Copyright Notice. This document is the property of Alberta Health Services (AHS).

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1 Copyright Notice This document is the property of Alberta Health Services (AHS). On April 1, 2009, AHS brought together 12 formerly separate health entities in the province: nine geographically based health authorities (Chinook Health, Palliser Health Region, Calgary Health Region, David Thompson Health Region, East Central Health, Capital Health, Aspen Regional Health, Peace Country Health and Northern Lights Health Region) and three provincial entities working specifically in the areas of mental health (Alberta Mental Health Board), addiction (Alberta Alcohol and Drug Abuse Commission) and cancer (Alberta Cancer Board).

2 Alberta s Provincial Diversion Program PHASE ONE Implementing The Provincial Diversion Program In Alberta Communities: Guidelines And Standards by Alberta s Provincial Diversion Working Committee January 2003

3 Material appearing in this report may be reproduced or copied without permission. Use of the following acknowledgement to indicate the source is required, however. Provincial Diversion Working Committee. (2003). Phase One--Implementing the Provincial Diversion Program in Alberta Communities: Guidelines and Standards. Alberta: Provincial Forensic Psychiatry Program (AMHB). In reproducing this document, please abide by the Terms of Use of the Alberta Mental Health Board website ( from which this document has been retrieved. Acknowledgement of the following ministries and consumer groups as part of the Provincial Diversion Working Committee: Alberta Health and Wellness Alberta Solicitor General Alberta Justice and Attorney General Alberta Children s Services Alberta Aboriginal Affairs and Northern Development Alberta Human Resources and Employment Alberta Community Development Alberta Mental Health Board Calgary Diversion Project Canadian Mental Health Association Municipal Law Enforcement Representatives Royal Canadian Mounted Police (R.C.M.P.) Schizophrenia Society of Alberta

4 The Diversion Program Implementation: Phase One document for a Provincial Diversion Program is submitted to the Mental Health and Justice Partnering Deputies Committee, consisting of the following members: Mr. Roger Palmer Mr. Murray Finnerty Mr. William J. Byrne Mr. Ron Hicks Mr. Terrence Matchett Ms. Paddy Meade Mr. Jim Nichols Mr. Ray Block Ms. Paula Tyler Deputy Minister, Alberta Health & Wellness Chief Executive Officer, Alberta Alcohol & Drug Abuse Commission (AADAC) Deputy Minister, Alberta Community Development Deputy Minister, Alberta Human Resources & Employment Deputy Minister & Deputy Attorney General Alberta Justice & Attorney General Deputy Minister, Aboriginal Affairs & Northern Development Deputy Solicitor General, Alberta Solicitor General Acting Chief Executive Officer, Alberta Mental Health Board (AMHB) Deputy Minister, Alberta Children s Services Acknowledgements page i

5 ACKNOWLEDGEMENTS The Provincial Diversion Working Committee members are acknowledged for their contribution and guidance in the development of the Provincial Diversion Program: Dr. Carol Adair Laurie Beverley, Co-Chair Norman Boucher Norma Boulton Dr. John Brooks Yvonne Collinson Director of Research, Alberta Mental Health Board Provincial Administrative Director, Forensic Psychiatry Program, Alberta Mental Health Board Chief of Police, Medicine Hat Police Service Director, Clinical Practice, Alberta Mental Health Board Provincial Medical Director, Forensic Psychiatry Program, Alberta Mental Health Board Team Leader, Population Health Strategies Branch, Alberta Health and Wellness Staff Sgt. Bob Couture Court Liaison/APU Administration, Calgary Police Service Carol Dillman Brent Doney, Co-Chair George Fernhout Sgt. Steve Gleboff Stacy Hodgson Sandra Harrison Aggy King-Smith Marty Landrie Beth Lipsett Orrin Lyseng Jim Merchant Ian McKnight Cassie Palamar Bob Reddick Bronwyn Shoush Aleck Trawick, Q.C. Irving Yaverbaum Sharon Zibin Rose Barvir Manager, Program and Service Initiatives, Aboriginal Affairs and Northern Development Director, Division Support Services, Correctional Services Division, Alberta Solicitor General Regional Services Manager, Joint Position Lakeland Regional Health Authority and Alberta Mental Health Board Criminal Operations, K Division R.C.M.P. Adult and Senior Services Manager, Red Deer Mental Health Clinic, AMHB Administrative Director, Children s Mental Health Services, AMHB Program Planning & Evaluation Coordinator, Young Offender Services, Provincial Forensic Psychiatry Program, Alberta Mental Health Board Adult Services Coordinator, Aboriginal Mental Health, AMHB Manager, Alberta Alcohol and Drug Abuse Commission Executive Director, Schizophrenia Society of Alberta Program Director, Adult Mental Health & Psychiatric Primary Care Alberta Mental Health Board Detective Spousal Violence Intervention Unit, Edmonton Police Service Manager, Human Rights & Citizenship Branch, Alberta Community Development Program Manager, Forensic Assessment and Community Services (FACS) and Centerpoint, Northern Alberta Forensic Psychiatry Program Director, Aboriginal Justice Initiatives, Alberta Solicitor General Board Member, Canadian Mental Health Association Senior Policy Counsel, Appeals, Criminal Law Policy & Planning Branch, Alberta Justice Provincial Quality Management Coordinator, Forensic Psychiatry Program, Alberta Mental Health Board Recording Secretary, Provincial Forensic Psychiatry Program, AMHB Acknowledgements page ii

