 Distinguished guests, good afternoon and welcome to the 34th annual Horace E. Reed lecture. Let me open today's lecture by acknowledging that we stand on traditional McMount territory. I'm Kim Brooks, Dean of the Schulich School of Law. It's a great pleasure to be here to say a few introductory words about this lecture and the man after whom it is named and a small amount about the woman who will give it. The Reed lecture was established to honor the memory of Horace E. Reed who was Dean of the Law School from 1954 to 1964. The lecture was established as a joint project by the Reed family and the Law School. Dean Reed's son, Dr. Robert Reed, is with us today alongside other family members including Ms. Michelle Raymond and Mr. Russell McKinnon. Horace E. Reed served this country in many ways. He served in the First World War, was chair of the Regulations Revision Committee, Royal Canadian Navy during the Second World War, was a long-time member of the Nova Scotia Labor Relations Board, a long-time member of the Conference of Governing Bodies of the Legal Profession, a long-time member of the Conference on Commissions on the Uniformity of Legislation, honorary president of the Nova Scotia Barrister Society in 1966-67 and Canadian Delegate to the Conference on Private International Law at the Hague in 1968. At the Law School, he's touted for his scholarly achievements, for his ability to teach and for his superb administrative skills. Indeed, I may suggest that his deanship has not treated those of us who have followed in his footsteps particularly kindly. When it was announced publicly that I would serve as the Dean of the School, I had two or three almost immediate calls from illustrious alumni. Each wished me good luck in the position, but each also cautioned that even if I were to be a good Dean, I should know that my deanship would certainly not come close to that of the great Horace Reed. In recognition of his exemplary life, Dr. Reed was appointed an officer of the Order of Canada in 1973. Other honours include honorary degrees from Acadia, Queens, Dalhousie and Windsor. In commenting on his remarkable life, I can do no better than to quote briefly two paragraphs from a lengthy editorial of March 1st, 1975 in the Halifax Herald. Horace Emerson Reed, OC, OBE, QCBA, LLB, LLMSJD, LLD, former Dean of Dalhousie Law School and Legal Scholar and Law Teacher of International Renown was in the great tradition of the deans of Dalhousie. In many respects, he exceeded the talent and distinction of his predecessors. Horace Reed taught law certainly with all the authority of a profound and mature scholar of international renown, but he also brought to his teaching the benevolence and humanity which were among his most admirable qualities. Kindly and affable, readily available to students and colleagues alike by whom he was held in great respect and affection, he presided as Dean over a lengthy period of unparalleled expansion and development of the faculty of law and marked it firmly with his personal philosophy and objectives. When I commenced my tenure here, as I mentioned, more than a few people called me with congratulations and badly needed advice. One of them sent me to the text of a paper written by Dean Reed at the Interfaculty Symposium on Aims and Practices of University Education, which was held on a Saturday, I might note, December 15th, 1962. At the time, the law school had recently placed an ambitious five-year development plan before the Senate. In urging those at the meetings to embrace the faculty's bold ambitions, Reed made the following conclusory remarks. What must be maintained is a community of scholars striking out in new fields, conscious and convinced of the soundness of their goals and determined to reach them. We are confident that the direction to which we are committed is the right one. It is sound and principle and it is in keeping with the demands of a professional education and democracy, a democracy that has never before needed professionally such competent men and women with broad vision and social consciousness to guide its destinies. These conclusory remarks of Reed seem an appropriate transition to the introduction of the honorable Judge Ann Derrick of the Provincial, of the Nova Scotia Provincial Court, who will give this year's Reed's lecture. My colleague Sheila Wildman will introduce Judge Derrick to you, though I'm sure she needs no introduction. Let me say simply a few brief words about her topic tonight. We shall not cease from explorations, narratives about the hide inquiry about mental health and criminal justice before turning over the podium. That topic finds its roots in her work over the last year as the presiding judge of the hide inquiry. I'd say only hear something brief about that report. A colleague of mine sent me a link to the report mere minutes after it was released. I read the introduction and promptly decided to dedicate sufficient paper and time to the task of printing and reviewing all 462 of its pages. The paragraph that captured my attention was the one where Judge Derrick in her lucid and engaging style describes her aspirations for the report. I have endeavored in this report to do justice to Mr. Hyde's experiences in these last tragic hours of his life and to make his legacy one of hope for those who live with a severe persistent mental illness and for the people who work in the criminal justice and health care systems with persons with mental illness. I have tried to fashion out of the evidence recommendations that rest on the belief that for all that is done well as a society we can do better. This seems entirely in line with Dr. Reed's command of our sense of who we are as those engaged with law in its quotidian manifestations and what we should do with our attention to the broad vision and social consciousness. Welcome to tonight's Reed lecture. Thank you, Kim. As Kim mentioned, I'm Sheila Wildman. I teach here at the law school and I've known Anne for just about 15 years now. So greetings to the Reed family, esteemed members of the legal community, colleagues, students and friends. I've got the privilege tonight of introducing Judge Ann Derrick as Dean Brooks has said and really needs no introduction, at least not to this crowd. But I hope that you'll and she will indulge me as I share with you some of her many accomplishments. We can start with Ann's receiving upon her graduation from this law school in 1980 the Horace E. Reed Award for and I quote the greatest overall contribution to scholarship in student life. While a law student, Ann made particular contributions to Dalhousie Legal Aid as a founding organizer of the clinic's legal information sessions at Briney House, a shelter for women facing domestic abuse. Ann continued with that work for many years after and she's since worked with many other local and national advocacy organizations including Add Some House and Stepping Stone, the Elizabeth Frye Society, the National Association of Women in the Law and the Women's Legal Education and Action Fund. Ann's list of accomplishments in private legal practice prior to her 2005 appointment as a provincial court judge are impossible to scale in a brief introduction. Her practice engaged her in public interest and equality litigation, criminal law, constitutional law and social justice advocacy. In addition in the years prior to her judicial appointment Ann acted as a senior adjudicator for the Indian Residential Schools ADR program and as a human rights adjudicator in Nova Scotia. In her legal practice Ann argued some of the most important contemporary cases in which the rights and interests of women, Aboriginal persons and others historically marginalized by the justice system were vindicated. She's well known for her work as co-counsel to the late Donald Marshall Jr. at the Royal Commission into his wrongful conviction and at the inquiry into the adequacy of his compensation. She also acted as counsel or co-counsel at the Supreme Court of Canada to secure a number of important constitutional victories including important feminist victories. But Ann's legal practice also included much pro bono work that was done in relative obscurity. Ann was presented with the Weldon Award for Unselfish Public Service in 1998 for her vigorous and compassionate advocacy in criminal, civil and administrative contacts on behalf of persons in positions of social and economic disadvantage. It was noted at that time that as an advocate Ann had provided valuable personal as well as professional support to her clients. Ann was awarded an honorary doctorate from Mount St. Vincent University in 1999 also in recognition of the significance of her legal advocacy and social justice work. So I'll wind up. I recall sitting where you are in 1998 as Ann addressed an audience of law students giving us a glimpse of the challenges of legal practice. She said something then that filled me with wonder. She said that she had the privilege in her practice to work on the side of the angels. She wasn't claiming that her clients were perfect, far from it. As I understood it this was Ann's fearless way of maintaining the fundamental dignity of her clients even against all odds. It was a statement of her commitment to ensuring that all of us are recognized in all our humanity as equals before and under law. Again even against all odds. When