Post on 01-Apr-2015
Improving the Health of Canadians: Mental Health, Delinquency and Criminal Activity
Elizabeth Votta, PhD
Canadian Institute for Health Information
Presentation at Helping Canadian Kids Thrive!
National Conference on Positive Youth Development
Kamloops, British Columbia
May 1-2, 2008
Presentation Outline
1. Overview of the Canadian Institute for Health Information (CIHI) and the Canadian Population Health Initiative (CPHI)
2. Overview of CPHI’s Work in the Area of Youth Health and Development
• Highlights from CPHI’s report, Improving the Health of Canadians: Mental Health, Delinquency and Criminal Activity
About the Canadian Institute for Health Information (CIHI)
HealthInformation
Research and Analysis
Health Indicators
Data Holdings
Standards
Laying a foundation for health information
Capturing the portrait of health care
Building new health knowledge
Taking health information further
Priv
acy,
Con
fiden
tialit
y an
d Se
curit
y
Com
mun
icat
ion,
Con
sulta
tion
and
Dis
sem
inat
ion
Canadian Population Health Initiative (CPHI)
CPHI’s Mission:
• To foster a better understanding of factors that affect the health of individuals and communities; and
• To contribute to the development of policies that reduce inequities and improve the health and well-being of Canadians.
CPHI’s Strategic Functions
Knowledge Generation
Policy Synthesis
Knowledge Transfer Knowledge Exchange
CPHI Council Members (as of February 2008)
Cordell Neudorf (Chair)
David Allison André Corriveau
Nancy Edwards Brent Friesen
Judy Guernsey Richard Massé
Deborah Schwartz Elinor Wilson
Ian Potter (ex-officio) Gregory Taylor (ex-officio)
Michael Wolfson (ex-officio)
Expert Advisory Group Members
Gregory Taylor (Chair), Public Health Agency of Canada
Carl Lakaski, Public Health Agency of Canada
Kathy Langlois, First Nations and Inuit Health Branch
Alain Lesage, Louis-H. Lafontaine Hospital
Dora Nicinski, Atlantic Health Sciences Corporation (Region 2)
Rémi Quirion, Canadian Institutes of Health Research
Margaret Shim, Alberta Health and Wellness
Phil Upshall, The Mood Disorders Society of Canada
Cornelia Wieman, Indigenous Health Research Development Program
and University of Toronto
CPHI’s Key Theme Areas: 2004-2007
Place and HealthHealthy Transitions to Adulthood Healthy Weights
Improving the Health of Young Canadians
• First in the series of reports for 2005–2006
• Canadian youth aged 12 to 19 years
• Explores links between adolescents’ social environment and their health
• Discusses themes from current research
• Reviews relevant programs and policies
Adolescent Health and Development
Themes from the Research:
1. Cluster: Positive & negative behaviours ‘cluster’ together
2. Engaging youth: Participation in meaningful & structured activities
3. Resilience: Youth’s ability to successfully cope in adversity
4. Assets: Positive relationships, opportunities, values and self-perceptions correlated with healthy development
Youth Health and Assets in the Social Environment
CPHI’s report, Improving the Health of Young Canadians, looked at the roles of family, schools, peers and communities in healthy adolescent development:
• Parental nurturance
• Parental monitoring
• School engagement
• Peer connectedness
• Community engagement
IHYC Report Findings: Summary TableParental
NurturanceParental
MonitoringSchool
EngagementVolunteerism Connected to
Peers
High self-worth
Exc. or VG Health Status
Low Level of Anxiety
Peers who commit crimes
Alcohol Use
Tobacco Use
Marijuana Use
Injuries
-
+++
+++
+++
++
-
-- -
-
- ---
--
- -
++
Multiple Assets and Health
Research (e.g. U.S. Search Institute) indicates that the more assets adolescents possess:
• The greater their likelihood of engaging in good health practices (e.g. wearing helmets when riding a bike, wearing seatbelts, higher levels of physical activity); and
• The less likely they are to engage in harmful health practices (e.g. tobacco/drug use, risky sexual activity)
Health Outcomes and Behaviours by Number of Positive Assets
0
20
40
60
80
100%
of Y
out
h (1
2-15
yea
rs)
0-1 Positive Asset 48 54 84 37 55 31 36
2-3 Positive Assets 68 74 88 23 44 22 24
4-5 Positive Assets 82 83 94 17 26 11 12
High Self-Worth
Exc. or VG Health
Low Level of Anxiety
Contact Peers - Crimes
Alcohol Use
Tobacco Use
Marijuana Use
*
*
*
*
*
* **
***
** **
*
*
*
* All pair-wise comparisons significantly different at p < 0.05. ** Significantly different from two or three assets and zero or one asset at p < 0.05.*** Significantly different from two or three assets and four or five assets at p < 0.05.