6 The Provincial Diversion Working Committee gratefully acknowledges the contributions of time, energy and thoughtful discussion by numerous subcommittee members and the Calgary Diversion Project Steering Committee and Calgary Diversion Project Staff. Fran Barnes Laurie Beverley, Co-Chair Yvonne Collinson Brent Doney, Co-Chair Staff Sgt. Bob Couture Cindy Davison Ramona Deer Dr. Rick Enns Ken Hagel Karen Hala Peter Halpin Fay Herrick Aggy King-Smith Marty Landrie Orrin Lyseng Beth Lipsett Jim Merchant Lynn McLean Bob Reddick Sharon Sutherland Aleck Trawick, Q.C. Sharon Zibin Calgary Diversion Project Manager Provincial Administrative Director, Forensic Psychiatry Program, Alberta Mental Health Board Team Leader, Population Health Strategies Branch, Alberta Health and Wellness Director, Division Support Services, Correctional Services Division, Alberta Solicitor General Court Liaison/APU Administration, Calgary Police Service Arrest Processing/Court Liaison Unit, Calgary Police Service Program Manager, Calgary Young Offender Centre, Alberta Solicitor General Former Program Manager, Centerpoint, Northern Alberta Forensic Psychiatry Program Assistant Chief Probation Officer, Solicitor General Manager, Alberta Alcohol and Drug Abuse Commission, Calgary Team Service Coordinator, Community Geographic Team Resources, Provincial Forensic Psychiatry Program, Alberta Mental Health Board Education/Advocacy, Schizophrenia Society of Alberta, Calgary Chapter Program Planning & Evaluation Coordinator, Young Offender Services, Provincial Forensic Psychiatry Program, Alberta Mental Health Board Adult Services Coordinator, Aboriginal Mental Health, Alberta Mental Health Board Executive Director, Schizophrenia Society of Alberta, Provincial Office Manager, Alberta Alcohol and Drug Abuse Commission, Edmonton Program Director, Adult Mental Health & Psychiatric Primary Care, Alberta Mental Health Board Alberta Alcohol and Drug Abuse Commission, Calgary Program Manager, Forensic Assessment and Community Services (FACS) and Centerpoint, Northern Alberta Forensic Psychiatry Program Past Chair, Provincial Advocacy Committee Schizophrenia Society of Alberta, Provincial Office Board Member, Canadian Mental Health Association Provincial Quality Management Coordinator, Forensic Psychiatry Program, Alberta Mental Health Board Acknowledgements page iii

7 PREFACE The most effective diversion begins at the community level through prevention programs, prior to an individual s contact with the law. As such, the Provincial Diversion Working Committee supports the need for prevention and intervention programs within communities, based on the premise that, whenever possible, communities and individuals should have access to mental health, social and support services before it is necessary for law enforcement to be involved. Although the Provincial Diversion Working Committee s mandate does not include those individuals with mental illness who are not in conflict with the law but who are at risk of offending, it is recognized that the optimal situation within communities involves a strong support for prevention and intervention programs. The overall goal of this Diversion Program Implementation: Phase One (2003) document is to provide a set of provincial guidelines and standards for Alberta communities involved in the diversion of individuals with mental illness who are in conflict with the law. As indicated in the Proposed Provincial Diversion Implementation Plan (2002), program is defined as consisting of agreed upon values, protocols, processes, and standards of operation that are used within the provincial context and across ministries in the diversion of individuals with mental illness who are in conflict with the law. 1 The intent is to capitalize on the existing resources and expertise within communities, and, if necessary to augment resources as needed. For the purposes of the Provincial Diversion Program, mental illness refers to clinically significant patterns of behavioural or emotional functioning that are associated with some level of distress, suffering, or impairment in one or more areas of functioning (for instance, school, work, social and family interactions). At the basis of this impairment is a behavioural, psychological, or biological dysfunction, or a combination of these. 2 As noted in previous reports prepared by the Provincial Diversion Working Committee, the operational definition of diversion and the one that has received support in principle from the Mental Health and Justice Partnering Deputies Committee includes the following components: Redirection of individuals with mental illness from the criminal justice system, whenever appropriate, to mental health, social and support services. Preface to Diversion Program Implementation: Phase One page 1

