Please note: In an earlier version of this post, Dr. Melissa Stoops was incorrectly listed as a student researcher. Dr. Melissa Stoops is a health researcher with a background in anthropology, community health, and epidemiology. Her research interests include population health, social perceptions and lived experiences of health and wellness, and health services and policies.
Authors: Caroline L. Tait, Mansfield Mela, Garth Boothman, and Melissa A. Stoops
Journal: Transcultural Psychiatry
Dr. Caroline Tait is a medical anthropologist with particular research interests in Indigenous health and social justice, and the challenges faced by women who are marginalized. She is with the Department of Psychiatry at the University of Saskatchewan. Dr. Mansfield Mela is an academic forensic psychiatrist in the University of Saskatchewan and a founder of the forensic subspecialty in Canada. He is a CanFASD research lead in diagnostics. He brings a clinical perspective to his research questions and seeks to generate research and implement knowledge to achieve evidence-based practice amongst forensic mental health and FASD populations. Garth Boothman is one of the subjects of this research and chose to be a coauthor. Dr. Melissa Stoops is a health researcher with a background in anthropology, community health, and epidemiology. Her research interests include population health, social perceptions and lived experiences of health and wellness, and health services and policies.
This paper shares the stories of two men, Garth and Arnold, who met and became friends in prison in 1980 and eventually lived together as roommates in the community in 2013. The authors explore the elements that supported their successful cohabitation for 18 months and what contributed to its breakdown.
As an introduction to Garth and Arnold’s stories, the authors summarize the issues many individuals with FASD face as they move through the criminal justice system. Because of variability in learning, language, and memory skills, some individuals with FASD may seem to understand certain parts of their charges, rights, and trial experience, but they may not be able to remember these details or be able to follow through with standard probation conditions. As a result, breaches of conditions of release are common for paroled offenders living with FASD, which can lead to ongoing involvement with the criminal justice system. The authors use the word vulnerable to describe the transition to the community after incarceration:
“Undiagnosed FASD with comorbid psychiatric illness, along with a lack of supports such as stable housing and transportation, and effective treatment options, exacerbates the problem and increases the risk of recidivism.”
Garth and Arnold are men in their 60s whose life histories involved significant turbulence and trauma in their childhoods, suicide attempts, and psychiatric illnesses that were diagnosed while in prison serving lengthy sentences for serious crimes. In addition to their FASD diagnoses, Garth is diagnosed with borderline personality disorder, antisocial personality traits, and schizoaffective disorder and Arnold is diagnosed with depression and schizophrenia. Fortunately, Garth and Arnold attended a specialized clinic in Saskatoon, Saskatchewan that is dedicated to addressing the gap in FASD assessment for paroled offenders living with mental illness. Earlier research out of this clinic identified five success factors for parolees living with FASD and comorbid psychiatric illness:
(a) a stable, consistent, and trusting relationship with a psychiatrist;
(b) a medication regime that provides optimal satisfaction (e.g., fewest side effects while successfully regulating symptoms);
(c) living in a stable, safe home environment;
(d) consistent family and social support networks; and,
(e) constant and reliable mentors trained in the skills required for hands on mentoring with individuals with FASD
To explore how these factors play out in the lives of parolees with FASD and mental illness, Garth and Arnold shared their lives with the researchers through interviews and photographs representing their everyday lives.
Supports and Success: Upon release from prison, the men shared the same community support worker and parole officer. After living in different living arrangements for a few years (supervised mental health approved home, then less structured home, then independently for Arnold and semi-independently for Garth), the support workers suggested they share an apartment to help with living expenses. The men were proud of their home and found many positives in living together. These included “having another person around to talk to, share a home life with, who understood what it was like to live with mental illness, and whom they could rely on to help them if they were becoming sick again.” They made community connections and were contributing to society in meaningful ways. The shared and coordinated supports meant they received regular check ins that helped them adhere to their parole conditions and organize their daily routines.
“To foster independence, mental health services usually encourage reducing and withdrawing services when clients are doing well.” However, the next part of Garth and Arnold’s story is a powerful and persuasive argument against this reduction in services even when things are going well.
Breakdown: Unfortunately, contact with their care team decreased over time. There were several stressors in Arnold’s life that led to him becoming very sick and losing touch with reality, and although some steps were taken to connect him with his health care team, there was an over-reliance on Garth to manage Arnold. Arnold became increasingly disordered and violently attacked Garth, resulting in acute injuries for Garth and two months in the psychiatric hospital for Arnold. Remarkably, the men remain friends. Garth asked for charges not to be laid against Arnold because he understood “Arnold was very sick when he attacked him and because he knew that being sent back to prison would destroy the progress Arnold had made postincarceration.”
The Lessons:
- Success and stability should not be met with complacency or the removal of community or health services for individuals living FASD with or without comorbid mental illness.
- Although there are no specific guidelines for long-term treatment of FASD, the authors suggest “support, supervision, and structure as well as mentoring by support workers and referral to specialists including psychiatrists and psychologists.” Garth and Arnold experienced 18 months of success with this model until supports were decreased.
- There is resilience and vulnerability in Garth and Arnold’s story. 24-hour mentor availability and hands on access to care can support resilience through treatments and supports while also recognizing ongoing vulnerability by monitoring for relapse signs and risks for recidivism.
- Garth and Arnold experienced significant adversity in their childhoods. This adversity, combined with neurocognitive deficits, likely elevated their risk for criminal justice involvement. The authors point to the “need within our society to protect and nurture vulnerable children, best done by notable reductions in poverty, comprehensive and sustainable supports for vulnerable families, and revisions to the child welfare system” (Link to more work done by Dr. Tait on this topic).
Hello! I’m Dr. Marnie Makela and I’m one of the voices behind the CanFASD blog. I’m also a researcher with CanFASD and a Registered Psychologist in Edmonton, AB. I received my PhD in School and Clinical Child Psychology from the University of Alberta. I work with individuals with FASD and other complex disabilities, their families, and their service providers to complete assessments and develop effective intervention plans that will create meaningful and positive life experiences.