Mr. Sapers: Thank you for the invitation to appear before this Committee and discuss two important issues facing federal Corrections, namely the care and custody of offenders with mental health disorders and access to programs to prepare offenders for timely and safe reintegration into the community.
Before I address these two issues, I would like my Executive Director and General Counsel, Dr. Ivan Zinger, to provide you with a brief overview of the role and mandate of my Office.
Following this overview, I will outline my concerns regarding the delivery of mental health services to federal offenders. I will then ask Dr. Zinger to speak about access to correctional programs (including substance abuse programs).
Dr. Zinger: Last year, the Office of the Correctional Investigator celebrated its 35 th anniversary. The Office was established in 1973 to strengthen the accountability and oversight of the federal correctional system. The Office was given a legislative mandate on November 1, 1992 with the enactment of the Corrections and Conditional Release Act .
The Office investigates and resolves individual federal offender complaints. As well, it has a responsibility to review and make recommendations on the Correctional Service of Canada's policies and procedures associated with individual complaints. In this way, systemic areas of concern can be identified and appropriately addressed.
The Office has twenty-four staff, and receives between five and seven thousand offender inquiries and complaints annually. Last year, our investigative staff spent approximately three hundred days in federal penitentiaries conducting interviews with more than two thousand offenders. In addition, our staff met with many other individuals during their penitentiary visits, including Wardens, correctional staff, inmate committees, native brotherhoods and sisterhoods, and health care professionals.
Overall, the most common inmate complaints are related to health care, followed by institutional transfers, administrative segregation, and case preparation for conditional release. It should be noted that specific offender complaints related to mental health services are relatively infrequent. However, mental health issues are often a key factor in many complaints received by this Office. For example, offenders may complain about being placed in administrative segregation or transferred into a higher security penitentiary, or having been subject to an unjustified use of force. After investigating, we discover that the placement in administrative segregation or the transfer to a higher security institution or the use of force were the result of a disruptive behaviour due to a pre-existing mental health condition.
Mr. Sapers: As you can see, my mandate expresses important elements of the criminal justice system. The Office reflects Canadian values of respect for the law, for human rights, and the public’s expectation that correctional staff and senior managers are accountable for the administration of law and policy on the public’s behalf. Good Corrections, after all, equals public safety.
Let me now turn to the issue of mental health in federal Corrections. First, the Correctional Service of Canada is legislatively mandated to provide health care to offenders through the Corrections and Conditional Release Act ( CCRA ) as federal offenders are excluded from the Canada Health Act and are not covered by Health Canada or provincial health systems. The Correctional Service therefore must provide health care services (including mental health services) directly to federal offenders, including those residing in Community Correctional Centres. The CCRA states that the health care services provided must conform with "professionally accepted standards."
In the last decade, Canada experienced a significant increase of offenders with mental illness entering federal penitentiaries. The Correctional Service is now in the position of having to manage offenders that require a high degree of professional mental health service and care. The ability of the Correctional Service to effectively and humanely manage this increasing and challenging population is being tested to its limits.
Mental health problems are up to three times more common among inmates in correctional institutions than among the general Canadian population. More than 1 out of 10 male inmates and 1 out of 5 female inmates have been identified at admission as having significant mental health problems, an increase of 71 percent and 61 percent, respectively, since 1997. A recent snapshot of federally incarcerated offenders in Ontario indicated that 39% of the Ontario offender population were diagnosed with a mental health problem – a staggering challenge for any correctional authority.
The Correctional Service has been aware of its challenge in this area for a long time. In fact, in July 2004, it approved a Mental Health Strategy that identified serious gaps in services and promoted the adoption of a continuum of care from initial intake through the safe release of offenders into the community. At the time, my Office concurred with the Correctional Service’s identification of gaps in mental health services and endorsed its strategy.
The Strategy indicated that significant investments were required in four major areas:
- comprehensive clinical intake assessment;
- specific requirements for enhancing the current five Regional Treatment Centres (i.e., psychiatric hospitals ran by the Correctional Service);
- intermediate mental health care units within existing institutions to provide on-going treatment and assessment during the period of incarceration; and,
- community mental health to support offenders on conditional release.
