Reducing Criminal Justice Involvement

Reducing Criminal Justice Involvement of
Individuals Experiencing Homelessness and Mental
Illness: Perspectives of Frontline Practitioners
Laurence Roy *
Centre de recherche de l’Institut universitaire en santé mentale Douglas
École de physiothérapie et d’ergothérapie, Université McGill
Anne Crocker
Centre de recherche de l’Institut national de psychiatrie légale Philippe-Pinel
Département de psychiatrie et d’addictologie, Université de Montréal
Roch Hurtubise
École de travail social, Université de Sherbrooke
Eric Latimer
Centre de recherche de l’Institut universitaire en santé mentale Douglas
Departement de psychiatrie, Université McGill
Michelle Côté
Centre de recherche de l’Institut national de psychiatrie légale Philippe-Pinel
Service de Police de la Ville de Montréal
Isabelle Billette
Service de Police de la Ville de Montréal
François Boissy
Maison du Père
Abstract: Individuals experiencing both homelessness and mental illness have high rates of interaction
with public safety and criminal justice institutions. Several cross-sector diversion programs have been
developed over the past decades as alternatives to incarceration. Most of these initiatives rely on the commitment
and expertise of frontline practitioners from different sectors and backgrounds. Th is research
examines the perspectives of frontline practitioners regarding practices and policies that target justice
* Please direct correspondence to Laurence Roy, School of Physical and Occupational Therapy, McGill University,
3654 Promenade Sir William Osler, Montréal, Quebec, Canada H3G1Y5; [email protected]
© 2020 Canadian Journal of Criminology and Criminal Justice / Revue canadienne de criminologie et de justice pénale,
62, 2, (April / avril), 1-21 doi:10.3138/cjccj.2019-0056
22 Roy et al.
involvement of individuals experiencing both homelessness and mental health issues in a Canadian urban
context. Findings from focus groups with 55 participants drawn from the police, the community and public
health and social services sectors indicate that frontline practitioners value and support close proximity in
cross-sector action, while raising ethical and legal issues related to this type of practice. Participants also
describe how exclusion from services for this population, lack of involvement from corrections, housing,
and forensic mental health services, and ineffective use of involuntary treatment mechanisms shape and
constrain frontline practice. Th e findings of this article give voice to the specific concerns of frontline
service providers. Given these findings, we suggest potential strategies to better serve individuals who are
identified as “harder to serve” but who might also benefit from diversion from the criminal justice system.
Keywords : courts, community, criminality, interdisciplinary, police, professional development
Résumé : Les personnes vivant à la fois une situation d’itinérance et un trouble mental sont fréquemment
en contact avec l’ensemble de l’appareil judiciaire et de sécurité publique. Plusieurs initiatives de nature
intersectorielle ont été développées dans les dernières décennies comme alternatives à l’incarcération pour
ces personnes. Ces initiatives reposent en grande partie sur l’expertise et les actions d’intervenants de
proximité issus de différents secteurs et disciplines. Cette étude s’attarde aux perspectives des intervenants
de proximité quant aux pratiques et politiques susceptibles de diminuer les interactions judiciaires chez les
personnes en situation d’itinérance et ayant des troubles mentaux, dans le contexte d’une métropole canadienne.
Les résultats d’entretiens de groupe auprès de 55 acteurs des secteurs policiers, communautaires et
sociosanitaires indiquent la valeur accordée par les participants aux interventions de grande proximité dans
l’action intersectorielle, tout en mettant en lumière les préoccupations légales et éthiques associées à cette
pratique. Les facteurs organisationnels et politiques influençant et contraignant l’intervention judiciaire de
proximité sont aussi identifiés. Compte tenu de ces résultats, des pistes de stratégies permettant de soutenir
les personnes aux besoins complexes au sein des programmes d’alternatives à l’incarcération sont suggérées.
Mots clés : tribunaux, communauté, criminalité, interdisciplinarité, police, développement professionnel.
More than half a century has passed since the mass de-institutionalization and noninstitutionalization
movements of the 1960s and 1970s in most high-income countries,
including Canada ( Sealy and Whitehead 2004 ; Markowitz 2011 ). Over those fi ve decades,
care for people living with mental illness has progressively shifted towards an array of
community-based mental health services, and recovery-oriented approaches have dominated
the mental health policy landscape ( Mental Health Commission of Canada 2012 ).
These systemic changes have also been associated with a rise in the number of individuals
with mental illness who experience criminal justice system involvement, incarceration,
and/or homelessness ( Michalski 2017 ; Markowitz 2011 ). Canadian data indicate that 73%
of new federal inmates have a diagnosable mental disorder and 12.4% have a major or
severe mental illness ( Beaudette and Stewart 2016 ). 1 Although data on provincial inmates
are scarce, a recent examination of mental illness among all justice-involved individuals
in one Canadian province indicates that 39% had some form of major mental disorder,
compared with 26% of the provincial general population (Hensel et al. 2020).
