Proceedings of the Standing Senate Committee on
Social Affairs, Science and Technology
Issue 29 - Evidence - March 12, 2015
OTTAWA, Thursday, March 12, 2015
The Standing Senate Committee on Social Affairs, Science and Technology met this day at 10:29 a.m. to study Bill S-208, An Act to establish the Canadian Commission on Mental Health and Justice.
Senator Kelvin Kenneth Ogilvie (Chair) in the chair.
[Translation]
The Chair: Welcome to the Standing Senate Committee on Social Affairs, Science and Technology.
[English]
I'm Kelvin Ogilvie from Nova Scotia, chair of the committee. I'm going to invite my colleagues to introduce themselves.
Senator Seidman: Judith Seidman from Montreal, Quebec.
Senator Stewart Olsen: Carolyn Stewart Olsen, New Brunswick.
Senator Enverga: Tobias Enverga, Ontario.
Senator Patterson: Dennis Patterson, Nunavut.
Senator Wallace: John Wallace, New Brunswick.
Senator Nancy Ruth: Nancy Ruth, Toronto.
Senator Raine: Nancy Greene Raine from British Columbia.
[Translation]
Senator Chaput: Senator Maria Chaput from Manitoba.
[English]
Senator Cowan: Jim Cowan, senator from Nova Scotia.
Senator Eggleton: Art Eggleton, senator from Toronto, deputy chair of the committee.
The Chair: Thank you, colleagues.
We are continuing our study of Bill S-208, "An Act to establish the Canadian Commission on Mental Health and Justice." Just before I welcome the guest on our first panel, I will remind the committee that we have three panels in this meeting this morning. This session will end no later than 11 a.m. The one-question-per-senator rule will be in order. I will be starting with the sponsor and the interim critic of the bill as the first questioner, followed by Senator Eggleton.
With that, I want to welcome Don Head, Commissioner, Correctional Service Canada. We welcome your presentation and I will open it up to questions immediately following it.
Don Head, Commissioner, Correctional Service Canada: Good morning, Mr. Chair, and honourable senators of the committee. I'm here to provide any information you may require regarding the Correctional Service Canada, or CSC for short, as related to Bill S-208 currently before you. I will keep my comments short to allow you more time for questions.
As you may be aware, CSC is responsible for the administration of court-imposed sentences of terms of two years or more. To address the mental health needs of offenders, CSC delivers a continuum of mental health services from intake to warrant expiry. CSC is committed to providing reasonable and effective levels of mental health services for offenders and has a Mental Health Strategy that includes five key components, namely, mental health screening at intake; primary mental health care in institutions; intermediate mental health care to address the needs of offenders who are unable to cope in regular institutional settings, but whose mental health problems are not so severe as to require care in a regional treatment centre; intensive care at the regional treatment centres; and transitional care for release to the community.
In addition to providing mental health screening at intake, interdisciplinary teams of mental health professionals have been enhanced in mainstream institutions to provide essential mental health services and supports. In fiscal year 2013-14, approximately 48 per cent of offenders received at least one institutional mental health service. Approximately 73 per cent of women offenders and approximately 51 per cent of Aboriginal offenders also received an institutional mental health service.
CSC is currently refining its model of mental health service delivery in order to ensure that the most effective essential mental health care services are being offered to meet the needs of the offender population. CSC's refined model of care will be consistent with the World Health Organization's Continuum of Care, allowing inmates to receive the most appropriate level of care when they need it.
Accredited Regional Treatment Centres are available to provide care for men offenders with the most serious mental health conditions who require inpatient treatment. Also, CSC currently has in-patient care beds available for federally incarcerated women at the Regional Psychiatric Centre in Saskatoon, Saskatchewan. External in-patient psychiatric hospital beds are available for women offenders at L'Institut Philippe-Pinel de Montréal and the Brockville Mental Health Centre for hospital care. In addition, intermediate care is currently available for minimum and medium security women offenders through the Structured Living Environments, or SLEs, at the regional facilities for women.
