PRISON BREAK

How A Groundbreaking Ottawa Court Program Is Diverting Young People
With Mental Illness Away From The Justice System And Toward The Help They Need

When 15-year-old "David" punched his mother in the face and shoved
his grandmother headfirst into a table, he was unprovoked, according
to the police report presented in the most unusual court in the city,
if not the entire country.

It did not take much to send the developmentally delayed boy into a
rage, his lawyer told Justice Dianne Nicholas, who presides over
Ottawa's youth mental health court, the only one in Canada devoted to
helping young offenders with psychiatric problems.

While David has the intellectual capacity of a much younger child, he
is already bigger than most grown men. And when dealing with a
6-foot, 275-pound child, temper tantrums can be frightening and dangerous.

David's outbursts are most often triggered when he is denied food, so
his mother used food to pacify her son. Poor diet then led to
diabetes, which likely contributed to increasingly drastic mood swings.

Forensic psychiatrists are still trying to figure out David's mix of
afflictions, although it's clear he's severely delayed and he
certainly does not understand the consequences of the alleged attacks
against his mother and grandmother, his lawyer, Heather Perkins-McVey, said.

Before last spring's assaults, a series of 911 calls brought officers
to the family's home around a dozen times in what police said was a
pattern of escalating violence involving the boy, whose name has been
changed here to protect his identity in accordance with the Youth
Criminal Justice Act.

Officers had always tried to calm him down and defuse the situation
without resorting to criminal charges. This time, however, his mother
needed medical attention and his grandmother required stitches to
close a gash on her head. David was arrested and charged with assault.

After his arrest, David's lawyer agreed with the prosecutor that if
he were allowed to return home, the boy posed a risk to his family
and himself. It's an unusual position for a defence lawyer to take.
"This is a strange situation where I've called the Crown attorney and
said, 'You cannot consent to him going back to that residence'," Ms.
Perkins-McVey said.

In fact, most of the proceedings in the youth mental-health court
have an unusually co-operative tenor. For one Friday each month, the
typical antagonism between prosecution and defence disappears and the
courtroom adversaries work together and reach agreements on how best
to treat offenders who are too young to cope with the onset of mental
illness, prolonged drug use and tragic family histories.

"There's a fantastic interaction between the court and the Crown, the
defence and the parents, as well as the youth mental health worker
and the doctor," Ms. Perkins-McVey said.

The shared goal is to divert youth offenders who suffer from mental
illness out of the criminal justice system and connect them with
specialized services in the community, resources most judges are
simply not aware of.

The architects of the new court say they believe they are building a
model for an important evolution of Canada's legal system, one that
recognizes the special circumstances driving youth with mental
illnesses into conflict with the courts.

Dr. Gregory Motayne, a psychiatrist who deals with adolescents at the
Royal Ottawa Mental Health Centre and a member of the court's
steering committee, said the initiative breaks new ground in
integrating reliable, consistent medical expertise into youth court.
"We're at the forefront of this and we're going to work out all the
kinks that arise," he said.

There have already been some and there are bound to be more. In many
ways the functioning of Canada's justice system relies on the
symbiotic relationship between two warring factions. The Crown
prosecutes offenders and defence lawyers scour the law and implore
judges for, if not acquittals, lenience. Justice is supposed to come
from weighing each side's strongest arguments. What happens to the
rights of the accused if defence lawyers are no longer their absolute
advocates?

So far, however, the court has shown real promise. David, for
example, is staying at a small residential facility designed to care
specifically for those with developmental disabilities. He continues
to meet with Dr. Motayne. And he is being treated for his diabetes,
which has helped stabilize his moods.

Since David's last court date, he has lost 30 pounds in a month. He
is far calmer and less prone to emotional volatility. And through
supervised visits, specialists are teaching the family how to
properly care for David once he is ready to come home.

According to Tania Breton, the youth worker assigned to the court, he
is not ready yet. In the lead-up

to the July court date, however, David's mother disagreed. She wanted
him back and she threatened to withdraw from a voluntary agreement
that gave the Crown temporary custody of her son. "It's breaking my
heart right now because he's doing so well," Ms. Breton said.