In December 2005, the Correctional Service secured funds to strengthen the community component of this strategy. This Office welcomed the news of these new investments—approximately $6 million per year for five years—in community mental health. We also were pleased when the Government of Canada included in its March 2007 Budget new temporary investments—approximately $21 million over two years—to address the lack of a comprehensive mental health intake assessment process and to improve primary mental health care in CSC institutions. The March 2008 Budget provided ongoing funding for these initiatives—approximately $16 million per year.
Despite these important investments (totaling over $60M to date), I continue to be disappointed by the very slow pace of change and by the lack of real, demonstrable improvements in the level of mental health services and support provided to offenders with mental disorders.
There is no doubt that the Correctional Service has had some successes in the last two years, such as the implementation of a new mental health training package for front-line staff, the development of a mental health screening system at intake and the implementation of an enhanced discharge planning community initiative. However, the overall situation of offenders suffering from mental health disorders has, in my view, not significantly changed since my Office first reported about the troubling situation back in 2004.
The problem faced by the Correctional Service is largely one of capacity to respond to an increasing number of offenders with significant mental health issues. This problem is compounded by the inability of the Correctional Service to recruit and retain trained mental health professionals, and by security staff that are ill-equipped to deal with health-related disruptive behaviours.
For example, the majority of a psychologists’ day within CSC is spent conducting mandatory risk assessments to facilitate security or conditional release requirements rather than treating or interacting with offenders in need of their clinical services. Those offenders with acute needs, or requiring specialized intervention, may be sent to one of the five Regional Treatment Centres; however only if they meet the admissions criteria that they possess a serious and acute psychiatric illness. Typically, however, the offender is monitored at the RTC only to be returned to the referring institution after a period of 'stabilization.' Driven by volume, the Regional Treatment Centres have become a revolving door of referrals, admissions and 'discharges.'
The overwhelming majority of offenders suffering from mental illness in prisons do not generally meet the admission criteria that would allow them to benefit from services provided in the Regional Treatment Centres. They stay in the general institutions, and their illnesses are often portrayed as "behavioural" problems, not mental health issues per se . This is especially true for offenders suffering from brain injuries and those with FASD .
I am particularly concerned by the persistent and pervasive use of segregation to manage and isolate offenders with mental disorders in federal penitentiaries. As I noted in my testimony before the Senate Standing Committee on Social Affairs, Science and Technology, in 2005 offenders who are locked up in segregation for up to 23 hours a day in maximum security institutions are often intellectually challenged or present behavioural problems, have learning disabilities and/or symptoms of attention deficit hyperactivity disorder, or have fetal alcohol spectrum disorder. The mentally ill often suffer from illogical thinking, delusions, paranoia and severe mood swings. In the correctional environment, mentally ill offenders do not always comprehend, conform or adjust properly to the rules of institutional life. Irrational and compulsive behaviours associated with their individual affliction can result in verbal or physical confrontations with staff or other inmates, which often leads to institutional charges and long periods in administrative or disciplinary segregation. Mental illness can lead to a vicious cycle in correctional settings.
Simply placing an offender in ever more restrictive conditions of confinement and isolation is not an effective correctional or mental health intervention. Prolonged periods of deprivation of human contact cannot but adversely affect mental health and is counterproductive to rehabilitation. Far from treating personality disorders and mental illness, the conditions of deprivation in most segregation and dissociation cells too often serves to exacerbate the symptoms and "acting-out" behaviours such placements are supposed to be managing. After conducting an investigation, my Office often discovers that these placements are the result of disruptive behaviour from a prevailing mental health condition. It is a classic "catch-22" scenario: when the intervention fails, the response is to do more of the same.
The practice of confining mentally disordered offenders to prolonged isolation and deprivation must end. It is not safe, nor is it humane.
A case in point is the death of Ms. Ashley Smith. Ms. Smith died on October 19, 2007, at the age of 19 at Grand Valley Institution for Women ( GVI ). She died in segregation, having never been the subject of a comprehensive psychological assessment during her 11.5 months in federal custody. In my report of June 20, 2008, amongst my 16 recommendations, I recommended that the Correctional Service:
- immediately review all cases of long-term segregation where mental health issues were a contributing factor to the segregation placement.