8 Continuum of integrated yet distinct services that include pre-charge diversion and span the points of entry and exit to and from the criminal justice system and reflect the unique needs of Alberta's communities. 3 Not all individuals, either because of the nature of the offence, previous criminal history, or their potential risk to society, may be appropriate for redirection from the criminal justice system. Some individuals may be deemed to require probation and mandated treatment or even incarceration. For a truly comprehensive diversion program, those individuals with mental illness who are incarcerated and those who are released from correctional facilities also require access to mental health, social and support services. 4 In recognition of this need, the this document outlines guidelines not only for those diversion points at which individuals are redirected from the criminal justice system to mental health, social and support services but also for those points that reflect probation, incarceration and reintegration back into the community. IMPLEMENTING THE DIVERSION PROGRAM IN ALBERTA S COMMUNITIES In developing the Phase One diversion document, the Provincial Diversion Working Committee strived to achieve a balance between ensuring provincial standards for a diversion program and allowing for a reasonable degree of flexibility for communities. The strategies, standards and suggested processes will guide a community in its development of a diversion program. A provincial diversion representative will be available to communities to further assist with the implementation process. Following is an overview of the key elements: Diversion Points refer to those points or occasions during which individuals with mental illness (or are thought to have mental illness) who come in conflict with the law may be o redirected from the criminal justice system, if appropriate, to mental health, social and support services Preface to Diversion Program Implementation: Phase One page 2

9 o or provided access to and directed to mental health, social and support services, while within the criminal justice system. The points address pre-charge diversion and all other points of entry and exit to and from the criminal justice system. 5 Having a number of potential diversion points helps ensure individual and community safety and provides the individual with a number of opportunities for assistance and greater access to mental health, social and support services. (See Section I: Diversion Points & Eligibility Criteria for further discussion.) It is not expected that every community will offer or have the resources or infrastructure to provide opportunities for diversion at all points presented in this program. Communities are encouraged to select the specific points that best meet their needs. Eligibility Criteria are necessary for every community diversion program. These criteria include at minimum the following three considerations: nature of the incident, individual s situation, and available community resources. Depending on the diversion point, eligibility is decided by a representative of the criminal justice system, based on the three areas of consideration and any other factors, in conjunction with any mental health assessment that may be deemed necessary. The premise is that a lesser offence, a more positive and supportive individual situation, and availability of appropriate community resources for an individual s situation increases the likelihood of that individual being diverted without charges and/or without incarceration. Existing judicial and corrections processes are in place for diversion points 5 to 7 while the individual is either on probation, incarcerated or being released from incarceration; therefore, eligibility per se does not apply to these three points. Individual safety and community safety are the most important considerations in whether a certain diversion point is appropriate for an individual. It is recommended that a risk management framework be developed for each diversion community and that appropriate assessments of risk are conducted as part of determining an individual s eligibility. (See Section V: Appropriate Care, Support and Treatment.) Preface to Diversion Program Implementation: Phase One page 3

10 No restrictions exist on the number of times an individual may enter the diversion program/process. Research, along with evidence from the Calgary Diversion Project, demonstrates that it may take a number of interactions with mental health, social and support service professionals before an individual with mental illness may feel comfortable and benefit from contact with that professional. Community resources vary in terms of types of services, accessibility and ability to be involved in a diversion program. The Provincial Diversion Working Committee supports the use of informal supports and ethnoculturally-specific resources as being important to providing appropriate care, support and treatment. During the development of each community diversion program, an evaluation of all potential resources is recommended, including strengths and gaps in service. Cross-ministerial, cross-agency collaboration: From the research and based on the Calgary Diversion Project, collaboration and a case management approach are key elements to a successful diversion program. It is recommended that communities ensure that collaboration exists between regional health authorities, governmental and nongovernmental agencies/organizations, families or other informal supports (if appropriate) in providing services to the target population. In addition, a case management approach is important to ensuring that individuals receive appropriate referral, monitoring and follow up. (See Section V: Appropriate Care, Support and Treatment.) Sharing of information among service providers involved in the care, support and treatment of the target population and between these groups and the criminal justice system will be necessary. It is recommended that information be shared only with informed consent and on a need-to-know basis. (See Section III: Information Sharing.) Education and training are necessary components in the development of a community diversion program. The belief is that education and training contribute to better knowledge of the diversion process and the roles and limitations of community partners, as well as to greater commitment by all stakeholders. It is also important to educate the community about diversion and its potential impact. (See Section IV: Education and Training.) Preface to Diversion Program Implementation: Phase One page 4

11 Appropriate Care, Support and Treatment: For a diversion program to be successful within a community and on a provincial level, minimum or base standards are required for care, support and treatment. (See Section V: Appropriate Care, Support and Treatment.) Evaluation of Diversion Programs: Determining whether a program is successful will be based on appropriate evaluation, with outcome measures addressing a number of components, including level of functioning, quality of life, degree of re-offending, along with a cost-benefit analysis. As well, evaluation must consider the perspectives of all involved stakeholders. (See Section VI: Evaluation and Accountability.) Each of following sections provides information about what is important to successful implementation of a diversion program and what strategies to use. A provincial diversion representative will assist in developing the details for a specific community. Preface to Diversion Program Implementation: Phase One page 5