In this case, the involvement of the family in deciding the fate of
their loved one, a stated principle of the court, started to
backfire. Ms. Perkins-McVey did not fault David's mother, however.
"She loves her son, she wants him home," she said. "It's what any
other mother would do and she has the best of intentions."

Her change of heart raised the possibility that the Children's Aid
Society might ask a judge to order wardship to the Crown. After a day
of pleading, however, Ms. Perkins-McVey was able to convince David's
mother that the court was not trying to take her son away from her.
David would stay in his treatment program.

As the husky lad fidgeted in the public benches of the courtroom with
his family and social workers, Judge Nicholas said she was impressed
with the teen's progress and allowed for David to make short,
unsupervised visits at home.

"You're doing well," Judge Nicholas said as the boy was led out of
the courtroom. "I'm happy. I hope you have a good birthday next week."

It's difficult to say for certain what would have happened to David
if not for the existence of this new court. Chances are he would have
spent more time in jail. And he probably would have been sentenced
and sent to a group home that lacks the expertise to treat his
specific disabilities.

If David's current treatment plan does not always suit his mother,
Ms. Perkins-McVey said, she makes no professional compromise in
imposing a solution that she and the Crown deem is in her client's
best interest.

The emphasis the legislation puts on rehabilitation makes it her
responsibility, in fact, to work with the Crown and Ms. Breton to
ensure youth offenders have access to the appropriate resources.
"It's a different form of advocacy."

For now, David will return to court each month so Judge Nicholas can
get an update on his progress, until the Crown makes a decision on
whether to stay or withdraw the charges that brought him there in the
first place. Until then, the charges stand.

In regular youth court, there are very few options for treatment in
advance of a guilty plea or conviction. After that, the sentence may
prescribe the best possible treatment options, or it may not. It all
depends on the judge and lawyer involved.

Many young offenders, once they enter the court system, will be back
before long, according to the region's chief Crown attorney, Hilary McCormack.

"The word 'snowball' is very aptly describing what happens to young
offenders," Ms. McCormack said. "You've got somebody who may have had
a fairly minor first offence, and all of a sudden, they have a whack
of charges." The goal of the specialized new court is to stop that cycle.

Recent cases predating the court's inception, in fact, emphasized how
ill-equipped Ottawa's standard youth courts are to deal with mental
illness. In December 2006, a 16-year-old girl who smoked crack
cocaine to the point of psychosis appeared before Judge Nicholas on
charges of assault, fraud and breach of probation.

In the courthouse cells the girl stripped naked. When brought
upstairs, her manic behaviour in the prisoner's dock rattled those in
the courtroom.

"This kid was truly ill," Ms. Breton said. At the time, Judge
Nicholas expressed frustration that the Ottawa region lacked a
residential treatment facility for youths with addictions and mental
health problems who face criminal charges.

She was told the Royal Ottawa was designated for adults only. Two
beds at the centre's secure Roberts/Smart Centre are available only
to youths already diagnosed with a psychiatric disorder.

"This should not be happening in 2006," Judge Nicholas told the
court. There were, and still are, no forensic assessment beds for
youth in Ottawa.

When later in the day the troubled teen threatened to kill herself,
Judge Nicholas ordered a psychiatric assessment at the Children's
Hospital of Eastern Ontario. Doctors there, however, assessed the
teen's problems as behavioural and, in any event, CHEO usually will
not admit patients for forensic assessments, Ms. Breton said.

In the middle of the night, Ms. Breton received a call from Ottawa
police asking where to take the girl. She called Judge Nicholas, who
arranged for the girl to see another psychiatrist. "Through
partnership and band-aids and begging and pleading, we got her into
the Roberts/Smart secure treatment for a 30-day assessment and we
removed consent from her," Ms. Breton said. "It was extremely messy
and it was a manipulation of the system."

And while the new specialized court does a much better job of guiding
its accused into appropriate treatment and therapy, ultimately what
is needed is a secure residential facility, Ms. Breton said. "There
is still no hospital that will take a youth if they're acutely
mentally ill and need hospitalization."

