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Improving the Health of Canadians: Mental Health, Delinquency and Criminal Activity
Released:April 29, 2008
About the Canadian Institute for Health Information (CIHI)
HealthInformation
Research and Analysis
Health Indicators
Data Holdings
StandardsLaying a foundation for health information
Capturing the portrait of health care
Building new health knowledge
Taking health information further
Priva
cy, C
onfid
entia
lity a
nd S
ecur
ity
Com
mun
icatio
n, C
onsu
ltatio
n an
d Di
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inat
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Canadian Population Health Initiative (CPHI)
CPHI’s Mission:
• To foster a better understanding of factors that affect the health of individuals and communities; and
• To contribute to the development of policies that reduce inequities and improve the health and well- being of Canadians.
CPHI’s Strategic Functions
Knowledge Generation Policy Synthesis
Knowledge Transfer Knowledge Exchange
CPHI Council Members (as of February 2008)
Cordell Neudorf (Chair)
David Allison André Corriveau
Nancy Edwards Brent Friesen
Judy Guernsey Richard Massé
Deborah Schwartz Elinor Wilson
Ian Potter (ex-officio) Gregory Taylor (ex-officio)
Michael Wolfson (ex-officio)
Expert Advisory Group Members
Gregory Taylor (Chair), Public Health Agency of Canada
Carl Lakaski, Public Health Agency of Canada
Kathy Langlois, First Nations and Inuit Health Branch
Alain Lesage, Louis-H. Lafontaine Hospital
Dora Nicinski, Atlantic Health Sciences Corporation (Region 2)
Rémi Quirion, Canadian Institutes of Health Research
Margaret Shim, Alberta Health and Wellness
Phil Upshall, The Mood Disorders Society of Canada
Cornelia Wieman, Indigenous Health Research Development Program
and University of Toronto
CPHI’s Key Themes 2007-2010
Promoting Healthy WeightsMental Health and
Resilience Place and HealthReducing Gaps in Health
Improving the Health of Canadians Report Series on Mental Health
Series of three reports on the theme of mental health and how mental health is linked to the determinants of health• Two reports will focus on segments of the population often
identified as ‘vulnerable’• Final report will focus on the construct of positive mental health
Report Release Date
Report #1: Mental Health and Homelessness August 30, 2007
Report #2: Mental Health, Delinquency and Criminal Activity
April 29, 2008
Report #3: Promoting Positive Mental Health (working title)
February 2009 (exact date to be determined)
Improving the Health of Canadians: Mental Health, Delinquency and Criminal Activity
Purpose of Report• Examines the links between mental health, delinquency, criminal
activity and their various determinants
Section One• Looks at what mental health–related factors at the individual, family,
school/peer and community levels are risk factors for or protective factors against delinquency among youth
Section Two • Looks at people with a mental illness who were or are involved with
the criminal justice system (that is, in a mental health bed with a criminal history or in a correctional facility with a mental illness)
Delinquency Among Canada’s Youth
What Does the Data Tell Us?
Aggressive Behaviour: A score based on responses to the following six items:
i. I get into many fights,ii. I react to accidents with anger, iii. I physically attack people, iv. I threaten people, v. I bully or am meanvi. I hit others my age.
Often 10%
Some 34% *
None 56% *
Self-reported Delinquent Behaviour Among Youth Aged 12-15, 2004-2005
Source: CPHI Analysis of NLSCY (cycle 6, 2004-2005)
Note: These rates are based only on the 86% of youth who responded.* Significantly different from “often” at p<0.05.
Self-reported Aggressive Behaviour Among Males and Females Aged 12-15, 2004-2005
Source: CPHI Analysis of NLSCY (cycle 6, 2004-2005).
Note: Only among n = 3,768 responses (excludes non-response).
* Significantly different from “females” at p<0.05.
13%* 37% 50%*
7% 31% 62%
0% 20% 40% 60% 80% 100%% of youth (ages 12-15)
Males
Females
Often Some None
Mental Health, Delinquency and Criminal Activity:
Relationships at the Level of Individual, Family, School/Peer and Community
Mental Health, Delinquency and Criminal Activity: Individual Level
Various mental health-related factors specific to the individual level may be associated with delinquency.
