Mental Health, Criminal Justice, & Trauma:

The Need for New Approaches Consistent

with the CRPD

Criminal Justice/Mental Health Criminal Justice/Mental Health ParallelsParallels

Criminal Justice/PenalCriminal Justice/Penal Prison/JailPrison/Jail PrisonerPrisoner Political ModelPolitical Model Imprisonment Imprisonment CrimeCrime Denial of GuiltDenial of Guilt PunishmentPunishment IsolationIsolation Confession of GuiltConfession of Guilt ObedienceObedience Parole/ProbationParole/Probation

Mental HealthMental Health Mental Hospital/Psychiatric CenterMental Hospital/Psychiatric Center Mental PatientMental Patient Medical ModelMedical Model Involuntary CommitmentInvoluntary Commitment SymptomsSymptoms Lack of InsightLack of Insight Treatment/Therapy Treatment/Therapy

(Forced/Coerced)(Forced/Coerced) Seclusion & RestraintSeclusion & Restraint Admission of Mental Illness Admission of Mental Illness

(insight)(insight) Cooperation/ComplianceCooperation/Compliance AOT order/Case Manager/Tx TeamAOT order/Case Manager/Tx Team

Statement by Manfred NowakStatement by Manfred NowakSpecial Rapporteur on torture and other cruel, Special Rapporteur on torture and other cruel,

inhuman or degrading treatment of punishment.inhuman or degrading treatment of punishment. ““First, they are often segregated from society in institutions, First, they are often segregated from society in institutions,

including prisons, social care centers, orphanages, and mental including prisons, social care centers, orphanages, and mental health facilities. They are de-facto deprived of their liberty, health facilities. They are de-facto deprived of their liberty, sometimes for long periods of time, either against their will or sometimes for long periods of time, either against their will or without their free and informed consent. Inside these without their free and informed consent. Inside these institutions, persons with disabilities are frequently subjected institutions, persons with disabilities are frequently subjected to neglect, severe forms of restraints and seclusion, aw well as to neglect, severe forms of restraints and seclusion, aw well as physical, mental and sexual violence.”physical, mental and sexual violence.”

““Similarly, in the private sphere, persons with disabilities are Similarly, in the private sphere, persons with disabilities are especially vulnerable to violence and abuse, including sexual especially vulnerable to violence and abuse, including sexual abuse, inside the home, at the hands of family members, abuse, inside the home, at the hands of family members, caregivers, health professionals and members of the caregivers, health professionals and members of the community. “community. “

---- Manfred Nowak ---- Manfred Nowak October 23, 2008October 23, 2008

The mental health and criminal justice systems are both traumatizing and repressive.

Criminal Justice/Penal SystemCriminal Justice/Penal System Abolition/Reform can not be Abolition/Reform can not be

accomplished through the mental accomplished through the mental health/psychiatric system.health/psychiatric system.

Systems are reciprocal ( movie)Systems are reciprocal ( movie) Systems are reactive, fear based & Systems are reactive, fear based &

Coercion/ForceCoercion/Force

CRPD - ArticlesCRPD - Articles

Article 12 – Legal Capacity (capacity to have Article 12 – Legal Capacity (capacity to have rights and capacity to act)rights and capacity to act)

Article 13 – Access to justice for PWD Article 13 – Access to justice for PWD (accommodations support networks)(accommodations support networks)

Article 14 – Liberty & Security of the person on Article 14 – Liberty & Security of the person on a equal basis with others (Probation/AOT/IOC)a equal basis with others (Probation/AOT/IOC)

Article 15 – Prohibits torture & cruel, inhuman Article 15 – Prohibits torture & cruel, inhuman or degrading treatment or punishment or degrading treatment or punishment (forced/coercive interventions – Intimidation)(forced/coercive interventions – Intimidation)

CRPD ArticlesCRPD Articles

Article 16 – requires prevention of Article 16 – requires prevention of exploitation, violence and abuse. (free & exploitation, violence and abuse. (free & informed consent – conditions (psychiatric informed consent – conditions (psychiatric drugs/probation/parole) – due to diagnosis.drugs/probation/parole) – due to diagnosis.

Article 17 – PWD right to respect for Article 17 – PWD right to respect for physical/mental integrityphysical/mental integrity

Article 19 – Right to live in community with Article 19 – Right to live in community with choices equal to others (Probation/Parole choices equal to others (Probation/Parole conditions medications/MH conditions medications/MH courts/Residential)courts/Residential)

CRPD - ArticlesCRPD - Articles

Article 25 – equality in health care Article 25 – equality in health care and services, including free and and services, including free and informed consent. (Forced/Coerced informed consent. (Forced/Coerced medications in all aspects of medications in all aspects of Penal/MH system – development & Penal/MH system – development & access to holistic alternatives in access to holistic alternatives in these systems) (MH screening results these systems) (MH screening results in discrimination/labeling obsolete to in discrimination/labeling obsolete to informed trauma care)informed trauma care)

