Proceedings of the Standing Senate Committee on
Social Affairs, Science and Technology
Issue 6 - Evidence, February 16, 2005 - Morning Sitting
TORONTO, Wednesday, February 16, 2005
The Standing Senate Committee on Social Affairs, Science and Technology met this day at 9:02 a.m. to examine issues concerning mental health and mental illness.
Senator Michael Kirby (Chairman) in the chair.
[English]
The Chairman: Senators, first, I want to thank our witnesses who have come from across the country to Toronto to meet in the one place to which everybody from the rest of the country travels occasionally, and then is happy to leave — it is just the nature of Toronto.
Beginning today, we will be focusing on the forensic side of mental health. We have representatives of three police forces from across the country, all of whom are involved in police/mental health liaison.
We will follow that with groups such as the Elizabeth Fry Society, and others, who deal with police/mental health liaison, not from the policing side, but from the viewpoint of helping people once they are convicted. At the end of the day, we will be hearing from two judges from the Mental Health Court here in Ontario, so we will be covering the spectrum.
Our first trio this morning consists of Terry Coleman, Chief of Police in Moose Jaw and the Co-Chair of the Canadian National Committee for Police/Mental Health Liaison; Michael Arruda is responsible for mental health issues with the Montreal police force; and Sean Ryan, who, we discovered in an earlier, brief conversation, grew up in the same town as my mother and my grandfather and we know all kinds of people in common. Sean Ryan, as you can tell both from the name and the accent, is from St. John's. Thank you very much for coming. He is with the Royal Newfoundland Constabulary — I still love the name.
We will have comments from the three of you and then we will open it to questions. Thank you all very much for coming. We appreciate it.
Mr. Terry Coleman, Chief of the Moose Jaw Police Service;Co-Chair of the Canadian National Committee for Police/ Mental Health Liaison: Good morning. I am the Chief of Police in Moose Jaw, but the reason I am here today is I am the Co-Chair of the Canadian National Committee for Police/Mental Health Liaison, which is a subcommittee of the Canadian Association of Chiefs of Police. We thank you for the opportunity to present a police perspective, and to some extent, the justice system perspective, to your important discussion. You probably have in front of you a paper from all three of us that will give you more information than I am about to share today. I am sure it will provide some basis for you to ask questions.
I have been a police officer for over 36 years, initially in Calgary and more recently in Moose Jaw. What Inspector Ryan, Agent Arruda and I have to share today is representative of the police community in Canada, notwithstanding some differences from community to community. That police will interact with mentally ill persons is inevitable and, to some extent, necessary. After all, it is we who have the 24/7 telephones and the staffing to respond to calls for service and people in crisis. Police services spend a significant amount of time and money working with people who are experiencing mental health crises.
The London Police Service, in conjunction with the University of Western Ontario, conducted research in this respect approximately two years ago, and I think it would be fruitful to have them make a presentation to you. I will not present their research to you, but it was extremely useful and rare in the Canadian context. This was —
The Chairman: Just to interrupt, that was a study done by the London, Ontario, police force?
Mr. Coleman: That is correct.
The Chairman: Do you have a name?
Mr. Coleman: Yes, I do.
The Chairman: Can you give us the name later?
Mr. Coleman: I can. I have the name of the person.
The Chairman: That would be great. Thank you.
Mr. Coleman: It is rare in the Canadian context, and Inspector Ryan will talk a little more about research before we are finished.
This research is enlightening, and as I said, the only such research in Canada, to my knowledge. Their findings, broadly, were that the police service was devoting substantial resources to their interactions with mentally ill persons, and I repeat, "substantial.'' As I said, I recommend you access and read that report and perhaps meet with those people.
I do not share this purely from the "This is costing the cops too much money'' perspective, although resources are scarce, as we all know, but to demonstrate the extent to which police organizations are already involved in the mental health business, and their commitment. Although replication of the research in other parts of Canada would be useful, research is also costly, and it took them some time to put together. However, having examined the methodology used in London and based on my experience, I consider it as representative of policing across Canada in general.
In the context of this forum today, the questions we often ask ourselves are: Are we the police the best people to be dealing with people with mental illness, and are we equipped to meet their needs and best interests? The answer, by and large, to both questions is we are not, at least not after perhaps an initial contact and maybe the diffusion of a violent or confrontational situation.
However, we are frequently frustrated by being unable to refer or take these persons to mental health professionals and/or the appropriate facilities, to be received in the appropriate manner. We in policing are also client/consumer focused, and being unable to deliver service on that basis frustrates us.
We realize there has been some improvement in some centres in the last few years. In fact, there are some excellent programs in some places to address the frustrations I speak of, and that is really encouraging, but as always, we need to do better.
We must continually evaluate and improve the consultation and collaboration. The deinstitutionalization of the mentally ill dramatically and directly affected police organizations across Canada. While I am not about to get into the debate about whether such deinstitutionalization is or was good or bad, my colleagues and I across Canada know that we and our communities in general were not prepared. Why not?
To make a complex situation simple for the sake of brevity here this morning, no one told us what was about to happen, or what the effect on our communities might be. We were unprepared. I raise this for obvious reasons, but also to encourage you to consider that we can all learn from that. That is, we must ensure mental health professionals and consumer groups communicate and work with police — and vice versa — and also make sure that in the future, police are included with respect to ensuring mentally ill persons receive the attention and care they deserve.
I would be remiss if I did not address the often-offered panacea for fixing the deficiencies with respect to the intervention of police with the mentally ill. That is the notion that training will fix it. Just give them a little more training and all will be well, if you will pardon the pun. Well, this is not so.
To the extent communication has happened in the past, it has been through individual organizations approaching police organizations or associations of chiefs of police, at the provincial or even the federal level, national level, and asking to introduce their specific training into a police curriculum.
Actually, my interest in becoming involved with the particular committee that I co-chair was born out of frustrations with numerous organizations approaching the police, each with their own interest, to be delivered by training, and frankly, it is not practical for police colleges and police organizations to introduce a course for each different mental illness.
Over the past two years, Dr. Cotton and I have been conducting research in our spare time — and we both have very little of it — with respect to recommendations on fatalities, coroner's inquests, resulting from the death of a person during a police intervention. Far too often, these persons were mentally ill. While not all recommendations of the inquests included training the police more or training them with respect to this illness or that illness, many of them did, and, ladies and gentlemen, while in some situations training may be part of the solution, it is not the solution. Therefore, what is required?
Mental health professionals and police must work together to change structures whereby we understand each other and work more closely such that we complement each other in providing what the consumers and their families need and deserve. It is a systemic problem, not just a training problem. Just adding training to a structural problem will not improve what we are seeking to improve.
Working with and assisting people with mental illness are consistent with our mandate as police organizations, and certainly consistent with the philosophy of contemporary policing. In fact, four of the fundamentals of contemporary, or community, policing, as you may know it, are a customer/client/community focus, consultation and collaboration with the community, quality and valued client/customer service and increased communication. All of these also speak to our work with people with mental illness and the systems that serve them.
I must also share with you some progress I am party to with respect to mental illness within police organizations, and we have our share. The Canadian Association of Chiefs of Police Human Resources Committee, of which the committee I am here today to represent is a subcommittee, will hold a human resource conference in Vancouver at the end of this March, and one of the topics is "Operational Challenges in Managing Human Resources.'' We will have a presentation and a discussion around mental health within police organizations. This is a huge step in our culture, where mental illness is something we deal with externally, but we often hesitate to deal with internally.
This is what drives us as police organizations. As you can see, we too are client/consumer focused. Although process is important, it is the outcomes we are and should be concerned about. On behalf of the police community, I am pleased to tell you that we want to be part of the solution. We are ready to work on this matter for the benefit of consumers, their families and their communities. Change in the public sector, and policing is no exception, occurs far too often as a result of a crisis or crises. It seems to take a tragedy to get the attention of policy-makers and those who are able to assign necessary resources. I am sure I do not need to tell you that that is not our preferred way of policing.
Once again, we appreciate today's opportunity to contribute to solutions to address a complex but important issue. We look forward, whether at the local or at a more global level, to police being included as part of these solutions in the future.
We would like to think it is a good sign that we are here at all today. Traditionally, forums such as this would not have included us in a discussion like this, and we look forward to our continued involvement and thank you for the invitation today. Such work is consistent with our mandate, and certainly consistent with the philosophy of contemporary policing, and I thank you on behalf of your police organizations and your police officers.
Mr. Michael Arruda, Agent and Counsellor, Action Strategies with the Community, Mental Health and Intellectual Disabilities, Montreal Police Service: Senator Kirby, Senator Keon, members of the standing committee, I have had the opportunity to listen to the committee hearings, read some passages from the committee's last report and meet some of the consumer/survivors who were asked to testify before the committee. I want to thank the committee members for their involvement and for inviting me here today.
I am happy that the government is finally looking at the subject of mental health and that your recommendations may one day be implemented. This is a beginning, a time for change, a time when people will begin discussing mental health like any other health problem. As a family member of someone who has a mental health problem, I can sympathize with and relate to the frustrations that the survivors and their families go through. Believe me, I quickly understood why mental health consumers have earned the right to be called "survivors.''
As a police officer, I must admit that I find it quite disturbing and sad that family members and survivors have to turn to the police in the hopes that they can get the proper care. I think it is a sign of how wrong, or rather, sick our system is. Although police interventions are usually very traumatizing for all parties involved, family members and survivors know that we are probably the only service anywhere in Canada that operates 24 hours a day, 7 days a week, 365 days a year, and will act immediately to secure someone who is in a mental health crisis.
Families expect officers to take their loved ones to the appropriate professionals. Ironically, most of the time, these professionals are not available, or, in some places, non-existent. In the places where services are available, usually local hospitals, two officers are asked to stand guard on the mentally ill person until the professional comes to see them. I have tried to look back and remember when was the last time I stood guard and made sure that someone with cancer or diabetes got treated.
What is most alarming is the number of calls that officers across our country receive concerning someone who is in a mental health crisis. Calls range from the person who seems confused and is wandering the streets to the ultimate crisis call, the person who attempts to commit suicide.
Crisis calls are just one facet of police interventions. Officers are routinely asked to apprehend people under the Mental Health Act, interview witnesses and victims who have mental health problems, and arrest people who are mentally ill and have committed a variety of illegal acts.
Furthermore, homeless people with mental health problems are often shunned by the communities in which they live. The community ignores the real issues: lack of mental health services, facilities and supervised housing. It is much easier just to call the police.
Officers are obliged to intervene, again with few solutions. Although they are not specialists in the matter and often have no formal training, some police officers have to make assessments and evaluate whether the person is a danger to themselves or to others. In small rural communities, where few services are available, officers are forced to come up with desperate solutions, and in some cases, these solutions have sad and tragic endings. Police officers are overwhelmed and feel ill-equipped to intervene adequately. These are interventions that need particular handling and care.
As the honourable members of the standing committee already know, the difficulties encountered by all parties concerned are numerous, and it would only be tedious and repetitive of me to enumerate the problems.
Now, is there anything positive going on in the police service? Yes, there is. First, I must caution you that the programs available are usually in major urban areas and that in fact, very few police forces have them. Some police services have taken it upon themselves to offer mental health crisis intervention training to their personnel. Basic training courses vary from 4 hours to 26 hours of classroom time. Officers are introduced to communication techniques, verbal crisis intervention, abnormal psychology, observation methods and medical notions and language. Police departments are starting to gather data in order to evaluate their services and develop a better understanding of the situation.
Major police services have designated mental health liaison officers who work on developing the mental health units and are responsible for developing standard intervention procedures in order to have conformity throughout the areas where they work.
Memoranda of agreement and protocols between police services and medical facilities have been developed and implemented to define the police and medical roles. Others have started initiatives such as police and community joint programs, and crisis teams from local health facilities have also joined the police in order to fill the gap. Cooperative programs such asCar 87 in Vancouver, Coast in Hamilton, and the Montreal Joint Response Model are initiatives that were developed as a result of the needs of the communities they serve.
Regional and local police/mental health liaison committees have also been developed throughout different cities to try to resolve immediate and long-term issues. The Canadian National Committee for Police/Mental Health Liaison was also developed to support, inform and provide guidance to all agencies across Canada directly touched by the mental health issue.
Ontario has developed mental health courts, while several provinces have diversion programs. Officers have been trained in the use of less lethal weapons when intervening with someone in a high-risk situation and crisis negotiation has become the norm in major cities.
