Mental Health and the Law – Research Projects

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Mental Health and the Law – Research Project

Therapeutic jurisprudence, rehabilitation, and responding to mental illness in the context of criminal courts in remote, mainly Inuit Arctic communities

Project summary: This project examined whether the suite of therapeutic jurisprudence principles, goals, and objectives that guide criminal court mental health initiatives in southern Canada and elsewhere internationally are transferrable to the Nunavut context—and if so, what they would look like in this culturally distinct, geographically remote and resource-constrained context. Participating communities were Arviat, Iqaluit and Qikiqtarjuaq. The project involved 71.25 hours of interviews with health and justice professionals including judges, prosecutors and defence lawyers, psychiatrists and nurses, as well as members of community organizations, elders and care givers of people with mental illness. A focus group was also held in each of the three communities.

Results: The results were consistent across all three communities, despite community differences in population size, available mental health and justice resources, and relative geographic remoteness. That is, participants identified the following three therapeutic jurisprudence objectives (from a suite of objectives) as most salient to the Nunavut context: 1) the identification of people with mental illness; 2) treatment; and 3)) collaboration between the court and the community. The relative importance of culture, remote geography and constrained resources to a potential criminal court mental health initiative was also consistent across communities, with participants engaged in discussions about culture to a slightly greater extent than the other two topics.

Conclusion: The results suggest that Inuit culture, including its recent history of cultural disruption and change, affects the vulnerability of Nunavut communities to the potential legal and moral pitfalls associated with therapeutic jurisprudence and criminal court mental health initiatives. These pitfalls include the dominance of biomedical approaches when identifying a target population, the medicalization of behaviour and culture, the risk of “paternalism” in therapeutic interventions, and shortcomings in interdisciplinary collaboration that limit considerations of Inuit culture. These pitfalls are not fatal to efforts to bring the rehabilitative benefits of these initiatives to Nunavut, but they require careful vigilance when employing therapeutic jurisprudence principles in Indigenous circumpolar context. Further, with respect to meeting the challenges of geographic remoteness, the results of this project betray a gap between the justice and health sectors with respect to their perceptions of accessibility, quality, and effectiveness of video-conferencing for the purposes of court-related psychiatric assessments and treatment in remote communities in Nunavut. Finally, on the topic of resources and criminal court mental health initiatives, participant interviews revealed that the need for mental health and drug treatment centres, as well as other rehabilitation services in Nunavut, is one that is widely recognized.

Publication:  Ferrazzi, P., & Krupa, T. (2016). “Symptoms of something all around us”:  Mental health, Inuit culture, and criminal justice in Arctic communities in Nunavut, Canada. Social Science and Medicine, 165, 159-167. http://www.sciencedirect.com/science/article/pii/S027795361630394X