Criminal Justice System/PsychiatricCriminal Justice System/PsychiatricDiversion - Institutions – Re-Entry Diversion - Institutions – Re-Entry

Institutions Institutions (Jail/Prison)(Jail/Prison)

1.1. JailsJails2.2. PrisonsPrisons DiversionDiversion1.1. CrisisCrisis2.2. Specialized CourtsSpecialized Courts Re-entryRe-entry1.1. Probation (AOT/IOC)Probation (AOT/IOC)2.2. ParoleParole

People w/disabilities who are People w/disabilities who are detained/imprisoned are subjected:detained/imprisoned are subjected:

Force/CoercionForce/Coercion Violence (Restraints/tying to Violence (Restraints/tying to

bed/chairs & chemical restraints)bed/chairs & chemical restraints) Isolation/Seclusion (based on PWD)Isolation/Seclusion (based on PWD) Sexual Assault Sexual Assault

(Dominance/Subordination)(Dominance/Subordination) Discriminatory Disciplinary Policies Discriminatory Disciplinary Policies

(Reasonable Accommodations – (Reasonable Accommodations – Prison/Jail Programs exclusion)Prison/Jail Programs exclusion)

DiversionDiversion

Police Response to “crisis” (ER/Involuntary Police Response to “crisis” (ER/Involuntary Commitment)Commitment)

Social Issues Criminalized – (family/neighbor Social Issues Criminalized – (family/neighbor disputes, homelessness, substance abuse & disputes, homelessness, substance abuse & assumed “odd behaviors” Voices/Visions)assumed “odd behaviors” Voices/Visions)

Court Based Diversion (Mental Health Courts Court Based Diversion (Mental Health Courts – Segregating People by “illness” with the – Segregating People by “illness” with the judicial system, mandating tx & punishing judicial system, mandating tx & punishing failure, serves to perpetuate the failure, serves to perpetuate the criminalization of PWD) Serve Jail Time criminalization of PWD) Serve Jail Time and/or adhere to treatment/service plan)and/or adhere to treatment/service plan)

Re-Entry Re-Entry

Shift from CJ to MHShift from CJ to MH – there is a – there is a significant shift in due process significant shift in due process procedures.procedures.

Probation/Parole Stipulations – Probation/Parole Stipulations – mandated tx, psychiatric drugs, mandated tx, psychiatric drugs, coercion/force, threat of non-compliancecoercion/force, threat of non-compliance

Penalized – Penalized – Social Problems, Social Problems, unemployment, poverty, substance unemployment, poverty, substance abuse, traumaabuse, trauma

RecommendationsRecommendations

Language – Language – Social issues being Social issues being criminalized – trauma – people criminalized – trauma – people see/feel their issuessee/feel their issues

Reasonable Accommodations –Reasonable Accommodations – Access: Legal services, peer Access: Legal services, peer support/advocacy, family support. support/advocacy, family support. (Assisting w/lawyers) – education, (Assisting w/lawyers) – education, medical treatments, holistic medical treatments, holistic therapies, exercise & therapies, exercise & accommodation for programs accommodation for programs

RecommendationsRecommendations

Criminal Justice system needs to remain a Criminal Justice system needs to remain a system based on law & not a treatment system based on law & not a treatment referral system. referral system.

Legislative Changes Must Occur – Policy Legislative Changes Must Occur – Policy Abolition & Development Abolition & Development (parole/probation/MH laws (parole/probation/MH laws IOC/AOT/Institutions)IOC/AOT/Institutions)

Countries: Human Rights Treaty Obligations. Countries: Human Rights Treaty Obligations. (US obligations – CAT, ICCPR, CERD) US does (US obligations – CAT, ICCPR, CERD) US does not hesitate to criticize other countries for not hesitate to criticize other countries for their HR violations – it has been derelict in their HR violations – it has been derelict in complying with our own HR commitments. complying with our own HR commitments.

What Does "Trauma Informed" Mean?

trauma model an alternative to medical model

recognize 90%+ people with mental health diagnosis are trauma survivors

all psychiatric symptoms can potentially be explained by trauma perspective

what happened to you, not what is wrong with you.

values subjective experience of people rather than focuses on expertise about pathology (changing?)

way to address how system traumatizes + retraumatizes people. rates of violent/traumatizing events much higher in institutions

looks at power relationships and misuse of power in institutions

emerged out of consumer/patient movement, women's movement, domestic violence activism, reform police & hospitals

political resistance to recognizing trauma: Freud, sexism, medical expertise, status quo, oppressions <-> trauma

"trauma informed" is an evolving concept. create ongoing dialog and education in your community and organization

RESOURCESRESOURCES

www.CHRUSP.orgwww.CHRUSP.org www.WNUSP.netwww.WNUSP.net (CRPD Manual) (CRPD Manual) www.mentalhealthpeers.comwww.mentalhealthpeers.com www.willhall.netwww.willhall.net