Bolder initiatives, such as consumer/survivor advisory committees, have been developed to counsel, educate and inform police forces on how to intervene with people who have mental health problems. The consumer/survivors are by far the best experts in the mental health field, not because of their education, but because of their life experience.
Cross-training initiatives have been developed. Personnel such as psychiatrists, psychologists, nurses, researchers, teachers, public health officials, low-income housing officials, government officials and anyone directly involved with mental health are invited to patrol with police officers and see the situations they come across. They are then debriefed, asked to analyze the interventions and come up with better solutions. Officers are asked to work in the other person's milieu and are exposed to the other's reality. The same procedure is repeated.
Consumer/survivors are an integral part of this process. The purpose is to understand everyone's reality and the difficulties encountered in each organization. Solutions are sought, taking into consideration the restraints that everyone has. Furthermore, the bond that is created is exceptional. Participants see that there are faces and real people with names in each organization. It is no longer the police, the psychiatrist, the consumer, but rather, Mike, Nadia and John.
As you can see, efforts and initiatives are being developed. What we need is a government that is ready to face the challenges and willing to take the initiative. How can we better our services? Well, very simply put, let us start by talking.
The Chairman: Thank you, Mr. Arruda.
Mr. Sean Ryan, Inspector, Royal Newfoundland Constabulary: Good morning, Senator Kirby. Like my colleagues, I thank you and the members of your distinguished panel for giving us the opportunity to speak to you today on this extremely complex social issue.
I come from a large family of 20 siblings in Newfoundland, and I too speak from personal and professional experiences on how the existing system is less than adequate to meet the continual needs of persons suffering from mental illness.
Like many other law enforcement agencies in Canada, the Royal Newfoundland Constabulary had to come to terms with analyzing the way we handled issues surrounding mentally ill persons and, equally, our lack of collaboration and cooperation with our health care system.
In 2000, the Royal Newfoundland Constabulary was involved in two police shootings, one of which was fatal. In that same year, our federal counterparts in Newfoundland, the RCMP, were also involved in a fatal shooting. Unfortunately, all three incidents involved persons suffering from a mental illness.
As a result, a judicial inquiry was held into the two fatal shootings, chaired by the Honourable Judge Donald Luther, and it was through that forum that a methodical analysis of the way we conduct business was completed that resulted in Judge Luther making several articulate and beneficial recommendations.
Chief Coleman eloquently set the stage by providing you with the generic overview of the way police do business as well as the history relevant to where we are today. Agent Arruda gave you an accurate account of what police officers across Canada go through on a daily basis, with the common thread that speaks to the police doing whatever is humanly possible to help those in need.
Over the next few minutes, I will endeavour to provide you and your distinguished panel with some suggestions on how we feel a federal body such as you represent can help.
We recommend that you help to create a national, centralized repository where data collected by police agencies in Canada can be received, collated and analyzed to provide quality and, conceivably, tactical analysis to aid in developing strategic approaches. Also, we see the potential of these same data being analyzed to provide equally strategic analysis that could assist in establishing standardized services that meet the consumer needs, as well as determining any common themes or trends.
We also seek your assistance in recommending funding be made available for research by police and health care providers in collaboration on issues, as well as funding to support independent research for the same common goal.
The research that is available in Canada today has rarely been done in Canada. Most of the data that we refer to are U.S. data, which is sad to say, with the exception of, as Chief Coleman said, the study that was done in London.
The research will be done with the intention of bettering our services as individual agencies as well as in cooperation with joint measures. We request your support in funding national education and training initiatives for police and mental health care workers alike, a national, public education program that would decrease the unfortunate stigma attached to and fear of those who suffer from a mental disorder.
We request your support in helping both police and health care services to break down the bureaucratic and regulatory barriers that we experience in attempting to share information, imperative information that can provide the necessary intelligence to assist in formulating an effective response by either department.
We request your support in providing the framework for a national forum for law-enforcement agencies across Canada to share best practices, comparable to the forum that was set up in the 1990s and led by the Canadian Association of Chiefs of Police to deal with a national use-of-force model and continuum. This particular forum was so successful that it has been adopted today nationwide and serves for all of us as a standardized framework, and I believe the same thing can be done with mental health issues.
Ladies and gentlemen, we readily recognize and appreciate that we as individuals, as well as our respective agencies and our provinces, have an obligation to provide the best service possible to persons suffering from mental illness. We realize that enhanced training developed from quality research can assist us, the police, and health care providers with providing a prophylactic measure for the percentage of our society who suffer from a serious illness and that, ultimately, can become embedded within the justice system.
We would be remiss if we did not impress upon you the enormous fiscal strain our present antiquated response to the mentally ill puts on already pressured police budgets. For example, as Agent Arruda mentioned, police officers spend hours upon hours endeavouring to seek out the needed help for the people we serve, but at the same time, contributing by our mere presence to the associated criminality stigma attached to those who are ill.
Please, let me impress upon you that despite appearances, and although we, the police, are looking for help, it is not about the police. This is not about us. Moreover, it is all about the consumers, and once again, the seeking and availing ourselves of such opportunities as this in an effort to provide the best care to those who desperately need it.
We three, along with thousands of our colleagues, are advocates for the mentally ill, and are proud to be so. We do not profess to have all the answers, but we are surely eager to help you and any other body willing to step forward to find those answers.
With your help, we can and will provide the service that meets the need, and if through this forum and like opportunities we can make a difference that benefits even one person, then that will indeed move it forward.
I thank you for this opportunity and the great work that you have already done. We are prepared and eager to help you in any way we can in your future endeavours and we wish you Godspeed. Thank you.
The Chairman: Thank you very much to the three of you for your thoughtful statements, and, as I say, for all the effort you made to get here.
Before turning to my colleagues, could I just ask the three of you for some clarification?
You mention a national forum in another area of policing. Who funded that? Did the federal government fund that, or does anybody know?
Mr. Coleman: Actually, no, it did not. There was no funding for it. It was a a collaboration that came out of the Canadian Association of Chiefs of Police Human Resource Committee, and the Ontario Police College took a lead role in this. They have a representative on that committee and we jointly put that together. It took several years for everybody to agree on it, but there was no funding per se, although, obviously, different agencies contributed in kind by way of people and resources.
The Chairman: The forum, Chief, was essentially a week-long symposium or something?
Mr. Coleman: It was a series.
The Chairman: You are saying that you need something similar with respect to mental health issues.
Mr. Ryan: Absolutely, senator, and I brought that up simply because it was an issue that was crucial to how the police conduct business, and it was through the collaborative effort from coast to coast that a framework was established that has been adopted today and works very well. My point is that if we can do it with one particular facet of policing, we can certainly do it with this.
The Chairman: Second question: You talked about the barriers to sharing information. Are they barriers among police forces or between the police and local health authorities, and what kind of information are you talking about?
Mr. Ryan: Well, it is a combination of them all. There are issues and, of course, there are privacy act issues within our provinces as well. There is bureaucracy within each organization — we refer to it as "turf'' — that prevents the sharing of information; and quite frankly, information from a health care agency can certainly help us to formulate a proper response, but oftentimes, we are left with second-guessing ourselves and trying to determine what is happening in an immediate fashion.
There is an expectation that the issue can be solved through training, and Chief Coleman referenced it. Society cannot expect us to turn police officers into street diagnosticians. Quite frankly, it is difficult to get two psychiatrists to agree on one diagnosis, so in the absence of some intelligence, it is difficult for a police officer to make some determination as to what a person is suffering from and try to formulate an effective response. However, it can be aided by a full exchange, without imposing on somebody's personal health, over an issue that could contribute to the individual's safety or someone else's safety.
The Chairman: At the present, there is reluctance on the part of people in the medical profession, for example, or in any health profession, to deal with that?
Mr. Ryan: In some cases.
The Chairman: I can understand that, because of privacy laws and so on, but that is the problem?
Mr. Ryan: In some cases, yes, it is reluctance, but in most cases, these departments want to share that with us and it becomes an issue of a particular individual who happens to be on call that night sitting back and second-guessing, "If I do, what are the ramifications of my sharing this information?''
I bring forward the issue, albeit I understand that there may be no pat answers. Insofar as suggestions are concerned, I bring it forward for your collective wisdom.
Senator Cook: I have just had an opportunity to scan your carefully laid-out document here. I will ask you a number of questions, but my focus is on effective mental health legislation.
We are a federal team and you work in provincial jurisdictions — which I think tends to create silos — and I note that the arrest rate of those with mental illness is higher than for others. Sean, I will speak to you, mainly because I am a Newfoundlander. I know, because I worked as a volunteer at the Pottle Centre, that agencies tried to offer a caring environment after the deinstitutionalization — that is a long word — to people when they came out of the Waterford. However, those community supports were not there, and the people who came out could not live in a community. I think society failed them, and we have been trying to play catchup ever since. If you want to respond to that, you can.
Mr. Ryan: You are absolutely right. It is an issue, and we have seen it in the recent judicial inquiry into the deaths of Darryl Power and Norman Reid.
One gentleman was from a rural community. There was absolutely no social network there to support him, and Judge Luther in his recommendations clearly articulates his position on that. The issue of community treatment orders came up, and any number of areas, to try to deal with rural communities. I know Constable Arruda and I have discussed that in connection with communities outside the urban centres.
The infrastructure that is in place within urban centres is less than adequate. Outside of urban centres, it is essentiallynon-existent and I believe that in a forum such as this, it is imperative that we as public servants discuss the undiscussable. Otherwise, we are not being fair to the people that we are trying to serve, mentally ill persons.
Senator Cook: Your brief tells me about the variety of circumstances in which you come into contact with people who appear to be mentally ill and are victims of crime, and then I see that you are telling us that the police should not be the de facto first line of support for most people with mental illness. Well, if not you, who?
Mr. Ryan: I know that various recommendations were made after the inquiry in Newfoundland. In keeping with joint programs that are already in existence, such as the famous Coast program in Hamilton, our recommendation was to have a mobile mental health crisis response team associated with the respective health care centres. Our position was that even if there is a joint effort on the response, there is still the associated criminality of somebody being mentally ill.
In the vast majority of police officers' calls dealing with people who are suffering from mental illness, there is no criminality, but the police departments have been the catch basin for an otherwise non-existent social network, and that is as frankly as I can put it. I apologize if I —
The Chairman: No. Please do not apologize. Be very blunt. This committee said in its previous report that in our view, the prisons have become the asylums of the 21st century. You deinstitutionalize, you do not put anything in place, so prisons take over as the only place to put people. Please, the blunter you are, the more helpful it is to us.
Mr. Ryan: Thank you.
Senator Cook: You also talk about local strategies, and I think you do commendable work in local areas, but you are in search of something more, and I understand that. I like your reference to being a taxi driver, and if you are a uniformed cop in a car, picking up a person who appears to be mentally ill, that does not lend a comfort level to someone who is stressed or having a problem.
Mr. Ryan: Well, ma'am, to bring a sense of reality to what you are saying, I worked as a district commander responsible for the city centre of St. John's, and I remember getting a visit from two patrol constables one morning who were very upset for a number of reasons.
On their previous shift, they had spent 10 hours in a hospital emergency room sitting by the side of a woman who was suffering from depression, simply because there was nobody there. We were called to respond. We get calls on a daily basis from hospitals. "Can you transport this person to the Waterford Hospital?''
We are wearing uniforms, we are carrying guns and we drive well-lit vehicles. Are we not a part of the problem as opposed to the solution? That is a real concern for us and it is frustrating, because — Mike and I talked about this — we are speaking from personal experiences within our families as well as our professional experiences. Quite frankly, I think the attitude of most Canadians is that everything happens to everyone else — we have to admit that is true — and it only becomes important when it hits home.
We are here today to plead with you about how important this is, and not for the police. This is not about a badge. This is not about a uniform. This is about people who suffer a physiological, biochemical problem comparable to cancer, to tuberculosis, but the treatment that they receive is diametrically opposite.
Senator Cook: Would effective mental health legislation help you?
Mr. Ryan: It is a good question. Yes, it would, because federal legislation would override many other particular regulations, but I think it is imperative that there is careful consultation with justice and law-enforcement officials.
It is imperative to talk to the people on the ground. We see it in the corporate context, where executives speak to issues but never go to the floor to see how the plant worker sees things. I make that analogy with us. Mike and Terry and I can speak from our early days of what it was like, how horrible it was.
