Home Health How do we take care of mentally ill criminals?

How do we take care of mentally ill criminals?

Fred van Zuiden, 85, called 9-1-1 and said he was an intruder in his home. When the police arrived, they found the 56-year-old wife struck to death and Mr. van Zuiden asking where he was. He was charged with second-degree murder but, suffering from dementia and deemed unfit for trial, was sent to a forensic psychiatric facility, where his condition deteriorated.

Richard McPherson, 60, sexually assaulted another resident and an assistant in his nursing home, then assaulted a security guard. Suffering from dementia, he spent almost two years awaiting trial in the medical wing of the prison before being convicted. Mr. McPherson was sentenced to life imprisonment, but remained in prison because it was not possible to find a suitable placement for the community.

Katharina Abrams, 68, wandered into a park, grabbed a seven-year-old boy by the arm and tried to drag him away. The bystanders intervened quickly, but Mrs. Abrams was accused of forcibly kidnapping another person. Suffering from schizoaffective disorders and dementia, and believing that she has the mental capacity of a child, she was found not to be criminally responsible but was kept in custody, again, because she could not find a bed for her in a nursing facility.

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A new 272-page report by the Dementia Justice Society of Canada, entitled "Nowhere To Live," presents many of these troubling tragic stories and eloquently points out that the criminal justice system still has to understand how to treat criminal offenders with dementia fairly and compassionate.

The authors point out that dementia patients who kill and rape are a rarity, saying: "At the macroscopic level, our population is statistically insignificant, but at an individual level the human cost is profound".

The image of the common media of people with dementia is that of elderly people who are confused and wander about getting lost. But there are dozens of types of dementia, each with a varied mix of symptoms. Many patients with Alzheimer's, but can also be aggressive and paranoid. Symptoms of frontotemporal dementia often include disinhibition and hypersexuality. Those with Lewy body dementia can have frequent hallucinations. And so on.

How do you know anyone who treated a loved one with dementia (and there are more than 500,000 people with dementia in Canada), behaviors that can cause – urinating in public, groping, shoplifting, traffic violations, verbally or physically lashing – they can bring people with dementia into contact with the police and the judiciary.

Collecting and incarcerating people for these unrepresented actions is not helpful. Rather, we must invest in prevention. This includes police training on how to interact with people with dementia, leaving prosecutors the freedom not to impose charges, provide relief programs for caregivers, and adequate housing for people with dementia.

We must also recognize that having dementia does not mean that people can not commit crimes. When they do, however, they must be treated differently. One of the most troubling aspects of this complex story is the shocking rate of domestic violence experienced by those caring for their loved ones with dementia.

Take the case of Joseph McLeod, an Alzheimer's patient who has pushed his wife; he fell and hurt himself gravely when a glass frame shattered. Mrs. McLeod did not want her husband to be charged, but the mandatory debit policies meant that he had been imprisoned.

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When people are arrested and incarcerated, there is a loss of freedom. For a person with dementia, this can have serious side effects.

A person with a contactless order – common with allegations of domestic violence – loses their caregiver. A patient in dementia kept in custody is at serious risk of losing the bed if it is already in a facility. In the strict prison environment, health often deteriorates rapidly. And, once you have a record, no home wants you.

There are now mental health courts that allow judges to treat defendants with mental illness differently, such as condemning them to treatment rather than prison. Some dementia sufferers end up there by default, but the more specialized dementia courts would be welcome.

The ultimate problem, however, as the new report by Dementia Justice makes clear, is the lack of adequate housing available for people with dementia, and even more for those of them who are violent.

Nursing homes and long-term care facilities are not the bad guys here. Sixty percent of his clientele already suffers from dementia. They do not have the staff or facilities to treat violent criminals and there is a serious lack of specialized facilities.

The idea that sufferers end up in prison and default forensic units is aberrant. Justice requires that criminals with dementia receive adequate care, not punishment.

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