health issues while in prison.
Bill would amend paragraph 721(3)(a) of the Criminal Code, mandating that unless otherwise specified, when a pre-sentence report is required by a court, in addition to information such as age, maturity, character, behaviour, attitude, and willingness to make amends, information outlining any mental health disorder, as well as any mental health care program available to the accused, be provided as part of the pre-sentencing report.
As Bill passed through the House, a range of opinions were expressed on the bill as it currently stands. Arguments were made questioning the need for such a bill, and in contrast that the bill does not go far enough. I'm happy to have this opportunity to discuss those concerns, and I'm intrigued to see what amendments may be proposed.
Today, there exists no mandate for the court to consider the mental health history of an individual in pre-sentencing proceedings, yet the court is mandated to take into account such nebulous and subjective factors as attitude or character. As Bill ensures that pertinent information will be taken into account during pre-sentencing, an individual with a history of mental health issues will be afforded the appropriate care and treatment during the administration of justice and their rehabilitation.
In the long term, the legislation presents an opportunity for us to take a real step forward, decrease recidivism, improve rehabilitation, and further erode the stigmatization of mental illness. In the short term, there are immediate benefits to the quality of life in our prisons, as well as to the efficacy of the services in the administration of justice and the rehabilitation of vulnerable populations.
In any individual sentence, our justice system is well-served by being made fully aware of relevant mental health concerns. With mental health information included in a pre-sentence report, the interplay of mental health with the condition of incarceration can be taken fully into account. Readily available mental health information is invaluable when considering a step as drastic as solitary confinement or choosing the facility that can best provide the appropriate mental health services.
By ensuring that mental health concerns are considered in these decisions, we can reduce the strain on penitentiary security officers while creating an environment that mitigates inflammatory factors and encourages conditions that reduce recidivism in the long term. This can be particularly useful in crafting cases of conditional sentencing as well as in creating conditions for effective reintegration following release.
Ensuring that mental health information is available at every step of the process will also make cases less vulnerable to attack on appeal, saving time and money for our judicial system and providing a net benefit to the overall cost and burden associated with mental health issues. Many members of Parliament do not have a chance to see their private members' bills seen before the House, let alone passed to committee. I'm proud of the bill that you have before you today, but it's decidedly a product of compromise. A private member's bill is one of the most direct venues through which a member of Parliament can direct real change on behalf of their constituents, and this private member's bill is a tool to further the discussion on this topic.
While I wish the scope and the reach of this bill was more encompassing, I believe that this balancing act has produced a bill that will do tangible good in the lives of Canadians while attracting common sense support on all sides. Likewise, I'm excited to work with the committee to re-examine and potentially strengthen the bill through amendments, and I believe the legislation as it stands is a strong model that will facilitate a fruitful discussion.
To conclude, I would like to remind the committee that the nexus of mental health care in our criminal justice system is complex, dynamic, and evolving. A judge must be presented with the relevant information in any given case in order to take advantage of this. This complex situation should be addressed by more than a single private member's bill, and I certainly would not frame Bill as a be-all solution.
I thank you for the opportunity. I would like to also acknowledge the work of Mr. Glenn Bradbury, who was instrumental in getting the bill to this state.
Mr. Chair, colleagues, I'm ready to answer questions from the committee.
Thank you very much.
Thank you very much, Mr. Jowhari, and thank you for introducing this bill. Thank you as well for your comments that you're prepared to look at amendments that might strengthen or clarify the bill. Certainly we appreciate that.
I'm pleased to see, and we're all grateful for the fact, that you're focusing on the whole area of mental health. We've come a long way in this area, even within the criminal justice system. When I was a kid, they used to tell me the last thing someone would ever want to do was plead guilty by reason of mental problems, because then you would be detained, basically, for the rest of your life. They used to say it was at the pleasure of the lieutenant-governor. So that was completely avoided, but nonetheless, we've come a long way since then.
Now, one of the issues that the present Minister of Justice has raised and set out on a number of occasions is that she wants to expedite the process, to move the justice system so that it's not clogged up and so that delays won't result in people having their charges stayed.
Pre-sentence reports are very common in our criminal justice system, and, as you pointed out, some of them contain facts about the age, the background, and the criminal records of the individuals. According to your analysis, will adding this new requirement for a pre-sentence report on mental health slow down the justice system as it is right now?
That's great. Thank you, Mr. Chairman.
Good afternoon, members of the committee.
Thank you for inviting us here today. My name is Dr. Patrick Smith. I'm the National CEO of the Canadian Mental Health Association. Bill is a very important bill to us. I would definitely have been there in person if today weren't April 26, 2018. Today marks 100 years to the day when, in 1918, Dr. Clarence Hincks came together with other prominent Canadians in the historic Château Laurier, just around the corner from you, to form what is now the Canadian Mental Health Association. Today we are a Canada-wide organization with divisions in every province. We provide services to more than 1.3 million Canadians in over 330 communities across Canada.
We are celebrating this important milestone today in Toronto with some of Dr. Hincks' immediate family, in honour of his vision and commitment to two very clear goals: to end stigma and discrimination, and to provide more humane care for people with mental illness. In many ways—100 years later, to the day—this discussion on Bill is about addressing these same issues.
Today, I'd like to focus on some of the ways in which mental illness, including addiction, intersects with our criminal justice system, as well as on key areas that we believe will help to ensure that Canadians with mental health problems are supported in their treatment and in their recovery.
Specifically, I will be speaking in favour of passing Bill , because we know that it will confer significant benefits onto many Canadians who are marginalized and living with mental illness and substance use problems. We're also confident that the bill will lessen the burden on our criminal justice system.
