- Backgrounder -
Key Concerns, Analysis and Recommendations
November 5, 2010
- Access to Physical and Mental Health Care
- Deaths in Custody
- Conditions of Confinement
- Aboriginal Issues
- Access to Programs
- Federally Sentenced Women (Horizontal Priority)
I. Access to Physical and Mental Health Care
Staffing to Meet Mental Health Challenges
- Prevalence of mental health issues in federal corrections is increasing. One in four new admissions to federal custody presents some form of mental illness.
- System faces a number of capacity, accessibility and quality of care challenges, including lagging recruitment and retention of mental health professionals.
- 20% vacancy rate in psychology positions.
- Enhance recruitment efforts for mental health professionals, including exploring the possibility of securing exemptions on rates of pay and to work with professional licensing bodies on scope of practice, training, portability and professional development.
- Renew correctional officer recruitment standards to ensure new hires have the requisite knowledge, personal competencies and educational background to manage an increasingly demanding offender mental health profile.
Management of Self-Injurious Offenders
- Incidents of self-harming behaviour are rising; at least 25% of the women inmate population has a history of self-harming.
- Management of this problem requires investments in specialized infrastructure, expert staffing, clinical tools and research.
- Revise the National Strategy and National Action Plan to Address the Needs of Offenders who Engage in Self-Injury to specifically respond to documented concerns raised by this Office to include:
- A permanent funding strategy
- A proven treatment program/plan supported by clinical research
- A commitment to physical environment(s) conducive to a therapeutic, patient-centred and continuum of care approach to managing self-harm in prisons.
- Develop a clinical management plan ( CMP ) for all offenders who self-harm or attempt suicide in prison. The CMP would be updated regularly as a continuum of care tool.
Use of Physical Restraint Equipment
- The “compliant” use of physical restraints to manage self-injury/suicidal behaviour is no longer considered a reportable use of force.
- Physical restraints should only be applied as an extraordinary measure, as a last resort and for the shortest period possible.
- The Service must provide more rigorous ethical guidelines and clinical instruction to govern the use of physical restraints in a prison environment – e.g. consent to treatment.
- Issue revised Commissioner’s Directives on the Prevention, Management and Response to Suicide and Self-Injuries and Use of Restraint Equipment for Health Purposes as a matter of priority consistent with recognized best practices, inclusive of the American Bar Association’s Criminal Justice Standards on the Treatment of Prisoners .
Intermediate Mental Health Care
- The transition from a treatment-based and therapeutic environment (such as a Regional Treatment Centre) to the general inmate population is often problematic, pointing to the need for intermediate care units and better information-sharing tools between clinical and front-line staff.
- Designate at least one Intermediate Care Unit in each Region, and develop dedicated intermediate care capacity (beyond the current Structured Living Environments) for women offenders. (Note: In endorsing the John Service report on mental health, the CI letter of September 23, 2010 calls upon CSC to internally reallocate resources to fund intermediate care).
- Ensure updated clinical management plans ( CMP ) accompany every offender discharged from the regional treatment centres back to their home institution. This plan should include basic information and instruction that could be shared with front-line staff that would not breach privacy or confidentiality standards.
Segregation and Mental Health
- The long-term (over 60 days) segregation population is growing. The average number of days spent in segregation is 95. The daily segregation count averaged just over 900 offenders in 2008-09.
- High segregation numbers give rise to concerns about the adverse effects of solitary confinement on mental health and reintegration potential.
- The restrictive “supermax” environment of the Special Handling Unit (SHU) is not conducive to treatment interventions for acute mental health problems; the SHU should not be used to warehouse mentally ill offenders who cannot be managed elsewhere in the system.
- Prohibit prolonged segregation of offenders with acute mental health issues.
- Conduct an independent and expert review of the mental health profile of offenders residing at the Special Handling Unit, which would include options and recommendations for managing these offenders in the least restrictive and most clinically appropriate manner possible.
Physical Health Care
- Prevalence rates of infectious diseases (Hepatitis C and HIV) are increasing. 30% of the inmate population is infected with HepC.
- Good prison health is also good public health. Offenders do not have the same access to harm reduction measures as the community.
- The offender population is “graying” presenting physical health care challenges:
- management of chronic health problems and diseases associated with aging
- physical ambulation
- independent living
- palliative care.
- Provide a full and comprehensive range of harm reduction measures to federal inmates.
- Conduct a comprehensive population health analysis of the incarcerated population aged 50 years and older, and devise a strategy to meet current and anticipated physical health care needs in the areas of accommodation, program development, independent care and living and conditional release planning on compassionate grounds.
II. Deaths in Custody
- 532 inmates died in federal custody from 1998-2008. The suicide rate is 7 times higher in federal penitentiaries than the national average.
- In 2009-10, OCI conducted quarterly assessments of CSC ’s progress in preventing deaths in custody.
- While the Service is committed to reducing preventable deaths in custody, improvements are required in the following areas:
- response to medical emergency
- monitoring of suicide pre-indicators
- management of mentally ill offenders
- quality/frequency of security rounds and patrols
- balancing security requirements against preservation of life principles
- quality of internal investigative reports
Publicly release CSC ’s Performance Accountablity Framework to Reduce Preventable Deaths in Custody in fiscal year 2010-11. This document should serve as the public record for tracking annual progress in this area of corrections.
- CSC has implemented an “alternative” Section 19 exercise for reviewing deaths by natural cause referred to as the Mortality Review Process ( MRP ).