Since April 2007, CSC has trained approximately 10,800 staff working in both the institutions and in the community on the fundamentals of mental health training. An additional 560 non-CSC staff and community partners have also received the training. As of fiscal year 2013-14, this training is now part of the orientation training for newly hired correctional officers.
This is but a snapshot of the model CSC has in place to address the mental health needs of offenders under our supervision. I will now turn the floor back to you, honourable senators, and answer what questions you may have with regard to this and other issues.
The Chair: Thank you very much. As I indicated, I'll start with Senator Cowan.
Senator Cowan: Welcome, Mr. Head. It is nice to see you again. I've heard you testify on other occasions before various Senate committees, including Legal and Constitutional Affairs. I recall one occasion where you were talking about the difficulty of recruiting and retaining qualified and quality mental health professionals. Can you tell me where that stands now? How are you doing in filling the staffing requirements that your strategy contemplates and also retaining them on a long-term basis?
Mr. Head: Thank you, senator, for that question.
We've actually made a lot of progress since the last time you heard me talk. We have been able to engage various groups, various associations in terms of helping to promote Correctional Service Canada as a place for mental health professionals to come and work, particularly focusing on psychologists and nursing professionals.
One of the challenges we still have, though, is that the physical location of many of our institutions are not ideally located. They're not in places that those professionals want to come and live and practice. When we look at some of the places such as Grande Cache in Alberta, it's a beautiful part of the country, but you can imagine how difficult it is to attract sufficient professionals to go there. So our geographic location continues to be a bit of a challenge for us. But we've worked a lot with the various nursing associations and psychological associations to encourage people where we are located to come and work with us, either on a full-time basis or in some cases under contract.
Senator Seidman: Thank you, Mr. Head. Under clause 4 of Bill S-208, the commission would be responsible for developing training programs for correctional officers to ". . . maximize their effective involvement in the detection of mental health problems and the provision of mental health care." In your view should the design of training programs for correctional officers be undertaken by an organization outside the CSC? Why or why not?
Mr. Head: Thank you, senator. That is a good question.
We have actually been working with other organizations to help us develop some of our training courses right now. For example, the Centre for Addiction and Mental Health, CAMH as it's commonly referred to, has been working with us to redevelop our dialectical behaviour therapy training that we offer to women offenders. We've worked with CAMH. We're currently working with the Royal Ottawa Hospital group to revitalize the suicide self-injury behaviour training. So we work with various groups that have expertise beyond our own, and we would continue to look to engage those kinds of partners and expertise.
We also have relationships, for example, with the University of Saskatchewan, doing work there in terms of not only training, developing and recruiting psychiatrists, but also using them to help to review the various training that we provide for our staff.
Senator Eggleton: I note the improvements that you talk about in your system which is good.
Yesterday, CAMH were here and said that the suicide rate in the federal correctional system is seven times the national average. Of course, there have been well-publicized cases, such as Ashley Smith and Edward Snowshoe, related to what is being criticized as excessive solitary confinement leading to suicide or further mental disorders. Can you comment on what's being done to counter that?
Mr. Head: Thanks for the opportunity to address that question, senator.
We have been constantly examining how we use segregation. The term "solitary confinement," which has been used in the media quite a bit, actually refers to something different than what we do in Canada. Solitary confinement is usually a lockup for 22 to 23 hours a day with no meaningful human contact.
When we have individuals in segregation, there is constant engagement. They may be locked up for 22 to 23 hours a day, but there is engagement by correctional officers and, in certain cases, psychologists. The wardens of the institutions are required to visit segregation and the offenders in segregation every single day. Health care staff are required to visit all offenders in segregation every day.
Having said that, there are still some challenges for us in relation to managing offenders in segregation who have mental health problems. One of the reasons we use the segregation space is that when individuals act out in a manner that jeopardizes the safety of staff, other offenders or even themselves, we have to take them out of circulation from the mainstream institution. The only place that we have in our institutions is the place called segregation. While they're in there, we try to stabilize their behaviour and look to getting them back in the general population as soon as possible.