12 ENDNOTES 1 Provincial Diversion Working Committee. (2002). Alberta s Provincial Diversion Program: Proposed Implementation Plan for Reducing Criminalization of Individuals with Mental Illness. 2 Provincial Diversion Framework Working Committee. (2001). Alberta s Provincial Diversion Framework: Reducing the Criminalization of Individuals with Mental illness 3 Provincial Diversion Framework Working Committee. (2001). Alberta s Provincial Diversion Framework: Reducing the Criminalization of Individuals with Mental illness. 4 Provincial Diversion Framework Working Committee. (2001). Alberta s Provincial Diversion Framework: Reducing the Criminalization of Individuals with Mental illness. 5 Provincial Diversion Framework Working Committee. (2001). Alberta s Provincial Diversion Framework: Reducing the Criminalization of Individuals with Mental illness. Preface to Diversion Program Implementation: Phase One page 6

13 SECTION I DIVERSION POINTS & ELIGIBILITY CRITERIA Contents RELATIONSHIP BETWEEN DIVERSION POINTS & ELIGIBILITY CRITERIA DIVERSION POINTS SUMMARIZED DETERMINING FACTORS FOR ELIGIBILITY The Nature Of The Incident The Individual s Situation Available Community Resources THE SEVEN DIVERSION POINTS Commission Of An Offence/No Apparent Crisis Situation Commission Of An Offence/Crisis Situation During Case Review For Potential Pre-Trial Diversion While An Individual Has Been Remanded To Custody In Sentencing, Mandated Treatment/ Probation During Incarceration Upon Release From Incarceration

14 RELATIONSHIP BETWEEN DIVERSION POINTS & ELIGIBILITY CRITERIA There may be several points at which an individual with mental illness who is in conflict with the law may be diverted from the criminal justice system. 1 Historically, the belief has been that diversion is either pre-charge or post-charge. However, the Provincial Diversion Working Committee has expanded the definition of diversion to include the need for appropriate care, support and treatment, even if an individual is incarcerated or transitioning from incarceration to the community. By taking this comprehensive approach, The Provincial Diversion Working Committee hopes to achieve the following: Opportunities for communities to select which points are most appropriate to them, based on their community s characteristics and available resources. The option to defer the decision to divert an individual until later in the process if there are concerns about individual and/or community safety. For instance, in some cases, law enforcement or the Crown may feel uncertain as to whether an individual should be considered for diversion and may require the opinion of a judge. Most importantly, an opportunity for individuals with mental illness to be provided with access to appropriate care, support and treatment regardless of whether or not they enter the criminal justice system. If incarceration is deemed necessary they should still have opportunities for appropriate care, support and treatment. Research and preliminary stakeholder consultations have also demonstrated that criteria are required to assist communities in determining who is eligible for diversion particularly in diversion points 1 through 4 as outlined in this section. 2 Three factors have been identified as being important in determining eligibility: nature of the offence, individual s situation, and community resources. It is also important to stress that communities may use their discretion in determining eligibility on a case-by-case basis. The Provincial Diversion Working Committee provides these diversion points as guidelines for communities that develop a diversion program. Section I: Diversion Points & Eligibility Criteria page 1

15 DIVERSION POINTS SUMMARIZED The following seven diversion points have been identified as those most appropriate for a comprehensive Provincial Diversion Program for individuals with mental illness who come in conflict with the law. They reflect the continuum of care from prevention and intervention to reintegration into the community after incarceration. 1. An individual has committed an offence, and this individual is thought to have a mental illness. There is no apparent mental health crisis. First Contact is by Law Enforcement and/or EMS or Mental Health Team, if available a. Referred to diversion/no charge b. Referred to diversion/charged with offence 2. An individual has committed an offence, and this individual is thought to have a mental illness. There appears to be a crisis and suspected need for immediate assessment or stabilization. First Contact is by Law Enforcement and/or EMS or Mental Health Team, if available a. Stabilized and released with no charge b. Stabilized and charged with offence Referred to diversion Referred to diversion 3. During the Pre-Trial Case Review, based on the decision of the Crown 4. While the individual is remanded to custody a. Individual released and referred to diversion prior to first court appearance b. Individual detained in remand and is directed to mental health, social and support services available in remand The following three diversion points differ from the previous four in that the individual is involved in the criminal justice system. Including these three points supports the Provincial Diversion Working Committee s belief that the provision of appropriate care, support and treatment is important to the individual s ability to successfully reintegrate into the community. 5. During Sentencing, at which time a period of probation is mandated, along with participation in a mental health program and/or social and support services 6. During Incarceration, at which time the individual is directed to mental health, social and support services within the correctional setting and as a part of discharge planning 7. Upon Release from incarceration, at which time an individual is directed to mental health, social and support services either as a condition of his/her release or as part of discharge planning and transition/reintegration into the community. Section I: Diversion Points & Eligibility Criteria page 2

