Young offender's best chance for mental health care is to go south, Nunavut agencies decide

It's a case that would normally go unnoticed on Nunavut's court docket. A youth offender with a couple of assault charges.

But this file was a rare case where the justice system and Nunavut government representatives held a conference to find the most appropriate treatment for a young man with a range of mental health issues, shedding light on how few mental health services are available for Nunavut's most vulnerable, and the disconnect between the criminal justice system and the GN.

A teenager with a temper, who needs help 

The youth cannot be identified under the Youth Criminal Justice Act. 

He grew up impoverished, and got as far as Grade 9 in school. His father killed himself.

He has schizophrenia and fetal alcohol spectrum disorder, and also has a history of solvent abuse. 

When he was 17, he was sent to a group care facility in Ontario to treat his solvent abuse. There, he assaulted a female staff worker after she asked him to stop yelling. He also assaulted a second female staff worker who stepped in to help her colleague. That second staffer was pregnant, and he punched her in the stomach. She later lost the baby from the emotional stress of the incident, according to prosecutors in Ontario. 

The youth was only recently sentenced for both assaults. 

Government overstepping boundaries, lawyer says 

Crown and defence sought four months of custody and two months of community supervision on each charge. With credit earned for pre-trial custody in a youth detention facility, the custody portion of the sentence is up later this week.

In his home community there is a mental health nurse and a psychiatrist visits twice a year – both voluntary services which the youth has declined to use. 

It's a recipe for him to re-offend, says his case worker. 

At his sentencing hearing April 8, the court heard from two Government of Nunavut employees tasked to handle his case. Susan Breddam is an adult services specialist with the Department of Child and Family Services also the deputy public guardian. She said the youth is a danger to himself and others. She applied to make the youth a ward of the Crown, so any treatment plan would essentially be mandatory. 

But Breddam said coming up with a treatment plan was up to the Department of Health. Esther Warriner represented the health department as the manager of mental health for the Baffin region. 

She said the youth has been assessed as suicidal and homicidal. In her view, a residential group home wouldn't work for the youth because they weren't "staffed by qualified, trained people in psychiatry." 

Instead, she said he needed to be placed in a forensic setting, and recommended that the court declare him "not criminally responsible" to have access to those forensic services. 

But Crown prosecutor Barry McLaren pointed to a key oversight in Warriner's recommendation: the youth couldn't be found not criminally responsible.

"[He] knows what he did," McLaren said. 

"He seems to be able to understand what is going on, and to tell Mr. Murdoch-Flowers what he wants to do. So ... unless he attracts more charges, do you know the forensic option is not on the table?" 

Warriner replied: "That's unfortunate." 

The youth's defence lawyer Joseph Murdoch­-Flowers blasted Warriner for the move.

"Seeking a [not criminally responsible ruling] is something that is initiated by the defence or the prosecution, jointly. It's not something that's initiated by mental health services," Murdoch- Flowers would later say in court on May 2.

"I'm concerned, very concerned, that an agency in our territory, presumably whose mandate is to provide care, both physical and mental, would seek to insert itself in the role of prosecution or defence to seek an NCR outcome. It's disturbing."

Disconnect between service providers 

To get everyone on the same page, the Justice of the Peace in the case, Calvin Clark, called a conference of all the parties involved in the case, under section 19 of the Youth Criminal Justice Act. It was believed to be only the second time a section 19 conference had been called in 15 years in Nunavut. 

A few more have been called since this case, because of its effectiveness. 

Nunavut's representative for children and youth co-ordinated the pair of meetings between the justice of the peace, Crown and defence lawyers, and representatives from the Government of Nunavut departments of Health and Family Services and the group came up with a plan to place the youth in a residential group home in Ottawa. 

In court on May 2 as the case wrapped up, Murdoch-Flowers called the meetings a "very productive exercise," but noted the solution only came through once push came to shove, and under tight deadlines. 

"Everything has come together in a very positive way, but it causes me a great deal of concern that it takes this much effort to just scrape by," Murdoch-Flowers said. 

"He's required to travel far away from his community, his family, his language and his culture, and I lament that we do not have adequate services in our territory to care for our most vulnerable." 

While she wouldn't comment specifically on the youth's case for privacy reasons, Nunavut's representative for children and youth Sherry McNeil-Mulak said she's seen a lack of co-ordination between different agencies for many government-offered services for youth. Among other things, McNeil-Mulak says a lack of training in departmental procedures and a high staff turnover rate and heavy workloads are to blame. 

State of mental health services in Nunavut 

The Government of Nunavut also wouldn't comment on this case specifically, but says it's taking steps to provide more training for mental health workers. Last month the government began mandatory three-week training sessions in Iqaluit. The course also includes a section on the Mental Health Act. 

Victoria Madsen, director of mental health services for the Government of Nunavut, said her department is aware of the shortcomings for mental health services. 

She says she hopes someday to see a treatment facility for those with mental health care needs open in Nunavut, but there's no timetable in place.