INDIVIDUAL LEVELProtective Factors High levels of optimism, life
satisfaction and emotional capability, trustworthiness, sense of belonging
Risk Factors Low self-worth, hyperactivity, victimization
CPHI Analysis: Aggression and Individual-level Protective Factors
Source: CPHI Analysis of NLSCY (cycle 6, 2004-2005).* Significant difference between levels within each mental health factor at p<0.05.
44%
61%*
47%
63%*53%
65%*
46%
73%*
48%
75%*
0%
20%
40%
60%
80%
100%
% o
f you
th re
port
ing
noag
gres
sive
beh
avio
ur
Self-Esteem SelfMotivation
Adaptability StressManagement
EmotionalCapability
Medium-Low High
CPHI Analysis: Aggression and Individual-level Risk Factors
Source: CPHI Analysis of NLSCY (cycle 6, 2004-2005).E: Coefficient of variation between 16.6% and 33.3%. Interpret with caution.
* Significantly different than same level of aggression for “all youth” at p<0.05.
56% 34% 10%
27%* 48%* 25%*
23%*E 46% 31%*
25%* 48%* 27%*
0% 20% 40% 60% 80% 100%
% of youth (aged 12-15)
All Youth
Anxious
Indirectly Aggressive
Hyperactive
None Some Often
Mental Health, Delinquency and Criminal Activity: Family Level
Various mental health-related factors specific to the family level may be associated with delinquency.
FAMILY LEVEL
Protective Factors Nurturing parenting style, high level of parental monitoring
Risk Factors Harsh or inconsistent parenting style, lack of parental supervision
CPHI Analysis: Aggression and Parenting Style
Source: CPHI Analysis of NLSCY (cycle 6, 2004-2005).
* Significant difference between levels at p<0.05.
42%*
66%
50%*
62%
0%10%20%30%40%50%60%70%80%
% o
f you
th (1
2-15
) re
porti
ng n
o ag
gres
sive
be
havi
our
ParentalNurturance
ParentalMonitoring
Medium-Low High
Mental Health, Delinquency and Criminal Activity: School and Peer Levels
Various mental health-related factors specific to the school and peer levels may be associated with delinquency.
SCHOOL AND PEER LEVELSProtective Factors School environment in which
youth feel involved, feeling connected with one’s peers
Risk Factors Lack of school involvement, poor academic achievement, negative peer influences, bullying, truancy
CPHI Analysis: Aggression and School/Peer Risk Factors
Source: CPHI Analysis of NLSCY (cycle 6, 2004-2005).
* Significantly different than same level of aggression for “all youth” at p<0.05.
56%* 34% 10%
41%* 43%* 16%*
39%* 43%* 17%*
46%* 42%* 12%
0% 20% 40% 60% 80% 100%
% of youth (aged 12-15)
All Youth
Few Positive Peer Connections
Peers with Problem Behaviours
Feels like an Outsider
None Some Often
Mental Health, Delinquency and Criminal Activity: Community Level
Various mental health-related factors specific to the community level may be associated with delinquency.
COMMUNITY LEVELProtective Factors Feeling a positive bond to society
Risk Factors High turnover of neighbourhood residents, high rates of violent crimes, feelings of hopelessness
CPHI Analysis: Protective Factors Among Youth who are Not Aggressive
• Just over one half (56%) of 3,768 responding youth reported no aggression.
• Compared to these youth, youth with identified protective factors were significantly more likely to report not being aggressive.
Source: CPHI analysis of Statistics Canada’s, NLSCY (cycle 6, 2004-2005).
Top 5 Protective Factors % of Youth Not AggressiveEmotional capability 75Able to manage stress 73Nurturing parents 66Likes school 65Adaptable 65
CPHI Analysis: Risk Factors Among Youth who are Often Aggressive
Source: CPHI analysis of Statistics Canada’s, NLSCY (cycle 6, 2004-2005).