We have a rigorous review process, which we're looking to tighten up even more. Anybody that goes into segregation is reviewed within 24 hours of being placed there. Anyone who has self-injurious behaviours or suicidal ideations is seen by professional staff quickly once placed in there, and then we have a formal review process after five days and 30 days.
We have been compared a lot to other jurisdictions around the world, for example, the U.S., which is starting to look at doing reviews after an individual has been in there for 120 days. As I mentioned, we start our reviews after 24 hours.
Having said that, we still have challenges, particularly with individuals with mental health problems.
Senator Stewart Olsen: I know the difficulties you face. Years ago, they used to have institutions or hospitals where portions of the hospital would be dedicated to the criminally insane, as I think they used to call them. I think that, suddenly, when they decided to close them, the Correctional Services was kind of gifted with many of these people. I think that the expectations were that it would be easy to deal with them, and I know that it's not.
If you have a crisis situation, do you have a crisis team? Could you briefly tell me what would happen, if you wouldn't mind?
Mr. Head: Thanks, senator. Briefly, leading to your question, I joined the Correctional Service 37 years ago, in 1978. At that time, truly, individuals that presented with mental health problems as we see them today were not in the mainstream institutions that I worked in. As provinces and territories had to shut down their facilities for various reasons, we started to see an increase of individuals coming our way into the 1980s and 1990s, and those individuals obviously came with significant mental health problems but also the fact that they had run into conflict with the law. That caused us to relook at how we do business.
Even then, during those times, our engagement with individuals that would act out was more a security-based response dealing with the outward behaviour, not necessarily with the factors driving that behaviour. It's probably only within the last 10 years and maybe even more so the last five that we've been able to focus more specifically on what's behind the behaviours for a lot of those offenders.
Since that time we've put in place rather extensive assessment processes. There's still more work we can do there, but we use various assessment tools to determine mental health issues or disorders that people have. We've put in place interdisciplinary teams made up of psychologists, nurses, doctors, social workers, occupational therapists and front- line staff to examine cases and look at alternatives. We continue to use our regional treatment centres, which are accredited psychiatric hospitals for the most acute cases. On any given day across the country, we have about 150 that meet those criteria, individuals that are either certified or agree to and need that extensive inpatient 24-hour professional care.
We still have some challenges with those that do not meet those criteria, who are certified or would stay in a psych hospital. We're still doing some work there. Part of what we're doing is reprofiling some of our beds across the country so that we can at least provide ongoing support to individuals.
The bottom line is that I have become the default mental health holder in the country, and that's not what a correctional system should be.
Senator Wallace: Thank you, Mr. Head. As you've described, it's a huge challenge to deal with mental health issues in prisons. We understand that. You're operating under a Mental Health Strategy. There's a strategy, a plan, but I think we all recognize, certainly Senator Cowan does with his initiative, that more is needed. There's more work to be done, and the question is how to go about that.
I was interested in your comments when you described the types of services and efforts you have been involved in, but you said this morning that you're currently refining your model of mental health service delivery. I take it from that comment that that's not in place now but is being worked on at present and that that model would be consistent with the World Health Organization's continuum of care.
Could you give us the highlights of what this new model would look like? How would it improve the situation that exists today?
Mr. Head: Thank you, senator. Again, I think I'll preface my comments with the statement that what we're doing is trying to fill some gaps. What I'm able to do will never, ever replace a good community-based mental health strategy, which is what's needed. I honestly believe that there needs to be a different assessment and a different approach in the engagement of individuals right at the first time they come into conflict with the law, before they get to me. I'm picking them up at the back end of the system.
