Remoteness and its impact on the potential for mental health initiatives in criminal courts in Nunavut, Canada

Abstract

Remoteness in the isolated communities of Nunavut, Canada adversely affects access to mental health services. Mental health initiatives in criminal courts exist in many cities to offer healthcare alternatives to regular criminal court processing for people affected by mental illness. These initiatives do not exist in Nunavut. A qualitative multiple-case study in 3 Nunavut communities involving 55 semi-structured interviews and 3 focus groups explored perceptions by health, justice and community stakeholders of the potential for criminal court mental health initiatives in the territory. Findings suggest remoteness is perceived to hinder mental healthcare support for court responses to people affected by mental illness, creating delay in psychiatric assessments and treatment. While communication technologies, such as tele-mental health, are considered an effective solution by most health professionals, many justice-sector participants are sceptical because of perceived limits to accessibility, reliability and therapeutic value. These perceptions suggest remoteness is a significant hurdle facing future criminal court mental health initiatives in Nunavut. Additionally, remoteness is viewed as affecting decisions by lawyers to bypass legislated mental health avenues, possibly resulting in more people with mental illness facing criminal justice sanctions without assessment and treatment.

Forensic psychiatry services in Nunavut

“…Nunavut is the largest geographical region in Canada, representing 20% of the country [1]. With a large land mass and remoteness, Nunavut has faced challenges in healthcare delivery and availability of services, often within the context of historical injustice and oppression, and with social disparities that persist today [2][3][4]. Nunavut has some of the highest rates of suicide and mental health issues across the country [4][5][6][7][8].…”

“…Nunavut has the highest government health expenditures per capita in Canada [ 21 , 24 ]. Despite this finding, on average, the territory reports a substantially worse health status than the rest of the country, including mental health [ 2 , 4 , 24 , 25 ]. Similar to many Arctic regions, Nunavut has faced challenges in establishing efficient mental healthcare systems for the sparsely populated region [ 2 , 4 , 26 ].…”

“…Despite this finding, on average, the territory reports a substantially worse health status than the rest of the country, including mental health [ 2 , 4 , 24 , 25 ]. Similar to many Arctic regions, Nunavut has faced challenges in establishing efficient mental healthcare systems for the sparsely populated region [ 2 , 4 , 26 ]. The remoteness of Arctic regions contributes to a scarcity of adequate infrastructure and lack of accessibility to healthcare resources and professionals [ 2 , 27 , 28 ].…”

“…Similar to many Arctic regions, Nunavut has faced challenges in establishing efficient mental healthcare systems for the sparsely populated region [ 2 , 4 , 26 ]. The remoteness of Arctic regions contributes to a scarcity of adequate infrastructure and lack of accessibility to healthcare resources and professionals [ 2 , 27 , 28 ]. Arctic regions must adapt the governance and organisation of their healthcare system to meet the challenges of having a dispersed population, underdeveloped infrastructure, and harsh climates.…”

“…Qikiqtani General Hospital, located in Iqaluit, is Nunavut’s only hospital and has 35 acute care beds [ 2 ]. Nunavut’s primary healthcare system relies mostly on nurses rather than physicians, especially in remote communities [ 29 ].…”