- Just over 100 natural deaths falling under the MRP were reviewed by the Office in 2009-10.
- OCI is concerned that the MRP lacks the kind of rigour and integrity required to detect errors, take corrective action and avert future preventable deaths. A number of deficiencies are noted in the current MRP Guidelines :
- no external membership
- no independent review
- devoid of analytical content or clinical comment
- limited senior management review and follow-up.
- Suspend the Mortality Review exercise immediately until such time as the Guidelines can be independently and expertly validated to meet section 19 provisions of the Corrections and Conditional Release Act. In the interests of transparency and accountability, the results of this review should be made public.
III. Conditions of Confinement
- The physical conditions of confinement are becoming more restrictive. There are limited opportunities for inmate association, movement and assembly at the higher security levels.
- Inmates are spending more time in their cells as a result of an increasing number of lock-downs, “exceptional searches” and “modified” routines.
- These activities are disruptive and impede access to programs, visits and associational privileges.
- Good dynamic security practices are critical to the overall health and safety of inmates and staff alike.
- Measurably strengthen dynamic security practices and principles, and implement the recommendation of the Working Group Report on Medium Security calling for additional and mandatory refresher training in dynamic security.
- In past 5 years, double-bunking has increased by 50%. One in ten inmates is now double-bunked. Double-bunking in segregation and in the secure units of the regional women’s facilities has been reported.
- High double-bunking rates reflect other problems; including limited capacity to move offenders to minimum security institutions before release to the community.
- Estimates suggest that the inmate population will continue to grow, with the highest pressures in medium security institutions. We can expect more institutional violence and unrest.
- Complete inmate accommodation placement criteria for double-bunking assignments in a timely and comprehensive manner and review by regional authorities on a regular (i.e. quarterly) basis.
- Conduct a review of all offenders that were released by the National Parole Board to the community directly from medium security facilities and determine the reason why these offenders were not housed in minimum security institutions prior to release.
- Publicly release long-term capital, accommodation and operations plans, once approved by Treasury Board, including offender population forecasts and planned capital expenditures for new construction as well as ongoing maintenance costs.
Segregation by “any other name”
- Increasing number of segregation-like units/ ranges operating outside of policy and procedural safeguards.
- The law recognizes only two inmate populations – general population and administrative segregation.
- Minister to direct the Service to conduct an immediate review of all inmates in segregation-like units to ensure they are provided the same legislated protections and access to programs afforded to the general inmate population.
Use of Force Policy
- Use of force incidents increased 25% over previous year, despite recent policy changes to no longer include the display of a firearm as a reportable use of force.
- Reporting these incidents is necessary to ensure that staff are acting in a manner consistent with policy and the “least restrictive measure” principle. The display of a weapon is an act of force for which the Service should be accountable.
- OCI review of use of force incidents reveals several areas of non-compliance:
- least restrictive option
- videotape policy
- use of privacy barriers
- decontamination procedures
- follow-up health care monitoring.
- Consider all incidents that involve the use of chemical or inflammatory agents, or the displaying, drawing or pointing of a firearm, up to and including its threatened or implied use, a reportable use of force.
IV. Aboriginal Issues
- Aboriginal offenders account for close to 20% of the inmate population; the Aboriginal women offender population has grown by almost 90% in last ten years.
- The correctional “gap” between non-Aboriginal and Aboriginal offenders is widening:
- released later in their sentence
- over-represented in segregation
- more likely to be released at statutory release
- more likely to be classified as higher needs and risk
- Current practice does not require the Service to disclose how Gladue principles impact decision outcomes for Aboriginal offenders.
- Provide clear and documented demonstration that Gladue principles are considered in decision-making involving the retained rights and liberties of Aboriginal offenders in the following areas: segregation placements, access to programming, custody rating scales, penitentiary placements, access to the community, conditional release planning and involuntary transfers.
- Increase the use of Sections 81 and 84 of the Corrections and Conditional Release Act to their fullest and intended effect.
V. Access to Programs
- Too many offenders are not getting the programs they need when they need it. Less than 25% of the inmate population is engaged in correctional programming at any given time.
- Research indicates that programming is associated with greater likelihood of conditional release grants, lower readmission and decreased recidivism rates.
- A significant portion of the inmate population have a history of unstable work and/or lack job skills – e.g. dependability, reliability, ability to work with others.
- Prison-based employment and vocational programs, such as the prison farms, provide transferable job market skills and valuable life lessons.
- Provide a public report, prior to the closure of any Corcan agri-business operation, on how lost farm jobs would be replaced. The report should also detail the kind of employability skills and vocational training that is envisioned in federal corrections, including how the Service intends to create viable, realistic and meaningful job opportunities in the penitentiary environment to meet present and future market demands.
VI. Federally Sentenced Women
- The number of women offenders has increased by 40% in last ten years.
- Women offenders have significantly different needs and profiles than male offenders:
- twice as likely to have a significant mental health diagnosis
- twice as likely to be serving a sentence for drug-related offences
- serving shorter sentences
- high percentage has been sexually or physically abused
- more likely to be supporting dependants on the outside
- There is currently no stand-alone minimum security institution for women.
- Recent policy changes have significantly reduced participation in the mother-child program.
- Review eligibility restrictions on the Mother-Child program with a view to maximizing safe participation.
- Modify perimeter controls in the regional women’s facilities to allow minimum security offenders to reside outside the high security fence. In facilities where this is not achievable, provide stand-alone accommodations for minimum security women residing in the community.