View source for Health and Substance Abuse as a Sentencing Factor

[[fr:La santé et la toxicomanie comme facteur de détermination de la peine]]
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==General Principles==
{{seealso|Sentencing Factors Relating to the Offender|Sentencing Factors Relating to the Offence|Sentencing Factors Relating to the Criminal Proceedings}}

Generally speaking the existence of medical conditions cannot be use to avoid what is otherwise a fit and proper sentence.<ref>
{{CanLIIRx|Bulic|jccfq|2020 ONCA 845 (CanLII)}}{{TheCourtONCA}}{{atL|jccfq|13}}<Br>
{{CanLIIRx|Heron|h41zt|2017 ONCA 441 (CanLII)}}{{atL|h41zt|25}} ("medical conditions cannot generally be used to avoid what is otherwise a fit and proper sentence")
</ref>
If health is being used to avoid a jail sentence there must be some evidence showing that the condition cannot be properly treated in jail.<reF>
{{CanLIIR|HS|g6mkb|2014 ONCA 323 (CanLII)}}{{perONCA|Epstein JA}}
</reF>

{{reflist|2}}
==Physical Health==

Physical disabilities that may make a custodial sentence more difficult can be mitigating.<ref>
{{CanLIIR|M T-S|jzfkh|2023 ONSC 4448 (CanLII)}}{{perONSC|Gibson J}}{{AtL|jzfkh|27}}
</ref>
An offender's health condition that is not "life threatening" will not justify a sentence outside the "usual range of sentence" unless there is evidence the condition cannot be treated within the custodial institution.<Ref>
{{ibid1|M T-S}}{{AtL|jzfkh|28}}<Br>
{{CanLIIR|LaCombe|jwhhm|2023 ONSC 1975 (CanLII)}}{{perONSC|Dawson J}}{{atL||36}}<br>
{{CanLIIR|HS|g6mkb|2014 ONCA 323 (CanLII)}}{{AtsL|g6mkb|37| to 38}}
</ref>

{{reflist|2}}

==Mental Health==
Mental health can be a mitigating factor to sentence even where it is not so severe to remove criminal responsibility.<ref>
{{CanLIIRP|Peters|1nc5q|2000 NFCA 55 (CanLII)|194 Nfld. & PEIR 184 (NLCA)}}{{perNLCA|Green JA}}, (“the mental illness of an offender will often be considered a mitigating factor in sentencing even though it is not of the sort that would establish a verdict of not criminally responsible on account of mental disorder at the time of the commission of the offence.”)</ref>

Reduction of sentences due to psychiatric grounds fall into two categories. The mental illness contributed to or caused the commission of the offence or the effect of imprisonment or penalty would be disproportionately severe because of the offender's condition.<ref>
{{CanLIIRP|Belcourt|2d2hg|2010 ABCA 319 (CanLII)|490 AR 224}}{{perABCA|Slatter JA}} (2:1){{atL|2d2hg|8}}<Br>
</ref>

An offender's emotional condition due to the personal circumstances of the accused should not be conflated with "mental health problems" that should accord some special treatment in sentence.<ref>
{{CanLIIRP|Lausberg|fz80n|2013 ABCA 72 (CanLII)|544 AR 56}}{{perABCA|McDonald JA}} - Sentencing judge erred by considering the emotional state as being a mental health problem<br>
</ref>

The offender must show that a lengthy sentence would have a "severe negative effect on the offender such that it should be reduced on compassionate grounds."<ref>
{{CanLIIRP|Prioriello|fsklm|2012 ONCA 63 (CanLII)|288 OAC 198}}{{perONSC|O'Connor J}}{{atL|fsklm|12}}
</ref>

; Causal Connection
Generally, for a mental illness is to be considered mitigating, the offender must show that there is a causal link between the condition and the criminal conduct.<ref>
{{ibid1|Prioriello}}{{atL|fsklm|11}} ("In order for a mental illness to be considered as a mitigating factor in sentencing, the offender must show a causal link between his illness and his criminal conduct, that is, the illness is an underlying reason for his aberrant conduct")<Br>
{{CanLIIR-N|Robinson|, [1974] O.J. No. 585 (C.A.)}}
</ref>

