Psychiatric Service to the Juvenile Court a Model

Abstract

The interface between psychiatry and the law developed unevenly and the greatest concentration has been in the area of criminal behaviour—family law and juvenile deliquency have been relatively ignored. When developing a clinical service in relation to a Family Court, the lack of literature on the subject became obvious. This paper gives an account of the historical development of the Family Court Clinic in Toronto beginning in 1920 at the time of the appointment of the first full-time Juvenile Court Judge. In terms of the problems and limitations the development of this clinic was typical of similar ventures elsewhere in North America. These problems include insufficient funding and staffing, unrealistic demands for service by the Courts, and incomplete understanding of the operation and needs of Courts on the part of mental health workers. A Family Court Clinic at the Clarke Institute of Psychiatry is offered as an example of a survivor of these and other vicissitudes, with the hope that some of its policies and practices may be useful to those involved in this work. It is felt that several ingredients are responsible for the success of the clinic, among them being attachment to a university clinical setting, a flexible appointment schedule such as evening office hours and the avoidance of a solely diagnostic approach to the work. In the past many clinics have failed because they were chiefly assessment-oriented, offering formulations of the problems but very little in the way of remedies. While unable to provide ongoing treatment for its very large clientele, the clinic operates in such a way as to provide a very broad range of service including a referral policy which treats the process of referral to other services more as a ‘service brokerage’ than the more conventional procedure of a referral letter. This is a much more active involvement which does not cease until the patient has begun receiving a service. Other programs of the clinic in relation to the Juvenile Court are mentioned in the paper and include training programs for judges and other court staff and also research activity. Experience over the past five years with the clinic is discussed in terms of the difficulties encountered in development and the attempts to resolve these. There is a need for clinicians involved in such enterprises to share problems and solutions and to anticipate increasing demands upon psychiatrists for service in relation to family law and family courts.