It is unsurprising that the specific population of individuals experiencing homelessness in
addition to mental illness have very high rates of police interaction, arrest, and incarceration
( Roy et al. 2014 ; Gonzalez et al. 2018 ; Kouyoumdjian et al. 2019 ). In the Canadian context,
almost half of the 2,221 participants of the At Home/ Chez soi study ( Goering et al. 2011 )
reported some criminal justice involvement in the six months prior to study enrollment
( Roy et al. 2016 ; Goering et al. 2014 ). Criminal justice involvement among Homeless People
with Mental Illness (HPMI) has been associated with increased duration of homelessness
( McGuire and Rosenheck 2004 ; Caton et al. 2005 ; Levitt et al. 2009 ), poorer employment
© 2020 CJCCJ / RCCJP, 62, 2, (April / avril), 1-21 doi:10.3138/cjccj.2019-0056
Reducing Criminal Justice Involvement of Individuals Experiencing Homelessness and Mental Illness 33
and community integration outcomes ( Frounfelker et al. 2010 ; Poremski et al. 2015 ), and
increased risk of victimization ( Choe, Teplin, and Abram 2008 ). High rates of police interaction
and criminal justice involvement also add considerable pressure on Canadian police,
courts, and corrections services ( Swanson et al. 2013 ; Latimer et al. 2017 ).
In response to the over-representation of HPMI in police interactions, courts, and correctional
facilities, several initiatives have been developed over the past decades. Th eir common
purpose is to reduce criminal justice involvement among homeless adults and youth living
with mental illness, usually with the short-term aim of diverting individuals towards health
and social care rather than jail when appropriate ( Munetz and Griffi n 2006 ). Pre-arrest
diversion initiatives include Crisis Intervention Training (CIT), which provides training to
police officers on mental illness and de-escalation strategies ( Bonfine, Ritter, and Munetz
2014 ; Mulay et al. 2016 ), as well as various forms of mobile co-response teams ( Shapiro et al.
2015 ; Horspool, Drabble, and O’Cathain 2016 ). Post-arrest diversion strategies consist of an
array of courts-based services for individuals presenting with mental illnesses, addictions,
or homelessness, the most well-known example being mental health courts ( Schneider,
Crocker, and Leclair 2016 ). Other, less documented, initiatives that do not involve either
police or courts are grounded in community-based mental health services or advocacy/
support groups. Examples of these initiatives include training community mental health
service providers in risk assessment and management ( O’Rourke, Wrigley, and Hammond
2018 ), in the hope that they will be better equipped to address and prevent behaviour that
could lead to justice involvement of HPMI, or providing HPMI with legal advice or assistance
( Bouclin 2016 ).
The current study stems from a need identified by several local organizations in Montreal,
to better document the implementation of a range of cross-sector initiatives aimed at reducing
criminal justice involvement of HPMI. Between 2009 and 2015, Montreal police patrol
offi cers were involved in several serious encounters that resulted in the death of homeless
men living with mental illness ( Coroner du Québec 2012 , 2016 ). This, alongside nationwide
policy changes in community policing ( Wood and Watson 2017 ) and increased awareness
of the prevalence of local police calls related to individuals living with mental illness ( Charette,
Crocker, and Billette 2011 ), resulted in the creation of an array of cross-sector services
within the urban area of Montreal. Th e first of these services was implemented in 2009 and
consisted of a mobile co-response team dedicated specifically to individuals experiencing
homelessness, with an emphasis on cross-system collaboration and cooperative agreements
with both health service providers and local courts ( Rose et al. 2012 ; Hurtubise and Rose
2016 ). Subsequent initiatives included a mobile co-response team dedicated to individuals
experiencing mental health crises and CIT training for a portion of Montreal police patrol
officers. Community organizations serving the Montreal homeless population have instituted
programs aimed at providing justice-involved HPMI with legal assistance, advocacy,
and psychosocial support ( St-Jacques 2016 ). Finally, various programs at municipal and
provincial courts now offer diversion programs for individuals who have a mental illness or
for those who are homeless ( Provost 2011 ). A common denominator across these projects
is that they rely on the collaboration of the municipal police, local community health and
social agencies, and several community-based organizations.