I speak about Newfoundland — and this is not unlike other communities in Canada — where just a short while ago, a short-stay unit was established within the Waterford Hospital in St. John's, the hospital for the psychiatric patients. Prior to that, if I as a patrol constable detained somebody under the Mental Health Act who met the three conditions in what is now known to be a very antiquated act — of harming themselves, harming others, or harming property — if I could not get them into a hospital setting, my only recourse was to detain that person at the city lockup. Now, if that is not spreading bacteria on an open wound, I do not know what is.
Senator Cook: Yes. We are here to try to understand and do what is best for the consumer, the person who I think is the most stigmatized in today's society, and while I can sit here and be happy that the Pottle Centre cooks a meal for 45 people and they went out and got their own groceries, I suppose everything starts with one.
However, I think we are in search of something more, Mr. Chairman. We are in search of a national standard, one that enables everyone — you, the consumers of mental health and all the other caregivers — to go about with dignity and do the job that needs to be done. Again, I have to say, "Well, you work in a provincial jurisdiction and we can only do so much.''
Then I look at the budgets and feel really negative, because no matter how good a program is, if cutbacks come where do you think they will be made? Are they likely to be made in programs that you would advocate to deal with something like this? How can we ensure that there is continuity? What will legislation do?
Mr. Ryan: Well, we have asked ourselves, and I have asked myself many times, who do our political leaders work for? They work for us and for our citizens, and they should say loudly and clearly when cuts are made to whatever programs, it cannot be cuts that directly affect the health and welfare and simple dignity of Canadians.
Senator Cook: However, you and I know that in the real world that is not so, because even in a school program, if cuts come, music goes, gym goes.
I will end on this, Mr. Chair: I am looking for a way that we can put in a national standard, something effective, be it legislation or whatever, to ensure that what you have given me in this wonderful document is not jeopardized in any way.
Mr. Ryan: I wish I had the answers to give you.
Senator Cook: I guess that is our job.
The Chairman: Yes, it is.
Mr. Ryan: Thank you.
The Chairman: And we will.
Mr. Ryan: I hope so.
Senator Pépin: I have a supplementary question to what Senator Cook was talking about, because in Bill C-10 that was tabled in the house on February 7, 2005, it mentions allowing peace officers arresting an accused who is in contravention of an assessment order or a disposition to release, detain, compel the appearance of, or deliver the accused to a place specified in the order. Maybe that could facilitate things?
Senator Cook: That is a start.
Senator Pépin: It is there, and I did not know if you were aware of that. It was tabled last week, I think.
You spoke about training of police officers for from 4 to26 hours. I was wondering how you decide that, let us say, a group of officers will get 4, 10 or 26 hours? Is it because of the time available and who is available, or is it their background? How are you able to organize that?
Mr. Arruda: I mentioned 4 to 26 hours because different police forces offer different training. Some police forces will give four hours of training, others one day. Some will give three or four days of training.
Senator Pépin: Okay.
Mr. Arruda: In Montreal, for example, we give one day of training and it is for all police officers who are on patrol. Front-line officers are obliged to take the training, which is base training.
Senator Pépin: I understand, and I think it will be interesting to know how police services, as employers, are able to deal with the problem of mentally ill — if you have any employees, policemen, who have a mental health problem or someone in their family who is suffering from mental illness — and we know that the police are working under stress — what kind of program do you have? First, do you have any programs for your employees, such as counselling or diagnostic programs, and how can you help those policemen who are coming back to work to integrate? Maybe we can learn from your experience, if any, in that field.
Mr. Arruda: Effectively, most police services employ psychologists. In Montreal, we have a team of four psychologists who are there for the personnel, for the employees. Employees can see a psychologist at any time. They are on call, available 24 hours a day.
When there are major incidents in which police are involved, the officers are automatically met by a psychologist and there will be a debriefing. If police officers feel that they are not fit, or if the psychologist or the medical personnel feel that they are not ready to return to work, they will be put on sick leave. When they feel ready, when the medical personnel feel they are ready, the officers are slowly integrated back into the system.
We also have a 1-800 number that police officers can call if they have problems. If they do not feel right or they do not want to meet the psychologist, we have a 1-800 number so they can call other police officers who have been in similar situations and can counsel them.
Senator Pépin: I was wondering if Mr. Coleman or Mr. Ryan had something to add to this.
Mr. Coleman: Senator, I have been in this business for a long time and there has been tremendous change over the last 20 years. Michael is correct. Many police services now have in-house psychologists, certainly the larger ones, and many of the rest of us, the smaller ones, contract out our employee and family assistance programs, so that there is access, but there is still a fair amount of stigma in our organizations about acknowledging that one needs this, and that is probably not unusual.
In Calgary, after a police officer has been involved in a situation where there has been a death or very serious injury, it is now mandated that that person will meet with the in-house psychologist, because many would not do so unless told, "You will go.'' That is not the best way, perhaps, to get somebody to meet with the psychologist, but it was not happening otherwise.
There has been tremendous progress, but it is still not anywhere close to what it should be, and we are looking forward to raising this issue on the national stage at our conference in Vancouver, in March. It is a first for our conferences, so it will be interesting to see how we can build on that.
Senator Pépin: We can sometimes compare the police to the military on this issue.
Mr. Coleman: Absolutely. Yes.
Mr. Ryan: Our agency has comparable setups to those described by Agent Arruda and Chief Coleman. We contract with a psychologist to deal with these outside issues, and of course, there is help within the employee assistance program.
I think it speaks to the broad spectrum of the mental health issue — and I spoke to this at the judicial inquiry — in that we had an officer who, unfortunately, had to take the life of another person. The victim was suffering from a mental illness, and as a result of that incident, there were huge mental health problems for the officer and the family, with the issues being brought to the forefront through the media. The officer's children and family and friends were asking questions, and the individual suffered from the pressures that occurred in a particular incident while doing their job.
It is such a broad spectrum when we look at not only dealing with mentally ill people, but the spinoff from that within the service, so we need to have our own house in order before we go outside.
Senator Pépin: I think it is a big step forward when, as a policeman, you realize that something needs to be done for your employees, for the police, because the stress they live under must make things very difficult.
Mr. Ryan: Absolutely, and I thank you for pointing that out.
Mr. Coleman: If I could just add to that, there is sometimes a feeling that the rate of suicide in police organizations is higher than the norm.
There is a professor at the University of Lethbridge whose name escapes me right now, but I read his work. He has done some research on this, and you might be interested in him in your travels. He found that it is not actually out of line with the general population. However, it comes about for a variety of different reasons.
All of us, I am sure, have had friends who have committed suicide. I had not been in Moose Jaw more than a few weeks when one of our police officers shot himself in our locker room first thing on a Sunday morning — he had major problems — and it caused huge problems within our organization, which is not really large. Therefore, we are only too well aware of the issue, but the professor from Lethbridge has done some interesting work around determining the incidence of suicide in police organizations.
Mr. Arruda: Just to add a little to that, in Montreal, for example, and I do not have the exact numbers, but in 1999, there were 1,600 consultations by police officers, and in 2002 it was 2,700, so it is growing. Police officers are less reluctant to seek help.
Senator Pépin: Merci beaucoup.
The Chairman: As is true, increasingly, in the general public. It has a long way to go, but at least the trend line is a little better.
Senator Cochrane: I too welcome you all here, and I will start with Chief Coleman.
Are you part of a forum that addresses mental health only within your organization, or do you address mental health to learn about all the problems and then go back to the institution and implement some of these changes that have been made by other organizations?
Mr. Coleman: The subcommittee that we represent today came about as a result of an initiative by Dr. Cotton, whom I believe you will be listening to later on, and she can explain some of the history behind that, but we are a group of interested people. We hold an annual conference that has grown every year. We are just putting the fourth annual conference together in Vancouver, and Senator Kirby will be speaking to us. We have already arranged that.
We share, for want of a better phrase, and it is a cliché, best practices. We look at what other people are doing, at the Coast program in Hamilton, the Car 87 in Vancouver, and there are a variety of programs around that are actually pretty good. They all try to serve the same purpose, but they are slight different models.
Yes, we are a liaison group; hence the name. We meet, we share, we explore. We have attracted the attention of people from overseas. We have had people come from Ireland two years in a row because they experience similar problems to the rest of us. We had people from the United States attend last year.
We are a group that shares, mostly at the annual conference, but Dr. Cotton has established a list, and I think a couple of hundred people contribute to that, and different issues are debated, depending on what is the hot topic in any particular jurisdiction. They look for input from other people, both mental health workers and police, across the country.
Senator Cochrane: You have passed on down through the system some of the positive things that have come out of this and a lot of them have worked?
Mr. Coleman: That is correct, but certainly, I can only speak from the police side.
For example, we have a provincial police college in Saskatchewan, and representatives from that college, with some encouragement from me, attended our conferences and have restructured their training for recruits and in-service people around this very issue. We try to disseminate knowledge and support people, yes.
Senator Cochrane: That is wonderful. You mentioned in your opening remarks that the police are probably not the right people to call on for these problems, and that you get calls frequently. My first reaction is that it is probably because you are the most accessible, with the 24-hour service and the 1-800 numbers. Is that why? Do you have any suggestions about who people should call? What should they do when they need help?
Mr. Coleman: Well, at the risk of sounding a little naive, if there were sufficient support services in our communities we would probably not encounter many of these people, if any, in a utopian situation.
Many of the people we encounter are on the street, although not all by any means. They cannot call a mental health worker or even the emergency ward at the hospital, because they do not have the resources in a crisis to go out and meet these people.
We accept that there is a role for us in the initial interaction to try to stabilize a situation. We try to make sure that these people then get the appropriate services, and that becomes frustrating because, and at the risk of sounding like a whining cop, we have spent far too many hours in emergency wards.
If we could just get emergency-ward doctors to understand a little about this, because we witness those doctors in hospitals who are very busy fixing broken legs, bleeding, heart attacks and everything else. The person in crisis is guarded by two police officers because in many cases, hospitals have laid off their security staff, so there are no in- house people to look after these situations. We end up spending our time at the hospitals guarding these people, and you have heard that from my colleagues here.
In the ideal world, we would not encounter these people under most circumstances. The next best thing is if, after we have stabilized and assessed the situation, we can then refer the person to somebody better equipped. The Montreal model I recommend is excellent, and there are other models around the country that do that, but it is not universal by any means.
Senator Cochrane: We heard some sad cases yesterday and people are saying that they are just not getting the service that they should, that they deserve. From your experience of bringing these people to the hospital, are the doctors looking on these people as regular patients?
Mr. Ryan: No.
Senator Cochrane: Because of stigma, is it?
Mr. Ryan: Well, in our experience, they are bumped to the end of the line, and if someone else comes in, they are bumped back even further. That is understandable, in the sense that —
Senator Cochrane: Not because of real emergencies.
Mr. Ryan: Oftentimes not. When we look at our advanced society today, it is a sad state of affairs when someone who may be suffering from a breathing problem or some physiological ailment can call an ambulance and receive medical attention, but yet people suffering a mental health crisis invariably call the police. It is horrible.
Mr. Arruda: I would just like to add that there is a paradox in that. When police officers bring people into the hospital who are mentally ill, who want to commit suicide, it is because there is a serious danger to their health. Yet when we get there, the doctors or the medical personnel do not see it as a danger, and so the broken leg or the cuts become a priority and are treated first, even when there is an actual life in danger, and this is what frustrates police officers.
We bring them in because there is a serious danger, and once we get to the hospital, they are categorized a 4 or a 5, which is the lowest priority given. Often, when these people are left there or go in by themselves, they wait two, three, four hours — and these are people in serious crisis. There are quite a few who leave and commit suicide because they did not get the attention they needed.
Mr. Ryan: To add to what Agent Arruda was saying, how could we ever find out why somebody committed suicide? In talking to the people who have attempted it and trying to understand their mindset, it was not necessarily for any particular reason. It was simply that there was no network, they had nowhere to go, and there was nobody willing to accept them. The infrastructure is not in place and we are losing Canadians every day. We sit back and try to determine why they have done that horrible thing, but I would submit, ladies and gentlemen, that it is simply because, in many cases, there is no help for them.
Senator Cochrane: Chief Coleman, would you say that is the case across the country?
Mr. Coleman: I would, yes. Of course, we get to meet police officers and mental health workers from across the country through our conference, and when the experiences are shared, informally and formally, and through our listserv, I would say that is representative of the country as a whole.
Senator Cochrane: Do you have an idea of what percentage of your budget is spent on mental health issues?
Mr. Coleman: Well, codifying our interactions with people with mental illness becomes problematic and is a hit-and- miss situation, so when we go into our databases, as wonderful as they are at storing all sorts of information, if it is not entered correctly, we cannot retrieve it.