16 DETERMINING FACTORS FOR ELIGIBILITY Individual and community safety must be reflected in decisions surrounding whether an individual is eligible for entry to a diversion program. Accordingly, these considerations the nature of the incident, the individual s situation, and the availability of community resources should provide the basis for determining eligibility. It is still important to have the opportunity to determine an individual s eligibility on a case-by-case basis. 1. Evaluating The Nature Of The Incident The nature of the incident is of particular importance when the decision is made to divert an individual without charging him/her. Instead of a comprehensive list of offences that can be included in a diversion program, the following guidelines should be considered when determining whether the nature of the offence makes it appropriate for an individual to be diverted: i. The safety of the individual and community is of primary consideration. ii. Generally, offences that would be appropriate for diversion without charges would be those that are considered to be low risk, minor offences. iii. The determination is made on a case-by-case basis. In some situations, the offence may be major if based strictly on a legal perspective; however, the circumstances or knowledge about the individual may indicate that a justice system response is not appropriate. The individual s past history of offending may or may not be known when a law enforcement officer comes in contact with the person. 2. Evaluating The Individual s Situation An individual s personal situation is an important factor in determining the individual s success in a diversion program, especially in the case of diversion without charges. For instance, Seide (1999) points to the following types of individuals as being least appropriate for diversion: Individuals with poor motivation to change their lifestyle Those with repeated treatment failures and medication non-compliance Those with an inability to adjust to limits and structure Those with little or no community support 3 Section I: Diversion Points & Eligibility Criteria page 3

17 Research also shows that certain conditions may decrease an individual s likelihood of participating voluntarily in mental health, social and support services. A transient lifestyle, access to appropriate housing, marginal employment skills, few or no support groups, and substance misuse are often the complicating factors that may determine whether an individual will attend a voluntary treatment program or not. 4 Supported by many researchers, Seide s observations provide a community with a look at the realities regarding this target population. 5 It is important to recognize that these factors are central to determining whether an individual may be successful but not to use only them in evaluating an individual s eligibility. It is also necessary to determine what community resources may be available to assist in changing the individual s situation. These are the guidelines for evaluating an individual s situation: i. The safety of the individual is of primary consideration, especially if an individual is in an immediate crisis. ii. Support increases the individual s likelihood of following through on the referral, and perhaps on medication compliance, if appropriate. 3. Evaluating A Community s Resources In order for diversion to be effective, there must be a minimum set of both informal and formal community resources to provide services for the individual. 6 The following guidelines are to be considered when communities evaluate their resources in relation to the needs of the individual and to the nature of the incident. It is recommended that communities: i. Identify existing community governmental and non-governmental agencies and organizations that would participate in a diversion program ii. Outline the roles and mandates of participating agencies and organizations and share that information with all professionals involved in diversion iii. Define all potential informal supports that may exist and outline the role of those informal supports in diversion. In summary, these three considerations are provided as guidelines to assist communities in determining eligibility and necessary supports if an individual is eligible for diversion. Section I: Diversion Points & Eligibility Criteria page 4

18 THE SEVEN DIVERSION POINTS: Eligibility Criteria & Diversion Processes The following charts each relate to a different diversion point, labelled 1 through 7. The information can assist a community in determining the following for each diversion point: whether an individual is appropriate for diversion at select points who is involved in the diversion process what general steps can be incorporated for the specific diversion point. Alberta s communities are unique and vary in many ways, including available resources, degree of collaboration, geography, ethnocultural factors, and others. In consideration of the uniqueness of each community, the following guidelines for each diversion point are designed to provide flexibility in determining which points may be most appropriate. They also allow communities to adapt the procedures for a potential diversion point to their unique circumstances. Further development of the guidelines will occur in conjunction with each community as it plans its diversion program. Section I: Diversion Points & Eligibility Criteria page 5

19 1. COMMISSION OF OFFENCE / NO APPARENT CRISIS SITUATION a. Diversion Without A Charge b. Diversion With A Charge (Involving Law Enforcement / Mental Health Professionals / EMS) Nature of Incident Individual s Situation Resource Requirements Low risk, minor offence Determined on a case by case basis Criminal history may or may not be known Individual is thought to have a mental illness but does not appear to be in a crisis situation in which he/she would require immediate or emergency psychiatric assessment and/or admission Individual has some support /stability in the community either housing, family supports, active involvement in program(s). OR Individual does not have stable environment, but demonstrates willingness to participate in care, support & treatment. A safe living environment may be necessary for a designated period. Individual is thought to have a mental illness with a co-existing disorder such as substance abuse, Fetal Alcohol Syndrome (FAS), amongst others YOUTH SPECIAL SERVICES A youth may not have family stability but may need or currently is under protective services of Alberta s Children s Services Individual should have informal supports available, such as family or community supports, if appropriate, who are willing to assist in enabling individual s participation in the diversion program. These informal supports may include teachers, church leaders, aboriginal community members, or other individuals deemed appropriate Access to timely mental health assessment, if deemed necessary, via one of the following: --Local mental health professionals --Telemental Health Services within reasonable proximity or availability of transportation to Telemental Health Services location Access to mental health, social and support services, including addictions, housing and financial supports Potential Diversion Procedures 1. Based on the criteria, the attending officer determines whether individual should be diverted without charges or with charges. a) if the individual is not charged, the attending officer provides the individual with a referral to person/organization responsible for diversion, who arranges for assessment and a treatment plan. The referral should be written, indicating the name of the diversion person/organization, the address, and phone number. b) if the individual is charged, the attending officer provides the individual with a referral to the mental health professionals responsible for assessment for the diversion program indicates to the individual that following through on the referral may be a consideration in how the Crown views the charge contacts the diversion program personnel as designated in the community to conduct the assessment and prepare a report to be forwarded to the Crown Prosecutor s office regarding recommendation for entry to the diversion program and adjournment for a designated period 2. The option of referring to Extra Judicial Measures and Extra Judicial Sanctions is available, should the individual s situation be appropriate and agreed to by the Crown and Probation within the community. 3. In the case of a youth, the attending officer notifies the youth s parents, guardians or deemed responsible party of the following: the nature of the incident/offence the expected action by the youth any requirements for follow up on the youth s progress Section I: Diversion Points & Eligibility Criteria page 6