Mental disorders, such as schizophrenia, can be a mitigating factor even when there is no a direct causal connection between the offence and the illness. <ref>
{{CanLIIRP|Ayorech|fqjzl|2012 ABCA 82 (CanLII)|[2012] AJ No 236}}{{TheCourtABCA}}{{atL|fqjzl|10}} (“mental disorders, particularly schizophrenia, can significantly mitigate a sentence, even if the evidence does not disclose that the mental illness was the direct cause of the offence or that it was carried out during a period of delusions, hallucinations, or such.”)</ref>
This is also true where the offender was not suffering from delusions at the time.<ref>
{{CanLIIRP|Resler|flrdq|2011 ABCA 167 (CanLII)|95 WCB (2d) 165}}{{TheCourtABCA}} (3:0)<br>
{{ibid1|Ayorech}}</ref> 
It is sufficient that the illness contributed in some way to the offence.<ref>
{{supra1|Belcourt}}</ref> 
However, the offender's mental health condition is not a factor in sentencing where there is no connection at all between the offence and the condition.<ref>
{{CanLIIRP|Shahnawaz|1fbgv|2000 CanLII 16973 (ON CA)|149 CCC 97}}{{perONCA|Charron JA}}</ref>

By contrast, a person who commits a crime of violence "while in a sane and sober condition, unaffected by mental impairment of any kind, has the highest level of responsibility, or moral culpability."<ref>
{{CanLIIR-N|Hagendorf|, 2000 CarswellOnt 5245 (S.C.)}}{{perONSC|Durno J}}{{at-|50}}</ref>

; Incarceration
Treatment in the community is generally preferred over incarceration.<ref>
{{CanLIIRP|Lundrigan|fs0sg|2012 NLCA 43 (CanLII)|[2012] NJ No 231 (NLCA)}}{{perNLCA|Rowe JA}}{{atL|fs0sg|20}}<br>
</ref> 
However, this is less so for serious offences.<ref>
see {{CanLIIR-N|JM|, [2008] NJ No 262 (P.C.)}}<br> 
{{CanLIIRP|Taylor|fs56r|2012 CanLII 42053 (NLPC)|[2012] NJ No 251 (P.C.)}}{{perNLPC|Mennie J}}<br>
</ref>

Mental illness is often considered a basis to order treatment and supervision over punishment.<ref>
see {{CanLIIRP|Valiquette|1phqx|1990 CanLII 3048|60 CCC (3d) 325}}{{perQCCA|Rothman JA}}{{atp|331}} (“most people understand that the mentally ill require treatment and supervision, not punishment”)</ref>

; Deterrence and Denunciation
General deterrence should be given "very little, if any, weight" since it is not an appropriate manner of making an example to others.<ref>
{{supra1|Belcourt}}{{atL|2d2hg|8}}
</ref>

Where mental health plays "a central role in the commission of the offence ... deterrence and punishment assume less importance."<ref>
{{CanLIIRP|Batisse|22cd6|2009 ONCA 114 (CanLII)|241 CCC (3d) 491}}{{perONCA|Gillese JA}}<br>
</ref>

However, at times mental illness will be considered an aggravating factor that will increase sentence where it is necessary to protect the public from a dangerous persons who has committed a dangerous offence.<ref>
{{CanLIIRP|Lockyer|1nc5p|2000 NLCA 59 (CanLII)|[2000] NJ No 306}}{{perNLCA|Roberts JA}} (2:1)</ref>
Mental illness reduces the importance of denunciation and deterrence and increases the importance of treatment. This includes situations where rehabilitation or cure is impossible.<ref>
{{CanLIIR-N|Hiltermann|, [1993] AJ No 609 (CA)}}{{ats-|4-8}}</ref>