Ann was appointed as a judge I felt a slight sense of regret despite my overwhelming sense that this was a fitting recognition of her uncommon legal mind and her fierce commitment to professionalism in the administration of justice. My worry was that the angels had lost a champion. But on reading some of Ann's decisions including sentencing decisions that read as if she's demanded and digested the whole book of the person's life and not just the call's notes and on reading the Hyde report and its strict yet expansive attention to Mr. Hyde's humanity and to the systemic forces that betrayed him I've come to realize that Ann's appointment to the bench was anything but a loss. What Ann's work as a judge brings home to me is that law itself properly interpreted and applied is on the side of the angels or it can be if we're willing to work with the dogged commitment to justice in and through law that is the dogged commitment of Ann Derek. So with that let me present to you this year's read lecture the honorable judge Ann Derek. I have to start by saying thank you Sheila that was extremely generous introduction and reminds me of what it's important for me to aspire to. Thank you. I also want to thank Dean Brooks for her introduction to the lecture and to my presenting it. It's a tremendous honor for me to be here tonight and to have been invited to speak as a Horace E. Reed lecture. I recognize this as being a prestigious lecture at the law school and I'm very honored indeed to have been asked to to give it. I should be remiss if I didn't say in listening to Sheila's very kind introduction that I owe great debt of gratitude to what was Dalhousie Law School when I graduated from it and certainly the education it gave me particularly perhaps at Dalhousie Legal Aid that has supported the the work that I've gone on to do in the past 30 years. Maybe you've wondered a bit about the title for my talk tonight. It's from a verse it's a verse from a poem by T.S. Eliot that I used to introduce the conclusory chapter of the Hyde Inquiry Report and it goes like this. We shall not cease from exploration and the end of all our exploring will be to arrive where we started and know the place for the first time. When I embarked on my journey at the Hyde Inquiry I really felt I knew nothing. The place I came to know for the first time at the end was a place I had really not known before. I was taken there by the narratives that made up the threads of the inquiry and it is some of these narratives I'm going to talk about tonight. The Hyde Inquiry tapped into a staggering wealth of information and expertise. Witnesses with decades of experience and knowledge testified for a day if that. It was not possible for the inquiry to explore everything all the witnesses had to offer. And I'm going to offer you even less just a small sampling of some of the issues located at the intersections of criminal justice and mental health. It will be appropriate to start as I will shortly with a brief narrative of Mr. Hyde's journey through the health and criminal justice systems. It will be nothing more than a fleeting glimpse. The larger story was contained in the testimony of 84 witnesses including a number of experts. Those 84 witnesses produced 11,000 pages of transcript. There were 291 exhibits presented to the inquiry including extensive medical records concerning Mr. Hyde. There were many hours of video surveillance primarily from the jail but also captured in the events and in the in police booking. And I can tell you that that video surveillance is very difficult to watch. The lawyers at the inquiry some of whom are here tonight and I can tell you that without their stellar work I never could have produced the report that I did took the evidentiary narratives and fashioned more than 400 pages of submissions out of them. Their oral submissions took up 500 pages of transcript and they offered close to 200 recommendations for my consideration. In addition to what was presented to me I also consulted a number of publicly available sources including the United Nations Convention on the Rights of Persons with Disabilities, the United Nations Standard Minimum Rules for the Treatment of Prisoners, the American Bar Association's 2010 Criminal Justice Standards on the Treatment of Prisoners, and the Consensus Project, an American document prepared in 2002 by the Council of State Governments with the Association of State Correctional Administrators. The Consensus Project had a steering committee of six organizations and was advised by more than 100 of the most respected criminal justice and mental health practitioners in the United States. The UN Convention is a potentially transformative document that I can only briefly describe at the conclusion of this presentation. Although I think it is useful for you to understand the scope of what the Hyde Inquiry considered my presentation this afternoon is not a discussion of my report. There are significant aspects of the inquiry's work that I will not even be mentioning. I will not be reviewing my major findings or any of the 80 recommendations I made. There are many specifics that emerge from the evidence I heard and materials I reviewed I will not be talking about. This is not because I have flattered myself into thinking that you will have read my report. Indeed I expect the only person in the room to have read the entirety of my report including the recommendations which you read twice is my mother. Understandably she drew the line on maternal devotion and did not review the over 3,000 end notes. What I will be doing is dipping into Mr. Hyde's narrative to discuss particular themes including stigma, stigma and violence, the criminalization of persons with mental illness and the issue of accessing services and supports in the community. As there may be some inclination to think that mental health courts are the answer to the disjunction between the criminal justice and mental health systems, I will be making some general comments about these specialized courts and because criminal justice and mental health also intersect in a significant context, albeit one that did not apply to Mr. Hyde, I'm also going to talk briefly about federally sentenced prisoners. My final topic will be two international instruments, the United Nations Standard Minimum Rules for the Treatment of Prisoners and the United Nations Convention on the Rights of Persons with Disabilities. If you want a learned treatment on the subject of the UN Convention you would do well to ask Professor Kaiser, a nationally recognized expert in mental health law, to give a presentation. The irony for the most comprehensive inquiry in Nova Scotia about mental health and criminal law is that most unfortunately for the inquiry Professor Kaiser was unable to participate. What he has done by way of personal support has been incalculable. In this presentation I will be referring to evidence from the Hyde inquiry but will rarely be identifying witnesses by name. When I do so it is not because that evidence was viewed in preference to or exclusion of other voices, it is just that certain evidence relates to the themes I have pulled out of the vast riches of the inquiry for this lecture. If you want to experience the breadth of what the inquiry witnesses had to offer I can do no more than encourage you to read the 390 pages that comprise the text of my actual report and I hope that doesn't sound like shameless product promotion. This brings me to what will be a mere sketch of the events that started on November 21st 2007 and ended with Mr. Hyde's tragic death on November 22nd. After assaulting his common law partner Howard Hyde was arrested by Halifax regional police officers on November 21st at approximately 1 a.m. He had been experiencing a recurrence of his chronic schizophrenia for several weeks which is characterized by paranoia, anxiety, agitation and psychosis. Mr. Hyde was transported to Halifax regional police services booking to be placed in cells in anticipation of a court appearance in the morning for arraignment on a charge of assault. While being processed in booking Mr. Hyde became terrified and a struggle ensued with police officers when he tried to get away from them. A conducted energy weapon you may be more familiar with the term taser but I wanted to avoid product placement in my report was deployed and Mr. Hyde was shocked in two separate incidents. Following a further struggle in the booking hallway Mr. Hyde collapsed and stopped breathing. He was revived with CPR and taken to hospital. His heart may or may not have stopped beating. Mr. Hyde was at the QE2 emergency department from approximately 2 30 a.m. until 9 15 a.m. on November 21st. His condition stabilized and he was discharged back into police custody for court. Police officers had in fact remained with him at the emergency department because he had not been released from their custody after his arrest. The emergency department physicians believed that Mr. Hyde urgently needed a psychiatric assessment and treatment for his illness. They thought he would be sent by the court for a psychiatric assessment and were under the erroneous impression this would serve to get him the care he needed for his mental illness. The evidence revealed that had they known he would end up remanded to jail without any psychiatric assessment or care they would