Remoteness and its impact on the potential for mental health initiatives in criminal courts in Nunavut, Canada.

Remoteness in the isolated communities of Nunavut, Canada adversely affects access to mental health services. Mental health initiatives in criminal courts exist in many cities to offer healthcare alternatives to regular criminal court processing for people affected by mental illness. These initiatives do not exist in Nunavut. A qualitative multiple-case study in 3 Nunavut communities involving 55 semi-structured interviews and 3 focus groups explored perceptions by health, justice and community stakeholders of the potential for criminal court mental health initiatives in the territory. Findings suggest remoteness is perceived to hinder mental healthcare support for court responses to people affected by mental illness, creating delay in psychiatric assessments and treatment. While communication technologies, such as tele-mental health, are considered an effective solution by most health professionals, many justice-sector participants are sceptical because of perceived limits to accessibility, reliability and therapeutic value. These perceptions suggest remoteness is a significant hurdle facing future criminal court mental health initiatives in Nunavut. Additionally, remoteness is viewed as affecting decisions by lawyers to bypass legislated mental health avenues, possibly resulting in more people with mental illness facing criminal justice sanctions without assessment and treatment.

Reciprocal Inuit and Western research training: facilitating research capacity and community agency in Arctic research partnerships.

Engaging community partners to work as co-researchers and research assistants for research involving Inuit communities or regions helps to ensure the equitable recognition of community and researcher priorities, mutual trust and respect, participation by local participants, inclusion of local knowledge and local uptake of research findings. However, research knowledge still in development among community members has been described as a barrier to effective Arctic community research partnerships. This paper describes two 3-day, cross-cultural research training workshops held in the Nunavut communities of Arviat and Iqaluit during Spring 2017. The purpose was to encourage reciprocity as a basis for research training that incorporates both Western and Inuit approaches and that emphasises relationship building to benefit both Inuit and non-Inuit research communities. A review of participant responses to the workshops suggests value in using an integrated Western-Inuit framework of educational objectives to guide the training. Responses suggest the workshops helped improve understanding of research practices and ethics rooted in different traditions for participants interested in assisting with or conducting research in Canada's Arctic communities.

"Symptoms of something all around us": Mental health, Inuit culture, and criminal justice in Arctic communities in Nunavut, Canada.

RATIONALE: Rehabilitation-oriented criminal court mental health initiatives to reduce the number of people with mental illness caught in the criminal justice system exist in many North American cities and elsewhere but not in the mainly Inuit Canadian Arctic territory of Nunavut. OBJECTIVE: This study explores whether the therapeutic aims of these resource-intensive, mainly urban initiatives can be achieved in criminal courts in Nunavut's resource constrained, culturally distinct and geographically remote communities. METHOD: A qualitative multiple-case study in the communities of Iqaluit, Arviat and Qikiqtarjuaq involved 55 semi-structured interviews and three focus groups with participants representing four sectors essential to these initiatives: justice, health, community organizations and community members. These interviews explored whether the therapeutic jurisprudence (TJ) principles that guide criminal court mental health initiatives and the component objectives of these principles could be used to improve the criminal court response to people with mental illness in Nunavut. RESULTS: Interviews revealed 13 themes reflecting perceptions of Inuit culture's influence on the identification of people with mental illness, treatment, and collaboration between the court and others. These themes include cultural differences in defining mental illness, differences in traditional and contemporary treatment models, and the importance of mutual cultural respect. CONCLUSION: The findings suggest Inuit culture, including its recent history of cultural disruption and change, affects the vulnerability of Nunavut communities to the potential moral and legal pitfalls associated with TJ and criminal court mental health initiatives. These pitfalls include the dominance of biomedical approaches when identifying a target population, the medicalization of behaviour and culture, the risk of "paternalism" in therapeutic interventions, and shortcomings in interdisciplinary collaboration that limit considerations of Inuit culture. The pitfalls are not fatal to efforts to bring the rehabilitative benefits of these initiatives to Nunavut, but they require careful vigilance when employing TJ principles in an Indigenous circumpolar context.

Re: Mental health rehabilitation in therapeutic jurisprudence: Theoretical improvements.

Legal scholarship relevant to criminal court mental health initiatives that divert people with mental illness from prosecution to treatment has created the concept of therapeutic jurisprudence (TJ), an approach that seeks to maximize the law's potential for therapeutic outcomes. Despite recognition that TJ includes a rehabilitative response as a key animating principle and that it advocates for interdisciplinary synthesis, TJ has developed mainly from within the practice and discipline of law and without reference to the discipline of rehabilitation science, in which approaches to mental health rehabilitation (MHR) have witnessed significant developments in recent decades. In particular, concepts of MHR have shifted from a biomedical focus to a psychosocial approach, such as the recovery model, that incorporates values of self-determination, independence, and empowerment. It is argued that greater consideration of MHR will improve the theoretical validity of TJ by 1) helping define what 'therapeutic' means; 2) constructing a normative framework; and 3) broadening the scope of TJ as an interdisciplinary approach. More research is needed to ensure concepts from MHR rehabilitation science are considered in TJ legal scholarship and criminal court mental health initiatives.

Therapeutic Jurisprudence in Health Research: Enlisting Legal Theory as a Methodological Guide in an Interdisciplinary Case Study of Mental Health and Criminal Law.

Studies that seek to understand and improve health care systems benefit from qualitative methods that employ theory to add depth, complexity, and context to analysis. Theories used in health research typically emerge from social science, but these can be inadequate for studying complex health systems. Mental health rehabilitation programs for criminal courts are complicated by their integration within the criminal justice system and by their dual health-and-justice objectives. In a qualitative multiple case study exploring the potential for these mental health court programs in Arctic communities, we assess whether a legal theory, known as therapeutic jurisprudence, functions as a useful methodological theory. Therapeutic jurisprudence, recruited across discipline boundaries, succeeds in guiding our qualitative inquiry at the complex intersection of mental health care and criminal law by providing a framework foundation for directing the study's research questions and the related propositions that focus our analysis.