It is suggested it should be given little if any weight since the punishing of the offender will not make an example to others by way of general deterrence.<ref>
{{CanLIIRP|Newby|2dth0|1991 ABCA 307 (CanLII)|84 Alta LR (2d) 127}}{{perABCA|Foisy JA}}<br>
{{CanLIIRP|Rhyno|2694m|2009 NSCA 108 (CanLII)|900 APR 246}}{{perNSCA|Oland JA}}<br>
{{CanLIIRP|Dickson|1tsdq|2007 BCCA 561 (CanLII)|228 CCC (3d) 450}}{{perBCCA|Finch CJ}} (3:0)<br>
</ref>

The mental condition will attenuate the relative importance of deterrence and denunciation.<ref>
{{CanLIIRP|Tremblay|1p97b|2006 ABCA 252 (CanLII)|401 AR 9}}{{perABCA|Martin JA}}{{atL|1p97b|7}}<br>
{{CanLIIRP|Resler|flrdq|2011 ABCA 167 (CanLII)|95 WCB (2d) 165}}{{TheCourtABCA}} (3:0){{atL|flrdq|14}}<br>
</ref>

; Degree of Responsibility
A mental illness diminishes the offender’s degree of responsibility.<ref>
{{CanLIIRP|Ayorech|fqjzl|2012 ABCA 82 (CanLII)|522 AR 306}}{{TheCourtABCA}}{{atL|fqjzl|12}}<br>
{{CanLIIRP|Resler|flrdq|2011 ABCA 167 (CanLII)|95 WCB (2d) 165}}{{TheCourtABCA}}{{atsL|flrdq|9| to 10}}, {{atsL-np|flrdq|16|}}<br> 
{{supra1|Belcourt}}{{atsL|2d2hg|7| to 8}}<br> 
{{CanLIIRP|Muldoon|1pzrv|2006 ABCA 321 (CanLII)|213 CCC (3d) 468}}{{TheCourtABCA}} (3:0){{atsL|1pzrv|9| to 10}}</ref>

; Impact of Jail
Incarceration of persons with mental health issues can create a disproportionate impact upon them, which can be a mitigating factor.<ref> 
{{supra1|Newby}}<br>
{{supra1|Ayorech}}<br>
</ref>

An Offenders mental illness can make a jail sentence more severe.<ref>
{{supra1|Ayorech}} at 13  (“Ayorech’s mental disorders have left him vulnerable, such that Dr. Santana opined that he ‘was ill equipped to survive in the prison system.’")</ref>

While it has also been observed that the managing of mental health issues and other medical factors are best handled by correctional authorities who are obligated to provide essential health care including mental health care.<Ref>
{{CanLIIRx|CF|jb5zd|2020 ONSC 5975 (CanLII)}}{{perONSC|Leibovich J}}{{atL|jb5zd|57}}<Br>
{{CanLIIRP|Shahnawaz|1fbgv|2000 CanLII 16973 (ON CA)|149 CCC (3d) 97}}{{perONCA|Charron JA}} (2:1){{AtsL|1fbgv|30| to 34}}<br>
{{supra1|Prioriello}}
</ref>

It is recognized that it is "difficult" to predict the mental health condition of persons in custody.<ref>
{{ibid1|Shahnawaz}}{{atL|1fbgv|34}}
</ref>

; Cognitive Deficits
Diminished intellectual capacity is not a mitigating factor warranting a lesser sentence.<ref>
{{CanLIIRP|H(MJ)|1jjnk|2004 SKCA 171 (CanLII)|257 Sask R 1}}{{perSKCA|Richards JA}} (3:0)
</ref>

The cognitive deficit from Fetal Alcohol Spectrum Disorder (FASD) results in limited restraints as well as an appreciation of the immorality of their actions. This reduces the impact on deterrence and denunciation and increases the mitigation on sentence.<ref> 
{{CanLIIRP|Ramsay|fsl7t|2012 ABCA 257 (CanLII)|292 CCC (3d) 400}}{{TheCourtABCA}} (3:0)</ref>