not have discharged him into police custody. From the QE2 Mr. Hyde was returned to police booking and then transported to court in Dartmouth around 2 p.m. He appeared for his arraignment a couple of hours later and was remanded overnight to the central Nova Scotia correctional facility which is the provincial jail in Burnside as it was too late in the day for him to arrange his bail and get released. From approximately 6 p.m. on November 21st until 7 30 a.m. the following morning Mr. Hyde was housed in a health segregation cell in the jail. Correctional officers and nursing staff were of the view he would be safer there than in the general prisoner population. He paced relentlessly all night and did not sleep. In the morning of November 22nd while being escorted from his cell to an area in the jail where he would get ready and then be transported to court Mr. Hyde became extremely fearful and refused to proceed down a long hallway. He attempted to get away from the correctional officers who were escorting him. He was overpowered and taken to an empty cell in the admissions area the plan still being that he would be taken to court. A second struggle erupted when Mr. Hyde balked at the entrance to the cell. Mr. Hyde was taken to the floor and restrained. While being physically restrained in the cell Mr. Hyde stopped breathing. Nursing staff were on the scene within a minute of being called. They could not find a pulse. Mr. Hyde was taken to the Dartmouth general hospital emergency by ambulance and pronounced dead at 845 a.m. on November 22nd. He had been in custody of the police sheriff services and correctional services for a little over 30 hours. He had spent almost seven hours at the hospital. He received no psychiatric or mental health services or supports during that time. I found on the evidence that he had not been taking his anti-psychotic medication for five months although his prescription for anti-anxiety medication had finished only about three weeks before his death. I will return to the issue of medication and medication compliance later. All that I have just described became Mr. Hyde's narrative seen through the lens of an inquiry and yet the richness of Mr. Hyde's life and personality was hard to draw out of the narrative that formed around his death. We had to rely on his partner to tell us what she had experienced of him when he was healthy. And I'll quote, a very fantastic person. He was very caring of people. He loved people. He loved sports. He was a musician. He loved singing. He was just an incredible man. He was very lively. He enjoyed life. He was very, very sociable. Many people liked him. He was just a joy to be around. He was so interested in nature. He was a very, very likable man. When Mr. Hyde died he was 45 years old. He had attended although not completed university. He began to experience the symptoms of what would eventually be diagnosed as paranoid schizophrenia when he was in his late teens or early 20s. He reported dropping out of university because of the onset of his illness, which first manifested itself as a psychosis characterized by pacing, verbal aggression, and paranoia. Mr. Hyde tried to make an independent life on the south shore of Nova Scotia although relatives observed that he experienced considerable difficulty looking after himself and managing the requirements of daily living. Notwithstanding the recurrence of his illness during the time he lived in the Shelburne area and the challenges he encountered because of it, Mr. Hyde found some creative outlets for his talents. For a time he gave speeches about his illness and was very highly regarded as an excellent public speaker, articulate, and unlike me, never nervous. People liked listening to what he had to say. He was also described as handsome, which no doubt added to his appeal. He played tenor saxophone and clarinet and enjoyed singing karaoke. He reported being a member of the Lockport Sports Program playing basketball, badminton, and hockey. He was involved with Special Olympics and assisted the Jordan Bay Community Hall with their Friday Night Bingo. Following up an interest in theater, which he had studied in university, he appeared in a local production of Thornton Wilder's Our Town. But sadly, Mr. Hyde's illness continued to intrude. He started saying he was not really ill, which led to a discontinuance of his public talks as his outlook was thought to be unhelpful to other people living with mental illness. He also stopped playing his instruments and there were recurring incidents involving family, the police, and hospitalization. From 1987 to 2002, Mr. Hyde was hospitalized 12 times at hospitals in Yarmouth and Shelbur. In these years, he also made numerous visits to general practitioners and psychiatrists, although there was not, in the material presented to me, an indication that treatment went much beyond prescribing medication and efforts to have him comply with taking it. Mr. Hyde had a long history of poor compliance with his medications. When ill, he exhibited acute agitation, delusional thinking, flight of ideas, pressured speech, and thought disorders. He could be angry and threatening. He was paranoid. It was noted that social isolation contributed to his deterioration. I want to talk about stigma and social isolation for persons living with a serious mental illness. But before I do, I want to comment on this issue of medication compliance. There is an insistency that surrounds this aspect of the mental illness narrative. If people would just stay on their medication, there is a tendency to view a failure to comply and, at its most pronounced, a resistance to a medication regime as being the location of the problem. That view does not appreciate the complexity of the issue. Mr. Hyde, for example, apparently went off his medications for a variety of reasons, which included the challenges presented by unpleasant side effects. On the final day of the evidence, the inquiry watched an amateur video of Mr. Hyde made several years before his death. The very first subject he addressed in the video was the drug use, was the drug he was prescribed for his psychotic symptoms and the need for medications that, to use his words, don't make you fat with better side effects. Even when he was recovering in hospital on November 21st 2007 from the events and police booking, Mr. Hyde was describing the negative effects of his medication to the police officers who were guarding him. It was a theme that emerged again while Mr. Hyde was in the custody of sheriff's services awaiting court on the afternoon of November 21st. He told the sheriffs his medications were poisoning him. There was nothing unique about Mr. Hyde's problems with non-compliance. It was identified by the psychiatrist who testified at the inquiry as a common problem. A person will respond to medication and their symptoms will diminish, but relapse happens when they stop taking the medication because they think they no longer need it or because they find the side effects disagreeable. Sometimes the medication regime will be too complicated to follow and one missed dose leads to more misdoses. Mr. Hyde's aversion to his medications was not irrational. The unpleasant effects of his medication were real. He experienced weight gain and sexual dysfunction, both of which are common to the anti-psychotic drug he was prescribed. The forensic psychiatrists who testified at the inquiry talked about how the medications that are used to treat psychosis can have long-term serious effects, some of which are not yet known. One eminent psychiatrist acknowledged that the side effects can be horrible and expressed sympathy with Mr. Hyde's reaction. I was also told that medication non-compliance is not unique to persons with mental illness. With an approximate rate of 40 non-compliance in the general population, health services broadly speaking have had to identify ways to help people with physical illnesses or conditions take their medication as prescribed. Unpalatable medication regimes are just one of the burdens of living with an illness as challenging as schizophrenia in conditions defined by poverty and limited services. One witness talked about schizophrenia being an incredibly difficult illness to live with, with the medical treatment options carrying significantly adverse side effects and the result that people are making choices based on not necessarily great options to use the witness's words. She had an opinion about these issues in her view providing and I quote, more resources in the community and people seeing the possibility of living healthier, happier lives that aren't layered in poverty and lack of access to services would provide incentive and hope. Better opportunities and access to more services and resources could contribute to people seeing a value in managing their symptoms more effectively. Mr. Hyde's illness was managed on a regime of medications that held his psychotic symptoms at bay. Once off those medications he decompensated a pattern that on many occasions had led to his hospitalization. The evidence at the inquiry as a whole suggested that it is unhelpful to simply see the issue as one of poor compliance. There exists the possibility that the emphasis on medication in the treatment of Mr. Hyde's illness did not allow for the development of other approaches to care that would have