- amend its segregation policy to require that a psychological review of the inmate's current mental health status, with a special emphasis on the evaluation of the risk for self-harm, be completed within 24 hours of the inmate's placement in segregation.
- immediately implement independent adjudication of segregation placements of inmates with mental health concerns.
It is almost a year since I submitted my report to the Correctional Service, and few concrete steps have been taken to respond to these recommendations. I understand that Correctional Servbice will shortly publicly release its response to my 16 recommendations flowing from my investigation into the tragic death of Ms. Ashley Smith, and I look forward to a detailed and robust action plan that will address my recommendations and reduce the likelyhood of future preventable deaths in custody.
I will now ask Dr. Zinger to discuss the issue of program access and substance abuse.
Dr. Zinger: The Correctional Service is mandated by law to provide programs and interventions that address factors related to an offenders’ risk of re-offending. The Corrections and Conditional Release Act ( CCRA ) stipulates that the Correctional Service must provide a range of programs designed to address the needs of offenders and contribute to their successful reintegration. The CCRA also includes specific provisions for the delivery of programs to women and Aboriginal offenders.
From a series of evaluation reports we know that correctional programs work in contributing to public safety and are a good value for money.
Offenders who complete their programs are significantly more likely to be granted a discretionary release and are less likely to re-offend following their release. In terms of value, internal CSC documentation suggests that for every dollar the Service spends on correctional programs it saves, on average, $4 in avoided incarceration costs (due to earlier community releases or extended stays in the community).
Programs address a number of important issues that when dealt with can significantly reduce the risk of re-offending. The Correctional Service offers numerous very good programs, including in the areas of sex offenders, anger management, family violence and substance abuse.
In terms of addiction issues, about four out of five offenders now arrive at a federal institution with a serious substance abuse problem, with one out of two having committed their crime under the influence of drugs, alcohol or other intoxicants.
The main problem with programming is access. The Correctional Service allocates only 2% of its total annual budget to offender programming. Currently, the Service spends $37 million annually on all its core correctional programs (including for women and Aboriginals). The program funding envelope, which has remained stable over the last decade, includes training, quality control, management and administrative costs. We do not think 2% of an over $2 billion annual budget is enough. The Correctional Service has indicated to us that it hopes in the next fiscal year to reallocate a significant portion of the $48.1M it anticipates receiving as part of its Strategic Review initiative to core programming. We look forward to seeing more programs being provided to more offenders as this reallocation rolls out.
The most recent investments dealing with drugs and addiction in penitentiaries has been limited to interdiction initiatives. In August 2008, the Minister of Public Safety announced a five-year $120M investment into the CSC ’s Drug Strategy. All funding went to interdiction initiatives, including drug detector dog teams, increase in security intelligence capacity, ION scanners and X-Ray machines. No new funding was allocated to treatment programs for addiction or harm reduction initiatives.
Drug interdiction alone can only go so far in addressing addiction issues and the spread of infectious diseases. Over the last five years (2004/05 to 2008/09), the Correctional Service has spent significantly more time and money on efforts to prevent drugs from entering its institutions. A measure of the success of these efforts is the percentage of positive urinanalysis samples, which indicate drug use. Institutional random urinanalysis has shown that drug use declined by one (1) percentage point in the last five years. In the last fiscal year (2008/09), the rate of positive samples was 10.8% (889 positives out of 7,543 urinanalysis samples taken in CSC institutions). Five years earlier, it was 11.8%.
For now, offenders have to contend with long waiting list for programs, cancelled programs because of insufficient funding or lack of trained facilitators; delayed conditional release because of the Service’s inability to provide timely programs they require to complete their correctional plans; and longer time served before parole consideration. The situation is becoming critical as more and more offenders are released later in their sentences, and too often having not received the necessary programs and treatment to increase their chance of success in the community.
Mr. Sapers: The health and welfare of our federal inmates is a public issue. The vast majority of inmates are one day released into society. It is beneficial for everyone if these offenders return to society having received adequate mental health services and rehabilitative programs.
All of us have a vested interested in treating offenders with humanity and responding to their clinical needs to help them lead productive and law abiding lives upon release.