It shows up in a variety of ways. We may get a call about a disturbance at the 7-Eleven or about damage being done to somebody's car. It is not necessarily coded at any point as an incident involving a person who is mentally ill. We can usually give you an assessment of how much time we spend sitting in hospitals waiting for the appropriate people to deal with the situation.
The study that I told you about in London, Ontario, is a structured, sound, scientific study. They took the material from the London police database and have done a really good job. I cannot remember the figures. As I said before, I would recommend that you look at that study. I have read it and I have a copy here — it was shared with me just for information — and it is representative. It is relative, depending on the size of the service, but I consider it to be representative of what is happening across the country, and it is substantial.
Senator Cochrane: Okay. We will get that.
Senator Keon: First of all, thank you very much for being here. I am a medical doctor, a surgeon, and in the course of my training, I had to spend a lot of time in emergency rooms training in surgery, and I can confirm that when you people brought somebody in who had to be restrained, you just stayed there, because it seemed we could do something useful for the other people and did not know what to do with the person you were looking after.
I have always had the greatest admiration for the police, who have to act sometimes in a terrible situation where people are being violent, and the next minute they have to act with compassion. I will tell you a little story that is not relevant, but I will tell it anyway.
About 25 years ago, two heavily armed young men robbed a bank in Ottawa, the police were called and entered the bank, gunfire was exchanged, and one of the robbers was hit in the head and the other in the chest. The operational frame of mind of those police officers flipped in a split second, and they took the two young men out and put them in the back of the cruiser. They did not call an ambulance, and they radioed ahead that they had one person with a head wound and one with a chest wound.
I was contacted immediately, and I said, "Bring the fellow with the chest wound directly to the operating room. Do not stop in emergency,'' and when they got him to the operating room, his heart had stopped. He was shot through the heart, but we were able to restart his heart and suture the front and back of it, and he eventually stood trial and served his time. When he got out of jail, he came to see me and told me that he intended to lead a useful and productive life.
I have lost track of him. I do not know what became of him, but I thought it was such a classic example of the range of operational mindsets with which police officers have to deal. One second they are defending the employees of a bank, with bullets going in every direction. The next second, they turn with total compassion to the people lying on the floor who were shooting at everybody.
Now I want to turn to the system. If we can accomplish what we want to do, by next fall, we will have outlined a structural framework and, hopefully, a national strategy for dealing with mental health in Canada; and we will have defined, I hope, the necessary components, from forensic custodial facilities to community facilities.
There is a tremendous opportunity now to do this correctly, particularly in the design of community facilities that will include hospital facilities, primary care facilities and home care. I think from your point of view, it would be useful if we involved the emergency services people, because I have spent a great deal of time since 9/11 and SARS sitting on committees working on the design of emergency service systems in Canada. I believe we will surface with realistic emergency service systems, as you said, Officer Ryan, especially in the cities. It will be more difficult in the small communities, but at least in the cities, I can assure you we will look at that aspect to see what can be done.
It would be worthwhile to bring in the emergency services arm and see how it can be integrated into community, hospital and police services, so that your officers know exactly where to go or who to call when they are confronted with a street person or somebody who is violent.
I would like to hear all three of you respond to that.
Mr. Ryan: Thank you, senator, for your kind words; we welcome every shot in the arm that we can get.
There is a framework and a system in place in major centres so that officers know where to go from a standard operating procedure point of view. As I said, prior to the judicial inquiry that dealt with the two shootings, our only recourse was to detain people in the city lockup until they were seen by a psychiatrist. Thankfully, that has changed. You are right, there needs to be a connection between all the emergency services.
Where we are running into difficulties, as I said earlier, is in the exchange of information and the restrictions placed on agencies as to how and when they can share it. When you call someone at three o'clock in the morning to make a decision on giving information out on whether Sean Ryan has a propensity for violence or has any specific diagnosis, then that is not always readily available. That is one of the key components necessary to link up a multi-agency response.
Society expects us to be omnipotent, omnipresent, telepathic, and be doctors, lawyers, priests and counsellors. We welcome that responsibility, quite honestly, but we are human too, and this forum gives us the opportunity to say that at times we get tired.
Senator, I certainly endorse and support what you are saying about the necessity of inter-agency connections to formulate an effective response, but the first issue that springs to my mind is information sharing, so that may be something that you could speak to in your report.
Mr. Coleman: I include — I think you do — the staff in emergency wards in the emergency services group. They are wonderful people, overworked, and we do not want to sound as if we are dumping on them, but I think an increased awareness would be useful for many of them.
I go back to a previous situation. Back in 1978 in Calgary, I was one of four police officers who formed what turned out to be the first sexual assault investigation unit in Canada. We were trying to improve the way in which sexual assaults were investigated. That had not been done terribly well in the past, partly out of ignorance, partly out of lack of resources. We were looking for best evidence, which in many of those cases, if not most of them, comes from our emergency ward doctors who examine victims after they are brought in. One of my colleagues developed what we now call a sexual assault kit, with all the appropriate swabs and other things to collect the evidence. However, this was pretty foreign to the doctors in our emergency wards, and Calgary had quite a few hospitals and a lot of emergency doctors.
With the cooperation of the hospitals, we spent a lot of time working with the doctors and explaining to them — training them, if you want. There is a medical school at the University of Calgary and we got on their agenda. Once a year, we would go to speak to doctors who were about to graduate or go out into the hospitals and explain to them what we were looking for, how this worked and its importance, and that was very beneficial. We developed some useful rapport with doctors in those emergency wards around the issue of sexual assaults.
I think it would be very useful to do something similar around the issue of mental illness and share with them our role in this to try to build a better relationship for the benefit of the mentally ill person.
I want to talk a little about the sharing of information, though. The various privacy acts across the country are somewhat frustrating, in that they have limited some of the information that can be shared, and maybe some of it was shared inappropriately in the past — I am not privy to those particulars. I find that although there are provisions in the various pieces of legislation to allow for the sharing of information under certain circumstances, the staff in the medical business particularly, and that includes the paramedics, the ambulance personnel, are scared silly of the legislation and actually overreact. They tell you, "I cannot share this because of this act.''
If you chase it down and talk to somebody in a position of authority in a health region, they will say "Oh no, under those circumstances, they could have shared this'' because of this, that and the other. Because they do not want to be disciplined or lose their job or whatever they see as the consequences, people often overreact to some of the provisions in that legislation and then we do not get the information and cannot help people.
Mr. Arruda: Actually, in Montreal, we have started gathering all the people in emergency services together. We have, as I mentioned before, a local police/mental health liaison committee that includes all the emergency services people, the police officers, the ambulance technicians, people from the government health department and also doctors. We get together to discuss how can we improve our services.
We have noticed that information does come forward more easily. Without going into specifics, there is less constraint. They know the people whom they are dealing with, so emergency committees do work very well and should be spread throughout the country.
Senator Callbeck: Welcome.
I want to come back to C-10, which was mentioned a few minutes ago, and which is before the Senate right now. It is an amendment to the Criminal Code dealing with people who are unfit to stand trial or are found not criminally responsible. The bill gives a lot of new powers to the review board, it deals with victim impact statements and so on, and the police have also been given some new powers. It gives them more options when they arrest someone who is in contravention of a disposition.
To give you a little background, back in 1992 there was an amendment to the Criminal Code that had to be reviewed in 10 years, so it was reviewed in 2002 by a House of Commons committee. I know that the police were very much involved in that review, and C-10 is the result.
Were there other amendments that the police would have liked to see that are not in C-10? It would be very helpful to know that because the bill is before the Senate right now, and will be going to a standing committee.
Mr. Ryan: Senator, I was just conversing with my colleague here, and this is news to us. I am not familiar with the development of C-10, nor have I heard within law-enforcement circles about the level of consultation with police. I am not familiar with the nuances of the changes that you have just mentioned, so I cannot comment effectively on that. Chief?
Mr. Coleman: I am a little embarrassed because I am not familiar with C-10 either. I assume, and one should not do that, I suppose, that the Canadian Association of Chiefs of Police law amendments committee has been working with the various authorities on that. We can look at it and come back with a written response to the committee if you wish, but I cannot comment on it.
Senator Callbeck: Who would be the person for me to contact to find out about that?
Mr. Coleman: In what respect, ma'am?
Senator Callbeck: Whether there were any suggestions or recommendations put forward by the police association that they wanted incorporated into C-10 and that are not there.
Mr. Coleman: You can use me as the conduit. I will contact the law amendments committee of the Canadian Association of Chiefs of Police, which is in Ottawa, and they are very active in the area of new legislation and amendments to legislation. I will find out what submissions they made, or if they have even been asked for any submissions.
Senator Callbeck: Thank you.
Senator Cordy: My question will be very quick because you actually dealt with it already, and that was the breaking down of barriers, which I think is so important. It took 9/11 to get government departments to talk to one another about security in our country, but 9/11s are happening every day in the field of mental health.
How do we go about balancing the privacy of the individual, which is a big issue, with what is in the best interest of that individual and finding help? I just think we should let people know how important the role of the police officer is in mental health issues, because we talk about primary care doctors as the first step, but in fact, you are the first step in many situations that the mentally ill person deals with, and how do you get the information? You said the people at the top know that the information can be shared, but yet the emergency services people do not have it.
Mr. Ryan: As Chief Coleman mentioned, there are provisions within our respective privacy acts that allow for the sharing of information when there are emergent issues, but this is not transferred to the worker who is called into the middle of the night, in terms of educating them as to what they can and cannot do. As Chief Coleman alluded to, it works its way down in the form of, "Well, I would rather say nothing and be perceived as a fool than open my mouth and remove all doubts.'' That is the position that some of them adopt, very innocently, based on the fear of repercussions.
Senator Cordy: And you cannot really blame them.
Mr. Ryan: You cannot, but there is, moreover, an onus on the employer, the people at the top.
As we have said, the CEOs and the COOs — whatever acronym they give themselves — are aware of the specifics of the regulations that are applicable to them, but it seems not to find its way down to the factory worker on the floor who needs to know; and at three or four in the morning, we are talking to the factory worker on the floor.
Senator Cordy: You have raised an excellent point, so thank you so much for today's presentation. It has been invaluable.
Senator Trenholme Counsell: Thank you, Chair, colleagues, and very distinguished members of the policing community across Canada.
I just want to make one comment on what you said about help not being there in the case of suicide. I am a family doctor by training and I would say there is a great difference between those who threaten suicide, talk about it, cut their wrists, so on and so forth, and those who actually commit suicide. In so many cases, help is there, it has been offered, and I just have the feeling that when that mindset is there — now the mind may be only set for 15 minutes or for two hours, or it might have been set for several days — it is very hard to deal with once the person has made that decision.
If we have enough time, I wanted to have a little more discussion of community-based policing because I think that is at the heart of it, and when you come from a small community, as I do, it makes sense. Whether it makes sense in Montreal or Regina or St. John's, Newfoundland, I am not sure.
I wanted to ask you about data sharing. I believe that right across this country you can type in a licence plate number and get a name and some information. Let us say you have intervened in the case of a manic incident with a person who is bipolar. Is there any record on this database that I think you have — and maybe you are not able to tell us what you have — that this person is bipolar or this person is schizophrenic or whatever? Is that in the database?
Mr. Coleman: Well, the short answer is no. Databases that are managed by individual police organizations may have a record of an interaction with a person apprehended under a mental health act order or something similar, but you would not be able to type in and find out that so and so was bipolar.
Senator Trenholme Counsell: If you have something saying "mental health incident,'' is that shared only locally, let us say by a municipal police force, or in the case of the RCMP, across the country?
Mr. Coleman: They certainly have a national database, but by and large — and there is a qualification here — the databases are local and unique to each police organization. However, there is a large movement that is slowly rolling out — and I stand to be corrected — and most police services in Ontario are now either linked or in the process of becoming so.
The Solicitor General's department has an integrated data management program. I cannot remember what it is called now; it has one of those catchy acronyms that only government can come up with. There is a movement to try to link databases across the country, although it is very slow and very expensive, but I am not sure that it would address your question.
Senator Trenholme Counsell: Well, Chairman, I was anxious to find this out. I think it is of the utmost importance. Just to give you a very common example that people can understand, I have been involved in cases of diabetics experiencing an insulin reaction, and at one stage in that process, they can become very aggressive. I am thinking of one case amongst many, of a person brought into the emergency department and the assumption was that the individual was being violent. It took a little while to find out that that person was an insulin-dependent diabetic.
I know that in one hospital in New Brunswick, all medical information will be shared now. We are moving on, data will be shared, and I think we as Canadians need to think about that.