improved his potential for sustaining himself in the community. Psychiatrists who testified at the inquiry talked about how the symptoms of a chronic mental illness are problematic but do not represent the problem itself. As one psychiatrist put it, the problem is inside the person. So if you don't actually get inside the person and work with them and figure them out and understand who they are and what drives them and the symptoms are not going to go away, people take their pills and they are great, they go up their pills, their psychosis comes back. What a surprise. The interventions Mr. Hyde received as an outpatient during various stages of his illness were always intermittent. Several witnesses discussed the importance of building relationships and a community of support for people living with a severe mental illness to help them stay engaged with services. There was a universal agreement amongst the witnesses engaged in the delivery of services to persons with mental illness that reliance on hospitalization and emergency departments can be reduced by offering better more accessible and more appropriate resources in the community. Some of the difficulty for Mr. Hyde and again his reaction was not extraordinary can be directly attributed to the stigma associated with having a severe chronic mental illness. Mr. Hyde was acutely aware of this. His medical records reveal that he consistently identified this stigma as an issue in his lived experience. The Mental Health Commission of Canada defines stigma as a negative and unfavorable attitude that causes those living with mental illness to be labeled, stereotyped and feared. Stigma emerges and I'm quoting here from beliefs and attitudes about mental health problems and illness that lead to negative stereotyping of people living with mental health problems and illnesses and to prejudice against them and their families. These are often based on ignorance, misunderstanding and misinformation. The labeling of people that occurs as a result of this prejudice can become all-encompassing to the point that it leads some to no longer view people living with mental health problems or illnesses as people but rather is nothing more than their mental health problems or illnesses. As a result people with mental health problems are defined by label rather than by who they really are. Mr. Hyde experienced this in life and in death when he was defined by the label schizophrenic. In some narratives Mr. Hyde did not merely have a diagnosis, he was the diagnosis. I've already described to you a narrative that demonstrates he was so much more. The Mental Health Commission of Canada makes the point that people should not be defined by the challenges they face as a result of the symptoms of an illness or disability. Stigma has been recognized by the Supreme Court of Canada as very damaging with the court noting its pernicious role in the historic marginalization of persons with mental illness. Mr. Hyde resisted being defined by his diagnosis. He denied having schizophrenia and expressed the belief that it could be cured. He wanted schizophrenia to be seen as a condition not a disease, illness or disorder. He wanted to be accepted as he saw himself a very intelligent person. I don't have anything wrong. Likely at times it was not helpful for Mr. Hyde to resist the reality of his illness but I think his doing so has to be understood in the context of the challenge of living with such a stigmatizing diagnosis. The desire expressed by Mr. Hyde to normalize was identified to the inquiry by one of the forensic psychiatrists who described how stigma influences the way a person with mental illness may manage their condition. He said, I don't think anybody wants to be regarded as crazy. They don't want to be taking medications seeing the clinic. Those kinds of things which reinforce your mental patienthood. Mr. Hyde was doubly stigmatized because he also had a forensic history having spent from 2002 to 2004 in the care of the East Coast Forensic Hospital following a finding that he was not criminally responsible for some offenses that occurred after a disagreement with a girlfriend. And a telephone call to the East Coast Forensic Hospital when he was out past his curfew he complained that he did not belong in hospital and that being there had ruined his life. In his words having the tag forensic it really sucks. He felt that even people living with mental illnesses in the community whom he met in supportive specifically organized environments was shunning him because they knew he was a forensic patient. It contributed to his perceived and actual social isolation. He reported that loneliness was a problem and that he had no close friends. Mr. Hyde had it right. Involvement in the criminal justice system amplifies the stigmatization of persons with a mental illness. Expert witnesses at the inquiry confirmed this compounding effect. Witnesses identified the fear and misunderstanding that underlies the stigma and the inappropriateness of applying the term forensic to describe a person with a past history of criminal behavior or incarceration. The ability to improve services for persons with a mental illness in conflict with the law is compromised by a failure to properly understand that the forensic system is specific to the criminal code and the assessment process provided for there. It does not have as its purpose or its objective the treatment of persons experiencing a serious deterioration in their mental health. Amongst the most common stereotypes are beliefs that persons living with mental illnesses are typically violent or dangerous or unpredictable. In its decision in Swain the Supreme Court of Canada called this belief irrational. It is a belief that materially contributes to the heightened stigmatization of persons with a diagnosis of mental illness who come into conflict with the law. In Mr. Hyde's case his illness did make him aggressive and threatening at times, but his brothers-in-law speaking to RCMP investigators after his death explained that they had never felt threatened by him even when he was angry or agitated. We know from the evidence presented to the inquiry that Mr. Hyde lashed out at his partner on November 21st because he was angry about her attempts to get help. With his history and experience he would have been aware that an outside intervention could once again result in him being taken to hospital or arrested. Records from some months earlier indicate that he had become extremely angry at any mention of medication, doctors, or hospital. By November 21st his anxiety and paranoia had reached a fever pitch. But the point to be appreciated is that his distress was not without a coherent content. In a 2003 psychiatric report it had been noted that Mr. Hyde was and I quote, most prone to act impulsively and or aggressively when acutely psychotic and feels his liberty is about to be curtailed. Mr. Hyde's behavior did get him into trouble on occasion when he was ill, but his resistance to having his liberty infringed is a human response we can all relate to. On this issue of stigma and violence I found it interesting to recently read a statement prepared in the wake of the Arizona shootings by a prestigious American organization, the Judge David L Basilon Center on Mental Health Law. Here in part is what the Basilon Center has said. It would be a mistake to conclude that incidents such as this are characteristic of people who have mental illness. In fact these events are rare. Studies show that having a mental illness in itself does not increase one's propensity to commit serious violence. Other factors come into play including co-occurring substance abuse, trauma, and perhaps in this instance today's vitriolic political climate. The Basilon Center goes on to urge a turning away from stigmatizing people who have mental illnesses with false stereotypes or pursuing laws that use courts to compensate for gaps in basic services. An American study by the MacArthur Foundation confirmed that persons diagnosed with mental illnesses as a class are no more violent than the general society. The Foundation's research found that there was no significant difference between the prevalence of violence by patients without symptoms of substance abuse and the prevalence of violence by others living in the same neighborhoods who were also without symptoms of substance abuse. Substance abuse significantly raised the rate of violence in both. At the inquiry it was noted that Mr. Hyde did not have either of the two characteristics that can amplify a tendency to violence when associated with mental illness substance abuse and personality disorder. Witnesses told the inquiry how stigma compromises the public's understanding of the issues around mental illnesses and its effect on access to services and care even within the health care system itself. One of the forensic psychiatrists who testified at the inquiry referred to the uneasy relationship in general emergency departments between as he put it what they like to think of is true emergencies and the mental illness emergencies. Other witnesses talked about the importance of developing recovery based individualized respectful care. The experience of persons living with mental illness is essential to the development of mental health systems that are able to respond appropriately to the needs of service