We talk about the current shortfalls.... As many of you are aware, in the 1970s, the deinstitutionalization of mental health services transferred mental health service delivery from psychiatric facilities to more local communities, resulting in the closure of psychiatric hospitals across Canada. This shift has been heralded as a positive step in respecting the rights, dignity, and self-determination of people with mental illness.
However, the psychiatric deinstitutionalization has been replaced by a new form of institutionalization: the Canadian prison system. Given that mental health supports at the community level are often underfunded and poorly integrated, many people with mental illness and in need of treatment fall through the cracks and end up in the criminal justice system. You now know, through the debates over the last few years, that Canada has invested a lower percentage of its total health care budget in mental health care than any G7 country. Basic primary mental health care provided by addiction counsellors, psychologists, social workers, and specialized peer support workers form the bedrock and the foundation of other G7 countries' response to the mental health needs of their populations. They're not covered in Canada's universal health care system. Thoughtful, targeted investments in treatments that are effective and save money have been replaced by the high burden of costs of untreated mental illness that we see in jails and prisons. These unnecessary costs are carried by every Canadian.
The Office of the Correctional Investigator estimates that at least one in four admissions to federal correctional institutions present with a mental illness, and many of these also have a concurrent substance use disorder. This number is highly disproportionate to the number of people with mental illness in the population at large.
Despite the high number of people with mental illness in Canadian correctional facilities, Canada's prisons are not equipped with enough staff, resources, and funding for mental health supports for people who are incarcerated. As a result, Canadians with mental illness who end up in the correctional facilities do not receive the treatment that they need to facilitate their recovery and rehabilitation. In fact, the absence of treatment for many inmates can result in violent confrontations with other inmates and staff, as well as additional charges and time spent in segregation, which typically exacerbate mental health problems.
Once out of prison, Canadians with mental illness are more likely to experience homelessness and to have difficulty reintegrating into the community. Many do not have the necessary wraparound supports, and subsequently end up cycling through the criminal justice system at high cost. They often face discrimination and stigma as a result of having been incarcerated, and have difficulty finding meaningful employment. That's unjust, especially because people with mental illness who enter the criminal justice system are far more likely to have committed minor criminal offences when compared to offenders who don't have a mental illness. The majority of arrests are for minor crimes, such as causing a disturbance, mischief, minor theft, and failure to appear in court, which may be directly or indirectly related to the mental illness or substance use itself.
As a community-based organization with a long history of supporting people with mental illness and addictions at the local level, CMHA knows from experience that providing the necessary supports and care for people can greatly change the course of their lives, the course of the lives of their families, and their communities.
An ideal health care system—and here I'm not even talking about the ideal, but even one that's based on smart investments in treatments that work—can actually save many people and can save money. People with mental illness would have easy and timely access to well-funded, integrated community-based services, including housing and employment supports and individual and family supports, in addition to accessing a range of professionals, including family physicians.
This continuum of services allows individuals to receive support in the community and to thrive in recovery. In Canada we don't have to take a leap of faith on this. When you're a pioneer, you often have to go out on a limb and see how it works. On this front, we're not pioneers; we're laggards.
We can learn from other G7 countries that have been in our situation and have made the smart investments in health responses to mental illness, and dramatically reduce the high cost of untreated mental illness. When community-based services are well coordinated, they can also positively impact people with mental illness who come into contact with the law. Although the research on court support and diversion programs is limited, these measures that divert people with mental illness, pre- or post-charge, have been shown to increase access to mental health services, improve mental health functioning, and reduce hospitalization and recidivism, again saving money. They also relieve some of the pressure on the criminal justice system.
Supporting people at the community level is also much less expensive than incarcerating them. In Canada it costs over $100,000 per year to house and support a male federal inmate and $180,000 a year for every female inmate. Offenders who are supervised in the community, on the other hand, cost considerably less, about one-eighth of those amounts. The funding that would be spent on the incarceration of people with mental illness would be better spent on proactive investment in treatment and social integration.
This brings me to Bill . This bill proposes to amend the Criminal Code to introduce information about mental health issues and disorders in pre-sentence reports. The goal of the bill, as I understand it, is to make the criminal justice system aware of and more responsive to individuals with mental health issues and to ensure that they receive the appropriate treatment and supports that they need throughout their rehabilitation.
Although some jurisdictions already collect information on mental health in pre-service reports, this bill would create a national standard for all jurisdictions to consider mental health during sentencing. It is important that you don't have to win the postal code lottery to know that you live in a province that just so happens to provide and seek your mental health information. That's good for you, but what about the ones who don't? We really are applauding this bill to ensure there is a national standard.
This is important because research conducted by Public Safety Canada suggests that pre-sentencing reports make a difference in sentencing outcomes. They've been shown to increase the likelihood that offenders will receive a community sentence rather than a custodial sentence. We believe that with the right supports, community sentences can better facilitate recovery for people with mental illness.
In conclusion, we believe that the Government of Canada needs to continue showing leadership by addressing the current gaps experienced by people with mental illness and addictions in our criminal justice system. We strongly support the government's efforts to conduct a comprehensive review of the criminal justice system, and one of its stated goals, which is to determine how services can be improved for offenders who suffer from mental illness.
Bill presents an important opportunity to achieve this goal and ensure that people with mental illness and substance use problems are treated with care and compassion. It is also an opportunity to break the vicious cycle of institutionalization that unfairly impacts people with mental illness and substance use problems.
We also encourage the government to continue to make smart investments in early health responses to mental illness, which not only save lives but also lower the high cost of untreated mental illness in our communities. As such, we strongly urge the government to support Bill .
Thank you again for inviting me here today. I'd be happy to answer any of your questions.