By the mid-1990’s at the Ontario Court of Justice at Old City Hall in downtown Toronto we began to see a significant increase in the number of mentally disordered accused coming through the courthouse doors. (There are a number of explanations for this growth which cannot be canvassed here.) Generally, but not always, these individuals are charged with relatively minor offences. The regular criminal courts were not handling this population very well. The tremendous increase in cases of this sort put incredible strains on the system. There were unacceptable delays and inefficiencies in dealing with the preliminary issues of fitness to stand trial (Assessment and Treatment Orders) and Diversion options were not being fully exploited. Accused would often spend multiple weeks if not months getting to the point where they could set a trial date or resolve their matters. As well, accused were returning to court at an alarming rate. In August of 1997 the problem was brought to the attention of the Chief Justice and Senior Regional Justice (Toronto Region) and it was proposed that we set up a court specifically designed to accommodate mentally disordered accused. The plan was endorsed by the Chief Justice and “Mental Health Court” was opened in courtroom 102 in May of 1998. It was the first in Canada, one of the first in the world, and the only one (to date) to address the comprehensive mandate set out below.
There were two primary objectives set for the court: 1) to deal with pre-trial issues of fitness to stand trial expeditiously, and 2) to, as much as possible, slow down the ‘revolving door’. As well, the court was designed to house the Diversion of Mentally Disordered Accused program as set out in the Crown Policy Manual. The court has also taken on the broader mandate of accommodating mentally disordered accused who, while their fitness might not be in issue, could be more sensitively or effectively dealt with given the resources attached to the Mental Health Court. Accordingly, bail hearings, guilty pleas, and ‘consent’ NCR trials also take place in Mental Health Court. Naturally, Disposition Hearings upon a verdict of Unfit or NCR are also held where a party requests. The original plan was for one central courtroom at Old City Hall to service the entire GTA in a manner similar to the way College Park Courthouse deals with all in-custody female accused. To date, for a variety of reasons, only College Park and Old City Hall have amalgamated.
The Mental Health Court is staffed by two permanent dedicated Crown Attorneys and two dedicated duty counsel. There are nine Mental Health Workers (social workers) attached to the court. Every day a psychiatrist from CAMH (Centre for Addiction and Mental Health) attends to perform ‘stand down assessments’. A second psychiatrist assists the court with the Diversion Program two days of every week. The court clerks have a special knowledge of the system and are equipped with the appropriate Forms and telephone numbers. There is, as well, an Administrative Assistant to assist with the faxing of reports and documents and the arranging of hospital beds when required.
The courtroom has adjoining offices for Mental Health Workers, Administrative Assistant, Duty Counsel, and the attending psychiatrists. The courtroom also has adjoining cells and interview rooms so that the Mentally Disordered Accused can be kept separately and close at hand.
To date no comprehensive evaluation of the court has taken place. There are however a variety of projects underway and results of some of these studies should be available soon. We do know that approximately 75% of the accused who would otherwise have been remanded for in-custody assessments at CAMH are now disposed of on a same-day basis as a result of our ability to do stand down assessments. Where an accused is remanded from another courtroom (typically a bail court) to the Mental Health Court, a stand down assessment, trial of the issue of fitness, and Crown application for a Treatment Order (if the accused is unfit) can all be accomplished on the same day. The Court Mental Health Workers assist with discharges in to the community. We try to ensure that when an accused leaves the court they have a basic ‘survival kit’ which would include: identification, residence, community psychiatric follow-up, social assistance, and clothing. It is not known whether this effort has actually reduced the frequency of appearances at the court.