Source: CPHI analysis of NLSCY (Cycle 4, 2000-2001), Statistics Canada.
Promoting Positive Youth Health
• Many programs across Canada for youth but few formally evaluated
• More outcome research needed including research that assesses health outcomes of youth-based policies and programs
• Three characteristics of programs/policies that are linked to healthy youth development: Comprehensive interventions that address common factors
associated with multiple behaviours
Approaches that support healthy youth development
Initiatives that engage youth
CPHI’s Key Themes 2007-2010
Promoting Healthy WeightsMental Health and
Resilience Place and Health
Reducing Gaps in Health
Improving the Health of Canadians Report Series on Mental Health
Series of three reports on the theme of mental health and how mental health is linked to the determinants of health• Two reports will focus on segments of the population often
identified as ‘vulnerable’• Final report will focus on the construct of positive mental health
Report Release Date
Report #1: Mental Health and Homelessness August 30, 2007
Report #2: Mental Health, Delinquency and Criminal Activity
April 29, 2008
Report #3: Promoting Positive Mental Health (working title)
February 2009
(exact date to be determined)
Improving the Health of Canadians: Mental Health, Delinquency and Criminal Activity
Purpose of ReportExamines the links between mental health, delinquency, criminal activity and their various determinants
Released:
April 29, 2008
Improving the Health of Canadians: Mental Health, Delinquency and Criminal Activity
How the Report is OrganizedSection One • Looks at what factors related to mental health within the
individual, family, school/peer and community contexts are related to youth delinquency in either a protective or risk capacity
Section Two • Looks at people with a mental illness who were or are involved
with the criminal justice system (that is, in a mental health bed with a criminal history or in a correctional facility with a mental illness)
Delinquency Among Canada’s Youth
What Does the Data Tell Us?
Aggressive Behaviour: A score based on responses to the following six items:
i. I get into many fights,
ii. I react to accidents with anger,
iii. I physically attack people,
iv. I threaten people,
v. I bully or am mean
vi. I hit others my age.
Often 10%
Some 34% *
None 56% *
Self-reported Aggressive Behaviour Among Youth Aged 12-15, 2004-2005
Source: CPHI Analysis of NLSCY (cycle 6, 2004-2005).
Note: These rates are based only on the 86% of youth who responded.
* Significantly different from “often” at p<0.05.
Property Delinquency: A score based on responses to the following 6 items:
i. I destroy my own things
ii. I steal at home
iii. I destroy other people’s things
iv. I tell lies or cheat
v. I vandalize
vi. I steal outside my home.
Often 7%
Some 44% *
None 50% *
Self-reported Property DelinquencyAmong Youth Aged 12-15, 2004-2005
Source: CPHI Analysis of NLSCY (cycle 6, 2004-2005).
Note: These rates are based only on the 86% of youth who responded.
* Significantly different from “often” at p<0.05.
Self-reported Aggressive Behaviour Among Males and Females Aged 12-15, 2004-2005
Source: CPHI Analysis of NLSCY (cycle 6, 2004-2005).
Note: Only among n = 3,768 responses (excludes non-response).
* Significantly different from “females” at p<0.05.
13%* 37% 50%*
7% 31% 62%
0% 20% 40% 60% 80% 100%
% of youth (ages 12-15)
Males
Females
Often Some None
Mental Health, Delinquency and Criminal Activity:
Relationships at the Level of Individual, Family, School/Peer and Community
Mental Health, Delinquency and Criminal Activity: Individual Level
INDIVIDUAL LEVEL
Protective Factors
• High levels of optimism, life satisfaction and emotional capability • Trustworthiness• Sense of belonging• Greater self-efficacy / High self-esteem
Risk Factors • Low self-worth• Hyperactivity• Depression• Victim of bullying, assault, threats, theft
CPHI Analysis: Aggression and Individual-level Protective Factors
Source: CPHI Analysis of NLSCY (cycle 6, 2004-2005).* Significant difference between levels within each mental health factor at p<0.05.
44%
61%*
47%
63%*
53%
65%*
46%
73%*
48%
75%*
0%
20%
40%
60%
80%
100%
% o
f y
ou
th r
ep
ort
ing
no
a
gg
res
siv
e b
eh
av
iou
r
Self-Esteem SelfMotivation
Adaptability StressManagement
EmotionalCapability
Medium-Low High
CPHI Analysis: Aggression and Individual-level Risk Factors
Source: CPHI Analysis of NLSCY (cycle 6, 2004-2005)E: Coefficient of variation between 16.6% and 33.3%. Interpret with caution.