users. The Mental Health Commission of Canada has recognized that it will be essential to ensure that people with a lived experience of mental health problems and illnesses actively participate in all aspects of the design, implementation and evaluation of a comprehensive person-centered mental health system. In my report I point out that the training of those in the justice system such as police, sheriffs and correctional officers must be informed by the same principle. As with any strategy designed to overcome stigma police sheriffs and correctional officers need to experience in their training direct contact with people living with mental health issues. Halifax Regional Police Services already incorporate this contact into their training program recognizing that such exposure will help to dispel stereotypes, deepen understanding and build confidence. This constitutes putting a face on mental illness and is a best practice for the health care and criminal justice systems. Criminalization is another fast set of the narrative of mental health and criminal justice. Testimony before the Hyde inquiry from frontline police officers and other witnesses illuminated the fact that people having problems with their mental health in the community often find themselves drawn into the justice system. Witnesses to the inquiry made a direct link between the inadequacy of mental health services in the community and through the hospital system and the criminalization of persons with mental illness. Stephen Lurie the executive director of the Canadian Mental Health Association in Toronto gave the inquiry his view of the issue and I quote from him we have failed in this to provide an adequate array of mental health services that will both keep people out of the justice system and when they get involved with the justice system will respond adequately to their needs and that will take a number of things. It will take increased funding. It will take a wider array of services and supports being available and it will take increased collaboration between the justice system and the mental health system to improve outcomes for people who are living with mental illness. Mr. Lurie told the inquiry that for persons living with schizophrenia the critical issues are access to a full range of comprehensive support services which tend to be lacking in many jurisdictions worldwide. He referred to what he called a care deficit the failure to invest in sufficient resources in providing comprehensive services in the community to people who are living with mental illness. Access to services in the community such as safe affordable and supportive housing has been shown to dramatically reduce involvement in the justice system psychiatric hospitalization and emergency department visits. The Baselon Center for Mental Health Law that I referred to earlier has echoed these observations by noting that the underlying issue for most individuals with mental illnesses who are charged criminally is their need for basic services and supports that public systems have failed to deliver in meaningful ways. The inquiry also heard that reliance on coercion to gain treatment compliance from persons with mental illness is less likely to have a positive response from service users. Personal autonomy is infringed by a coercive system for securing compliance where the forensic system is engaged the available services are accessed through criminalization. As Dr. Terrio the director of East Coast Forensic Hospital explained in order to avail yourself of all that the forensic system has to offer unfortunately the ticket into the system is through the courts which means through the criminal process. What Dr. Terrio was referring to was the process the emergency department doctors thought would get Mr. Hyde the psychiatric assessment and care he urgently needed a court ordered assessment. A court order assessment was not sought in Mr. Hyde's case and in any event would not have achieved the therapeutic objectives identified by the ER doctors as essential for Mr. Hyde at that time. Mr. Laurie suggested that as an alternative to the criminal process case management and community support services can be engaged to provide ongoing care or linkage to more specialized services so people do not get re-involved with the criminal justice system. As the consensus project has noted when clients find the services they receive to be helpful and meaningful they are far more likely to continue them for many people with mental illness developing this sense of connection is extremely important because individually tailored services lead to more sustained engagement in mental health treatment they are a critical link in preventing inappropriate criminal justice involvement. There is an indication although not in the evidence before the Hyde inquiry that in some jurisdictions when police officers were not aware of appropriate referral alternatives they were likely to arrest or charge the person who had a mental illness. According to a US study in 2002 this was compounded in communities with few psychiatric inpatient beds or limited community-based mental health services. The researchers concluded that in such cases where options are restricted it might seem to a police officer that psychiatric attention might be better accessed through the criminal justice system. This is worth being aware of as a danger a potential risk for criminalizing persons with urgent and acute mental health needs but it was not what underpinned Mr. Hyde's arrest. Mr. Hyde was arrested pursuant to the Halifax regional police services intimate partnered violence policy because he had assaulted his girlfriend. The police at the scene did not arrest him in order to obtain mental health services for him. His acute mental health issues were not recognized at the time and furthermore I will note that the police officers who testified at the inquiry spoke about their experiences of waiting many long hours in the emergency department sometimes an entire shift to obtain a psychiatric assessment for someone they had been called out to deal with. The police experience very directly the absence of appropriate or available mental health services in the community. A study in Ontario identified a direct cost of 308 million dollars in law enforcement relating to dealing with people with a serious mental illness who come into conflict with the law. The highest proportion of that cost is related to police interactions with people living with a serious mental illness. The inquiry heard that in the absence of a full range of community mental health programs the police are the only 24-hour responders available in many communities. In fact one of the measures of success for police mental health response models which I will discuss in a moment has been identified as a broad acceptance by police that mental health response is a core element of the police role. Police interactions with persons in a mental health crisis in the community are recognized by those studying policing and police training issues as an integral element of contemporary policing. The authors of the report containing that observation Dr. Dorothy Cotton and Terry Coleman proposed that training curricula designed to prepare police personnel for interactions with persons with mental illness should include more than fleeting attention to an explanation of why it is that police interactions are important. They comment that while most police officers do not usually think of policing as a social service it is in fact a social service albeit one with unique authorities that distinguishes it from other types of social agencies. Indeed as Mr. Hyde's case illustrates it is the police who frequently are the first responders in a crisis. In some jurisdictions Halifax being one there have been positive outcomes through the intervention of crisis intervention teams made up of trained police and mental health professionals. The success of such collaborations between the police and healthcare systems is in identifying treatment options and intervening to secure for people the treatment they need. In a research paper published in October 2010 research is evaluating Halifax's mobile mental health crisis team and covered several persistent themes amongst service recipients having someone to talk to which speaks to the cruel the cruel effects of of stigma and isolation obtaining advice and support and facilitating referral were cited as prominent benefits. Through a controlled analysis the researchers found that persons who had been in contact with the mobile service showed greater engagement without patient services than others with no access to the mobile crisis team. The study concluded that partnerships between police and mental health systems can improve collaboration efficiency and the treatment of people with mental illness. One aspect of the criminal justice system that Mr. Hyde's narrative does not help us understand is the mental health court. Mr. Hyde would not have been assisted by a mental health court that operates as a downstream process. The downstream model does not have a pre-charge disposition approach. Referrals to the mental health court are judicial referrals coming from the court of first instance. Mr. Hyde's only court appearance was in the arraignment court in other words the court of first instance. His mental illness was