The context of Montreal is not unique, as many Canadian cities and jurisdictions have
implemented police- and courts-based diversion services in multiple ways and forms
© 2020 CJCCJ / RCCJP, 62, 2, (April / avril), 1-21 doi:10.3138/cjccj.2019-0056
44 Roy et al.
( Slinger and Roesch 2010 ). These services share common characteristics that can impact
their implementation and their effectiveness. First, they rely heavily on frontline resources,
particularly community-based mental health teams, community-based support services, and
law enforcement patrol personnel. Second, and more importantly, their implementation and
effectiveness depend on the collaboration of frontline practitioners from diff erent sectors
whose roles, mandates, training, and vision may differ dramatically ( Cardinal and Mercier
2004 ; Hurtubise and Rose 2016 ). Cross-sector collaborations may be more or less formalized
and range from information sharing to coordinated or concerted interventions ( Morin
et al. 2015 ; Parker et al. 2018 ). The relatively rapid implementation of multiple programs at
the intersection of law enforcement, justice, health, and social services in a given area (as
in Montreal) implies major changes in the practices of frontline service providers. A critical
examination of how practitioners transform their practices to facilitate cross-sector collaboration
and implementation of initiatives aimed at reducing criminal justice involvement
of HPMI is thus crucial.
The objective of this article was thus to examine the perspectives of frontline practitioners
regarding cross-sector practices and policies that aim at reducing criminal justice involvement
of HPMI. Th ree specific research questions were addressed:
1. How do frontline practitioners from different sectors (police, public sector health and social
services, community organizations) understand the nature, scope, consequences, and reasons
for criminal justice involvement of HPMI?
2. What are practices and approaches enacted by frontline practitioners to reduce the criminal
justice involvement of this population?
3. What are the challenges identified by frontline practitioners in their daily actions and interactions
with this population?
Methods
Data for this study were collected as part of an ongoing Montreal-based knowledge transfer
and exchange (KTE) project at the intersection of mental health, homelessness, and justice.
Within the KTE project, an advisory committee composed of health and social service
providers, peer support workers, community advocates, police officers, and researchers was
created to inform the research process. Although data were collected on the perspectives
of both service users and providers, this article focuses on the results of a series of focus
groups with frontline workers. For this, a qualitative descriptive design ( Th orne, Kirkham,
and MacDonald-Emes 1997 ) was selected. Within that framework, we opted to use focus
groups based on Kitzinger’s framework ( 1995 ) to address the research questions, as this
method capitalizes on group dynamics (interactions between participants and not only
between the participants and the researchers) to provide a richer and more in-depth understanding
of norms and tensions in professional practices. The research was approved by
the Comité d’éthique de la recherche en Dépendances, Inégalités sociales et Santé publique
of the CIUSSS Centre-Sud-de-l’Ile-de-Montréal ethics board.
Participants were frontline service providers working directly with HPMI in one of the
following sectors: law enforcement, public health and social services, or community organizations.
Participants were eligible for the study if they were 18 years of age or older and
if they had been working in a frontline service provision role with the target population for
© 2020 CJCCJ / RCCJP, 62, 2, (April / avril), 1-21 doi:10.3138/cjccj.2019-0056
Reducing Criminal Justice Involvement of Individuals Experiencing Homelessness and Mental Illness 55
over a year. Participants (including health and social service providers) had to specify that
at least part of their mandate was to reduce or prevent criminal justice involvement among
HPMI. Recruitment occurred through announcements in team meetings or through the
internal Web servers of their organizations. Potential participants communicated with the
research coordinator to obtain information and to organize their presence at a focus group.
Recruitment continued until theoretical saturation of the data was obtained.
Focus groups lasting 180 minutes each were conducted in a community organization in
downtown Montreal; four of the groups were homogeneous (all participants were from the
same intervention sector) and two were heterogeneous (participants came from diff erent
sectors) to maximize diversity in the findings. Participants first provided written, informed
consent and completed a short demographic questionnaire. Th e first author, LR, conducted
all the focus groups; her role was to moderate the discussion, to ensure that all participants
contributed as much as possible, and to bring the discussion back to the research questions
if needed ( Kitzinger 1995 ; Krueger and Casey 2000 ). Moderation was based on an interview
guide developed by the research team. All data were audio recorded and then transcribed
verbatim by a research assistant present during the group, who also noted nonverbal aspects
of the group process.
LR and a research assistant read the transcripts several times; their content was then imported
into the NVivo qualitative data analysis software, coded, and analysed according to Miles
and Huberman (1994 )’s principles of data reduction, data display, and conclusion drawing/
verification. We first proceeded to data reduction using both inductive and deductive coding;
that is, an initial list of codes was developed to identify content associated with each
of the three research questions, and additional in vivo codes also emerged from the fi rst
cycle of coding. The two analysts coded a portion of the transcripts independently, and any
discrepancy in coding was discussed until consensus emerged. A second cycle of coding
involved constant comparison techniques ( Glaser and Strauss 1967 ) within and between
groups of participants (police, public health and social services, community organizations).
We then proceeded to the next step of data display using comparison matrices ( Miles and
Huberman 1994 ) that highlighted similarities and differences across groups of participants
for each of the emerging themes: the practices and work activities named by participants,
the perceived value and effectiveness of these practices, and the personal, interpersonal, and
contextual challenges that occurred in practice


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