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 
• Mental Health and Corrections: Scope of the Problem 
• Legislative and Policy Framework 
• Response of the Correctional Service 
• Issues, Challenges and Constraints 
• Change in Correctional Practice 
• Future Directions for Reform 
• Concluding Remarks 

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) 

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

Date modified 
2013-09-16