20 2. COMMISSION OF AN OFFENCE / CRISIS SITUATION a. Diversion Without A Charge b. Diversion With A Charge (Involving Law Enforcement / Mental Health Professionals / EMS) Nature of Incident Individual s Situation Resource Requirements Low risk, minor offence Determined on a case by case basis Criminal history may or may not be known to police Individual with mental illness is thought to be in a crisis situation at the time of commission of the offence and first contact by law enforcement Individual may have some support and stability in the community OR Individual does not have stable environment, but demonstrates willingness to participate in treatment. A safe living environment is available for a designated period of time Individual is thought to have a mental illness with a co-existing disorder, such as substance abuse, Fetal Alcohol Syndrome (FAS), amongst others YOUTH SPECIAL SERVICES A youth may not have family stability but may need or currently is under protective services of Alberta s Children s Services Individual has informal supports available, such as family or community supports, if appropriate, who are willing to assist in enabling the individual s participation in the program, once individual is past crisis. These informal supports may include teachers, church leaders, aboriginal community members, or other individuals deemed appropriate Immediate access to local hospital and/or psychiatric facility for assessment and stabilization (facility may vary in community) Mental Health Outreach Telemental Health Services within reasonable proximity or availability of transportation to Telemental Health Services Access to mental health treatment, social and support services, including addictions, housing and financial supports Potential Diversion Procedures 1. Depending on the nature of the crisis situation and availability of community resources, the attending officer EITHER: a) Calls for a Crisis Intervention Worker (CIT) to attend the scene and assess the degree of crisis, if such a position is available. If the crisis might create possible further risk to self or to community and/or involves weapons, then the CIT worker (or other appropriate mental health professional) assists law enforcement, if necessary, in ensuring the client is taken to a secure facility. If crisis is deemed to be of a minor nature, then the CIT worker (or other appropriate mental health professional), in conjunction with law enforcement if deemed necessary, will attempt to diffuse the crisis prior to release of the individual. OR b) Takes the individual directly to local hospital emergency or to other secure mental health facility for psychiatric assessment and/or patient stabilization. Specific community guidelines in conjunction with provincial Mental Health Act, if necessary should dictate the procedures involving the release of these individuals from the local hospital and/or psychiatric facility. 2. Once the crisis situation is controlled, and: a) if the individual is diverted without charges, the attending officer provides the individual with a referral to organization/agency responsible for diversion, which arranges for assessment and a treatment plan, if necessary. If required, the officer will give this referral via third party. b) if the individual is charged, the attending officer provides the individual with a referral to the mental health professionals involved with the diversion program, to be used upon the individual s release from hospital or psychiatric facility should the length of stay be minimal. If required, the officer will give this referral via third party. indicates to the individual that following through on the referral may be viewed favourably by the Crown contacts the diversion program personnel to notify of the referral, if consent for such contact is received. They in turn will conduct the assessment and prepare a report to be forwarded to the Crown Prosecutor s office regarding recommendation for entry to the diversion program and adjournment for a designated period of time. 3. The option of referring to Extra Judicial Measures and Extra Judicial Sanctions is available, should the individual s situation be appropriate and agreed to by the Crown and Probation within the community. 4. In the case of a youth, the attending officer notifies the youth s parents, guardians or deemed responsible party of the following: the nature of the incident/offence, expected action by the youth, any requirements for follow up. Section I: Diversion Points & Eligibility Criteria page 7