Even Ottawa's future residential drug-treatment centre, plans for
which were announced in June, will not have the resources to treat
teens with drug-induced psychosis. Some youth offenders appearing in
Judge Nicholas's court, however, will certainly benefit from the
addictions centre, which is tentatively scheduled to be up and
running by the end of next year.

For others, however, that may be too late.

Sixteen-year-old "Sean" has been in and out of foster homes since he
was a toddler. He has long been estranged from any family he has ever
known and exhibits signs of a mood disorder.

Though he does not admit to abusing hard drugs, Ms. Breton said he is
known to use almost any substance he can get his hands on, from
ecstasy to crack. When coupled with addictions, mental illnesses tend
to get amplified.

Sean's only sources of income are panhandling on the streets of
Ottawa and stealing change from unlocked cars, for which he is
periodically arrested. In the words of Ms. Perkins-McVey, who is
Sean's lawyer as well, the teen is "the vision of despair."

"He's always talking about wanting to die or have police shoot him.
Or he bangs his head until it's bleeding with gashes," Ms.
Perkins-McVey said. However, behind all the legal and personal
problems is an intelligent and polite young man with a strong sense
of humour and an affinity for Harry Potter and Eragon books, she said.

"I have a son that's not far from his age," she said. "There are
certain cases you think, gee, this is really sad. There are many
others you think, well, you're the maker of your own misfortune. But
the sad thing is this youth hasn't really had a chance. What we'd
like to do is give him some of these chances. Stable housing would go
a long way."

Without a good place to live and community assistance, Sean continues
to reoffend in the familiar snowball pattern. Less than 24 hours
after his July court date, when he was released from custody on a
promise to report to a downtown youth shelter, Sean was again
arrested for stealing from cars. This time, however, he was also
charged with assaulting a police officer.

"I'm totally running out of options," Ms. Perkins-McVey admitted.

One of the challenges in housing Sean is that he refuses to take
advantage of services made available to him, especially in downtown
Ottawa, where he believes people are out to get him, Ms. Breton said.

That in fact might be a fair assessment, she added, considering Sean
continually alienates his peers. For example, he recently sold phony
cocaine on the street as the real thing, she said.

And he trusts practically no one, Ms. Perkins-McVey said, with the
exception of Ms. Breton. "She is the one person who has connected
with him and I'm hoping she can flip the switch and get him on
track," she said.

In fact, everyone involved in the initiative said Ms. Breton is an
invaluable asset and the key link between the court and the
community. She is armed with extensive knowledge of services in the
area for the court to consider. And she is able to get through to
some of the most troubled teens.

"She's extraordinary," Judge Nicholas said. "She's made all the
difference. She has made us aware of some of the resources available
for treatment and sadly, very often, what it's made us aware of is
what services we don't have."

A course in deviance at the University of New Brunswick first piqued
Ms. Breton's interest in the field. "It was so interesting to hear
the dynamics into how a person is shaped," she said.

She then took a correctional-worker program at Algonquin College and
eventually was trained in reality therapy, an approach to counselling
that focuses on the present and puts the onus on the client to make
his or her own decisions.

"Usually they have a lot of problems with authority figures, so you
actually enter the room saying, 'I'm just here to support you, I can
give you all these toys in front of you and you can pick which toy
you want to use.'"

Similarly, most candidates for the mental-health court are judged on
their willingness to participate in the process and accept
responsibility for their misdeeds.

However, many others, like Sean, who have given up on everybody else
in their lives, most need somebody who will not give up on them, Ms.
Breton said. "I tell them, 'You can be an asshole, you can burn
through every possible service I set up with you, you don't have to
show up at my appointments, but at the end of the day you can still
call me.' That's what keeps them surviving and still connected to somebody."

She also has a knack for wading through bureaucracies to find
loopholes in accessing services. Part of the impetus for the creation
of the court itself emerged when Ms. Breton began to arrange for her
youth clients to be sent to adult mental-health court for tests on
their fitness to stand trial.

Now the court has access to its own psychiatrist and Judge Nicholas
can order an assessment at any time throughout the proceedings. As a
forensic psychiatrist working with adolescents, Dr. Motayne himself
is a bit of a rare breed. Most of his colleagues lack the training
required to deal with courts, he said.