In the interim, we're dividing our approach into three categories, as I briefly mentioned: the psychiatric hospital inpatient care for about 150 of the most acute cases, individuals that are certified or meet that definition and agree to treatment. We are then also focusing on 620 or 630 beds across the country for what we're calling intermediate care. These are individuals who have moderate or high-intensity mental health disorders or needs and do not meet the criteria to go into one of the psychiatric hospitals but need more intensive care. They're also usually individuals who do not agree to being housed in or taking programs at a psychiatric facility. As you're aware, under the accreditation rules for hospitals, if you're not certified and you don't agree, the hospitals can't hold that individual, so they come back to my mainstream institution. What we're doing at some of the mainstream institutions is setting up intermediate care and making sure they have access to the types of services those individuals need without physically being in a psychiatric hospital. In some cases, at some of our psychiatric facilities, we are repurposing beds and using them for intermediate care and keeping them there, even though they're not consenting to being in the full psychiatric hospital, and they're going to have access to the full services.
We're also enhancing our interdisciplinary teams to make sure we can respond to the essential mental health needs of offenders. We're also setting up ambulatory care teams that can follow inmates to different institutions as they move through the system, to make sure there's some continuity around the care.
As well, we're enhancing our overall assessment processes to make sure that we truly understand the mental health needs and disorders of offenders so that we can line up, at least initially, our first response while they're under our care, but ideally set up the proper handoff when they go back into the community so that they can at least link into the type of care that can support them beyond their warrant expiry.
Senator Enverga: This is more of a follow-up question to the transitioning part. According to the expected outcomes, it's transitioning from the community to the correctional system rather than reintegrating into the community. What percentage is going back to the community, and how many people are coming back to your facilities?
Mr. Head: That's a very good question, senator. In the early stages of evaluating the community mental health initiative we've been pursuing, we have found that individuals who have accessed mental health services while they're with us and then go into the community are 34 per cent less likely to have their conditional release revoked and about 64 per cent less likely to commit another offence. So we know that if we identify those individuals, identify their needs, we get them engaged in a mental health service, that when we start to transition them to the community, the fact that they've been a part of those mental health services means they're less likely to get into trouble or to be brought back in the short term.
One of our biggest challenges after they reach warrant expiry and they're no longer our responsibility in the community is how we get them linked up and able to maintain those links with the services that they need so they do not come into conflict with the law again.
Senator Raine: Thank you very much. I'm certainly no expert in the field of mental health institutions and what's happened in the past, but my understanding is that as drugs and treatment were developed and became more common, people were released from residences, asylums, places where they were being looked after, and then they couldn't cope for one reason or another. A lot of times they were responsible to take medications and if they didn't take them, their behaviours became a problem.
In the Canadian correctional system, are we using pharmaceutical interventions to treat patients? Are you worried that after they reach warrant expiry, when they are no longer supervised, the same problem will happen again?
As a follow-up to that, I just wanted to know —
The Chair: I'll get you to stop there.
Senator Raine: It's all the same issue. It's all about pharmaceuticals. Are you aware of a product called EMPowerplus, which is basically a mineral formula?
Mr. Head: Thank you, senator. Truly, that is an issue for us in terms of the aftercare.
Coming back to the first part of your question, under the authorities of psychiatrists who can prescribe certain medications, we do have offenders that have pharmaceuticals as part of their treatment.
The challenge for us, as I mentioned earlier, is that while they're in our care in the institutions and under our supervision in the community up until their warrant expires, we're able to monitor that and encourage them to continue using the drugs that have been prescribed. Once they reach warrant expiry, we have no control over that. If the individual chooses not to use those drugs and not to access the services that have been lined up for them, that's when we start to see the slip.
The drug that you talked about, yes, we're aware of it. I'm not sure that it has been used or prescribed by any of our people, but we're aware of it.
[Translation]
Senator Chaput: You develop your own training programs in the mental health area and you do the same for similar areas.
Do you think that it is time to create an independent organization that could maximize everyone's efforts and support the training being done at other levels?
[English]
Mr. Head: Thank you, senator. I have two quick comments.