May I ask about community-based policing? It is a wonderful philosophy. I have seen it work in some cities in terms of youth and drugs, street crime and so on. Is it what we are after, in the sense that it comes down to individual families on individual streets, individual business owners, and young people as part of families? I know it can be very relevant in town. How relevant is it in our major cities?
Mr. Coleman: It is very relevant and I am glad you raised the issue, because it is a pet peeve of mine that many people do not understand what it is, and if you will just indulge me for a moment, I will share with you the fundamentals of community policing, contemporary policing.
I shared some already — a customer/client focus, consultation and collaboration with the community, quality and valued customer/consumer service, continuous evaluation, continuous improvement and change, teamwork, decentralization of authority and decision-making, total involvement — that is, we are all committed to it — participative leadership, increased communication, internal and external alignment so that our processes inside our organizations line up with what is required on the outside. It is outcome focused; that is, rather than look at how many arrests we have made, for example, we ask what difference we have made in a community. It includes due process, equity and fairness. Those things are relevant to delivering public services.
That is what contemporary policing is all about. That leads you then into the collaboration and the working together with the mentally ill, the health districts, groups such as this. That opens the door, all for the purpose of achieving an outcome; that is, the quality and value of service that the consumer, the client, the community receives.
There is a big misunderstanding, even in my own business, about what community policing actually is.
Senator Trenholme Counsell: Well, I think in the area of mental health, this is the same philosophy we heard from the people from whom we learned so much yesterday. They are individual problems, but they are also community problems, and we listened to sad stories, but also wonderful success stories. In a sense, it was all about community, and it is terribly difficult for you people to work in isolation and not have follow-up.
For instance, I am wondering, if you were called to intervene with somebody who is manic — and we know how horrible that is and it happens often, I am sure, in your lives — do you recommend to your members that some weeks later or when the person is out of hospital, that they make any kind of effort to maybe have five minutes with that family, just to reconnect and put things on a different level?
Mr. Arruda: Effectively, part of the community policing philosophy was that we would have follow-up on what was going on. Unfortunately, it does not happen. In theory, it is great; in practice, it is not applicable. It is left to the police officer on the street, who, if he wants to know the outcome, would meet the family.
When we intervene with individuals, they are usually in a crisis and we bring them to the proper authorities. Once they have taken over, we lose contact with the person. We do not go back and see how the person is doing. The mentality was that we would go back and meet with the families and see how the person was doing. In theory, we are supposed to; in practice, it is not happening.
Senator Trenholme Counsell: And we know why, because you are so busy, but these are ideals we are talking about.
Mr. Ryan: I think it is safe to say that what Constable Arruda says is pretty much true nationwide, in the sense that most accredited police agencies embrace a community policing philosophy and would love the opportunity to go back and see how somebody is doing. The work demands just do not allow for it. It is a resources issue, and for the most part, it is not done.
Mr. Coleman: I could just add to that: If people who are mentally ill have been a victims of crime — they have been assaulted, they have been mugged, they have been stabbed, and this often occurs with our street and our homeless people — in many police organizations, and certainly in the one I used to work in and the one I currently work in, victim services organizations, which are composed largely of volunteers, will make some subsequent contact, and if it results in a court case, will even go to court with them and help them work their way through the system.
Victim services programs — and there are many of them across the country — do that follow-up, but only if the person has been a victim of a "crime.''
The Chairman: I thank you all for coming, and I cannot tell you how useful your testimony will be. It is terrific.
In closing, let me make one comment about an issue that we all knew of intellectually, but which the three of you put in excellent perspective. One of you said that if people have a heart attack and are in danger of dying, they call 911. If people are in danger of dying because they are thinking of committing suicide, they call the police. Right there you have the beginning of the dichotomy that mental illness is not really illness, and it continues when you get to the hospital, where you are always put at the very bottom of the list, because, as Senator Keon said, we know what to do with the person with the heart attack. Maybe we do not necessarily know what to do in your case, but the stigma that is attached to mental illness is so deeply embedded in society that it begins with the initial phone call, and that is a very telling observation on the nature of the system.
Mr. Coleman: If I could just respond, sir, thank you. We appreciate the opportunity and would be more than willing to continue to work with this group, collectively or individually, because we are committed to this issue also.
The Chairman: We will get back to you. Thank you very much for coming.
Senators, as we progress through the forensic mental health system in our hearings today, we will hear at the end of the day, as you know, from two members of the judiciary. We will now talk to people who, in many cases, deal with individuals once they have come out of prison. We have Kim Pate, who is the Executive Director of the Canadian Association of Elizabeth Fry Societies; Dr. Dorothy Cotton from Kingston, who is the Co-Chair of the Canadian National Committee for Police/Mental Health Liaison; and Randy Pritchard, who is with the empowerment unit at CAMH.
Ms. Dorothy Cotton, Co-Chair, Canadian National Committee for Police/Mental Health Liaison; Psychologist: I will reiterate what everybody else said, in that I am thrilled to be here, and I especially appreciate the fact that you have given me four hours to talk rather than the five minutes that everyone else has.
I am here wearing a variety of hats. As was mentioned, I am the co-chair of the group you just heard from, but I am a psychologist by trade, so I suppose I am the mental health part of things.
I am also a psychologist for Correctional Service Canada. I am on the executive of the College of Psychologists of Ontario, and I was formerly the director of a forensic program in a provincial psychiatric hospital. I have also been a consumer and have numerous family members who are consumers. My family is not as big as Sean's, but we have our numbers.
The first I thing I have to state, being a federal government employee, is the official disclaimer that I am speaking for myself and not any of the groups that I have mentioned. I have a vested interest in remaining employed.
I will also say that I think my comments will be a little disjointed, because I know you are hearing from a variety of groups and what I am trying to do is fill in some of the gaps rather than state things that you have heard from 50 people, such as, "We do not have enough services.'' I suspect you have heard that message by now.
The number one message in my opening remarks here, and I think you have copies, is talk to the police. As the director of a forensic unit and somebody who worked in a psych hospital for 25 years, it never occurred to me that the police had anything to do with our line of work, and I am embarrassed by that. We would hope that we do not do that again. Let me make some unrelated comments here.
Communication and information exchange is a big issue, no matter what level of the system you are talking about, and with all due respect to the three witnesses you just heard from about us confused mental health practitioners — they will murder me after this — it is not as simple as they like to make it sound.
In my current job, my current profession, I am governed by federal-provincial legislation, provincial privacy legislation, the CCRA, the Psychologists Registration Act, the Mental Health Act, the Regulated Health Professions Act and a few others that I am too nervous to remember right now.
All of these send me clear messages about what I can say to whom, and I will tell you something: Even though I am the chair of the complaints committee of the College of Psychologists, what I can say to anybody when one of my clients is having a crisis is completely beyond me, and as a result, we do not say anything to anybody.
The increasingly confusing part of that is it would be different if I were a social worker instead of a psychologist. Most of the people working in community mental health agencies are not regulated health care providers at all, so they are governed by entirely different, and hopefully fewer, sets of legislation than I am.
The communication issue in terms of the legislative situation is huge, and it is a major problem.
Secondly, on the subject of data, I always like to go around announcing that I am Canada's leading researcher in the area of police/mental health liaison. This is not as impressive as I like to make it sound. I am Canada's only researcher in this field. There is no funding for this kind of research and there are no data. If you want to go out and count people on a street corner, you can be the second leading researcher in this field, if you like. We have no data. We have no routine data collection. All the studies you hear about in this area are in fact American.
Within corrections, we do not have a very good idea of who is coming into our system, what their mental health needs are. We have some data. They are not great. You heard from some CSC people in your previous round of hearings, and I know that they are scheduled to be back again next week, but there are big problems with data and with research funding.
In fact, police and people who do research with police do not have access to any of the existing funds. If you are not an academic, basically, you cannot get research funds in Canada. I am a part-time academic. I am also not speaking for Queen's University. They are among the many groups I am not speaking for.
Unless you are an academic, you have no access to research funds in Canada, and no academic in his/her right mind, frankly, would research issues at the kind of level we are talking about here. We are talking about nose-counting. We are talking about very basic, descriptive kind of research. Nobody would get such articles published. I had an article turned down recently because it was claimed that I did not quote the previous research in this area. There is no previous research in this area. We need an entirely different conceptualization.
Contrary to what many of us in the health care professions think, there are a lot of police officers out there with degrees, with advanced degrees, with Ph.D.s, who are quite capable of doing high-level research, but they are not eligible for funding through SSHRCC and similar bodies because they are not affiliated with academic institutions.
The next point I want to make is simply that we need leadership. We had a great quandary in preparing for today, in that this is a federal forum, a national forum, and both policing and health are provincial jurisdictions. You probably know this. What can be done at a national level to further things? I think part of the issue is a lot of flag waving.
There are no champions in this field; there is no one leading the charge. There is no chief of mental health in Corrections Canada. There is no position responsible for that. In terms of research, in terms of all areas, there are no champions. We could use champions. The director of health care has no mental health background, not that she is not a fine person and does a very good job, but she is not a mental health person.
The Chairman: A lot of what this committee has examined, both in this study and our previous health care study, were issues that were directly in areas of provincial jurisdiction. We have made a series of recommendations in areas that the federal government could not do anything about, and none of that has caused any degree of upset to any provincial minister of health or provincial premier. They have taken our previous report, large parts of which are in the process of being implemented in various provinces, as not so much a report from "Federal politicians'' as a national report. We are quite happy to stray directly into areas of provincial jurisdiction and nobody seems bothered by that.
Ms. Cotton: That would be a good thing.
The next point I will make, however, is in terms of things that the federal government is directly involved in, two areas mentioned in your previous reports, Corrections Canada and the RCMP. The CSC is the largest employer of psychologists in Canada and the RCMP, of course, also employs a lot of them.
The federal government is a bad employer in this way: Wages are easily 30 per cent below market value for psychologists. It is humiliating, and contributes to the whole stigma issue.
I left a job as a senior manager at a hospital to become a front-line worker in corrections, which is probably the lowest-status job you can possibly have in my profession. I am sure three-quarters of the people in the town in which I live assume I was fired from my previous job, because no one in their right mind would make the kind of move I made. For the record, I was not fired from my previous job. It is one of those mid-life things.
I will reiterate what everybody else, and your previous reports, has said about stigma. As I have just suggested, it applies not only to the people with mental health problems, but certainly anybody affiliated with that system. My guess would be that being the mental health liaison officer with a police service is not the route to becoming the next chief. These are not — sorry, Michael — high-status positions in most places.
I appreciate that I am being a little disjointed here, but increasingly, the legal system is becoming the gold card for access to mental health services in Canada. If you break the law, you can be ordered into a hospital, you can be ordered into treatment by a judge, but if you do not break the law, nobody can make you take the treatment. You can be ordered into a hospital for treatment even when nobody else can get a bed. If a judge says you need a bed, you get a bed.
If you break the law and are charged, you might get access to a diversion program, and then you get a case manager and are hooked up with community services, such as they are, but if you do not break the law, you do not get those kinds of services. If you break the law and are convicted, you might get a parole officer who monitors your behaviour, enforces treatment and makes sure you get access, but if you have not been in trouble with the law, you do not get those services. If you annoy your neighbours and are generally disruptive, nobody will pay any attention to you until the police or the legal system gets involved.
Therefore, in some ways, it is to your advantage if you have a mental illness to run afoul of the law. You get access to a lot of services you would not otherwise, but it is a Catch-22, because once you become a "mentally disordered offender'' — such a lovely and flattering term — you are then denied access to services at all because community mental health agencies have exclusionary criteria. They do not want people with a history of criminal behaviour or people with substance abuse problems, and that accounts for virtually 100 per cent of the people who come out of the correctional system, needless to say.
I work in a psychiatric hospital within federal corrections, and it is completely impossible to hook up our departing offenders who have mental health needs with community agencies.
As you well know, psychiatric services within correctional facilities are grossly inadequate. We will leave it at that.
The Chairman: Thank you, Dorothy. You have raised a lot of questions that we will come back to.
Ms. Kim Pate, Executive Director, Canadian Association of Elizabeth Fry Societies: It is a pleasure to be here and thank you for inviting me.
I have worked now for more than 20 years, first with young people, then with men, and for the last 13 years in my capacity at the Elizabeth Fry Society, with women prisoners, and I and many people appearing before you, many people involved in this work, come with our own experiences, familial, personal, and in terms of the individuals with whom we have had the privilege, and sometimes challenges, of working.