not raised at this one very brief appearance. It is useful to have an appreciation for how a downstream mental health court would not have factored into Mr. Hyde's narrative. It might be tempting otherwise to think that now that there is such a court in the Halifax regional municipality it would have diverted Mr. Hyde out of the criminal justice process. I have no comments to make about the Dartmouth mental health court. My point is simply that had it existed in 2007 it would have made no difference to what happened to Mr. Hyde. I can tell you something about what others have had to say about mental health courts as a criminal justice mental health initiative. In an October 2009 presentation to the Canadian Congress on Criminal Justice Professor Archie Kaiser advances reasons to be and I quote skeptical about creating cautious about implementing and vigilant about monitoring mental health courts. That's using the language from the title to his remarks. One of his points is that mental health courts are a response to the criminalization of people with mental health issues that says in effect this is a special population requiring extraordinary institutions and controls amplifying the pre-existing stigma. He observes the danger of oversimplifying the complex reasons that bring persons with mental illness into conflict with the law some of which I have already addressed such as the previous failure to provide appropriate and accessible supports and services, poor collaboration between health and justice systems, and the correlation between poverty mental health crises and crime. Amongst a number of trenchant observations and thought-provoking comments Professor Kaiser notices that mental health courts are ultimately but one part of the solution with a broader effort at system reform being needed. He endorses the view that without such broader efforts courts can only have limited success. He suggests there are many more comprehensive reforms in the justice health and community services systems that can help reduce criminalization and expresses the fear that people may be processed through mental health courts in order to secure services for them that should be available anyway pursuant to domestic and international standards and obligations. The Baselon Center for Mental Health Law made similar points in a study it conducted entitled the role of mental health in system reform. The best approach to the problem of criminalization is to create a comprehensive system of prevention and intervention. Mental health courts may provide immediate relief to criminal justice institutions but alone they cannot solve the underlying systemic problems that cause people with mental illnesses to be arrested and incarcerated in disproportionate numbers. The center went on to observe moreover it is critical that services exist in the community for everyone not just offenders and the supports not be withdrawn from others in need and merely redirected to those who have come into contact with the criminal justice system. Additional specialized resources and programs are needed to reduce the risk of arrest for people with mental illnesses and the recidivism of those who have encountered the criminal justice system. There is not enough time this evening to discuss the range of supports and services that are needed to reduce the risks of criminalization for persons with mental illnesses. I will comment on one that is suggested by the evidence heard at the inquiry and in a moment touch on some others. Mr. Hyde's case brought into focus an issue that confronts many people with the diagnosis of mental illness who appear before the courts, support of housing. Mr. Hyde's case he had been charged with assaulting an intimate partner and there were concerns on the part of the crown that he might return to the apartment where he had been living with his girlfriend contrary to the release conditions the crown was requiring he agree to. It was for this reason that the crown's consent to Mr. Hyde's release was conditional on him finding a surety. The crown wanted someone to assume responsibility for Mr. Hyde to ensure he attended court and complied with his release conditions. Mr. Hyde went to the correctional center on November 21st because it was too late in the day to get the necessary arrangements in place for his release. This does spotlight the question of what difference the existence of safe supportive temporary housing might make in such circumstances. Removing the problem of the accused person's immediate housing needs would serve the interests of both the accused and the complainant. It would offer an alternative that presently doesn't exist, an alternative that could remove the barrier to release presented by a requirement for a surety. At the Hyde inquiry various witnesses identified stable housing as a significant issue for people living with mental illness. Stephen Lurie, who in addition to being the executive director of the Toronto branch of the CMHA, is also the chair of the Service Systems Advisory Committee of the Mental Health Commission of Canada. He testified that safe supportive housing is one of the determinants of mental health. Other witnesses also emphasized the importance of supportive housing including frontline police officers. Drawing on their experiences police officers identified housing as an issue for people with mental illnesses and agreed that housing with clinical supports would be a great asset for people experiencing a psychiatric crisis. There is no mental health crisis housing in Halifax. The Mobile Mental Health Crisis team has identified this as a deficit in services especially in the middle of the night when most resources and services are not available. The Mobile Team can respond to a person in a mental health crisis in the middle of the night but the only alternate housing options are temporary shelters such as Metro Turning Point for adults or Phoenix Youth Shelter for young people. The person in crisis may require supports that temporary shelters are not equipped to provide. The inquiry heard that the Toronto CMHA has approximately 526 supportive housing units 300 of which are dedicated to people involved with the justice system. Turnover is minimal however with only 15 units coming available in a year limiting access. Crisis Housing has also been established a network of crisis residential safe beds where people released from custody can stay for up to 30 days with supports to help them design a care plan to link them with services in the community. The inquiry was told that the demand in Toronto for longer term supportive housing and crisis housing for persons with mental illness is acute. Perhaps temporary supportive crisis housing could have had an impact on Mr. Hyde's narrative. We will never know. As it was the place that was available to house him was a jail. In the words of Kim Pate a former Reed Lecture presenter and the Executive Director of the Canadian Association of Elizabeth Frye Societies the criminal justice system is the one system that cannot say no. It is as the lawyer for the Ontario Review Board has said the social net of last resort. Witnesses to the Hyde inquiry were consistent in their observations that more supports and services are needed in the community for persons living with mental illnesses. The inquiry heard that seven out of ten people with mental illness in Ontario can't get services. A forensic psychiatrist from Ontario observed that extra supports in the community are lacking and that the stop gap is that we criminalize people. Police officers who testified spoke of the absence of even personal support systems such as family and friends in the community and noted their encounters with individuals who lived in unsuitable conditions and were burdened by poverty. Witnesses were explicit about the need for affordable housing that is not transitional in nature and access to more resources and services around employment education and social engagement. Here is how one witness described the need for conditions that will support people with mental illness living meaningful lives in the community. People having choices about how they want to spend their time having opportunities to connect with other people having adequate and decent housing having an adequate income having a job having access to a responsive service system so that when they do have a difficulty there is somebody at the end of the telephone line or there is a team that they can see. Steven Lurie connected the availability of opportunities to the issue of personal dignity by relating the comments of a friend who lived with schizophrenia and obtained work on a research project. He had been a newspaper reporter and was university educated. He had moved in and out of services. He said about the work he secured doing a doing a survey on community needs in a particular part of Toronto that it was the first time he had not felt like a mental patient. Knowing what services are available and accessing them is a significant facet of the problem for people looking for effective mental health care in the community. Police officers dealing as first responders with a mental health crisis encounter the same challenge. The provision of a sufficient variety of services from which persons with mental illness can make a choice is also relevant. Intensive support or case management