I'm open to any organization that has any expertise to help us out in this area. Whether it is groups like CAMH, the Royal Ottawa Hospital, East Coast Forensic Hospital, even the Mental Health Commission of Canada, I'm open to anybody that will help us out. Until there is some kind of body that does that, we continue to reach out to the organizations that we know are involved in these kinds of activities.
The Chair: It's impressive when we focus our questions and we have clear, concise answers from a witness who knows his stuff, we can get in that many questions in that amount of time.
I want to thank my colleagues and thank you, Mr. Head, for your comments today.
I'm pleased to welcome our next witnesses. From the Office of the Correctional Investigator of Canada, we have Howard Sapers, Correctional Investigator; and Ivan Zinger, Executive Director and General Counsel.
I remind colleagues that this session will end no later than 11:45.
Howard Sapers, Correctional Investigator, Office of the Correctional Investigator of Canada: Thank you, Mr. Chairman, and good morning, senators. It's a pleasure to appear before your committee this morning. I'm very anxious to contribute to the discussion of Bill S-208 and recognize the leadership shown by this committee and Senator Cowan in bringing this matter forward.
This committee has a history and tradition of providing leadership in this area. I'm very mindful of the contributions that led to the groundbreaking report Out of the Shadows at Last and how it contributed directly to the creation of the Mental Health Commission of Canada, which I know is part of our discussions.
The intersection between mental health and justice is both important and complex. Over the years, there have been many ongoing attempts to better understand and navigate this intersection. Is it may well be time for the creation of a high-level body to bring additional focus and lead important discussions about challenges and best practices.
For a moment, I want to speak to the prevalence of mental health disorders in the federal correctional system. I know that you've just heard from the commissioner. I will try not to repeat that testimony, but I will comment on the capacity of the Correctional Service to meet rising mental health care demands in federal prisons. I will conclude with some directions for reform, including the role that a commission could play.
I'm joined today by Dr. Ivan Zinger, the Executive Director and General Counsel of my office. Dr. Zinger will now speak to the legislative framework governing health care in federal corrections and will take us through some of the mental health prevalence data.
[Translation]
Ivan Zinger, Executive Director and General Counsel, Office of the Correctional Investigator of Canada: The Correctional Service of Canada is solely responsible for providing reasonable access to essential health care to federally sentenced offenders. According to the act, and I quote:
The provision of health care shall . . . conform to professionally accepted standards.
The Correctional Service of Canada is further obligated to consider an offender's state of health and health care needs in all decisions, including penitentiary placements, involuntary transfer, administrative segregation, discipline, and community release and supervision.
According to the Corrections and Conditional Release Act, the term mental health care means, and I quote once more:
the care of a disorder of thought, mood, perception, orientation or memory that significantly impairs judgment, behaviour, the capacity to recognize reality or the ability to meet the ordinary demands of life.
These disorders are increasing over time. The proportion of federal offenders with self-reported mental health needs more than doubled between 1997 and 2008.
In 2007-08, 11 per cent of federal offenders had a mental health diagnosis at admission, and 6.1 per cent were receiving outpatient services.
In addition, 30 per cent of women offenders, compared to 14.5 per cent of male offenders, had previously been hospitalized for psychiatric reasons.
The percentage of federally incarcerated offenders prescribed medication for psychiatric concerns at admission has almost doubled from 11 per cent in 1998 to 21 per cent in 2008.
A recent sampling of incoming offenders suggests very high prevalence rates for certain disorders. For example, the prevalence rate for mood disorders in this sample was 17 per cent. The prevalence rate for alcohol or substance abuse disorders was almost 50 per cent. The prevalence rates for borderline personality disorder and antisocial personality disorder were 16 per cent and 42.5 per cent respectively. Thirty-two per cent were afflicted with an anxiety disorder. These rates are two to three times higher than the prevalence found in the community.
Today, more than 60 per cent of offenders now entering a federal penitentiary require a mental health assessment or follow-up intervention. An August 2014 snapshot indicated that 63 per cent of federally sentenced women inmates were prescribed a psychotropic medication of some kind.
