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Rally organizer Maureen Bilerman holds up dots as about 1,000 people joined hands Wednesday, December 8, 2010 during the Connect the Dots demonstration in Fredericton, N.B, held to raise awareness of mental illness problems. Bilerman and other parents and critics across Canada say provincial governments are failing mentally ill children and youth.

David Smith/The Canadian Press

At 17, he was out of school, living on his own and occasionally stealing cough syrup from drug stores in Halifax.

His addiction, believed to be linked to an undiagnosed mental disorder, led to scrapes with the law, including a conviction of assault with a weapon.

Late last year, he made a brief court appearance in Halifax that spoke volumes about the challenges mentally ill youth face when they run afoul of the law.

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The court heard the youth was in a delusional state when he pulled a knife on a woman and scratched her neck.

"I feel really bad for what happened," he told Judge Pam Williams of Nova Scotia's provincial youth court. "I'm ready to move past this now."

But the judge had heard this sort of thing before, and she made it clear she had grown frustrated with the lack of help available for the teen, whose real name can't be revealed under the Youth Criminal Justice Act.

"The system has failed miserably in supporting [the youth]and his parents for a long, long time," the judge said, adding that she had little to offer him after 11 months in custody.

"I'm not even able to order intensive supervision in the community because our province has decided in its wisdom that the only way a youth can get intensive support ... is if it's pursuant to a custody order."

In other words, the judge couldn't offer the youth treatment unless he was sentenced to more jail time.

The judge's lament has become a common refrain across Canada, where a patchwork of inadequate programs and long wait times have contributed to what some say is a troubling trend: the criminalization of mental illness, particularly among youth.

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"It just forces us to watch these kids continue to cycle until they do enough damage to somebody to suddenly go to jail," says Megan Longley, a legal aid lawyer in Halifax.

"What happens is that you criminalize the health issues and we have absolutely zero services available in youth court. ... As long as we keep using jail as a dumping ground for these poor kids, nothing is going to change."

Longley says her greatest fear is that the province will not take action until one of her young, mentally ill clients kills someone or themselves.

The Canadian Mental Health Association estimates that up to 20 per cent of Canadian youth are affected by a mental disorder, representing the single most common affliction in this age group.

Even though 70 per cent of all psychiatric disorders emerge in childhood or adolescence, only one in five mentally ill children and youth in Canada are getting the help they need.

Meanwhile, the majority of provinces and territories do not have child and youth mental health plans, a policy gap that is exacerbated by a shortage of psychologists and psychiatrists who specialize in treating the young.

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"The waiting list for mental health services in Nova Scotia is not very much different than right across Canada," says Jean Hughes, a board member with the Nova Scotia wing of the Canadian Mental Health Association. "It's long. And if you're a child or youth, it's even longer."

At the IWK Health Centre in Halifax, the region's largest children's hospital, non-urgent patients are waiting up to 14 months for an appointment. As of October, there were 935 young people waiting for a mental health assessment at the IWK.

Patricia Murray, Nova Scotia's acting executive director of mental health services, says the province is aware there's a problem.

"We certainly acknowledge that we have great challenges in meeting the needs of children and youth with mental health issues," she says. "The cases are becoming more complex and it's taking longer to address the issues. ... The (wait-time) numbers are very high."

But Murray insists the province is doing all it can to help mentally ill young offenders.

The youth correctional centre in Waterville, N.S., for example, has its own mental-health team and the Halifax Youth Attendance Centre is available to provide at-risk youth with a variety of programs, including day school and housing assistance.

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"There are some services in the jail system ... but the corrections folks have priority over the health folks," says Hughes, who is also a professor specializing in mental health issues at Dalhousie University's school of nursing.

Even though the North American trend has been to refrain from locking away the mentally ill in large institutions, the lack of public support and services has left too many struggling to cope. In the end, a significant number end up in a different kind of institution: jail or prison.

Between 15 and 40 per cent of offenders currently in jails and prisons are believed to have a mental illness, the association says.

Earlier this month, a House of Commons committee issued a report saying governments must make a "serious investment" in the mental-health system to prevent the vulnerable from ending up in prison.

The public safety committee report says the federal prison service is "not able at this time" to provide adequate treatment to the majority of offenders with mental illness and addiction issues.

In New Brunswick, the tragic story of 19-year-old Ashley Smith - soon to be the subject of a public inquiry - threw a spotlight on this dark corner of Canada's justice system in 2007.

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When she was 15, the mentally ill Moncton girl was convicted of assault for throwing crabapples at a postman. But in-custody infractions caused by unruly behaviour linked to her mental condition added years of prison time to her original 90-day sentence.

She was transferred between institutions 17 times in the 11 months before she choked herself to death in an Ontario prison cell. Video evidence shows staff failed to respond immediately to the emergency.

The constant movement meant Smith never received treatment she needed, her family says.

New Brunswick ombudsman Bernard Richard issued a 2008 report saying the province had to do a better job of diverting youth with mental health issues away from the criminal justice system.

"We have to stop criminalizing these youth," he said at the time. "(Smith) needed very specialized mental health services. She really didn't get what she needed."

Nicholas Bala, an Ontario law professor who specializes in youth justice, says the principles of sentencing under the Youth Criminal Justice Act clearly state the law is not to be used as a way of accessing mental health services.

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But that is exactly what is happening in some cases.

Frustrated parents and police are often left to wrongly conclude that a jail sentence represents the only way to ensure a mentally ill youth gets proper treatment.

"Their criminal behaviour is a reflection of their mental condition," says Bala, who teaches at Queen's University in Kingston. "We're punishing people for relatively minor crimes, but they need mental health services."

As well, the professor says some provinces, including Nova Scotia and Ontario, have created a kind of no-man's land for mentally ill youth between the ages of 16 and 17.

In Nova Scotia, provincial legislation states the government has an obligation to provide social services to at-risk youth, but that obligation largely ceases at age 16.

The result is that youth with mental health issues are often released from group homes or other services if their behaviour deteriorates after their 16th birthday, says Hughes.

"The day you turn 16, goodbye, wherever you are. So if you're in a group home, goodbye."

Vicki Wood, director of child welfare at Nova Scotia's Community Services Department, says it's not that simple.

It's up to the courts to decide whether those over the age of 15 should remain in the care of the province.

"(But) children, as they get older, have rights in terms of liberty," Wood says, noting that her department can't force a 16-year-old to remain in the province's care unless they represent a danger to themselves or others.

"The older they get, the more reluctant the court is willing to (keep them in care). ... We can find ourselves with young people who simply do not want our services."

Meanwhile, the province announced in May that it is working on mental health strategy that is expected to address the service gap for 16 and 17-year-olds. The strategy is expected to be completed by next fall.

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