Top 5 Risk Factors % of Youth Often AggressiveIndirectly aggressive 31Hyperactivity 27Parental rejection 26Anxious 25Punitive parenting 21
• 10% of responding youth reported often being aggressive
• Youth with identified risk factors were more likely to report often being aggressive compared to these youth.
CPHI Analyses: Conclusions
The top five protective factors represent the presence of positive behaviours such as:
• Emotional capability, stress management, parental nurturance, liking school and being easily adaptable
As opposed to the absence of these protective factors, the top five risk factors for aggressive behaviour represent the presence of a negative behaviour, including:
• Indirect aggression, hyperactive, reporting parental rejection or punitive parents and being anxious
Analyses highlight the value of both promoting protective factors and reducing risk factors as a means of addressing aggression in youth
Preventing Delinquency: Policies and Programs
• There is a link between various skills-training programs within the family and school contexts with improved mental health outcomes and reduced delinquency among youth. Evidence from some programs indicates:
Reduced aggressive behaviour among children and improvements in social behaviours with self-control training.Increased self-efficacy and reduced juvenile delinquency with family-skills training in early childhood.Improvements in school and work functioning, decreased involvement in criminal activities and fewer mental health problems among youth receiving a school-based intervention.
• Some programs show less short-term delinquency, but no long-term differences in terms of having a criminal record.
Mental Health and the Criminal Justice System
Relationships between Mental Illness and Criminal Involvement
CPHI looked at data from CIHI’s Ontario Mental Health Reporting System (OMHRS) database to compare the characteristics of two groups of patients admitted to a mental health bed:• “Forensic admissions”: Patients for whom the reason for
admission listed that they were involved or charged with criminal activity
• “Patients with a criminal history”: Patients were reported (by themselves or others) to have had some police intervention for participation in a violent or non-violent criminal activity (excluding civil litigation)
Characteristics of Patients with Criminal Involvement Admitted to a Mental Health Bed
New analyses of data from CIHI’s Ontario Mental Health Reporting System (OMHRS) database show that from April 2006 to March 2007:• Of 30, 606 unique patients admitted to a mental health bed
9% had some current involvement with the justice system (forensic admissions)
28% reported a violent or non-violent criminal history
• Compared to non-forensic patients, forensic patients tended to be younger and a higher proportion were male, never married, and had lower education levels and less stable housing
Males were more than three times more likely to be forensic patients than females
Schizophrenia and Substance Abuse Diagnoses Among Patients Admitted to a Mental Health Bed
Source: CPHI analysis of Ontario Mental Health Reporting System (OMHRS), CIHI, 2006–2007.
54%
38%
17%
33%
25%
5%0%
10%
20%
30%
40%
50%
60%
Forensic Admissions Non-ForensicAdmissions
Schizophrenia Substance Abuse Disorder Both
Risk Factors at Admission among Patients with a Criminal History
Compared to patients without a criminal history, patients in mental health beds with a criminal history reported significantly more risk factors at admission:
• Reported rates of substance use were nearly two times higher
• Significantly greater victimization rate (38% versus 26%)
• Patients with a criminal history were more likely to have failed or dropped out of an education program (41% versus 25% of non- criminal history)
• For 44% of patients with a criminal history, the patient, family or friends indicated the relationship between the patient and immediate family was dysfunctional (versus 34% of others)
Risk Factors at Discharge among Patients with a Criminal HistoryCompared to patients without a criminal history, patients with a criminal history reported significantly more risk factors at discharge
Criminal History
No Criminal History
Reported being adherent to medication less than 80% of the time in the month prior to admission
31% 21%
No support person who feels positive about their discharge
23% 18%
Initial living arrangement expected upon release:Private home
HomelessCorrectional facility
Unknown
66%4%3%3%
77%1%
<1%2%
Source: CPHI analysis of Ontario Mental Health Reporting System (OMHRS), CIHI, 2006–2007.
All comparisons are significantly different between groups at p<0.05.