21 3. DURING CASE REVIEW FOR POTENTIAL PRE-TRIAL DIVERSION (At the Discretion Of The Crown / Recommendations From Defence) Nature of Incident Individual s Situation Resource Requirements May or May Not Be Low risk, minor offence Determined on a case by case basis Individual is suspected of having a mental illness, based on information gathered prior to trial or from observations of behaviour Individual is thought to have a mental illness with a co-existing disorder, such as substance abuse, Fetal Alcohol Syndrome (FAS), amongst others Individual may have been previously involved in the diversion process Individual expresses a willingness to participate in mental health assessment, treatment and in social and support services as deemed appropriate, but requires some formal sanctions to encourage participation Individual may or may not have support and stability in the community in terms of housing, family supports, and/or active involvement in treatment program(s) YOUTH SPECIAL SERVICES A youth may not have family stability but may need or currently is under protective services of Alberta s Children s Services Individual may or may not have informal supports available, such as family or community supports, if appropriate, who are willing to assist in enabling individual s participation in program. These informal supports may include teachers, church leaders, aboriginal community members, or other individuals deemed appropriate Access to timely mental health assessment, if deemed necessary, via one of the following: --Local mental health professionals --Telemental Health Services within reasonable proximity or availability of transportation to Telemental Health Services location Access to mental health treatment, social and support services, including addictions, housing and financial supports Potential Diversion Procedures 1. The decision for referral to a diversion program/process is made by the Crown Prosecutor s Office when the case is being reviewed prior to trial, or from a recommendation from defence counsel to the Crown during this time 2. The accused or counsel will be given contact information regarding the diversion program. A triage assessment is usually completed in an agreed upon, reasonable length of time based on specific community resources and the willingness of the court regarding length of time for adjournment. 3. Assessment report will be forwarded to the Crown Prosecutor s office. 4. The Crown Prosecutor will return to Court with the Assessment Report and either: Prosecute the charge(s), if candidate unsuitable for program OR Request further adjournment for referral to the local diversion process for a designated, reasonable length of time, based on specific community resources, when the situation can be re-evaluated in Court. 5. At the end of the designated time, a report from the diversion program, which will include information on linkages made, participation of client and progress made, will be forwarded to the Crown Prosecutor s office to decide whether to withdraw the charge. Section I: Diversion Points & Eligibility Criteria page 8

22 4. WHILE INDIVIDUAL HAS BEEN REMANDED TO CUSTODY (Involving Remand Staff / Mental Health Therapists / At The Discretion Of The Court) Nature of Incident Individual s Situation Resource Requirements May or May Not Be Low risk, minor offence Determined on a case by case basis Individual may or may not have support and stability in the community in terms of housing, family supports, and/or active involvement in treatment program(s) Individual is thought to have a mental illness with a co-existing disorder, such as substance abuse, Fetal Alcohol Syndrome (FAS), amongst others A. FOR REDIRECTION & RELEASE Prior to or during the individual s time in remand, he/she exhibits signs of mental illness Individual should have access to safe housing Individual is determined to not present a risk to self or others B. FOR ACCESS TO CARE, SUPPORT & TREATMENT IN CUSTODY Prior to or during the individual s time in remand, he/she exhibits signs of mental illness In addition to seriousness of offence, individual may present a risk to self or to others YOUTH SPECIAL SERVICES A youth may not have family stability but may need or currently is under protective services of Alberta s Children s Services A. FOR REDIRECTION & RELEASE Individual may or may not have informal supports available, such as family or community supports, if appropriate, who are willing to assist in enabling individual s participation in program. These informal supports may include teachers, church leaders, aboriginal community members, or other individuals deemed appropriate Access to timely mental health assessment, if deemed necessary, via one of the following: --Local mental health professionals --Telemental Health Services within reasonable proximity or availability of transportation to Telemental Health Services location Access to safe housing, if necessary Access to mental health, social and support services, including addiction, housing, and financial supports, if deemed necessary B. FOR ACCESS TO MENTAL HEALTH SERVICES IN CUSTODY Those mental health, social and support services deemed appropriate by remand centre Potential Diversion Procedures 1. The remand staff determines that an individual exhibits signs of mental illness and contacts a mental health professional affiliated with the diversion program to complete a mental health assessment. 2. Information regarding the court date is also provided to the mental health professional. 3. The Crown and the court will consider this information in determining if fitness for trial needs to be examined or if an adjournment for a designated, reasonable time will be requested while the individual participates in the diversion program. Section I: Diversion Points & Eligibility Criteria page 9

23 The following three diversion points demonstrate the Provincial Diversion Working Committee s belief that a comprehensive diversion program should include access to mental health, social and support services, even if an individual is sentenced and eventually incarcerated for an offence. 5. IN SENTENCING, MANDATED TREATMENT / PROBATION (At The Discretion Of The Court) Nature of Incident Individual s Situation The nature of the incident and individual s situation are those that the Crown Prosecutor will present to the court as part of sentencing. Resource Recommendations These resource recommendations are included to demonstrate their importance in improving treatment resources for the individual within the correctional system and his/her ability to function in the community upon his release. Individual may or may not have informal supports available, for instance, family or extended family, if appropriate, or other suitable community members, who are willing to assist in enabling individual s participation in treatment, once individual is past crisis Access to timely mental health assessment, if deemed necessary, via one of the following: --Local mental health professionals --Telemental Health Services within reasonable proximity or availability of transportation to Telemental Health Services location Access to mental health, social and support services, including addiction, housing, and financial supports, if deemed necessary Potential Diversion Procedures 1. Individuals with Supervised Court orders, which include participation in the diversion program, will be followed up regularly 2. The assigned probation officer will notify the diversion program with contact information. 3. The diversion program will contact the client s probation officer by telephone at appropriate, agreed upon intervals, for instance, every two weeks for the initial month of the individual s involvement and progress and then monthly. 4. At the end of the designated period, a report summarizing the individual s involvement and progress will be available to the probation officer. 5. If an individual fails to attend a scheduled appointment or refuses to participate in the diversion program, the Probation Officer will be notified. Section I: Diversion Points & Eligibility Criteria page 10

