Mental Health and Corrections

Department of Psychology Colloquium Series
Saint Francis Xavier University
Antigonish, Nova Scotia

Howard Sapers
Correctional Investigator of Canada

March 18, 2011



Mandate of the Office of the Correctional Investigator

Role and Mandate

  • The Office of the Correctional Investigator (OCI) acts as an Ombudsman for offenders serving a sentence of two years or more
    • independent monitoring and oversight of federal corrections
    • accessible and timely review of offender complaints
    • determines whether the Correctional Service of Canada (CSC) has acted fairly, reasonably and in compliance with law and policy
    • makes recommendations to ensure accountability in corrections
  • The Office was formally entrenched in legislation in November 1992 with the enactment of the Corrections and Conditional Release Act
  • The Act gives the OCI broad authority and the responsibility to investigate offender complaints related to "decisions, recommendations, acts or omissions" of CSC

Operations

  • The Office has approximately 30 staff, the majority of which are directly involved in the day-to-day addressing of inmate complaints. On average, the Office receives over 6,000 offender complaints annually
  • In 2009-10, investigators spent in excess of 330 days in federal penitentiaries and interviewed more than 1,600 offenders
  • The Office received 30,000 contacts on its toll-free number and conducted over 1,400 use of force reviews

TABLE: AREAS OF CONCERN MOST FREQUENTLY IDENTIFIED BY OFFENDERS (2009-2010)

Total Offender Population
CATEGORY # %
Health Care 766 14.68%
Cell Effects 397 7.61%
Administrative Segregation 394 7.55%
Transfer 393 7.53%
Staff 397 7.26%
Grievance 244 4.68%
Visits 220 4.22%
Telephone 168 3.22%
Case Preparation 157 3.01%
Information 154 2.95%

Mental Health and Corrections: Scope of the Problem

Mental Illness and Corrections

Prevalence Rates

  • Mental health problems are 2 to 3 times more prevalent in federal penitentiaries than in the general population
  • Proportion of federal offenders with significant, identified mental health needs has more than doubled between 1997 and 2008:
    • 71% increase in offenders diagnosed with mental disorders
    • 80% increase in number of inmates on prescribed medication

At admission (2007-08 data):

    • 11% of male offenders had a significant mental health diagnosis
    • Over 20% were taking a prescribed medication
    • Just over 6% were receiving outpatient services
    • Women offenders twice as likely to have mental health diagnosis at admission; over 30% had previous history of psychiatric hospitalization
  • Offenders with a diagnosed mental disorder are typically afflicted by more than one disorder (90%), often substance abuse (80%)

  • Incidents of serious self-harming behaviour in federal prisons (e.g. head banging, slashing, use of ligatures, self-mutilation) are rising; one in four women offenders has a history of self-harm

  • On average, 11-13 federal inmates commit suicide annually. The rate of suicide in federal custody is approximately 7 times higher than the national average.

  • According to CSC: "mentally ill inmates represent a considerable proportion of prisoners who commit suicide, and their suicides are probably the easiest to prevent."

Prisons and Mental Illness

  • Physical conditions of prison confinement (e.g. deprivation, isolation and separation from family and loved ones) can be hard on mental health functioning
  • Prison environments are often crowded, austere, noisy, devoid of natural light, violent, stressful, volatile, restrictive and unpredictable
  • These conditions are not conducive to therapy or rehabilitation
  • Some of the older penitentiaries lack the physical infrastructures, design and capacity to adequately respond to rising needs and complexity of mental health problems
  • For staff, managing mentally disordered offenders in prison creates professional and operational dilemmas related to conflicting priorities and objectives - security vs. treatment; inmate vs. patient; assistance vs. control; prison vs. hospital

Prisons as the New Asylums

Federal penitentiaries are housing some of the largest populations of the mentally ill in Canada, the cumulative result of:

  • Impact of the deinstitutionalization movement
  • Inadequate and fragmented community services and supports
  • 'Criminalization' of behaviours associated with untreated mental health problems and 'zero-tolerance' policies
  • Disproportionate incarceration of vulnerable and 'at risk' populations (Aboriginal, homeless, impoverished, addicted)

Legislative and Policy Framework

  • The CCRA provides that the Correctional Service "shall provide every inmate with essential health care and reasonable access to non-essential mental health care that will contribute to the inmate's rehabilitation and successful reintegration into the community."
  • The Service is further obligated to consider an offender's state of health and health care needs in all decisions, including placement, transfer, segregation, discipline and community release and supervision.
  • CSC policy states that a "continuum of essential care for those suffering from mental, emotional or behavioural disorders will be provided consistent with professional and community standards."

Response of the Correctional Service

  • Over $60M dedicated new funding has been committed in recent years:
    • $29M over five years for Community Mental Health Initiative (2005)
    • $21.5 M over two years for Institutional Mental Health Initiative (2007)
    • $16.6M annual permanent funding for Institutional Mental Health (commencing 2009-10)

Issues, Challenges and Constraints

  • Under-resourced (high vacancy rates for health professionals)
  • Lack of bed space at regional psychiatric facilities
  • Aging and inappropriate infrastructure to meet rising need
  • Lack of funding to create intermediate mental health care units
  • Recruitment and retention of mental health care professionals, especially clinical nurses, psychiatrists and psychologists
  • Training for front-line staff in recognizing and dealing with mentally disordered offenders
  • Sharing of information between front-line staff, mental health and health care professionals
  • Stressed and fatigued staff

Change in Correctional Practice

  • The pace of change has been slow and progress uneven
  • CSC's response lack coordination and integration across different sectors of correctional activity from admission to release
  • The overall effort lacks a sense of urgency, immediacy and priority

Future Directions for Reform

  • In cases where diversion is not possible and incarceration is necessary, minimum standards of care must be provided
  • Offenders that cannot be effectively treated or safely managed within CSC should be transferred to provincial/territorial psychiatric facilities on a case-by-case basis
  • Mental health programming needs to target risk and prevention factors

Concluding Remarks

  • Early detection, diagnosis and intervention, greater access to services, supports and treatment options in the community, and a range of prevention and diversion measures, offer far more promise than incarceration
  • A National Strategy for Mental Health and Corrections is required to bring coordination and integration of services and supports across different jurisdictional, sectoral and disciplinary divides ("justice health")
  • As a country, we need to address social problems that bring distressed and vulnerable persons disproportionately into contact with the criminal justice system - poverty, homelessness, substance abuse, exclusion and social marginalization