Mental Illness Among Adults in Correctional Facilities
Most people with a mental illness or compromised mental health do not commit crimes
However, information from various sources indicates there is a higher prevalence of certain types of mental illnesses among incarcerated adults compared to the general population, including:
• Psychotic disorders (schizophrenia)
• Major depressive disorder
• Anxiety disorders
• Antisocial personality disorder
• Substance abuse disorder
Mental Illness Among Youth in Correctional Facilities
Studies examining the prevalence of mental illness among incarcerated youth report similar patterns to incarcerated adults.
Rates of some mental illnesses are higher among incarcerated youth than among youth in the general population, including:
• Depression
• Anxiety disorders
• Attention-deficit/hyperactivity disorder (ADHD)
• Substance abuse disorders
• Conduct disorder
• Post-traumatic stress disorder (PTSD)
• Schizophrenia
Mental Illness Among Aboriginal Peoples in Correctional Facilities
Aboriginal Peoples are over-represented in the Canadian prison system
• In 2002, 17% of males and 26% of female inmates were Aboriginal
• 92% of Aboriginal federal offenders required help for a substance abuse problem; 96% reported a personal or emotional issue that needed attention
• Compared to non-Aboriginal inmates, Aboriginal inmates tend to have lower rates of completed education, greater unemployment histories, higher rates of unstable housing, higher rates of repeat offending and higher rates of violent offences.
The Aboriginal inmate population is also comprised of more females than the non-Aboriginal inmate population.
Suicidal Behaviour in Correctional FacilitiesAmong the general population, 12% of males and 19% of females (15 to 24 years) reported having suicidal thoughts at some point in their lifetime• 2% of males and 6% of females reported a suicide attempt
In 2002, the proportion of male federal inmates in Canada who reported a suicide attempt in the previous five years ranged from 10% in minimum security to 16% in maximum security• Proportion among female inmates ranged from 11% to 41%
Among incarcerated youth, published rates of suicidal thoughts range from 9% to 10% with a lifetime prevalence of 34%
• A British Columbia study found that 21% of incarcerated youth thought about killing themselves in the past year; 13% reported a past attempt
Programs for People Involved with the Criminal Justice System
Diversion Programs• Aim to intervene during the various points at which
persons with a mental illness may come into contact with the criminal justice system
• Participants in mental health diversion programs spend less time in jail and have more involvement with mental health professionals and community mental health services than individuals not involved in such programs
Programs in Correctional Facilities
Many jurisdictions offer mental health-related programming for offenders in institutional settings, including substance abuse treatment; violence prevention; and stress and anger management • Preliminary evaluations speak to the effectiveness of
violence prevention and anger management programs offered in correctional facilities
• Little is known about the long-term impacts on mental health–related outcomes or the accessibility of programs to offenders, particularly among those with mental health issues
Programs in Community Settings
Many jurisdictions offer mental health-related programming for offenders in supervised community settings. Successful community-based programs share the following features: • They are intense, highly structured and contain multiple components
targeting specific problems;
• Treating clinicians assume multiple roles, including treating patient’s mental disorder, preventing violence and crime, and taking responsibility for patient’s compliance with the program;
• Treating clinicians have the authority to re-hospitalize patients if they are judged to be at risk, to be committing other crimes, or to be in need of acute psychiatric symptom treatment; and
• Treating clinicians have the option to obtain court orders in order to ensure compliance with the treatment program.
Conclusions
Conclusions
• There is value in providing appropriate services and programs in order to prevent criminal activity.
• Within the individual, family, school/peer and community contexts, various factors may protect against or increase one’s risk for delinquency.
• Research suggests that no single program that targets only one risk or protective factor would be as effective as programming that targets the multiple factors associated with mental health, delinquency and criminal activity.
• There is value in providing offenders who have a mental illness with appropriate services and programs within correctional facilities and in the community.
CPHI Mental Health Current and Planned Reports and Activities
Complementary Products
• Workshops that reflect content of given mental health report
• Collection of Papers: “What Makes a Community Mentally Healthy?”
• Mental Health, Delinquency and Criminal Activity— Supporting Documents:
Literature search methodology
Data analysis methodology
Policy scanning methodology
Summary report
PowerPoint presentation
