P-HSJCC Webinar Series: Dementia and the Justice System
P-HSJCC Webinar Series: Dementia and the Justice System June 21, 2018 Moderator: Tasha Rennie Network Engagement and Communications Officer, HSJCC Secretariat HSJCC Webinars We will pause for key chat pod reflections following each section. Furthermore, we will hold a Q&A period at the end of our webinar. To ask a question, please type your question in the chat box. The power-point presentation will be available following the
webinar. Please complete the brief evaluation survey following the webinar. About the HSJCC Network HSJCC Network is comprised of: 39 Local HSJCCs 14 Regional HSJCCs Provincial HSJCC Each HSJCC is a voluntary collaboration between health and social service organizations, community mental health and addictions organizations and partners from the justice
sector including crown attorneys, judges, police services and correctional service providers. Collaborators for Todays Presentation Cathy Conway, Director, Education Programs, Alzheimer Society of Ontario Krista Schneider, Regional Coordinator, Erie St Clair BSO Monica Bretzlaff Behavioural Supports Ontario Sarah Denton Behavioural Supports Ontario
Katelynn Viau Behavioural Supports Ontario Dementia & Justice System June 21, 2018 HSJCC Webinar Our Vision: A world without Alzheimer's disease and other dementias Our Mission: To alleviate the personal
and social consequences of Alzheimer's disease and other dementias and to promote research MANDATE: Older with, or at risk for, responsive behaviours associated with dementia, complex mental health, substance use, and/or other neurological conditions. Inclusive in this
mandate are adults with age-related neurocognitive conditions (such as early onset dementia) and specialized support for family and professional care partners. VALUE STATEMENT: Together we value individuality, integration and innovation Introductions Dementia statistics, what is Responsive Behaviour? Krista Schneider
Dementia and Justice System statistics Monica Bretzlaff Case Studies Sarah Denton Areas of Focus and Potential Solutions Katelynn Viau Dementia foundations & Responsive Behaviours Krista Schneider Chat Pod reflection
Having completed this brief segment on dementia and responsive behaviours, please describe opportunities that may exist within the justice sector to enhance knowledge and build capacity in this area? What is dementia? A set of symptoms that occur when the brain is affected by certain diseases or conditions Symptoms may include changes in:
Memory Thinking Concentration Judgment Problem solving Functioning all of which affect a persons ability to perform normal daily activities. Dementia Statistics In 2016 -- 546,000 Canadians were estimated to be living with some form of dementia or cognitive impairment
Currently, there are over 230,000 older adults in Ontario (65+) estimated to be living with some form of dementia This number is expected to increase by 13% to nearly one quarter of a million people by 2020. Dementia Statistics In 2013 99,330 Ontarians (40+) living in the community (not including long-term care) were living with a diagnosis of dementia, an increase of more than 40% since 2007
In 2013 almost 60% of community-dwelling Ontarians with a diagnosis of dementia were women In 2013 the median age of community-dwelling Ontarians with dementia was 81 years old Dementia Statistics Under 65 While the risk for dementia increases with age, 210% of people with dementia are below the age of 65 In 2013 -- more than 8,900 community-dwelling Ontarians between the ages of 40 and 65 were
living with a diagnosis of dementia (9.0% of the total community-dwelling population) What is a Responsive Behaviour? Responsive behaviours is a term that is often preferred by persons living with dementia, mental health, substance use and/or other neurological disorders to describe how their actions, words and gestures are a response to something important in their personal, social or physical environment (Alzheimer Society of Ontario, 2014). These behaviours are often a result of changes in the brain affecting memory, judgement, orientation and mood.
Responsive behaviour indicates a change in a persons baseline behaviour. Chat Pod reflection Having completed this brief segment on dementia and responsive behaviours, please describe opportunities that may exist within the justice sector to enhance knowledge and build capacity in this area?
Dementia and Justice System statistics Monica Bretzlaff Chat Pod reflection What types of quantitative and/or qualitative data may be helpful to collect in order to advocate for enhanced supports and system improvements? Dementia and Justice System Statistics
The type of incident varies, but according to a study published January 2015 in JAMA Neurology, more than a third of people with frontotemporal dementia (FTD) act out criminal behaviors. The study raises questions about how the criminal justice system should handle people with FTD and, even more pressingly, concerns about the plight of undiagnosed patients who may be languishing in prisons or on the streets.