[English]
Mr. Sapers: Thank you, Dr. Zinger.
Providing prison-based health care is increasingly complex and very costly. Health care is consuming a greater and greater share of the corrections budget. The total annual of health services expenditure for federal corrections now exceeds $210 million. The cost to provide physical health care to inmates accounts for the majority of this budget, almost 70 per cent, or about $150 million. In contrast, mental health care services today account for about one third, or $66.4 million.
Offenders with mental health issues may exhibit symptoms of their illness through disruptive behaviour, aggression, violence, self-harm, suicidal ideation, withdrawal, refusal or, in fact, inability to follow directions or rules. There were more than 1,000 self-inflicted injuries involving 295 offenders in prisons last year, a rate that has more than tripled in the last five years. Incidents involving serious self-injury represented nearly 20 per cent of all use-of-force interventions reviewed by my office in the last fiscal year. According to Correctional Service Canada's records, mental health concerns were identified in nearly 30 per cent of all use-of-force interventions in 2013-14.
In terms of correctional outcomes, findings from CSC research show that federally sentenced offenders with mental health disorders are more likely to be considered higher risk and higher need, more likely to be penitentiary-placed in maximum security, less likely to be granted parole and more likely to be released by statute or statutory release, more likely to serve a greater proportion of their sentence behind bars and more likely to be revoked for technical violations of their parole conditions if they are conditionally released. Finally, they are more likely to incur more minor and major institutional charges, leading to higher rates of voluntary and involuntary segregation.
This profile of high needs, elevated risk and poor outcomes becomes even more problematic as you consider the influence of substance abuse and addiction issues on mental health conditions. Mental health disorders alone or in combination with alcohol abuse and drug addiction represent a major health care and public safety challenge.
Upon admission, 80 per cent of federally sentenced offenders have a history of a serious substance abuse problem. Over half reported that alcohol or drug use was a factor in the commission of their index offence. Over 90 per cent of offenders diagnosed with one form of a mental disorder suffer from at least one other disorder, usually, though not always, substance abuse.
[Translation]
Mr. Zinger: The Correctional Service of Canada currently has five regional treatment centres, which operate under applicable provincial mental health legislation. These hospitals offer in-patient care for acute and chronic mental health conditions, predominantly psychiatric disorders.
The total capacity of the treatment centres is less than 700 beds, which translates into an in-patient capacity to treat 4.5 per cent of the total inmate population. The total operating costs of the regional centres is approximately $110 million annually.
The overwhelming majority of inmates requiring mental health intervention do not meet the admission criteria for the regional treatment centres. Beyond a few pilot projects, the Correctional Service of Canada currently lacks capacity and services in its regular penitentiaries to meet the needs of offenders whose conditions do not require hospitalization.
To meet intermediate mental health care needs, the Correctional Service of Canada is currently implementing a plan which will see as many as 500 psychiatric care beds at the regional treatment centres closed. The idea behind the plan is to re-allocate acute care resources to create capacity for an "optimal model" of mental health care.
[English]
Mr. Sapers: In a series of public reports and investigations, I have pointed to several directions for reform in mental health service capacity and delivery in federal corrections. This morning, I will conclude my remarks with what I believe to be among the most serious and urgent requirements for prison based mental health care. This list is not exhaustive, but it is an important starting point for dialogue, for setting priorities and for implementing reform.
The need is current to recruit and retain more than mental health care professionals in corrections. We must treat serious self-injurious behaviour in prison primarily as mental health issues, not as security issues. We must prohibit the use of long-term segregation of offenders at risk of suicide or self-injury, as well as offenders with acute mental health issues. We should expand the range of alternative mental health service delivery partnerships with the provinces and territories. There should be appointed an independent patient advocate or quality-of-care coordinator to serve each of the Correctional Service's five regional psychiatric facilities and there should be 24/7 health care coverage at all maximum-, medium- and multi-security level institutions.
