The Impact of Therapeutic Jurisprudence: A Phenomenological Study of Toronto's Mental Health Court

Background and Purpose: The Toronto Mental Health Court (TMHC) is the first of its kind in Canada. Based on the theory of therapeutic jurisprudence, the court seeks to divert seriously mentally ill adults accused of minor crimes away from jail and towards psychiatric and social services. Mental health courts are expanding rapidly across Canada despite limited data about their impact or “success”. Quantitative comparisons between courts are problematic due to local variations of population, laws, social services, etc.  The published research focuses on recidivism rates and the opinions of experts such as judges, lawyers, and social workers. There is a distinct gap in knowledge from a consumer perspective about most such Canadian courts. This presented an opportunity to conduct a qualitative, ethnographic study, to assess the impact of the Toronto mental health court for the consumers who pass through the system and for which is designed to serve.

Methods: This study spanned eight months of observation and interviews with various stakeholders of the TMHC. Open-ended interviews were conducted with three groups of participants: professionals associated with the court including lawyers, judges, court clerks, and social workers; families of those who appeared in the court; and adults who had formerly passed through the TMHC as a “disordered accused”. Interviews were transcribed and analyzed using an interpretive phenomenological analytic framework. Themes were traced among the participants.

Results: Three major themes emerged from this research. (1) Participants interpreted the experience in the court as a threshold or rite of passage. They spoke of the court as a “second chance” and their lives as divided by the court experience as something “dark” before and “better” after. (2) Many spoke of the unseen and unheard “violence” associated with the court. Descriptions of various kinds of violence ranging from physical to psychological was often a critical component of the court experience for participants, challenging assumptions about what constitutes the space of the court and the separation of the courtroom and holding cells and jails. (3) Finally, many spoke of the role of pharmaceutical interventions as another form of discipline. Many associated their psychiatrists with other disciplinary authorities such as the police and reported ambivalent relationships with doctors. Despite the pivotal role of psychiatrists and pharmaceutical intervention in the court process, participants credited other aspects of the system with their current good mental health. 

Conclusions and Implications: A critical analysis of pharmaceutical intervention as a structural element of the surveillance processes of the court will be discussed. Finally, the meanings of the court to the various stakeholders will be compared. The experiences of the court invite a Foucauldian analysis of power and discipline and the participants’ interpretations of their experiences and the researcher’s participant/observation will be the basis for such an analysis.