Source: http://www.alzforum.org/ Criminal Behavior in Frontotemporal Dementia and Alzheimer Disease Criminal behaviours emerge in individuals with no history of antisocial activities and have been observed in patients with a variety of neurocognitive illnesses, including Alzheimer disease (AD), Frontotemporal dementia (FTD), semantic variant of Primary Progressive Aphasia (svPPA), Huntington
disease (HD), Human Immunodeficiency Virus related dementia, and Substance-induced dementia. The crimes committed by people with dementia range from theft, traffic violations with or without the influence of alcohol, violence, hypersexuality and homicide. Criminal Behavior in Frontotemporal Dementia and Alzheimer Disease
Of 2397 patients in the study, 204 (8.5%) had behaviours that could be interpreted as criminal. The major diagnostic groups included FTD (n = 64), PPA (n = 24) AD (n = 42), and HD (n = 6) 19.9% of patients with FTD were reported to the police for criminal behaviour https://jamanetwork.com/journals/jamaneurology/fullarticle/2088872 Madeleine Liljegren, MD; Georges Naasan, MD; Julia Temlett, MBBS; David C. Perry, MD; Katherine P. Rankin, PhD; Jennifer Merrilees, PhD; Lea T. Grinberg, MD, PhD; William W. Seeley, MD; Elisabet Englund, MD; Bruce L Miller, MD Crime Categories Across the Diagnostic Spectrum
Other Points to Consider Long term Care Homes (LTCHs) required to contact police if they feel a violation of the criminal code has occurred. Interpretation Implications Predictors and prevention Charges- discretion
Seriousness of offence Circumstances leading to offence Can alternative solutions be explored? Source: Wahl, Judith A, Advocacy Centre for the Elderly. When Worlds Collide: Unravelling the Issues when individuals living with dementia intersect with the Criminal Justice System, 2014 Other Points to Consider Domestic violence- charges laid, perpetrator removed from the home of the victim. What does this mean for someone with a dementia and responsive behaviour who is living with their primary care partner? What does this mean for the care
partner? Source: Alstrom, Corinne. Dementia and policing: Developing Best Practices for Law Enforcement. 2013. Chat Pod reflection What types of quantitative and/or qualitative data may be helpful to collect in order to advocate for enhanced supports and system improvements? Case Studies
Sarah Denton Chat Pod reflection Do these case studies resonate with your clinical experiences? What additional resources could have been of benefit in redirecting these cases away from the justice sector? Case Study A John is a 70y/o male who presents to acute care from the
community following an episode of verbal and physically responsive behaviours which have left his family fearing their safety. Family share a history of violence with prior contacts with police. There is a current restraining order preventing contact with his spouse. Diagnosis of a major neurocognitive disorder, vascular type. Case Study B Gary is a 65y/o male with a substance induced neurocognitive impairment. He currently resides in LTC and had been exhibiting wandering behaviours.
There was an unwitnessed incident where it is believed Gary exhibited physically responsive behaviours resulting in injuries to his roommate. The roommate later succumbed to his injuries in hospital. Police were involved to investigate further and to determine the potential for criminal charges, at the time of the referral to BSO. Case Study C Glenn is a 75y/o male who first came into contact with police following an incident of physically responsive towards his spouse in the community. The police officer who attended the
home pressed charges. Following, Glenn was brought into custody. During his presentation to court, he came into contact with a court worker, who in meeting with Glenn and his family suspected an potential underlying neurocognitive impairment, Alzheimers type and reached out to BSO. Case Study D Mary is a 82y/o female with frontal impairments currently residing in LTC. Her spouse resides in the community. She has been routinely approaching a male resident seeking contact and has been found in his room disrobed and more
recently engaging in sexual contact. Both residents have cognitive impairments, the male resident to a lesser degree. Marys spouse is quite upset by these behaviours had has threatened legal action if the long term care home does not address the situation. Case Study E Omar is a 78y/o gentleman with a suspected cognitive impairment who was born and raised in a male dominant culture. He exhibited sexually expressive behaviours on more than one occasion towards a member of the public resulting in
police involvement. Case was presented at a local First Response Strategy Table at which BSO is an active participant. Chat Pod reflection Do these case studies resonate with your clinical experiences? What additional resources could have been of benefit in redirecting these cases away from the justice sector?
Areas of Focus and Potential Solutions Katelynn Viau Chat Pod reflection For each promising practice identified, which key players do we need to engage in collaborative planning next steps? Prevention Strategies & Reactive Approaches
System Coordination/ Management Older Adult Liaison Committee, Rapid Mobilization Tables Focused discussion table where participants collaboratively identify situations of acutely elevated risk. Once a situation is identified, all necessary agency partners participate in a coordinated, joint response ensuring that those at risk are
connected to appropriate, timely, effective and caring supports Integrated Service Delivery: Intersectoral/ Interdisciplinary Care Pathway Development between relevant Community Providers: Coordinated response and process to assist persons with dementia and their care partners who are experiencing behaviours that may
result in a criminal offence Specialized Geriatric Law Enforcement Team: Concept of having all Police Officers trained in Dementia Basics (see column 3) but also having a Geriatric Intervention Team made up of Police Officers who would respond to calls whereby specific intervention skills and knowledge of dementia would be required.
Knowledgeable Teams & Capacity Building Education/Training Program containing the following components: About Dementia Situations whereby Police Officers may come into people with people living with Dementia Distinguishing Dementia vs. other conditions using relevant tools (especially delirium)
Communication Strategies Responsive Behaviours Engagement with Community Resources What Role might BSO play in each of these promising practices? System Coordination/ Management Older Adult Liaison Committee, Rapid Mobilization Tables, Start Hubs:
Having BSO Clinicians be members of these tables; having the expertise and availability to become involved in a timely manner when appropriate. Integrated Service Delivery: Intersectoral/ Interdisciplinary Care Pathway Development
between relevant Community Providers: Knowledgeable Teams & Capacity Building Education/Training Program containing the following components: BSO as part of the process pathway facilitating integrated response as appropriate.
Specialized Geriatric Law Enforcement Team: Psychogeriatric Resource Consultants (PRCs) aligned with BSO across the province provide education and other capacity building activities to providers across sectors. Chat Pod reflection For each promising practice identified, which key players do we need to engage in collaborative planning next steps?
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