Mental Health, Criminal Justice, & Trauma:

1. Mental Health, Criminal Justice, & Trauma: The Need for New Approaches Consistent with the CRPD

2. Criminal Justice/Penal Prison/Jail Prisoner Political Model Imprisonment Crime Denial of Guilt Punishment Isolation Confession of Guilt Obedience Parole/Probation Mental Health Mental Hospital/Psychiatric Center Mental Patient Medical Model Involuntary Commitment Symptoms Lack of Insight Treatment/Therapy (Forced/Coerced) Seclusion & Restraint Admission of Mental Illness (insight) Cooperation/Compliance AOT order/Case Manager/Tx Team Criminal Justice/Mental Health Parallels

3. Statement by Manfred NowakSpecial Rapporteur on torture and other cruel, inhuman or degrading treatment of punishment. • “First, they are often segregated from society in institutions, including prisons, social care centers, orphanages, and mental health facilities. They are de-facto deprived of their liberty, sometimes for long periods of time, either against their will or without their free and informed consent. Inside these institutions, persons with disabilities are frequently subjected to neglect, severe forms of restraints and seclusion, aw well as physical, mental and sexual violence.” • “Similarly, in the private sphere, persons with disabilities are especially vulnerable to violence and abuse, including sexual abuse, inside the home, at the hands of family members, caregivers, health professionals and members of the community. “ • ---- Manfred Nowak October 23, 2008

4. The mental health and criminal justice systems are both traumatizing and repressive. • Criminal Justice/Penal System • Abolition/Reform can not be accomplished through the mental health/psychiatric system. • Systems are reciprocal ( movie) • Systems are reactive, fear based & Coercion/Force

5. CRPD - Articles Article 12 – Legal Capacity (capacity to have rights and capacity to act) Article 13 – Access to justice for PWD (accommodations support networks) Article 14 – Liberty & Security of the person on a equal basis with others (Probation/AOT/IOC) Article 15 – Prohibits torture & cruel, inhuman or degrading treatment or punishment (forced/coercive interventions – Intimidation)

6. CRPD Articles • Article 16 – requires prevention of exploitation, violence and abuse. (free & informed consent – conditions (psychiatric drugs/probation/parole) – due to diagnosis. • Article 17 – PWD right to respect for physical/mental integrity • Article 19 – Right to live in community with choices equal to others (Probation/Parole conditions medications/MH courts/Residential)

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

8. Institutions (Jail/Prison) Jails Prisons Diversion Crisis Specialized Courts Re-entry Probation (AOT/IOC) Parole Criminal Justice System/PsychiatricDiversion - Institutions – Re-Entry

9. People w/disabilities who are detained/imprisoned are subjected: • Force/Coercion • Violence (Restraints/tying to bed/chairs & chemical restraints) • Isolation/Seclusion (based on PWD) • Sexual Assault (Dominance/Subordination) • Discriminatory Disciplinary Policies (Reasonable Accommodations – Prison/Jail Programs exclusion)

14. Diversion • Police Response to “crisis” (ER/Involuntary Commitment) • Social Issues Criminalized – (family/neighbor disputes, homelessness, substance abuse & assumed “odd behaviors” Voices/Visions) • Court Based Diversion (Mental Health Courts – Segregating People by “illness” with the judicial system, mandating tx & punishing failure, serves to perpetuate the criminalization of PWD) Serve Jail Time and/or adhere to treatment/service plan)

15. Re-Entry • Shift from CJ to MH – there is a significant shift in due process procedures. • Probation/Parole Stipulations – mandated tx, psychiatric drugs, coercion/force, threat of non-compliance • Penalized – Social Problems, unemployment, poverty, substance abuse, trauma

16. Recommendations • Language – Social issues being criminalized – trauma – people see/feel their issues • Reasonable Accommodations – Access: Legal services, peer support/advocacy, family support. (Assisting w/lawyers) – education, medical treatments, holistic therapies, exercise & accommodation for programs

17. Recommendations • Criminal Justice system needs to remain a system based on law & not a treatment referral system. • Legislative Changes Must Occur – Policy Abolition & Development (parole/probation/MH laws IOC/AOT/Institutions) • Countries: Human Rights Treaty Obligations. (US obligations – CAT, ICCPR, CERD) US does not hesitate to criticize other countries for their HR violations – it has been derelict in complying with our own HR commitments.

18. 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?)

19. 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

20. RESOURCES • www.CHRUSP.org • www.WNUSP.net (CRPD Manual) • www.mentalhealthpeers.com • www.willhall.net