For reform to take root in corrections, the key is to move away from a security-first response to actions and behaviours that are driven by mental illness. Meeting the symptoms or manifestations of mental illness with pepper spray, physical or chemical restraints or prolonged periods spent in observation, segregation or isolation is not conducive to positive mental health functioning or ultimately to enhanced public safety. At any given time, there are a handful of mentally disordered offenders whose symptoms, behaviours or the severity of illness is beyond the capacity of CSC to safely manage. These offenders should be transferred to provincial psychiatric or forensic hospitals as a matter of priority.
While I see these reforms as urgently required and important, I understand that they cannot be accomplished by corrections alone. In my investigation into the death of Ashley Smith, I called for the creation of a national strategy that would ensure better coordination among provincial-federal-territorial correctional and mental health systems. Bill S-208 recognizes that the provinces and territories, as well as the various components of the criminal justice system, have important parts to play in ensuring a coherent, integrated and seamless delivery system, a system that begins at first contact and follows offenders as they eventually reintegrate back into the community. In principle, a commission on mental health and justice could provide the energy and leadership to drive national reform and change. Though some work has been completed, there is much more room to divert mentally ill people in conflict with the law into treatment rather than rely on imprisonment where the outcomes and risks are both unpredictable and costly.
Thank you again for the invitation to appear before you this morning. I appreciate your attention and I would be happy to answer your questions.
The Chair: Thank you. I will open the floor to questions from my colleagues. The one-question-per senator rule is invoked and we will continue until our time is exhausted.
Senator Cowan: Thank you, gentlemen, for being here this morning and for your contribution to this discussion. I want to pick up on the last point that you made about the room to divert mentally ill people into the appropriate facilities.
I asked Mr. Head about the recruitment of mental health professionals and he provided his answer to that. The other part of that, of course, is the facilities and the budgetary constraints that you've alluded to in your presentation this morning. My question is with respect to that and your experience there. How are we doing? I noticed your comment about the closure of beds in the RTCs, so as to divert funds elsewhere. Are we really robbing Peter to pay Paul?
Mr. Sapers: Thank you, senator. Correctional Service Canada is well aware that amongst its primary challenges is matching capacity to need when it comes to mental health. The system was never designed to be the default mental health provider, but it has become that.
The recruitment and retention of professionals is critically important, as is the physical space and the quality of that space. We recently saw the closure, for example, of the Ontario Regional Treatment Centre which was part of the Kingston Penitentiary campus. Some of those individuals that were housed there were relocated to two institutions. There was lots of disruption in terms of their care, their treatment and therapeutic relationships. That consolidation is still going on and that relocation is still happening.
The further change that is now being implemented with the closure of two thirds or more of the currently designated acute care beds is very troubling. Those beds are currently occupied, so we would have to conclude that the clinical staff who have made the admission and discharge decisions have not done those appropriately because the people that are in those beds now have needs. We've looked at this in the past and in fact when this committee issued the report on Out of the Shadows at Last, I think one of the recommendations was that the acute care capacity of Correctional Service Canada should be increased, not decreased.
Now the other side of the coin, senator, is that the Mental Health Strategy that Correctional Service Canada has is an excellent strategy. It is a five-point strategy. A critically important component is intermediate care. The service has never been able to fund and implement that part of its strategy, so they are now reallocating resources away from acute care to finally implement intermediate care. That will provide some important service. It will provide some relief in terms of an alternative segregation placement. Intermediate care a good thing, but I'm very concerned that it comes at the expense of acute care capacity. I do not see a decrease in the demand for that. I'm aware of the World Health Organization model. I'm aware of the presentation around that model and who is promoting that model. It is just that; it's a model to be applied. It needs to be tailored to specific populations and I haven't seen that tailoring. This is very much a work-in-progress for Correctional Service Canada.
Senator Seidman: Thank you very much, Mr. Sapers.
