Winnipeg Free Press - PRINT EDITION
Courts face psych backlogs
Forensic unit down to one after exodus of psychiatrists
Winnipeg is scrambling to cope with judicial backlogs and delays following a sudden departure of doctors from the only provincial department designated to conduct court-ordered psychiatric exams.
The Health Sciences Centre's forensic services unit was having a tough enough time keeping up with the workload when it was fully staffed with five experts. Now the unit is down to one member after the other four abruptly announced they were leaving.
"It's not something a lot of people are interested in doing," Dr. Jeff Waldman, the last person standing and de facto head of the unit, told the Free Press Wednesday. He cited the heavy, time-consuming volume of cases, nature of the job and more lucrative pay in private practice as reasons for the exodus, which began in December.
"Every person has their own reason for moving on. It's not simply selfishness," said Waldman.
The development has sparked major concerns mentally ill accused will soon start falling through craters, rather than just cracks. Defence lawyer Greg Brodsky said court orders for fitness assessments are regularly being violated because the psych health unit can't come close to keeping up with the current demand for their services. That means people who may be in need of immediate mental-health intervention are simply languishing in custody without timely diagnosis or treatment.
Under the Criminal Code, judges can order a fitness-to-stand-trial assessment to be completed within seven days. A review to determine whether a person is not criminally responsible (NCR) should be done within 30 days. As of this week, the wait time for most offenders is at least two months and possibly longer, according to justice sources.
Brodsky cited the example of one client, Miloslav Kapsik, who was found guilty by a jury this week of murdering his wife in 2010. Kapsik claimed he should be found NCR for the slaying, citing major depression and psychotic symptoms at the time of the attack. At his trial, jurors heard it took two months before Kapsik was even seen by forensic services following his arrest.
"With the full complement they had then, it took two months. What's it going to be like now?" asked Brodsky. He said judges and jurors are being deprived of the best possible evidence when experts are only seeing accused long after the crime has occurred. Their evidence is weakened because the key issue is a person's state of mind when the offence happened, not weeks or months later.
"The guy who is being seen (by forensic services) is often not the same guy who was arrested," said Brodsky. Many other defence lawyers, Crown attorneys and even judges have expressed similar concerns in recent weeks.
Waldman said the current wait time for assessment and treatment is not acceptable. He said urgent steps are being taken before the situation reaches a crisis stage. One of those involves Waldman scouring the country, seeing if he can convince any other forensic psychiatrists to join his team.
"And we're still trying to see if anyone who's left will come back," said Waldman. He admitted it's unlikely they will ever be able to return to their full complement of five forensic psychiatrists.
"Those (private) contracts are very lucrative right now, and we can't match that in a hospital setting," he said.
As a short-term fix, the Winnipeg Regional Health Authority and provincial justice officials have recently agreed they can begin contracting out some of these court-ordered assessments to psychiatrists in private practice.
"We're looking to keep up as much as we can," said Waldman. The WRHA is also working toward revamping his one-man department to include a "multi-disciplinary" approach in which social workers and clinical psychologists will also be brought in to work with patients. Waldman believes the end result will alleviate the backlog and provide better-quality reports to the courts.
The provincial government has previously taken steps to address the need for better mental-health services in the courts, including the creation last year of a mental-health court. The province invested $600,000 to establish the weekly court, which will slowly begin expanding in numbers up to a maximum of 50 people on the weekly Thursday docket. It will work with mentally ill offenders who have typically committed minor crimes with the goal of diverting them from jail into a stringent treatment plan and hopefully reduce reoffending. Once they complete the 18- to 24-month program, they will have the offence cleared from their criminal record.
Treatment for offenders can involve substance-abuse counselling, community service and an apology to the victim. If they're not compliant, they can be sent back to the regular court system. To be accepted, the accused must first plead guilty to their crime and be accepted by both the Crown and provincial mental-health officials.
A close examination of the problem
-- What is the Health Sciences Centre's forensic services unit?
A "multidisciplinary clinical program that includes inpatient, outpatient, community-based and correctional-facility components." Forensic psychiatrists provide court-ordered fitness-to-stand-trial assessments and diagnoses regarding whether an accused should be found not criminally responsible (NCR) of an offence. It also offers programming and treatment for accused, jailed and convicted offenders, along with those found unfit to stand trial or NCR.
-- How quickly must these reports be completed?
Under the Criminal Code, judges can order a fitness-to-stand-trial assessment to be completed within seven days. A review to determine whether a person is NCR should be done within 30 days.
-- How long are these reports currently taking?
As of this week, the wait time for most offenders is at least two months and possibly longer, according to justice sources.
-- Who has left the department?
Four doctors -- Dr. Stanley Yaren, Dr. Giovana Levin, Dr. Frank Vattheuer and Dr. Daniel Globerman -- have all announced their departures since December 2012.
-- Who is left in the department?
Dr. Jeff Waldman is the only remaining forensic psychiatrist.
-- What reasons are being cited for the mass exodus?
Heavy workload, nature of the case-specific work and lucrative money to be made in private practice.
-- What is the short-term fix for the backlog and delays?
The Winnipeg Regional Health Authority is scouring the country, seeing if they can convince any other forensic psychiatrists to join their one-person team. The WRHA and provincial justice officials have also agreed they can begin contracting out some of these court-ordered assessments to psychiatrists in private practice.
-- What is being done long-term to address this issue?
The WRHA is working toward revamping the forensic unit to include a "multidisciplinary" approach in which social workers and clinical psychologists will also be brought in to work with patients.
Republished from the Winnipeg Free Press print edition March 14, 2013 A3
Updated on Thursday, March 14, 2013 at 9:53 AM CDT: adds missing word
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