In Quebec, a person who suffers from a mental disorder and who has committed an offence will stand trial before a regular court of the criminal justice system. The Quebec Review Board (QRB) will take over the case if the person is found unfit to stand trial or in order to establish the terms of his or her release/confinement if the person is found not criminally responsible on account of mental disorder.

Since 2008, a person considered fit to stand trial and who is criminally responsible can choose to participate in the Programme d'accompagnement justice-santé mentale (PAJ-SM) if the charges fall under the responsibility of Montreal's municipal court.

The PAJ-SM is not a new judicial entity, parallel to the Montreal municipal court. Rather, it is a social type program; a form of mental health court like those found in the rest of Canada and in the United States. In Montreal, this is a joint pilot project of the City of Montreal, the Quebec Justice Department and the Quebec Ministry of Health and Social Services. It was set up for a period of 3 years.

The program targets individuals with mental health problems who are facing “minor” criminal charges before the municipal court of the City of Montreal. Indicators of a mental illness may be in co-occurrence with intellectual deficiency or alcohol/drug dependence. No minor infraction is excluded from the PAJ-SM. The most common criminal charges are:

  • Misdemeanours
  • Threats
  • Public order disturbances
  • Simple assaults

Objectives

The PAJ-SM was set up to respond to very specific problems:

  • Ensure that judges and lawyers of the municipal court are aware of the mental health provisions
  • Ensure that those suffering from mental disorders, who are often disadvantaged or without resources, are referred to resources that meet their needs
  • Help defendants find their way through the sea of professionals who are involved in the regular courts
  • Avoid the revolving door syndrome, i.e., sending individuals home without appropriate care, thereby risking that they commit another offence

A multidisciplinary team

The PAJ-SM has a multidisciplinary team that is knowledgeable of mental health issues. It is composed of:

Justice and Public Safety :

  • 9 judges
  • 3 prosecuting attorneys
  • 1 defence attorney from legal aid
  • 1 probation officer

Health and Social Services :

  • 1 general practitioner specializing in mental health
  • 1 emergency case manager from UPS-J
  • 2 health and social services liaison officers

Network partners and collaborators :

  • CSSS teams
  • Psychiatric hospital teams
  • Partner institutions (Dollard-Cormier Center, Intellectual Disability Center)
  • Community organizations

Key elements

The key elements of the PAJ-SM are as follows:

  • Separate docket for defendants who suffer from mental disorders
  • Designated judge
  • Non-adversarial approach
  • More flexible rules of operation
  • Voluntary participation
  • Intervention plan designed for the needs of each individual
  • Possibility of having the charges withdrawn if the defendant cooperates

Better conditions for people with mental disorders

Too often, offenders with mental health problems receive sentences that are not adapted to their state of health. Imprisonment does not meet their needs. The goal of the PAJ-SM is to improve how these people are treated in the legal system so as to:

  • Ensure that cases are treated in a more uniform and consistent way
  • Avoid unnecessary detention and instead promote supervision and psychosocial/medical follow-up in the community
  • Provide follow-up to decrease the risk of recidivism
  • Reduce the time spent in detention for the purposes of psychiatric assessment

By promoting supervision, follow-up work in the community and care that is adapted to the defendant's personal circumstances, the PAJ-SM aims for a long-term reduction in criminalization and recidivism, better public protection, and better community reintegration of defendants suffering from a mental health problem.

How the PAJ-SM works

The PAJ-SM offers continuous monitoring over a variable period of time depending on the individual's needs. Once the municipal court hearings are over, the offender must adhere to a contract that sets out various restrictions according to his or her state, such as:

  • No alcohol or drugs consumption
  • Avoid contact with specific individuals
  • Respect the recommendations of the care team

The conditions of the PAJ-SM are not imposed in that failure to adhere will not lead to additional charges being laid. It is a form of "moral contract". As the defendant progresses in the program, the contract can be modified; for example, the conditions for release can be softened or the number of appearances before the Court can be reduced.

If the defendant respects the conditions of the contract, the prosecutor will ask for the charges to be dropped or will recommend a non-custodial sentence. If the defendant does not respect the terms of the contract, he or she must go back to a regular court, where a judge will apply the law more strictly without taking into account the defendant's mental health state.

For more information on PAJ-SM, please call 514-872-9958.

A highly active research topic

Since the PAJ-SM is a pilot project, a research team directed by Douglas Institute researcher Anne Crocker, PhD, is evaluating its implementation. The goal of the study is to:

  • Describe how the PAJ-SM works and compare it to other mental health courts
  • Documents the perception of staff, participants and their families
  • Assess participation and recruitment rates
  • Describe the clientele
  • Identify the characteristics related to withdrawal of the program

Anne Crocker and her team published an important paper on law and mental health in the Revue santé mentale au Québec. In this other document (in French), she summarizes a study on the implementation of the PAJ-SM, two years after its creation.

Other Mental Health Courts (MHC) in North America

There are over a dozen MHC in Canada and more than 250 in the United States.

In Canada:

In the United States:

  • List of all U.S. Mental Health Courts by state
  • California
  • Washington D.C
  • New York
  • The Consensus Project, a Pan-American criminal justice and mental health initiative consisting of resources for patients, their families, researchers and criminal justice professionals. Five MHC have been designated as "learning sites"

The effectiveness of Mental Health Courts (MHC)

General:

On the risk of recidivism and detention:

  • A Strategy That Works
  • Fewer incarcerations in Ohio
  • Lower rate of recidivism in Ohio

On the use of mental health care services:

  • Consumers of services in Ohio
  • A case study

On stigmatization and social support:

  • Impact of Diversion Programs on Consumers' Quality of Life and Depressive Symptomatology

On clinical outcomes:

[Justice and Mental Health in Quebec] [When a person suffering from a mental disorder commits an offence] [The Programme d'accompagnement justice-santé mentale (PAJ-SM) in Montreal] [When a person presents a danger to him or herself or others]