A troubled young man brandishing a pair of scissors is shot and killed by police. A suicidal woman is placed in solitary confinement “for her own protection.” A desperate boy finally gets the mental health care he needs, but only after he is charged with assault.

These are the devastating symptoms of a problem that a new report warns is escalating in Ontario: the criminalization of mental illness.

Ontario must stop punishing people for their mental health issues and take “bold and immediate action” to decriminalize mental illness, says the sweeping 40-page analysis by the John Howard Society of Ontario.

The report, obtained by the Star ahead of its Tuesday release, says the criminal justice system has had little success in responding to mental health concerns because it is simply the wrong place for the mentally ill.

Related: Ontario reviewing solitary confinement

It recommends a massive system overhaul, urging the province to quit relying on police and courts as primary responders and to take meaningful steps to improve the mental-health-care system and keep vulnerable people out of jails.

“When the health system fails to treat mental illness, the justice system punishes the symptoms,” said Jacqueline Tasca, a co-author of the report and policy analyst with the John Howard Society of Ontario, a non-profit that studies crime and justice-system reform and helps prisoners after release.

Ontario is three years into a 10-year mental health strategy that promises, in its next phase, to expand employment and diversion programs for people with mental illness, increase the number of supportive housing units and improve “transitions between police and hospital emergency departments,” among other initiatives. The John Howard Society recommendations are meant to help the province realize its goals, Tasca said.

A spokesman for the minister of health said he couldn’t comment on a report the ministry hadn’t seen, but emphasized in an emailed statement that the government continues to roll out its mental health and addictions strategy. “Our plan will improve accesses to services, reduce wait times, fill the gaps in our system,” he said.

Sixty years ago, people with serious mental illness were warehoused in hospitals and asylums. The 1960s deinstitutionalization movement arose out of the belief that patients would be better served in the community, but it led to the mass closure of psychiatric beds without a corresponding investment in social supports such as housing and mental health treatment. The movement spurred a troubling and unintended consequence: an increase in encounters between the mentally ill and police.

Now jails have replaced asylums as repositories for people who don’t have adequate resources to cope with community living, the report argues.

Recognizing this trend, the Ontario criminal justice community has developed specialized services — crisis services, mental health courts, more access to case management. But this well-intentioned response, the report says, has led to another unintended outcome: the criminal justice system has become one of the few access points for mental health treatment.

No one escapes the impact of this escalating problem. It is devastating to people with mental illness, “who are forced to navigate a system that was never intended to be therapeutic,” the report stresses. And society pays the price with clogged courts, overcrowded and dysfunctional jails, and preventable encounters that sometimes escalate tragically.

“It’s getting close to crisis proportions,” said lawyer Paul Champ, who represented an Ottawa-area woman in a landmark 2013 human rights settlement against Ontario, after she was held in solitary confinement for 210 days.

“The problems are fairly clear for all to see, but I think that a better response from the government could be found if they actually study the problem in more detail,” he said. “Because there’s no doubt about it — it’s far more expensive to put people in jail then to provide them with proper medical treatment.”

A common scenario is this: a desperate family tries unsuccessfully to get help for a son with a serious mental illness. Suicide threats are met with brief and ineffective hospitalizations. Finally, in a crisis, the family calls police, seeing the justice system as the only pathway to psychiatric treatment.

Criminal charges beget a whole new set of problems. In Ontario jails, people with mental illness have difficulty accessing medication and appropriate psychiatric care. They are frequently placed in solitary confinement because they are seen as too challenging to manage in the general population. This practice is widespread in Ontario and across Canada, even though there is a growing global consensus that isolating the mentally ill amounts to torture and should be banned.

Released from jail, people with mental illness face numerous barriers to successful reintegration and recovery, including shortages in clinical care and residential treatment options, and bail conditions that include absolute prohibitions on drugs and alcohol, which are often unrealistic for people with addictions to comply with. People with a police record often face additional stigma because it limits their job options and makes them ineligible for certain community supports.

These barriers, the report says, create a vicious cycle of re-involvement with the justice system that people can not easily escape.

By the numbers

60% of Ontario prisoners today are on remand, which means they have not been tried and are presumed innocent — only 26% were on remand 30 years ago.

20% of Ontario prisoners today are being held on non-violent administration of justice charges, such as failing to comply with bail or breach of probation.

A 2013 study of accused people on bail in Ontario who were being supervised by community agencies found that:

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70% had issues with substances (alcohol or drugs).

40% reported that they had current mental health issues.

31% had concurring mental health and substance use issues.

Criminal justice recommendations

Immediately cease the practice of isolating prisoners with serious or acute mental illness in solitary confinement.

Regulate the employer demand for police record checks and broaden the Ontario Human Rights Code to protect people against discrimination on the basis of non-conviction records.

Reduce the large remand population and overcrowding in Ontario’s provincial jails by fixing problems with the bail system in Ontario,

Whenever possible, divert people with mental health issues out of the justice system and only use jail as a last resort.

Consider decriminalizing drug use in line with CAMH’s cannabis policy recommendations.

Screen all inmates using a standardized and validated mental health assessment tool.

Screen for homelessness risk upon entry and anticipated risk of homelessness upon release.

Ensure inmates have high-quality, around-the-clock access to medical and psychiatric care in prisons.

Implement meaningful discharge planning for remanded prisoners.

Strike a balance between responding appropriately and humanely to the mentally ill while being cautious not to further entrench the justice system as an entry point.

Health and social recommendations

Create a proactive and accessible mental health care system in all communities.

Increase access to psychiatric professionals and clinical care.

Adopt a broad and inclusive definition of mental health that includes addiction.

Create system navigators who can help people access appropriate treatment and community support.

Keep the minimum wage above the poverty line and improve the accessibility, structure and allowance rates.

Implement an eviction prevention strategy for people on remand to prevent loss of housing for those jailed for short-term periods.

Expand access to supportive housing and crisis beds for people with mental illness.

Source: Unlocking Change: Decriminalizing Mental Health Issues in Ontario, a report by the John Howard Society of Ontario