* Significantly different than same level of aggression for “all youth” at p<0.05
56% 34% 10%
27%* 48%* 25%*
23%*E 46% 31%*
25%* 48%* 27%*
0% 20% 40% 60% 80% 100%
% of youth (aged 12-15)
All Youth
Anxious
Indirectly Aggressive
Hyperactive
None Some Often
Mental Health, Delinquency and Criminal Activity: Family Level
FAMILY LEVEL
Protective Factors
• Nurturing parenting style• High level of parental monitoring• Feeling loved and wanted• Having at least one parent home during at least one of four times during the day• High sense of family connectedness; doing activities together as a family• Being able to discuss problems with parents
Risk Factors • Harsh or inconsistent parenting style• Lack of parental supervision• Having a parent who struggles with an addiction or a mental illness and/or had a criminal record
CPHI Analysis: Aggression and Parenting Style
Source: CPHI Analysis of NLSCY (cycle 6, 2004-2005).
* Significant difference between levels at p<0.05.
42%*
66%
50%*
62%
0%
10%
20%
30%
40%
50%
60%
70%
% o
f y
ou
th (
12
-15
)
rep
ort
ing
no
ag
gre
ss
ive
be
ha
vio
ur
ParentalNurturance
ParentalMonitoring
Medium-Low High
Mental Health, Delinquency and Criminal Activity: School and Peer Levels
SCHOOL AND PEER LEVELS
Protective Factors
• School environment in which youth feel involved• Feeling connected with one’s peers• Feeling teachers are fair• Academic achievement
Risk Factors • Lack of school involvement• Poor academic achievement• Negative peer influences (older or delinquent friends, friends who committed or tolerated illegal acts)• Bullying• Truancy, suspensions
Mental Health Among Children & Youth:Students Who Do Not Feel Confident
Source: PHAC, The Human Face of Mental Health and Mental Illness in Canada, 2006.
Proportion of students who do not feel confident, by sex and grade, Canada, 2002
0
5
10
15
20
Pe
rce
nt
Girls 4.7 9.4 11.2 12.8 17.5
Boys 5.5 3.5 6.7 8.1 5.9
Grade 6 Grade 7 Grade 8 Grade 9 Grade 10
Mental Health Among Children & Youth:Students Who Feel Left Out or Lonely
Source: PHAC, The Human Face of Mental Health and Mental Illness in Canada, 2006.
Proportion of students who often feel left out or lonely, by sex and grade, Canada, 2002
0
10
20
30
40
50
Pe
rce
nt
Girls 23.1 24.8 30.4 27.6 31.8
Boys 21.9 24 26.1 25.2 25.9
Grade 6 Grade 7 Grade 8 Grade 9 Grade 10
Mental Health Among Children & Youth:Students Who Feel They Do Not Belong
Source: PHAC, The Human Face of Mental Health and Mental Illness in Canada, 2006.
Proportion of students who feel they do not belong at their school, by sex and grade, Canada, 2002
0
10
20
30
40
50
Pe
rce
nt
Girls 14 14 17.3 18.2 15.3
Boys 17.4 15.3 23.8 22.9 18.3
Grade 6 Grade 7 Grade 8 Grade 9 Grade 10
CPHI Analysis: Aggression and School/Peer Risk Factors
Source: CPHI Analysis of NLSCY (cycle 6, 2004-2005).
* Significantly different than same level of aggression for “all youth” at p<0.05.
56%* 34% 10%
41%* 43%* 16%*
39%* 43%* 17%*
46%* 42%* 12%
0% 20% 40% 60% 80% 100%
% of youth (aged 12-15)
All Youth
Few Positive Peer Connections
Peers with Problem Behaviours
Feels like an Outsider
None Some Often
Mental Health, Delinquency and Criminal Activity: Community Level
COMMUNITY LEVEL
Protective Factors
• Feeling a positive bond to society• Strong pro-social values
Risk Factors
• High turnover of neighbourhood residents• High rates of violent crimes• Feelings of hopelessness• High levels of marijuana availability• High numbers of youth in trouble with the law• Living in high-poverty neighbourhoods
CPHI Analysis: Protective Factors Among Youth who are Not Aggressive
• Just over one half (56%) of 3,768 responding youth reported no aggression.
• Compared to these youth, youth with identified protective factors were significantly more likely to report not being aggressive.
Source: CPHI analysis of Statistics Canada’s, NLSCY (cycle 6, 2004-2005).