It's imperative, he said, that courts have the expertise of
psychiatrists specializing in youth. Diagnosing adolescents is
different and in some ways more challenging than working with adults,
he said. Certain disorders may be difficult to distinguish from
typical youth rebellion and mood swings.

And in the early stages of mental illness, symptoms have yet to fully
evolve. "It may be very difficult to separate out, for example, a
child with attention deficit hyperactivity disorder and a child who
has an emerging psychotic disorder like schizophrenia or an emerging
mood disorder like bi-polar disorder," Dr. Motayne said.

He also bemoaned the lack of forensic assessment beds for youth in
Ottawa as a "huge discrepancy" and the source of much frustration.
"It's available for the adults and it's not available for youth."

The holdup, of course, is money.

And although the youth mental-health court itself can already boast
some diversions of youth out of the criminal justice stream, that
early success also comes with a price tag, Ms. McCormack said. When
in session, the court takes up valuable space and the time of the
judge, court staff and Crown attorneys.

Specialty courts are also very labour-intensive and go through very
few cases in comparison to standard youth or adult courts. "There's a
cost to that. It means our other courts either have a greater volume
or the delay to trial is longer," Ms. McCormack said.

Aside from courthouse resources, the initiative has yet to receive
any direct government financial support. Many of the community
organizations that Ms. Breton brings to the attention of Judge
Nicholas support the court on their own budgets.

But Ms. McCormack said that heightened awareness and new attitudes
toward mental illness warrant the added cost. And the courts are
beginning to progress with the times, she added.

"It's a very crude tool, we recognize that. When you hit the criminal
justice system there aren't an awful lot of things that are available
to us to do. It's often a place of last resort. You're here because
everything else has failed, parenting has failed, school has failed,
mental health facilities haven't been able to help," she said.

In addition, the legislative atmosphere may be just right as well,
Judge Nicholas said. The Youth Criminal Justice Act, which is still
relatively new, focuses more on rehabilitation and reintegration into
society than the Young Offenders Act it replaced.

"There is a right environment right now with this act to do some
things that are a little bit different than the traditional court
system," Judge Nicholas said. "There is a huge awareness now of the
complexity of these kids and something more than black-letter law --
this crime equals this punishment -- is needed."

While the court is in session, Judge Nicholas presides with a
maternal presence. In the August session, she smiled at 17-year-old
"Hannah," seated in the public benches, who has made much progress
since being charged with some violent crimes.

"She looks healthy," Judge Nicholas said to the teen's probation
officer, who replied that she was doing quite well in school. But she
had something to tell the judge, he said.

"I moved out," Hannah said sheepishly as she brushed her bangs behind her ear.

"You didn't," Judge Nicholas gasped as her face sunk. "Not with the boyfriend."

"Yeah," she replied and blushed.

Judge Nicholas closed her eyes and exhaled sharply as the girl's
probation officer explained that Hannah would apply for welfare.

The plan to end her probation early was off the table, Judge Nicholas said.

On the bright side, Judge Nicholas noted with a laugh, Hannah was now
much more likely to meet her curfew, a condition of her probation, if
she lived with her boyfriend.

Later in the afternoon, however, there was nothing but concern etched
on the judge's face as "Emily" was brought into the prisoner's box.
After the 15-year-old girl ran away from her group home, police
picked her up at a seedy downtown hotel known for prostitution.

Emily was naked in bed. Another young woman and a 23-year-old man
were in the room. Drugs were also found.

Judge Nicholas was encouraged, however, by a personal letter and a
drawing Emily gave her, which she said she would keep to herself.
"Your writing is very nice, by the way," she said to the girl, who
has problems with drug use, depression and personality disorders and
who is a chronic runaway.

She ordered the girl released to a home in Ottawa's outskirts.
"That's the one on the gravel road, right, not by any bus stops?" the
judge asked. She also made a condition that Emily not go within "a
mile" of the two people from the hotel room.

Emily also gave Judge Nicholas a handwritten plan for when she was
released from custody, which included making amends with her mother.
Most of all, however, one day Emily wanted to be able to say that,
"at 15, I was able to turn my life around."