03/04/2013 12:17 EST | Updated 05/04/2013 05:12 EDT

Good Mental Illness Policy Includes the Violence Taboo

Prime Minister Harper wants to enhance the safety of victims harmed by the violence of the untreated mentally ill with proposed changes to the Criminal Code in his Not Criminally Responsible Reform (NCR) Act (Bill C-54). Debates on the changes have just begun but his proposed changes ignored a significant group. The families of those declared NCR are at potential risk and they would still like to see better safeguards.

This group, called Advocates for Not Criminally Responsible Schizophrenia Sufferers (ANCRSS), is comprised of relatives, mostly parents or siblings, of people who have been declared NCR and who will be released from forensic units in the near future.

It is families who bear the brunt of care for those with serious mental illnesses. Many find themselves in the very difficult position of either trying to care for them or abandoning them to the streets, jail or even leaving them to die. Banishing them does not always work as they may return home periodically while in extreme psychosis.

In trying to care for their ill relatives, they leave themselves open to potential violence from those loved ones they are trying to help. After all, there are few hospital beds and few resources to treat them particularly if they deny they are ill and refuse treatment. As one of the mothers I spoke to said in an e-mail, "We slept with our bedroom door locked for many years, and hid the kitchen knives. I still remember when, at 4 AM, X was pounding on our door shouting 'I know that you are humanoids in there'."

Her experiences are borne out by research. A study conducted at the University of Pennsylvania in 2005 found that families of people with untreated psychotic illnesses "experience violence at a rate estimated to be between 10% and 40%, which is considerably higher than the general population."

A 2012 study found that, "There is substantial evidence that individuals with schizophrenia are at increased risk for violent criminal behavior and an even higher risk for committing murder, relative to the general population." That study compared a group that murdered with a group that did not and concluded, "The schizophrenic murderers demonstrated significantly worse neuropsychological impairment, involving executive dysfunction and memory dysfunction, relative to nonviolent schizophrenic men."

As I pointed out in my previous blog post, one of many problems with this proposed new legislation is that it still retains absolute discharge once the individual demonstrates that he/she is well and is taking medications.

Once discharged, there are no restrictions and no provision for ongoing monitoring to ensure that treatment is adhered to so that the individual will not regress and become a danger again. As another relative awaiting the absolute discharge of her loved one said, these proposed changes are an illusion to make victims feel safer.

She went on to say that the only way this can be achieved is to make it a provision of an absolute discharge "that the person is seen by a team or managed by a case manager." If the person stops seeing their psychiatrist and stops taking their medications then they should be returned to secure care. Also, blood testing should be carried out to ensure medication adherence and that the individual is not abusing alcohol or street drugs. Untreated psychosis coupled with drug and/or substance abuse is a prescription for violence.

As an aside, I wrote about this family in my book. They desperately tried to get help for the ill person and could not. As a result, the young man murdered both his parents. Had resources been available, this likely would never have occurred.

I will undoubtedly be lambasted for fostering increased stigma towards those with mental illness by talking about the existence of real and potential violence. Those who are politically correct contend that the mentally ill are less violent than other groups in society and they are right to a point.

The problem is, however, that those who are untreated are often violent and nothing is to be gained by ignoring reality. As DJ Jaffe of Mental Illness Policy Organization pointed out, most studies that show persons with mental illness are not more violent include a large percentage of those who are treated. He explains that this shows that treatment works and not that they aren't more violent.

The mother who lived behind a locked bedroom door observed that, "Stigma was the result of living with an ill person who was not being helped." And her other son who does not have schizophrenia said, "The reason that there is stigma is that some people with schizophrenia do these things!"

As many have said, including MP Irwin Cotler, the best solution is treatment and sufficient resources to provide that treatment to prevent these problems in the first place. Despite all the lip service from all the politicians, no one is doing this and the burden falls on the families to contend the best they can.

A Canadian Psychiatric Association Position Paper released in 2011 states that access to hospital care should be in place for all who need it and for as long as they need it but then points out that bed pressures and costs prevent this from happening. They recommend that, "Resources and services are put in place to provide appropriate and sufficient nonforensic, noncorrectional mental health treatment to prevent the criminalization of people with serious mental illness."

We all know that this has not happened. Until it does, we are not dealing with these matters appropriately. We would not ignore the elderly with dementia or to those with cancer, so why do we persist in not providing treatment to those with a brain disorder.

As the Canadian Psychiatric Association said in the above paper:

"Societies are often judged by how their disadvantaged members are treated. People with serious mental illness within the criminal justice system clearly fall within the disadvantaged group, with the double stigma of their mental illness and a criminal justice label. Stigmatized and discriminated against, this is a population that begs for social justice and our urgent attention."

15 Things Critics Fear In The Tory Crime Bil