I represent 25 member societies across the country that work with women and girls in the community. Some of them are the only community resource in their area. Some of them cover entire provinces, sometimes with only two or three staff, and their focus, the mandate of our organization, is to work with those who have been marginalized, who have been criminalized and imprisoned. I think some of you know that I am a lawyer and a teacher by training, so that is another piece in my background. I am currently getting some forensic mental health post-secondary education as well.
We first targeted this as an issue we needed to work on more than 10 years ago, because we started to see what Dr. Cotton has described as the gold card into the system. With the deinstitutionalization that was a worldwide phenomenon, we saw the numbers, particularly of women and girls, who had historically been overrepresented in mental health and psychiatric facilities but underrepresented in prisons, start to increase.
I noticed that the material that is available is fundamentally lacking in analysis of what impact all of this has on women and girls in particular, and it should interest you to know that while crime rates and incarceration rates are decreasing overall, it is not the case for women. In fact, women are the fastest-growing prison population, not just in Canada, but worldwide, even more so if they are Aboriginal and have mental health diagnoses, labels, difficulties, illnesses, disabilities; regardless of what the label is, that is the increasing trend.
We first saw this trend, not surprisingly, in the prison for women in Kingston, where a number of women were held in segregation, and most of them were from the Maritime provinces. Why, you might ask? Those of you who know our economic, political and social policy history know that some of the first and deepest cuts occurred in those provinces. With the cuts to national standards for health care, social services and education occasioned by the elimination of the Canada Assistance Plan, and the introduction of the no-strings-attached approach that you talked about, we also saw increased numbers of people who fell through all of those service cracks and ended up in the criminal justice system. That is because it is the only system that cannot close its doors and say, "No, we are full, our beds are full,'' and it is not difficult to characterize behaviour that is often symptomatic of mental illness as also criminal. Sometimes it is mischief, sometimes it is theft, sometimes, if you are resisting restraint, it can be assault, and so we first started to see some of those trends.
We are now in a situation where the corrections service, as Dr. Cotton has pointed out, is one of the largest employers of psychologists. The difficulty with that is trying to get an analysis that goes beyond that correctional mindset, and we had that experience when trying to intervene in the case of a woman who had committed suicide in the fairly new mental health unit of the federal prison in this province. We could not find a psychologist who was willing to testify at that inquest and critique the correctional policies in place; hence, the reason for my most recent educational endeavours.
The difficulty is that very well-intentioned, excellent people, like my colleagues here at the table, go in with a clear intention of trying to support, assist and facilitate the meeting of what has sometimes been described as disabling needs within the correctional structure. We know that the report of the Task Force on Federally Sentenced Women, Madam Justice Arbour's report and, just last year, the Canadian Human Rights Commission report chronicle some of the discriminatory treatment that women, including those with mental health issues, experience in our federal prison system. We see that the overlay of the criminal justice model, the overlay of the label of criminality, often interferes with the ability to address the mental health needs.
Particularly in the case of women, even though a tremendous amount of resources, time, energy and goodwill have been invested by corrections and others in developing services in house, we still see that those who pose the greatest challenge to the system — not necessarily a threat to public safety, however — end up being held in prison in the most isolating circumstances.
We see more women being held in the maximum security units, in isolation and in segregation. Even though their behaviour might be recognized in a hospital setting, in most cases, we are only able to have them removed into a hospital setting when they are in crisis. I cannot tell you the number of times I have been on my knees in front of a segregation cell, talking to someone through a meal slot, trying to convince her to stop smashing her head on the wall, and had staff say that they are told to count to 20, because then it is no longer just an attention-getting behaviour, it may be life-threatening. That is not because those staff are ill-intentioned, but they have been trained to believe that up to a certain point, it may just be a manipulative behaviour.
I am suggesting that we have to look at some of these areas because, short of training everybody in corrections to be mental health professionals — which I do not think is feasible — we have to develop some strategies for removing people from that system. There have been attempts through mental health courts, through other vehicles. Within corrections, as I mentioned, it is when someone is in absolute crisis that we can often trigger a removal to a psychiatric hospital. We often see people improve almost within 24 hours, and I do not mean to be overly simplistic, but part of the reason is they are then seen through the lens of the mental health issues/psychiatric label, not the lens of criminality. The intervention may have a positive result much more quickly.
Also, the individuals involved will often recognize that this is a mental health facility and although, arguably, the consent to treatment would be an issue, in our experiences, most women, and certainly the men and young people I worked with, would say they want some intervention because they recognize something is wrong. They may not know what.
We would advocate that in our cases, some of the increasingly non-available mental-health and psychiatric advocacy groups be encouraged to come in and assist in situations like that.
I found the reports extremely helpful, with the exception of not seeing much, if any, gender analysis, and I know from my experience in working with others internationally, with colleagues in the United States, the United Kingdom, Australia, less so in New Zealand, that they are finding a similar problem. The models in place may not meet the needs of women in those circumstances, and we are still seeing women posing some of the greatest challenges and ending up being criminalized as they try to survive and negotiate their way through the system.
In some of the models that you are looking at, that talk about plans for a range of services, there is a strong emphasis on the integration of social services and health services. We know that for integration to actually happen, even if you have excellent mental health services, all the things that everybody else is talking about, if there is no place for people to live, if they have no means to support themselves, then mental health issues quickly arise again. We all know that people will say, "If I could just have a job, have a place to live, I would feel a whole lot better.'' The beyondblue report talks a little about how to ameliorate depression and other mental health phenomena in a context where it is hard to imagine how people are even surviving.
If this committee could look at linking the recommendations you will make about mental health to the need for other social services and supports, and to the types of national standards that were virtually eliminated when the Canada Assistance Plan was cancelled, I think that would go a long way toward a solution, because it is those kinds of integrated services that we need.
We also think, of course, that ensuring that the Charter and human rights legislation apply is important. If any of the committee members are interested, there is a series of fairly extensive reports in which the DisAbled Women's Network of Canada and our organization in particular made recommendations about the kinds of interventions that would assist women in the system. Many people who have read them have indicated they would also assist men. I believe that is true.
They recommend advocates to assist people with negotiating access to programs and services, where they in fact exist. You have heard a lot about the lack of services, so I will not repeat that.
There is a need for community-based services, a need for almost a brokerage function. We use that term, and we are certainly open to suggestions on how we might more accurately describe it, but if you have a diagnosis, a mental health label attached to you, with that comes the understanding there will be allocation of resources that you will have some control over and some support in determining how those needs are met.
For instance, we are seeing in the Aboriginal women's community an overwhelming increase in the number of women and children being diagnosed with FAS — fetal alcohol syndrome — fetal alcohol effect, alcohol-related neurological disorders, et cetera, and so we are suggesting that if that diagnosis led to a triggering of an allocation of funds, we would see two things: Probably, we would not see the diagnosis as quickly, to be very blunt; and secondly, we would see some greater ability to access resources.
In the legislative framework, we would suggest that something akin to the work of the committee on the Youth Criminal Justice Act to ensure key principles are put in place would also be useful.
The principle of presumption that someone with a mental health issue would not be criminalized, first and foremost, would go a long way toward encouraging provinces and communities to develop resources, and combined with national standards, would mean a greater chance that people would actually be able to access resources in the community.
The continuation of the principle of using the least intrusive measure possible in light of the Charter and human rights protections would also be useful, in addition to looking at some national strategies and guidelines to encourage those accessing services to create some of the interesting community-based and consumer-driven options that people are talking about.
I have other comments, but I suspect I have run over my time, so I will pass it on to my colleague.
Mr. Randy Pritchard, as an individual: I read with great anticipation the first volume of the three volumes you produced, and when I saw the vision laid out there for the client-oriented, and possibly even client-directed, services I was exhilarated.
I then went on to read the rest of the documents and wondered how on earth did we end up here from that vision; I turned to the back of the volumes and looked at the witness lists, and then I understood.
The Mental Health Legal Advocacy Coalition is a non-profit group here in Ontario. The only requirement for membership is that people have been inpatients of a psychiatric unit. We look to address concerns of our members where the issues of mental health and the law intersect. We have successfully intervened in three Supreme Court cases to date: As a predecessor organization, Queen Street Patients Council, in LePage, which was joined with Winko in that landmark decision from the Supreme Court of Canada; in Starson, where competency to consent to treatment was an issue; and in Pinet and Tulikorpi, two forensic clients, which clarified once again that the least restrictive and least onerous provisions were to apply to an entire disposition warrant.
Having won those victories, there were those who believed that we could take a break, but what we have seen instead is the attempts of the mental health system to circumvent the rulings of the Supreme Court of Canada.
Shortly after the Starson ruling, a workshop was held at the Centre for Addiction and Mental Health here in Toronto to advise staff on what they could now do to get around the intent of that ruling. This is nothing new to us. We have been seeing this all of our lives.
I had originally planned to bring you a written version of my remarks but I jettisoned it yesterday after returning from an inquest in North Bay on Tuesday where I was a witness. It was into the suicide by hanging of a forensic client. Having had the opportunity to review the three volumes of documentation, clinical notes, various medical tests and testimony of individuals, I was appalled that the same mistakes were being made again. In reading the document here, I could not help but note that when you adopted the recovery philosophy, you defined it as it has been previously defined. You require some history on this.
The recovery philosophy was first adopted by mental patients in the United States who had noticed that the further away they got from the mental health system, in 30 per cent of cases symptoms disappeared. I think individuals mistakenly adopted that word "recovery'' to describe that in an attempt to prove to service providers that "Maybe what you are saying might apply to some people, but it does not apply to me.'' It has now been co-opted by service providers with the definition that we see driving the actions here.
Yesterday, you heard from the Gerstein Centre here in Toronto, and I believe that someone asked, "Well, why are there not these places across the country?'' and one of the panellists chimed in, "Well, because it is not medical,'' and that is the reason.
Fifteen years ago, you knew how to do this better. Fifteen years ago, the federal government made sure that significant numbers of users of services were involved in any consultation. I and many of my colleagues attended a federal-provincial consultation in Ottawa on mental health that was funded by the federal government. We made up about a third of the body there — as did the service providers and the bureaucrats — and our position was very different from anybody else's. The problem here, as far as I can see, is that you need to return to that vision of all change being driven by the user.
It is ironic that we can successfully intervene in court cases in an attempt to have our rights upheld, and then — you cannot believe how horrified I was — I read the presentation of the schizophrenia society that suggested you actually recommend removing the right of forensic patients to refuse treatment under the Criminal Code.
We need to stop and pay attention to what the Supreme Court said in Winko. It listed all of the protections that were in place, including our right to refuse treatment, as its justification for not calling it a section 15 Charter violation.
We have made a presentation to the parliamentary committee responsible for the proposed Criminal Code amendments, and there is a copy of that in your package because we understand that possibly, this committee will be reviewing it in the Senate. I implore you to fulfill your function as the chamber of sober second thought when it comes to that, because there are some horrible provisions in there that undermine our Charter rights.
We have surveyed, as part of a court challenge that has sponsored a small program here, individuals in the forensic health system in Ontario and in British Columbia. What is striking is that the system will periodically, as evidence of its accountability, tell you about the surveys that they conduct. There is a wonderful client satisfaction survey, done by the Law and Mental Health Program at the Centre for Addiction and Mental Health here in Toronto — staff- administered — that shows that people are generally pretty happy. When we interview those very same people, we get quite a different response, and I would suggest to you that the reason is, if staff members are administering a client satisfaction survey and their opinion determines your very liberty, you may be a little cautious about being forthright. All of these mechanisms have no validity.
I was so angry when I left North Bay after seeing the blatant attempts to duck responsibility for some very real physical problems that this man who killed himself had. It took 16 years for them to be addressed, and this is another common problem in the system, the tendency to see us according to our label, to dehumanize us and discount any of the realities.
A member of our organization complained for years about stomach problems and was told repeatedly, "Don't worry about it. It is just part of your illness.'' Recently, they finally got around to sending her for medical tests and a mass was found in her stomach that, thank God, was benign and will not kill her, but here we are again.
Two patients in North Bay reported sighting the missing patient shortly after he left the facility, and this should have triggered in the internal responses the call to the police to set the whole missing person case in motion. The nurse chose not to do that. Two hours later, a maintenance man who had done a lot of work at the facility also saw this man in the same general area and phoned in a report. Now, she believed him, and that triggered the search for him. In those two hours, he had sufficient time to get to where he wanted to go and he hung himself.