teams may not meet the needs or be accessed by individuals whose preference is to work with a peer support option. The Mental Health Commission of Canada has a study team looking into the issue of how peer support can be embedded into the mental health system in order to create and I quote, lots of opportunities for people not only to interact with caring clinicians who can help them with their treatment or caring service providers who can provide the range of community services but people who have actually been there have lived with mental illness and who can provide a role model and support to people in their own context. My point in referencing these themes of availability and access to services and supports is also to reflect on Mr. Hyde's experience so as to imagine the potential for a narrative a life narrative to have been different. What was not relevant for me to say in my report but which I will say now is that for all the value offered by Mr. Hyde's story a rich vein which the inquiry participants and I mined extensively a single narrative cannot be expected to inform our understanding of the complexity of experiences and needs of persons with serious mental illnesses who come into contact with the criminal justice and health care systems. It is critical to appreciate that Mr. Hyde was a white 45-year-old man with middle-class origins. There are many additional dimensions that merit attention examination and neither the mental health nor the criminal justice system can transform themselves without consideration of the unique experiences and needs of persons with mental illnesses who are of different races and cultures who are women and girls who are youths who are from origins that were poor or working class. I will also note that the factual narrative in Mr. Hyde's case did not offer an opportunity to examine in-depth or at all the wider experience of persons with mental illness in the correctional system on longer remands or serving sentences of incarceration and this brings me to another narrative and I am moving towards the end of them. I'm sure you'll be relieved to know but I have a few more things to say. Another narrative that did not emerge from Mr. Hyde's experience. What about prisoners in the federal correctional system? The federal correctional system is where men and women in Canada serve sentences of two years or more. What should we know about their circumstances? In keeping with the theme of narrative I'm going to start this aspect of my presentation with the perspective of federally sentenced prisoners according to the correctional investigator the independent federal prison ombuds. Statistics compiled in 2010 identified healthcare as the area of concern most frequently identified by both all prisoners to the correctional investigator. For Aboriginal prisoners specifically it was the area of second-graced concern after the issue of transfers. Mental health was specifically identified by women prisoners in their contacts with the correctional investigator's office and came up fourth on the list of most frequently cited concerns. Segregation which has mental health implications was identified as the third most frequently cited concern by all offenders and also for Aboriginal offenders and was second on the list for women prisoners. To get a picture of the mental health needs in federal prisons I have taken the following statistics from various sources including a 2010 independent review of the correctional service of Canada's mental health strategy implementation done for the correctional investigator's office. Prevalence rates for mental health problems and mental disorders in offenders exceed those of the general population. The correctional service of Canada reports substantial increases over recent years. The review notes that according to the latest available data 11 percent of offenders sent to prison had a mental health diagnosis, an increase of 71 percent since 1997. 21.3 percent had been prescribed medication for psychiatric illnesses and 6.1 percent had been receiving outpatient services prior to incarceration. A further 14.5 percent of male offenders had previously been hospitalized for psychiatric reasons. The correctional service of Canada had indicated that for reasons that include stigma these statistics are lower than the reality. Indeed the 2009-2010 report to parliament by the correctional investigator states that one in four new admissions to federal custody presents with some form of mental illness. The rates are said to be increasing by five to ten percent per year and the statistics for women are equally disturbing. At least 25 percent of federally sentenced women prisoners have a history of self-harming behavior. Women offenders are twice as likely as men to have significant mental health diagnoses and highly likely to have been sexually or physically abused on the street. In fact, Professor Kelly Hanamoffit, chair of the sociology department at the University of Toronto, has said in a Globe and Mail interview last month that close to 100 percent of female offenders suffer from a debilitating mental health problem such as psychosis, clinical depression, schizophrenia or coping strategies that involve self-harm. She said it is really hard to find somebody who doesn't have some of those issues. The prison environment itself challenges good mental health. As the 2010 mental health strategy implementation review observed it is designed as a punishment and as such as aversive. The review recognized that the prison experience which is described as stressful, crowded, violent, noisy and unpredictable, I'd add to that dangerous, is challenging for both prisoners and staff. This environment impacts disproportionately on Aboriginal prisoners who are released later in their sentences, are overrepresented in segregation and more likely to be classified by the correctional service as higher needs and risk. According to the correctional investigator, Aboriginal offenders now account for close to 20 percent of the federal prisoner population. This represents an almost 90 percent increase in federally sentenced Aboriginal prisoners in the last 10 years. According to the 2010 mental health strategy implementation review, the correctional service of Canada has found that the lack of available mental health services results in prisoners with untreated mental disorders being more likely than other prisoners to serve their full sentences in incarceration. The review explained this as being due to a number of factors including problematic behavior that influences how inmates are managed in the institution. People with untreated mental disorders are by definition less able to take responsibility for their behavior without help. Staff members report that they are often deemed ineligible for programs and less able to successfully complete the necessary steps required for consideration for early release. As a result, many language are necessarily in segregation and remain in prison longer. The review referred to this as an I quote obviously discriminatory unacceptable and not meeting the minimum standards set by the legislation governing federal corrections and not serving the public safety needs of the broader community. The correctional investigator's 2009-2010 report identified some of the problems associated with meeting the mental health challenges experienced by federally sentenced prisoners. Capacity, accessibility and quality of care issues are present complicated by lacking recruitment and retention of mental health professionals. The correctional investigator noted that there is a 20% vacancy rate for psychologists in the federal system. He indicated that the long term defined as over 60 days segregation population is increasing with the average number of days spent in segregation being 95. In his words and I quote high segregation numbers give rise to concerns about the adverse effects of solitary confinement on mental health and reintegration potential. He had this to say about segregation. In the correctional environment mentally disordered individuals do not always comprehend, conform or adjust properly to the rules of institutional life. They may suffer from illogical thinking, delusions, paranoia and severe mood swings. Irrational and compulsive behaviors and I will say with due respect to the author I would have favored different language associated with their individual affliction can result in verbal or physical confrontations with staff or other inmates which often lead to institutional charges and long periods in segregation. The correctional investigator goes on to say in the past year I have been very clear on the point that mentally disordered offenders should not be held in segregation or in conditions approaching solitary confinement. Segregation is not therapeutic. In too many cases segregation worsens underlying mental health issues. Research suggests that between one third and as many as 90 percent of prisoners experience some adverse symptoms in solitary confinement including insomnia, confusion, feelings of hopelessness and despair, hallucinations, distorted perceptions and psychosis. In his 2009-2010 annual report to parliament the correctional investigator recommended that prolonged segregation of offenders with acute mental health issues should be prohibited. At the other end of the prisoner spectrum from