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Fred van Zuiden, 85, called 9-1-1 and said there was an intruder in his home. When police arrived, they found his wife of 56 years bludgeoned to death, and Mr. van Zuiden asking where she was. He was charged with second-degree murder but, suffering from dementia and deemed unfit to stand trial, was sent to a forensic psychiatric facility, where his condition deteriorated.

Richard McPherson, 60, sexually assaulted another resident and a care aide at his nursing home, then assaulted a security guard. Suffering from dementia, he spent almost two years awaiting trial in the jail’s medical wing before being convicted. Mr. McPherson was sentenced to time served but remained in jail because no suitable community placement could be found.

Katharina Abrams, 68, wandered into a park, grabbed a seven-year-old boy by the arm and tried to drag him away. Bystanders intervened quickly, but Ms. Abrams was charged with forcibly seizing another person. Suffering from schizoaffective disorder and dementia, and deemed to have the mental capacity of a child, she was found not criminally responsible but was kept in custody, again, because no bed could be found for her in a care facility.

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A new 272-page report from the Dementia Justice Society of Canada, entitled “Nowhere To Live,” features many of these disturbingly tragic stories and eloquently makes the point that the criminal justice system has yet to figure out how to treat criminal defendants with dementia fairly and compassionately.

The authors emphasize that dementia patients who kill and rape are a rarity, saying, “at a macro-level, our population is statistically insignificant, but on an individual level, the human cost is profound.”

The common media image of people with dementia is older folks who are confused and wandering around lost. But there are dozens of types of dementia, each with a varied mix of symptoms. Many patients with Alzheimer’s wander, but they can also be aggressive and paranoid. Frontotemporal dementia symptoms often include disinhibition and hypersexuality. Those with Lewy body dementia can have frequent hallucinations. And so on.

As anyone who has cared for a loved one with dementia knows (and there are more than 500,000 people with dementia in Canada), the behaviours that can result – urinating in public, groping, shoplifting, traffic violations, lashing out verbally or physically – can bring people with dementia into contact with police and the justice system.

Fining and jailing people for these non-deliberate actions is not useful. Rather, we need to invest in prevention. That includes training police how to interact with people with dementia, giving prosecutors leeway to not lay charges, providing respite programs for caregivers, and appropriate housing for people with dementia.

We have to recognize, too, that having dementia does not mean people cannot commit crimes. When they do, however, they need to be treated differently. One of the most troubling aspects of this complex story is the shocking rates of domestic violence experienced by those who care for loved ones with dementia.

Take the case of Joseph McLeod, an Alzheimer’s patient who pushed his wife; she fell and cut herself badly when a glass picture frame shattered. Mrs. McLeod did not want her husband charged but mandatory charging policies meant that he ended up in jail.

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When people are arrested and jailed there is a loss of liberty. For a person with dementia, that can result in severe collateral consequences.

A person with a non-contact order – common with domestic violence charges – loses their caregiver. A dementia patient held in custody is at severe risk of losing their bed if they are already in a facility. In the strict prison environment, health often deteriorates quickly. And, once you have a record, no home wants you.

There are now mental health courts that allow judges to treat defendants with mental illness differently, such as sentencing them to treatment instead of jail. Some dementia patients end up there by default, but more specialized dementia courts would be welcome.

The ultimate problem though, as the new report from Dementia Justice makes clear, is the lack of available appropriate housing for people with dementia, and even more so for those of them who are violent.

Nursing homes and long-term care facilities are not the villains here. Sixty per cent of their clientele already suffer from dementia. They do not have the staff or the facilities to deal with violent offenders, and there is a severe lack of specialized facilities.

The notion that sick people are ending up in jails and forensic units by default is abhorrent. Justice requires that criminals with dementia get appropriate care, not punishment.

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