I think what needs to be understood here is people do not suddenly go mad. While I have avoided doing this for thelast 15 years, I will do it here: I was found not guilty by reason of insanity in 1981 on a charge of unlawful possession of explosives. I spent 10 years in the forensic system before I was suddenly, with the stroke of a pen, cured of my mental illness, and that was the criteria at that point for leaving the system. Today, it is that we are not a danger to the public.
What is incredibly ironic about that situation is in my final review board hearing, the one question they had for me was, "How do we know in the future that you will turn to someone for assistance if you run into trouble?'' My response was, "Rest assured I will not turn to you.'' There is a punishment involved. If you are forthright, if you are honest about your difficulties, expect to stay in longer, expect your incarceration to continue. I said, "But also be assured that my experience with you has been so unpleasant that I will do whatever I need to do not to come in contact with you again.'' What kind of a system would take that kind of criticism unchallenged and then turn around and say, "Okay. It is good enough for us. Go.'' That is exactly what happened.
Nothing has changed. On the day that I was on the stand in North Bay a report was released that another forensic patient at the Royal Ottawa Hospital had committed suicide. Most of the cross-examination of me while I was on the stand was an attempt to dismiss what I was saying, and the lawyer for the hospital said, "You will agree with me that the hospital did end up providing this piece of medical equipment.'' It is called a CPAP machine and allowed the man to keep breathing at night. My response was, "I will agree that after 16 years and ample evidence that a physical condition existed, two months before his death, you got that machine for him. Yes, I agree.''
Our issues: There was something ironically called the first annual database on warrant of the lieutenant-governor populations. It was commissioned in 1989 by the federal justice department and the review boards across the country and was authored by a man named Chris Webster, a researcher who was with the Clarke Institute at that time. It was a demographic study of the population across the country, and some rather interesting statistics came out of it — for example, the lack of education among people in the forensic system.
The highest grade average was in Alberta, at grade 11. Here in Ontario, it was grade 9; 25 per cent of people had zero income at the time of the offence. They were not on social assistance. They were not on anything. They had nothing; 25 per cent of that population was homeless. There was massive unemployment due to lack of education and vocational skills and substandard or no housing.
Even the World Health Organization recognized backin 1990 that income levels are basic determinants of mental health, and we seem to have swept that all aside. We pay lip service to the notion that these are the things that are required, when what is required instead is a massive intrusion of the services currently available in the institutional sector into the community.
I know that some questions were raised here yesterday about ACT teams. They are an absolute disaster. I was asked in 1990 as part of my job to review the prototype for ACT teams in this province at the Brockville Psychiatric Hospital, led by Dr. LeFevre. The battle was already being waged between staff people who had come from the institutional side and those who were more community oriented. Their goal at that time was to address five issues in people's lives: their housing situation, their employment situation, their educational situation, their recreational situation and their social situation.
When people presented at the hospital, the emergency ward, looking to be admitted, they were moved over to him. He would send them home with his staff, who were to remain with them until such time as the issues had started to be addressed. He was able to close a 38-bed psych ward as a result of that. He lost the battle for control, and what we ended up with, as the institutional sector side won, is what we have today.
I could go on for ever, but my time is up.
The Chairman: Thank you to all three of you for coming. I would like to ask all of you a question.
Given the number of people sentenced to prison who suffer from some form of mental illness — I am not now talking necessarily about extreme cases — what services, if any, do they actually receive; and when their prison term is over, has their problem actually been treated, has it become worse, or is it the same?
Mr. Pritchard: I would approach it from the perspective of the forensic mental health population because that is what I am most familiar with. There are a number of people who have been in both the prison system and the mental health system, or at least the forensic part of it, and when asked, a significant number would have preferred being sent to prison because they believe there were more options available to them there.
One of our recommendations to the jury in North Bay was, following the model of the Youth Criminal Justice Act, thatnon-clinical staff positions be created whose sole function is to be assigned to individuals when they enter the system and their only concern is the necessary tools when people leave and helping to address them. Quite frankly, if our life issues, which I tell you are major contributors to what we are choosing to call mental illness, are not addressed, if you open the door after years of incarceration and say, "Now, take care of your life and don't screw up,'' it will be a disaster.
Dr. Cotton: Not surprisingly, my answer to that is slightly different from Randy's. The people he is talking about are contained in the mental health system, the forensic patients. They are not in the prison system, and I would say that in the forensic system in Ontario, you get the same standard of care as in the rest of the psychiatric system. You can make your own judgments about what standard of care that is, but certainly my experience in forensic programs is the care was more or less the same as you got elsewhere in the psychiatric hospital, warts and all.
Certainly from my experience in talking to patient/consumer/survivors, one of the main reasons that people often prefer a prison sentence to a forensic sentence is that it is a determined length. When I was director of forensics, we had in our program a man who had shoved a bag lady. He would not have received five minutes of jail time had he been found guilty of that crime, but he had been in our program for over five years. There is a definite preference, unless you are serving a sentence for murder, for doing the jail time, because you will get out a lot quicker.
In terms of your specific question about services, it would be my personal opinion — and again, I hope not to be unemployed soon — that the standard of care in the federal correctional system does not come close to meeting a community standard. The principles of correctional treatment involve criminogenic needs, degree of risk and responsivity factors, and so mental health issues are primarily addressed only if it addresses the criminal behaviour.
The more generic needs, unless they are acute, are not generally addressed within the correctional system. It is not part of the mandate. Corrections is not health care, believe me. It is not health care. It is jail. It is a very low priority within the system.
The floor I am working on has eight psychologists, three nurses, a social worker, an OT and a clerk. This is a hospital. We are the hospital in Ontario for federal corrections. Our printer cartridge, one that 15 of us share, ran out and we were told we would get a new one in the next fiscal year, which, as you know, is April. That is how high we are in the priorities. It is not a community standard of care.
The Chairman: Is it fair then for me to conclude that you are really saying — and I am not talking about forensic patients now, I am talking about the general prison population — that if people clearly need mental health treatment of some kind, counselling, whatever, that by and large, that is not given and that they therefore come out, at the very least, no better and, conceivably, worse than when they went in?
Dr. Cotton: If their mental health issues are directly related to the commission of a crime, they will likely get some treatment that would not be as intensive or as ongoing as if they had been able to access services in the community. If it is directly related to their criminal offences, they are more likely to get treatment.
Also, it depends on what you are talking about. For sex offenders there is a lot of intensified, high-level and ongoing treatment available, and in spite of what the public seems to think, moderately successful treatment. However, the rate of depression, for example, among federal offenders is incredibly high, for a variety of reasons that you can guess at, and if it is not really related to criminal behaviour, they are low on the totem pole.
Institutions other than psychiatric hospitals will house 400 to 600 offenders, and will have maybe four or five psychologists; that is it. There is no team.
The final piece of the puzzle is the linkage to the outside world. The federal correction service does not provide aftercare. There is the parole system and there are some psychologists who work with ex-offenders in the community. However, if people need much more intensive care, they should be reintegrated and accessing the same services as everybody else. Of course, it is hard enough for everybody else to get access, and far more difficult for somebody with a criminal record.
Ms. Pate: My experience would be very similar to what has been discussed, except that when people are locked in isolation cells, often, any other place sounds better. I just want to be clear, getting people out to get them into a mental health or a psychiatric setting is not something I would normally advocate, but when faced with the prospect of people potentially dying in an isolation cell, obtaining a court order to get them out for an assessment has sometimes been the only way to get them before the court again. In some of those cases, we have managed to squeeze out a little space to reopen what has happened to them in the prison system. I do not want to be heard as in any way advocating putting people into forensic units. That is not it.
It has probably been a little different for women because five new mental health units have been constructed across the country in women's prisons in recognition of the reality that I was talking about earlier. However, the people who end up there are not the women who were, if you will, the rationale for those units being put in place, and in large part, it is because the type of program and the types of services that are being offered are not meeting their needs.
There are behaviour science technicians who offer the kind of psycho-social behaviour modification treatment that has been shown in many other places not to be the most effective way to deal with anybody, whether or not they are in prison or in mental health facilities. Our experience is that where there are in fact some supports, it tends to be the kinds that are provided outside the correctional milieu. It will be an individual who will take the time to provide some services. It may be a linkage to the community. It may be an advocate who has been in touch, and yes, the services in the community are lacking as well, and largely because it has not been a priority. A person who is low on the totem pole is actually in a significant place. In my experience it is quite the opposite, there are people who are not on the totem pole at all.
We have women who started out with 18-month sentences doing 18 years now, all from charges that have accumulated inside that have been linked to mental health issues. Most of them end up being held until their warrant expiry, because if they have the misfortune to have their criminal behaviour linked to their mental health, then they are more likely to be seen as dangerous, despite all the research to the contrary that I believe you have heard about. Lots of people, as well as those who live the experience, can tell you that in fact there is no correlation between mental illness or mental health labels and violence, and yet that is the first label to be attached.
Resisting restraint or busting down a segregation cell door that hits someone will cause people to end up facing charges of assaulting guards, that sort of thing. Sometimes they will actually assault a guard because that is the person they see as standing between where they are and where they need to get to.
I have been in the segregation unit and have sometimes argued, mostly unsuccessfully, to have those doors unlocked, and I have never been assaulted. What Randy was talking about is that we see a different person in a different context. The person with whom you are intervening understands that you are there to assist, to advocate, and not to further intrude on their rights. I am not suggesting it is a magical solution. I think it is quite straightforward that when you have that kind of control over your life, you will exercise it in a way that is beneficial for you and for others generally, even if you are seen to be in a state other than what is often termed "normal.''
As I mentioned, despite best efforts to develop programs and services inside, they are not meeting the needs, and it is fundamentally about seeing it through the correctional lens.
Therefore, our recommendation, and that of DisAbled Women's Network of Canada, was for the use of a provision in the Corrections and Conditional Release Act that for health reasons — and mental health comes under that — allows individuals to be taken out of prison at any point in their sentence for more appropriate health services that meet their needs in the community. I suggest that that is a mechanism that does not require law reform, but could trigger a look at community-based options.
For instance, in one case, a woman who was serving a life sentence was 15 years past her parole eligibility dates, but because primarily of her mental health condition, had not been able to even get the reports from corrections to go before the National Parole Board. Her mental health condition was linked to her offending, even though everybody agreed they did not know why because she had never shown any other instance of violence in the 25 years she had been in prison.
The only way we could publicize it was to approach a filmmaker to make a film, and if you have not seen Sentence Vie/Sentenced to Life I would recommend you have a look at it, either as a committee or individually. I think it captures some of what we are talking about, how people get spun into the system and can never get out. The insanity, and I use that word advisedly, of the system was exposed to public view and it resulted in corrections ceasing to put that woman in segregation and agreeing to let her have some control over the services she was accessing. I am happy to say that she is now more than half time in the community, starting with one of our halfway houses and with some additional supports, but those resources are still lacking.
If you look at the millions of dollars that have been spent by corrections on the women's prisons for these mental health units that are still not meeting the needs, versus the cost of an occasional extra mental health worker or support advocate in the community, you see the dichotomy.
On two occasions now, I have taken holidays for a week to go and walk with individuals whom we have identified as high profile. Our organization has identified about 17 women as high profile and with whom our two-woman office has become directly involved.
Even when resources are applied, there is virtually nothing in the community, so our halfway houses are being approached to provide services to women, but our staffing situation means we are unable to help in those ways. Means that could obviously be more humane and also far more cost effective are not being implemented.
Senator Trenholme Counsell: One of the questions I asked yesterday concerned information on persons in the correctional system. I wanted to know whether, given the intensive interrogation and examination that precedes an admission to a maximum or medium security facility, when a person arrives, do you have a substantial amount of good, correct, useful information on that person's health status and social status? Of course, now I am thinking mainly of mental illness. Do staff members avail themselves of that information? Is it mandatory? Is it a must?
Ms. Pate: Certainly my experience is limited, because I am not usually there when someone is being taken in, but because of inquests, some of the interventions we have done in court cases, and all the advocacy work I do, I often see some of those documents because the women ask me to review them. Generally, if it is linked to the offence, as Dr. Cotton said, if it is seen as a criminogenic factor, it will be there. If it is seen as linking to that, it will be there, but it will appear in very odd ways.
For instance, a woman who was labelled schizophrenic, who had been raped by her father, was seen as having inappropriate relationships. One of the things that were seen as contributing to her criminality and included in her file was that she had had a sexual relationship with her father. That was included as an indication of inappropriate behaviour, and my response was, in what context do we see rape of a child by her father as somehow within her control. Then how do we make the leap that it is somehow linked to her offending. It may very well be that her history of abuse was the reason she defended herself against the man who attacked her when she was being prostituted on the street, but it is certainly not indicative of a mental health issue, I would suggest.