isolation is the practice of double bunking which the correctional investigator advises has increased by 50 percent in the past five years. This trajectory will lead he says to heightened institutional violence and unrest. According to the correctional investigator the physical conditions of confinement are becoming more restrictive with prisoners spending more time in their cells. This can be the result of lockdowns due to institutional violence and unrest and such restrictions can in the correctional investigator's words impede access to programs visits and associated privileges all of which can have an adverse impact on the overall health and safety of prisoners and staff. I will note that in the Globe and Mail article I mentioned earlier veteran reporter Kirk Macon makes the following observation tougher laws and sentences have created a pressing need for more prison cells but the needs of the mentally ill are playing a small role in federal expansion plans. The stigma of prison follows a person released back to the street after his or her sentence and can affect access to services in the community. The 2010 mental health strategy implementation review indicates that family physicians who are already in short supply often do not want to add ex-offenders to their practices. Some community mental health programs and services require a referral from a physician. Ex-offenders fall between the cracks in the system in the words of the review leaving an institution with a two week supply of medication provides a small window within which to secure community-based mental health services. The review cites a study that found smooth transitions to community care are essential to effective outcomes. Although the correctional service of Canada's community services staff identified stigma and discrimination as serious issues in the community and with health service providers and employers according to the 2010 mental health strategy implementation review stigma is an issue that does not seem to have registered significantly in the strategy. One of the 16 recommendations made by the review is that stigma and discrimination identification and elimination should become a central pillar of the correctional services mental health strategy. The phenomenon of a compounded stigma was recognized by the review as existing for federally sentenced prisoners and one presumes prisoner sentenced to differential time that they carry the label of being in the words of the review both crazy and criminal. This you will recall is an echo of what Mr. Hyde painfully realized as the legacy of his experiences in the mental health and criminal justice systems. There is a narrative I have not yet mentioned and I will be concluding with this in brief. It is the narrative of human rights. In the context of prisons and prisoners the narrative of human rights is found in the Charter of Rights the Federal Corrections legislation the Corrections and Conditional Release Act and international instruments such as the United Nations standard minimum rules on the treatment of prisoners. Significantly a human rights narrative is not found in a policy paper on federal corrections prepared by a government appointed panel in 2007. Embraced by government as a transformation agenda for federal corrections in Canada the report has been critiqued for making no mention at all of prisoners human rights a contrast to most previous reports and commissions of inquiry. The United Nations standard minimum rules are resonant with human rights language emphasizing for prisoners serving sentences social rehabilitation and community reintegration and the provision of psychiatric services to address mental health issues that may impede a prisoner's rehabilitation. In the broader context one that encompasses persons living with mental illness in the community as well as those who are confined it is essential to reference the United Nations Convention on the Rights of Persons with Disabilities. Canada signed the Convention on March 3rd 2007 and ratified it on March 11th 2010. The significance of this can be understood from the Supreme Court of Canada's adoption of the following view of the influence of international law. The legislature is presumed to respect the values and principles enshrined in international law both customary and conventional. These constitute a part of the legal context in which legislation is enacted and read in so far as possible therefore interpretations that reflect these values and principles are preferred. The Convention is too rich and vast a document for me to tackle in this lecture needs to be discussed by those who have an expertise in this area of international law and justice. I can tell you that the Convention explicitly recognizes that there are attitudinal and environmental barriers that hinder the full and effective participation of persons with disabilities in society on an equal basis with others. It also recognizes the need to promote and protect human rights of all persons with disabilities including those who require more intensive support. The Convention identifies the critical need to address the negative impact of poverty on persons with disabilities and compounded discrimination based on gender, race, ethnic, indigenous and social origin amongst other grounds. The principles of the Convention include respect for inherent dignity, individual autonomy, including the freedom to make one's own choices and independence of persons. Other principles are full and effective participation and inclusion in society, respect for difference and acceptance of persons with disabilities, equality and accessibility. Accessibility is acknowledged to be a means to empowerment inclusion with education, health, work and employment, adequate standards of living and social participation amongst the rights recognized. Community inclusion is identified as human right as is access to services and supports. State parties to the Convention are obligated to prohibit all discrimination on the basis of disability and guarantee equal and effective legal protection against discrimination. State parties undertake to combat stereotypes, prejudices and harmful practices relating to persons with disabilities and are expected to nurture receptiveness to the rights of persons with disabilities. For 18 months in 2009 and 2010, from the start of the evidence to the filing of my report, my focus was on what Mr. Hyde's experience could tell us about mental illness and criminal justice. I concluded that what Mr. Hyde needed on November 21st and 22nd 2007 at an immediate fundamental level was human contact, reassurance and kindness. But what he needed in a more comprehensive sense were better options from the mental health and criminal justice systems. In my report, his experiences moved me to reflect. After all I have listened to and read I'm left to wonder what could Mr. Hyde's story have been. There has to be another narrative, one that leads to hope and integration and speaks to alternatives to the courts and jail for persons with severe persistent mental illness who come into conflict with the law. There are many resources including potentially transformative ones in the realm of international law to affect a new narrative for persons living with mental illness. I believe it is fair to say that it will do some justice to Mr. Hyde's memory if we confront the challenges exposed by his experiences and endeavor to meet them. I hope the narratives I've been sharing with you tonight will stay with you and I want to thank you all for your patient attention to my remarks. I was trying to think, it's one of the difficulties of having to close a lecture, is trying to think while the lecture is being given what you might say that would merit taking any time and closing. So you have especially because of what I said, it's not a high task. Let me say this. I was trying to think a little bit about what made both the lecture and the report so remarkable and it's certainly the case that both were lucid, thoughtful, thorough. Those were all extraordinary characteristics of both. In addition you have an incredible ability to both center the man at this who's at the heart of the inquiry but do that within the broader social challenge and context. Your ability to highlight and give credit to the significance of the evidence you heard in your time with the inquiry is extraordinary. The biggest thing though I think that makes both the lecture you gave tonight and the report extraordinary is your ability to tell what you heard in your own voice and yet to get out of your own way and I don't know how to put that better except to say that you are so located in the report and yet you've done that in a way that doesn't make the report about you. It's just not a dominating feature and that is just one of the most extraordinary gifts that you could have given us here tonight. So you have all of our thanks for both your work on the report and on the lecture. Judge Derrick has offered to take questions and what I would suggest in the light of the hour and the possible need for refreshment is that everybody join us in a either walk up the stairs or trip up the elevator to the third floor faculty lounge where we can do that in a congenial and slightly smaller environment. So please join us. Thank you very much for coming tonight. The 34th annual read lecture.