A view from CAMH

CrossCurrents

The focus of this issue of CrossCurrents reflects the longstanding reality of an intersect among mental illness, substance use and correctional facilities. When the Provincial Lunatic Asylum opened in 1850 (on the same plot of land where the new Centre for Addiction and Mental Health will be built over the next 10 years), it was a significant step forward. Until the facility opened, the mentally ill were locked in the basement of the York Gaol. Asylum in its most benevolent and compassionate sense was preferable to incarceration. However, asylums became in part the repository for people deemed “criminally insane” (as reflected in Simon Winchester’s wonderful book The Professor and The Madman).

Today, the field of forensic psychiatry is reflected in our Law and Mental Health Program at CAMH. The program provides assessment and treatment in both its inpatient units and outpatient services; it trains health professionals and law enforcement officers; and it conducts research to improve understanding and treatment for this population. From a person-centred perspective, the program brings services to where people stand accused; an assessment in the courthouse can result in someone suffering from a mental illness being diverted from a primarily custodial environment (jail) to a therapeutic one (a secure inpatient treatment unit or outpatient program).

Contrary to Hollywood depictions, the vast majority of people who run afoul of the law in the context of mental illness or substance abuse commit less than heinous offences, but still violate the rules of society. Much as the film One Flew Over The Cuckoo’s Nest provided an iconic and inaccurate depiction of electroconvulsive therapy, Silence of the Lambs antagonist Dr. Hannibal Lecter suggests a terrifying image of a forensic psychiatric patient (who is himself a psychiatrist, reinforcing yet another stereotype). All too often, people with mental illness or addiction who are incarcerated have fallen through the cracks of existing treatments. Treatable problems that underlie criminal behaviour demand both our attention and our compassion if we are to reduce the risk of recidivism to benefit the person, the family and society at large.

 

David S. Goldbloom, MD, FRCPC

Senior Medical Advisor, Education and Public Affairs, Centre for Addiction and Mental Health

Professor of Psychiatry, University of Toronto

 

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