Part of the reason that Madam Justice Arbour, the Auditor General, the Public Accounts Committee and the Canadian Human Rights Commission have recommended alternative strategies for assessment in classification of women is that it is usually an overlay of a male model. If a woman has experienced violence and then has reacted to that, it will often trigger the switching of a need to a risk, and it will be characterized as a risk factor. She may then be required to take anger management classes, when I would say — not to condone the use of violence — if you are a woman who has experienced a long history of violence and you react to another act of violence against you with violence, then to characterize the problem as only your violence and not put it in the context of what has been happening historically and currently in your life is problematic.
I am not sure if that answers your question, but certainly, there is often information there. How it gets used is often the greatest challenge, because it is seen through that lens of criminality.
Senator Trenholme Counsell: You have answered in part, but I was wondering, for instance, is there a social history, work history, medical history, criminal history or whatever? Is it all there in a succinct, accessible, clear fashion?
You are talking about the difficulties in the case of rape or reaction to violence. Those are not necessarily subtle, but they are factors of which I would expect to see some documentation. Not being part of the system, I am not sure how much could be put in such a record, but can the correctional officers, and you as an intervener, read that and know a lot about the person?
Ms. Pate: I find that out from talking to the individual herself.
Senator Trenholme Counsell: However, you do not have what I call a chart sheet. You do not have a file or whatever that you can go through quite quickly.
Ms. Pate: Well, there is the Correctional Service of Canada's intake process. Although we have challenged some of those provisions as unconstitutional because they go into things like social condition and start to translate them into risk factors.
Those are factors such as you have lived in a low income area, you do not have an education, or other family members have a criminal history. We know from the Causey report that in Alberta, 90 per cent of Aboriginal men have a criminal record by the time they reach the age of 30.
If those kinds of categories exist when people are being assessed, then it is left to the judgment of the individual, who can characterize that category as a risk factor. It could be done by the new 25-year-old caseworker.
Dr. Cotton: If I can comment on that, there is a fairly detailed history taken on people when they come in, but it is a criminal history and factors related to offending behaviour.
I am the neuropsychologist for Ontario, so I see all the institutionalized people who are viewed as having some kind of "brain damage,'' which includes everything. There is nothing in the files that constitutes what in a hospital would be called the social history, and it is problematic, for reasons that Kim points out.
A lot of the information can be used against the offenders, as can my report. It is a very delicate position for me to be in if I say, "This man has a lot of frontal lobe damage, and he has impulse control problems because he has damage to his left temporal lobe.'' The upshot of me saying that is they will keep him in longer because they will assume he is likely to reoffend, which may or may not be true. In fact, we do not have data to support that, but theoretically, it makes sense.
It also means there are "bazillions'' of sets of files within the correctional system, so the work that I and the mental health workers do in the system is not accessible to, for instance, the parole officers. Because of confidentiality rules, unless it is a health care issue, they do not have access to the files, the same as you would not have access to somebody's health care files in any other hospital. It is a basic right that your health care files are not public information, so it becomes very confused in the correctional system.
There tends to be history of criminal offences, there tends to be history of substance abuse, which is a "biggy.'' If somebody volunteers the information, there will be just a checklist on whether you have ever been treated for a mental disorder, but there is no particularly comprehensive psychiatric assessment done. Corrections, by and large, does not employ social workers, so there is nothing that would constitute what we would call a social history.
The Chairman: Kim, did I hear you say that there was a report done in Alberta that said that 90 per cent of Aboriginal women have a criminal record by the age of 30?
Ms. Pate: Men, sorry. It was men. By the age of 30, 90 per cent of Aboriginal men have a criminal record. It was the Causey report in Alberta. We now know that almost a third of the women serving two years or more are Aboriginal. It is increasingly rare to find people who do not have a family member with a criminal record, which gets used against them.
Senator Callbeck: Thank you for coming this morning with your presentations. I have a short question for each of you.
Ms. Pate, does the Elizabeth Fry Society come in contact with these people when they enter prison, or do you have contact with them before?
Ms. Pate: It largely depends on the community, but generally both. We generally have contact before. Many of our local societies provide early intervention services. Some also offer victim services in some parts of the country, so it depends on the community.
Senator Callbeck: You mentioned that the fastest growing segment of the prison population is women, and you also said that the greatest increase in the Kingston Penitentiary is people from Atlantic Canada. Does that mean in Atlantic Canada, we have the highest increase in the number of women in penitentiaries?
Ms. Pate: Thank you for asking that question because obviously I was not clear. I was saying that our organization flagged this issue more than 10 years ago because we first saw the trend coming from Atlantic Canada. It is now right across the country, but it is true that for about seven years, the Correctional Service of Canada had segregated maximum security units in men's prisons. In Atlantic Canada, they were put in Springhill Institution. There was never a time when I was in that institution that those units were not full of women with significant mental health issues. That was clearly the predominant issue when you went in. If you went into the one at the Saskatchewan Penitentiary, it was Aboriginal women, many of whom had also been diagnosed as having mental health issues.
I am not suggesting that it is just a phenomenon in Atlantic Canada. It is that is how we came to flag it as an issue our organization needed to be watching.
Dr. Cotton: Could I just make a comment related to that? I certainly understood anecdotally from a friend who used to be the chief psychologist at the Prison for Women in Kingston that the sentencing is somewhat dependent on the whims of judges. My impression, and correct me if I am wrong, is that there was certainly a trend afoot in Atlantic Canada to give sentences, particularly to women, of exactly two years because it gave them access to the federal as opposed to the provincial system. Much as Corrections Canada could do a lot better, it is Olympic class compared to most of the provincial systems, so if the provincial systems were particularly weak, you got almost differential sentencing.
Ms. Pate: Yes. For a time, the number of women serving federal sentences in Atlantic Canada quintupled. It has gone down a lot. It has almost halved, although it is still more than double what it was when they were at the Prison for Women, just because there is a prison there. It has tripled in the Prairie region as well.
Obviously, we are seeing the impact of the cuts to social services, health care, education in particular, that the provinces have been allowed to implement, because people are dropping through the cracks. In the women's context, we are seeing increasing welfare fraud, carrying packages across the border, across the country, prostitution to make ends meet at the end of the month. A number of Aboriginal women who in for armed robbery had demanded money after they had committed the sex act and not been paid, and then the man involved indicated she was in the process of robbing him. It is an Aboriginal woman. If she has a mental health issue, as Randy said, whose credibility is usually accepted?
Senator Callbeck: Dr. Cotton, you mentioned that salaries for psychologists in Corrections Canada are 30 per cent below the average. I know that we are short of psychologists in the system, but are there any vacancies that are not filled?
Dr. Cotton: There are vacancies on paper. I am not sure whether they are actively hiring. I know that on my floor there are three empty offices for psychologists who have moved on and those positions are on the book. There is no money, so the party line goes.
Recruitment is a big problem. It is a bigger problem for the RCMP. I notice in your previous report — I was quite struck by it — it says that, "All statement, no information was available from the RCMP,'' which speaks volumes.
Another one of my tangents is the area of police psychology, which does not exist in Canada. I will not go off on a tangent. It is in my written brief. I am involved in a national survey with a professor at the University of Moncton looking at police utilization of psychological services, and a big issue, particularly for the RCMP, is the inability to recruit.
A federal government salary for a psychologist is about $70,000. The community standard is about $90,000. In corrections, we get a term allowance, as they call it, so we get an extra $1,000 a week or a month or a year or something — I forget what it is — that is not actually part of our salary and they can take it away at any point. The RCMP does not offer that.
Therefore, they are trying to hire psychologists for $20,000 to $30,000 less than the hospital down the street is paying, and they cannot recruit them. If I had a dime for every time I have been approached by the RCMP to come and work for them, I would be a wealthy woman, but you cannot hire people for that kind of money. It also speaks to what they think of the profession.
Senator Callbeck: Mr. Pritchard, a question for you. I have not had time to read your brief, but I will.
However, there are some comments in here regarding the proposed legislation that is before the Senate right now.
Mr. Pritchard: Are we referring to C-10?
Senator Callbeck: Right, C-10, and I notice the provision dealing with the victim impact statement, which would be in cases where people are not criminally responsible for the act.
Mr. Pritchard: Correct.
Senator Callbeck: This proposed legislation would put a victim impact statement in place.
Mr. Pritchard: They exist already in legislation. This makes them far more onerous, and quite frankly, the position in the Winko ruling was their utility is in a criminal proceeding. It is the ability of the victim to impact sentencing.
Given that this special system has been created for forensic patients, the NCR accused, one of its hallmarks is that in law, punishment is not allowed. It precludes the value of that. I recognize that people who have been victimized by someone who ends up with an NCR designation have a right to be heard, but not in this forum. There have to be other mechanisms found for that. It just has no place in a system where someone is deemed, due to mental disorder, to have lacked the criminal intent, the guilty mind, as it were.
Senator Callbeck: Where would you suggest they be heard?
Mr. Pritchard: Quite frankly, I think there are mechanisms. I have a friend who was able to access victim services here in Ontario after being assaulted, and I would suggest that in terms of the healing process, I do not know how much value there is in being able to confront the perpetrator more than once.
In the current legislation, people are allowed to submit a written victim impact statement, and it can be considered in the initial disposition order. It is being proposed that they can now deliver it in person and that it can be used to make decisions about disposition orders into eternity, and that is quite contrary to the intent of the bill. It just does not have a place there.
We seem to be trying to make this comparison between the two systems, and there is none. It is not allowed in law, and I would suggest to you that if the provisions that are being proposed are passed, we will be the first out of the gate to organize a way to challenge you. They violate our section 15 Charter rights, and we will no longer be the placid little mental patients who were willing to put up with this. We will not.
Senator Pépin: Ms. Pate, I want to thank you for your presentation. I have been involved in the issue of violence against women for more than 25 years, but what you said this morning has added to it so much and I realize that I was missing lots of information, specifically on women inmates. We know that the correctional services are maybe not up to date, but I was wondering about the National Parole Board.
When they interview those patients, do you know if they are aware of those people's illness? Are they trained to do those interviews? I was wondering if you know anything about that, because they are the ones who decide if the patients will go outside.
Ms. Pate: Thank you for asking, because I think that there is an increased interest in this area at the National Parole Board, especially from the current vice-chair, and there has been more work done.
They actually had us do a training session a couple of years ago. They are in the midst of some research now arounddecision-making, how it differs between women and men, and how the interpretation of what happens to men impacts women's decisions, such as in violence against women situations.
Certainly, I think there is room for improvement. One of the challenges, however, is that the Parole Board relies on the information that is brought to it, and that is one of the reasons for suggesting more support people and groups like Randy's and others be involved. I am not suggesting we do not have enough work, but it is why we are involved in some of these other cases nationally as well as the one I was talking about.
We realize that we have to intervene and almost try to reconstruct the situation. In one case where we were able to do that, a woman was being referred for detention. The board had all of the information put forth by corrections, and again, it is not that people were not trying to help, but their interpretation of how to assist in that case was very different from ours. I can tell you, though, that that process — I was the one who worked on that particular case — took a hundred-and-some hours, going back to interview some of the same people, talking to the same psychologist, and reconstructing another version of how that case could be looked at.
The result was that she was released, with several conditions. She then reported feeling as if she was about to get into trouble, and she actually got into a car and drove it away. The keys had been left inside. The man who owned the car said, "I don't want to press charges,'' but that was the precipitating factor that led her to go back to prison to stay until her warrant expiry, even though everybody involved said, "Gee, would it not have been better if...'' She got into that car and drove back to the halfway house, went in and said, "I just stole a car.'' Now, technically, she did steal a car, and that was the basis on which the Parole Board put her back inside. They felt they did not have an option because it was a one-shot statutory release. That means you have one chance. If you breach any of the conditions, you are back in jail; so there she was.
When she was finally released, they felt they had to notify the police, again because of the structure that had been put in place. The long and the short of it is she has now been out for a year and a half after serving 10 years. Her original sentence was three years. She still has situations, but everybody says, "We cannot believe how much her mental health has improved.'' I do not mean to be flippant, but if we let a few more people out and had someone there to support them, a community of support and a place for them to live, then it is not that problems disappear, but as Randy said, the more people move away from the system, the less likely everything they do will be framed in that way.
The Chairman: May I thank all of you for coming. I really appreciate you taking the time to be with us.
The committee adjourned.