24 6. DURING INCARCERATION (Involving The Correctional Centres And Community Resources Available In Centre) Nature of Incident Individual s Situation The nature of the incident is such that warrants incarceration. The individual s situation may vary. A mental health assessment has been done to establish that a mental illness is prevalent. Resource Recommendations These resource recommendations are included to demonstrate their importance in improving treatment resources for the individual within the correctional system and his/her ability to function in the community upon release. Access to mental health assessment and treatment, social and support services Access to addictions services Access to additional social and support services that are deemed appropriate within a correctional setting Potential Procedures for Access to Mental Health, Social and Support Services The specific procedures for an individual s involvement in mental health, social and support services are based on each correctional facility and its resources. It is recommended that the correctional centres have in place procedures for a) assessing individuals who are suspected of having a mental illness b) referring individuals with mental illness to mental health, social and support services offered in the correctional facility c) monitoring and documenting the individual s progress within these programs d) sharing information regarding that progress with those involved in discharge planning and eventually transitioning into the community Section I: Diversion Points & Eligibility Criteria page 11

25 7. UPON RELEASE FROM INCARCERATION (Involving Correctional Centres; Transition, Mental Health, Social & Support Services) Nature of Individual s Incident Situation The nature of the incident is not relevant, unless it places conditions upon the individual s release. Resource Recommendations These resource recommendations are included to demonstrate the importance of appropriate transitioning and reintegration of the individual into the community upon his/her release. The individual may or may not have informal supports within the community Access to mental health, social and support services, including addiction, housing, and financial supports, if deemed necessary Potential Procedures For Transition Into Community 1. Discharge planning should be done in conjunction with forensic or community based mental health services. 2. With consent, sharing of information should occur regarding the types of programs/services accessed by the individual while in incarceration and his/her progress within those programs. This information can be used to plan potential programs/services for that individual upon release. 3. Transitioning into the community should consider the following: a) individual s housing situation and needs b) individual s financial needs c) individual s education or vocational achievements and needs d) formal community supports Section I: Diversion Points & Eligibility Criteria page 12

26 In summary, each community may determine which diversion points it wishes to incorporate. It is recommended that communities consider their resources and phase in different diversion points, rather than attempting to provide a comprehensive program from the outset. Granted, some communities may have the resources and the necessary foundation of collaboration among service providers that enables them to develop a more comprehensive diversion program from the start. However, based on the experiences of Calgary Diversion Project, it is important to ensure that everyone within the community understands the diversion program and supports the community diversion team in its efforts. This takes time and planning, as well as fine tuning of the diversion process. Therefore, the recommendation is to start with only a couple of diversion points in order to ensure that communities build a strong program for the target population. Section I: Diversion Points & Eligibility Criteria page 13

27 ENDNOTES 1 Ontario's Human Services and Justice Coordination Project. (1996). A Provincial Strategy to Coordinate Human Services and Criminal Justice Systems in Ontario. Ontario Ministry of Attorney General, Ministry of Community and Social Services, Ministry of Health, Ministry of the Solicitor and Correctional Service. (Although there are a number of sources that refer to the varied diversion points, the Ontario document is most comprehensive.) 2 Teplin, L.A. (2000). Keeping the Peace: Police Discretion and Mentally Ill Persons. National Institute of Justice Journal. Stakeholder Consultations, conducted October December 2001 with individuals involved with target population in select Alberta communities. *Numerous sources, as well as discussion from Provincial Diversion Working Committee members, refer to the need for criteria Seide, M. (1999). Letter: A Jail Diversion Program. Psychiatric Services, 50(2): National Alliance for the Mentally Ill. Dual Diagnosis: Mental Illness and Substance Abuse. (Substance Abuse complicates almost every aspect of care for the person with mental illness. Individuals are difficult to engage in treatment; difficult to diagnose; often not tolerated in community residences of rehabilitation programs.) Seide, M. (1999). Letter: A Jail Diversion Program. Psychiatric Services, 50(2): Alberta Mental Health Board Provincial Forensic Psychiatry Program. ( Document In Progress). Community Geographic Team Resources: Provincial Forensic Psychiatry Needs Assessment 6 Stakeholder Consultations, conducted October December 2001 with individuals involved with target population in select Alberta communities. Section I: Diversion Points & Eligibility Criteria page 14