Top 5 Protective Factors % of Youth Not Aggressive
Emotional capability 75
Able to manage stress 73
Nurturing parents 66
Likes school 65
Adaptable 65
CPHI Analysis: Risk Factors Among Youth who are Often Aggressive
Source: CPHI analysis of Statistics Canada’s, NLSCY (cycle 6, 2004-2005).
Top 5 Risk Factors % of Youth Often Aggressive
Indirectly aggressive 31
Hyperactivity 27
Parental rejection 26
Anxious 25
Punitive parenting 21
• 10% of responding youth reported often being aggressive• Youth with identified risk factors were more likely to report
often being aggressive compared to these youth.
CPHI Analyses: Conclusions
The top five protective factors represent the presence of positive behaviours, such as:• Emotional capability, stress management, parental nurturance, liking
school and being easily adaptable
As opposed to the absence of these protective factors, the top five risk factors for aggressive behaviour represent the presence of a negative behaviour, including:• Indirect aggression, hyperactive, reporting parental rejection or punitive
parents and being anxious
Analyses highlight the value of both promoting protective factors and reducing risk factors as a means of addressing aggression in youth
Preventing Delinquency and Involvement with the Criminal Justice System:Policies and Programs
Preventing Delinquency: Policies and Programs (1)
There is a link between various skills-training programs within the family and school contexts with improved mental health outcomes and reduced delinquency among youth.
• Project Early Intervention
• The Banyan Community Services SNAP™ Under-12 Outreach Project
• Syracuse Family Development Research Project
• Seattle Social Development Project
• Montréal Longitudinal Experimental Study
Policies and Programs (2)
• Project Early Intervention (Ottawa)
o Children aged 6 to 12 living in neighbourhoods at risk for delinquency
o Life skills training with sports/recreation programs, counselling
• The Banyan Community Services SNAP™ Under-12 Outreach Project (Hamilton)
o Boys aged 6 to 12 who previously committed offences
o Self-control skills and child-management parenting techniques
Outcomes:
• Reduced aggressive behaviour among children and improvements in social behaviours with self-control training
Policies and Programs (3)
• Syracuse Family Development Research Project (Syracuse)o 108 disadvantaged familieso Individualized daycare services, parental training, in-home support
• Strong Families, Strong Children (Moncton)o Families with children aged 5 to 12 who displayed risk factors for
crime and victimizationo In-home support, family nurturing program, parent support group,
social skills training, respite care
Outcomes:
• Increased self-efficacy and reduced juvenile delinquency with family-skills training in early childhood
Policies and Programs (4)
• Seattle Social Development Project (Seattle) o Children from 18 schools in different neighbourhoods
o Teacher/parent training, child social & emotional skills development
o Improvements in school and work functioning, decreased involvement in criminal activities and fewer mental health problems among youth receiving a school-based intervention
• Bully Prevention Program (Norway) o 2,500 elementary and junior high school studentso Different anti-bullying messages delivered by different people in
different contextso Decreases in bullying behaviour, being the victim of bullying, and in
rates of fighting, vandalism, theft, and truancy. Improvements in positive social relationships and positive attitudes towards school
Policies and Programs (5)
• Montréal Longitudinal Experimental Study (Montreal)
o Boys from families of low socioeconomic status
o Social skills training for children, parenting skills training, teacher support/information
o At 4-year follow-up, less delinquency, less aggression in school
o At 15-year follow-up, no differences in terms of having a criminal record
Mental Health and theCriminal Justice System
Characteristics of Patients with Criminal Involvement Admitted to a Mental Health Bed
New analyses of data from CIHI’s Ontario Mental Health Reporting System (OMHRS) database show that from April 2006 to March 2007:
• Of 30, 606 unique patients admitted to a mental health bed
9% had some current involvement with the justice system (forensic admissions)
28% reported a violent or non-violent criminal history
• Compared to non-forensic patients, forensic patients tended to be younger and a higher proportion were male, never married, and had lower education levels and less stable housing
Males were more than three times more likely to be forensic patients than females
Risk Factors at Admission Among Patients with a Criminal History
Compared to patients without a criminal history, patients in mental health beds with a criminal history reported significantly more risk factors at admission:
• Reported rates of substance use were nearly two times higher
• Significantly greater victimization rate (38% versus 26%)
• Patients with a criminal history were more likely to have failed or dropped out of an education program (41% versus 25% of non-criminal history)
• For 44% of patients with a criminal history, the patient, family or friends indicated the relationship between the patient and immediate family was dysfunctional (versus 34% of others)
Risk Factors at Discharge Among Patients with a Criminal History
Compared to patients without a criminal history, patients with a criminal history reported significantly more risk factors at discharge
Criminal History
No Criminal History
Reported being adherent to medication less than 80% of the time in the month prior to admission
31% 21%
No support person who feels positive about their discharge
23% 18%
Initial living arrangement expected upon release:
Private home
Homeless
Correctional facility
Unknown
66%
4%
3%
3%
77%
1%
<1%
2%
Source: CPHI analysis of Ontario Mental Health Reporting System (OMHRS), CIHI, 2006–2007.