Systemic failures to treat the offender's mental health are mitigating factors.<ref>
{{CanLIIRx|Adamo|g0ptp|2013 MBQB 225 (CanLII)}}{{perMBQB|Suche J}}<br>
{{supra1|Ayorech}} <Br>
</ref>

; Other Conditions
There has been some reference to PTSD being a mitigating condition.<Ref>
{{CanLIIRx|Walendzewicz|j4b3x|2020 ONSC 57 (CanLII)}}{{atL|j4b3x|37}}
</ref>

{{reflist|2}}

==Addiction and Substance Abuse==
Substance abuse, by itself, is not ordinarily a mitigating factor.<ref>
{{CanLIIRP|Ayorech|fqjzl|2012 ABCA 82 (CanLII)|522 AR 306}}{{TheCourtABCA}}{{atL|fqjzl|10}}<br>
cf. see {{CanLIIRP|Sheppard|27psj|1997 CanLII 14629 (NL CA)|147 Nfld. & PEIR 304}}{{perNLCA|O'Neill JA}}<br> 
cf. {{CanLIIRP|Lane|fww3f|2004 NLSCTD 49 (CanLII)|[2004] NJ No 95 (S.C.)}}{{perNLSC|LeBlanc J}}<br>
cf. {{CanLIIRP|Breen|gbrz7|1982 CanLII 3889 (NL CA)|37 Nfld. & PEIR 472}}{{perNLCA|Gushue JA}} (“the effect of alcohol or drugs” can be considered as mitigating factors in sentencing, “that consideration is normally confined to cases where the actions of a person are completely out of character. Thus, lenient treatment may be justified in anticipation of rehabilitation")<br>
</ref>
Nor is a history of addiction a mitigating factor to sentence. However, it can suggest a lower level of moral culpability and otherwise good character but for the addiction. It is also helpful for the court to know about to determine whether rehabilitation is a possibility when crafting an appropriate sentence.

Refusal to apply mitigation can be justified by the fact the accused has not availed of any treatment programs.<REf>
{{CanLIIR|Sesay|j4z95|2020 BCCA 41 (CanLII)}}{{AtL|j4z95|38}} ("Further, it is not surprising that the appellant’s substance abuse disorder was not treated as a mitigating factor where the appellant, despite his criminal history, has not availed himself of any form of drug or alcohol treatment in the past.")
</ref>

An offender with issues with substance abuse may be subject to probationary terms requiring them to abstain absolutely from the possession or consumption of the substances. However, some courts will take the view that such restrictions can be counter-productive where there is no belief that they will comply with the conditions.<ref>
{{CanLIIRx|Warren|fstt4|2012 CanLII 54025 (NL PC)}}{{perNLPC|Gorman J}}{{atL|fstt4|58}}</ref>

; Gambling
Gambling addiction is not generally a mitigating factor.<ref>
{{CanLIIRP|Holmes|5s4c|1999 ABCA 228 (CanLII)|237 AR 146}}{{TheCourtABCA}}<br>
cf. {{CanLIIRP|Wilson|frb00|2012 NSPC 40 (CanLII)|1002 APR 96}}{{perNSPC|Ross J}}<br>
</ref>
However, some courts have treated it as a reduction to moral culpability as it has the effect of reducing the accused's free will and power of control due to a mental disease.<ref>
{{CanLIIRP|Horvath|1mctn|1997 CanLII 9759 (SK CA)|[1997] SJ No 385}}{{perSKCA|Bayda CJ}}<Br>
</ref>

; Addictions and Mental Health
It has been noted that the combination of addiction and mental health make rehabilitation harder.<ref>
{{CanLIIRx|Fuller|hmvq6|2017 ABCA 361 (CanLII)}}{{TheCourtABCA}}{{AtL|hmvq6|13}}<br>
</ref>

{{reflist|2}}