All comparisons are significantly different between groups at p<0.05.
Mental Illness Among Youth in Correctional Facilities
Rates of some mental illnesses are higher among incarcerated youth than among youth in the general population, including:
• Depression
• Anxiety disorders
• Attention-deficit/hyperactivity disorder (ADHD)
• Substance abuse disorders
• Conduct disorder
• Post-traumatic stress disorder (PTSD)
• Schizophrenia
Mental Illness Among Adults in Correctional Facilities
Most people with a mental illness or compromised mental health do not commit crimes
However, information from various sources indicates there is a higher prevalence of certain types of mental illnesses among incarcerated adults compared to the general population, including:
• Psychotic disorders (schizophrenia)
• Major depressive disorder
• Anxiety disorders
• Antisocial personality disorder
• Substance abuse disorder
Mental Illness Among Aboriginal Peoples in Correctional Facilities
Aboriginal Peoples are over-represented in the Canadian prison system
• In 2002, 17% of males and 26% of female inmates were Aboriginal
• 92% of Aboriginal federal offenders required help for a substance abuse problem; 96% reported a personal or emotional issue that needed attention
• Compared to non-Aboriginal inmates, Aboriginal inmates tend to have lower rates of completed education, greater unemployment histories, higher rates of unstable housing, higher rates of repeat offending and higher rates of violent offences
Mental Illness and Suicidal Behaviour in Correctional FacilitiesAmong the general population, 12% of males and 19% of females (15 to 24 years) reported having suicidal thoughts at some point in their lifetime• 2% of males and 6% of females reported a suicide attempt
In 2002, the proportion of male federal inmates in Canada who reported a suicide attempt in the previous five years ranged from 10% in minimum security to 16% in maximum security• Proportion among female inmates ranged from 11% to 41%
Among incarcerated youth, published rates of suicidal thoughts range from 9% to 10% with a lifetime prevalence of 34%
• A British Columbia study found that 21% of incarcerated youth thought about killing themselves in the past year; 13% reported a past attempt
Programs for People Involved with the Criminal Justice System
Diversion Programs
• Aim to intervene during the various points at which persons with a mental illness may come into contact with the criminal justice system
• Participants in mental health diversion programs spend less time in jail and have more involvement with mental health professionals and community mental health services than individuals not involved in such programs
Programs in Correctional Facilities
Many jurisdictions offer mental health-related programming for offenders in institutional settings, including substance abuse treatment; violence prevention; and stress and anger management • Preliminary evaluations speak to the effectiveness of violence
prevention and anger management programs offered in correctional facilities
• Little is known about the long-term impacts on mental health–related outcomes or the accessibility of programs to offenders, particularly among those with mental health issues
Programs in Community Settings
Many jurisdictions offer mental health-related programming for offenders in supervised community settings. Successful community-based programs share the following features:
• They are intense, highly structured and contain multiple components targeting specific problems;
• Treating clinicians assume multiple roles, including treating patient’s mental disorder, preventing violence and crime, and taking responsibility for patient’s compliance with the program;
• Treating clinicians have the authority to re-hospitalize patients if they are judged to be at risk, to be committing other crimes, or to be in need of acute psychiatric symptom treatment; and
• Treating clinicians have the option to obtain court orders in order to ensure compliance with the treatment program.
Conclusions
Conclusions
• There is value in providing appropriate services and programs in order to prevent criminal activity.
• Within the individual, family, school/peer and community contexts, various factors may protect against or increase one’s risk for delinquency.
• Research suggests that no single program that targets only one risk or protective factor would be as effective as programming that targets the multiple factors associated with mental health, delinquency and criminal activity.
• There is value in providing offenders who have a mental illness with appropriate services and programs within correctional facilities and in the community.
CPHI Mental Health Current and Planned Reports and Activities
Complementary Products
• Workshops that reflect content of given mental health report
• Collection of Papers: “What Makes a Community Mentally Healthy?”
• Mental Health, Delinquency and Criminal Activity—Supporting Documents: Literature search methodology
Data and analysis methodology
Policy scanning methodology
Summary report
PowerPoint presentation
It’s Your Turn
cphi@cihi.ca www.cihi.ca/cphi