Your office is the ombudsman for federally sentenced offenders. Therefore, you provide independent oversight through investigation of individual and systemic concerns. I read that from your website. So I feel that my question might be well placed with you.
The Mental Health Commission of Canada has no legislative underpinning, so to speak. Although it may have the disadvantage of no certain longevity, as was pointed out yesterday by Senator Cowan, it does have the advantage of being arm's length from government.
In your view, what are the implications of creating a commission that has this legislative underpinning that is established in this bill, in other words, legislative authority, and does it have an impact on the credibility or the authority of the commission that would be created?
Mr. Sapers: Thank you very much for your question. You may not be surprised to know that I have an opinion about the importance of legislation and statutory authority. Certainly, my office benefits from that. It gives you stability and continuity. For example, it removes the question that the Mental Health Commission is currently facing; that is, will they exist beyond 2017? The importance of that can't be underestimated.
That's not to say that bodies or organizations can't exist without statutory authority. It's also not to say that statutory authorities shouldn't be sunsetted or reviewed from time to time, but I can tell you that I find having a legislative basis for my office to be very important.
Senator Eggleton: Thank you for your presentation. These are very startling numbers that you've given us. The increase in mental health issues in the prison system seems to be growing out of control for the institution.
Now, Mr. Head said that one of the difficulties they had was that some of the locations of the prisons in outlying areas doesn't attract the kind of professional staff in the nearby communities. It suggests that this is perhaps a major problem for patients with mental issues in those institutions. Do you have any suggestions as to how that might be handled?
Mr. Sapers: I do, and thank you. As I say, recruitment and retention is a huge problem. Salary levels are an issue.
When we talk to professional associations, they tell us about interprovincial mobility, licensing requirements, professional development. There are a number of barriers to health care professionals coming to work for Correctional Service Canada, and that's whether the prisons are in a remote location or in a more urban location. Correctional Service Canada has a very aggressive human resources strategy to try to deal with that and it's an ongoing problem.
One way of dealing with that, of course, is by enhancing the ability of alternatives to federal incarceration for that population, starting with police, prosecutors, the role of courts, and particularly mental health courts, and trying to find non-carceral options for people who need treatment first and foremost.
There is a population that could be safely managed in the community, with community-based sentences under supervision, at the same time they are undergoing treatment. We've seen examples of that. There are mental health courts in Canada, for example. There are police-based intervention and diversion teams across Canada. There are good examples of that, but they are very idiosyncratic. If you reduce the admissions of mentally ill individuals into prison, the capacity issues diminish. There will always be a need for mental health capacity within corrections because people also become ill while they're incarcerated. But that would be a very good starting place.
Senator Nancy Ruth: You said in your paper that 30 per cent of women offenders compared to 14.5 per cent of male offenders have previously been hospitalized for psychiatric reasons. We've heard other testimony over the days that women prisoners tend to have more mental health issues than male prisoners do.
I made some assumptions that this might have to do with incest, rape, sexual assault, trafficking and issues like that. Would you agree, and what other issues do you think cause the difference in statistics?
Mr. Sapers: Thank you, senator. This is a very troubling feature of incarceration. The increase in the rate of incarceration of women in this country is dramatic. In fact, it's astounding if you were talking specifically about Aboriginal women. It's a huge increase in the rate.
Almost without exception, when you look at the life histories of these individuals, they are overwhelmingly traumatic. That's not to say they're not guilty of a crime as well, but their life histories are such that if you look at these individuals, you often think of them primarily as victims. These are women who have been abused often in every way imaginable. They have tried to deal with their life situations sometimes quite unsuccessfully through self-medication, substance abuse, and it's very troubling. It's a very traumatized and vulnerable population. Correctional Service Canada is doing an increasingly better job of dealing with those issues, but the question still remains if the extent of incarceration is something that we have to look at.
There are a lot of reasons why more women are coming into conflict with the law and there are a lot of reasons why, once in conflict with the law, they are receiving carceral sentences. But the bottom line is, yes, this is a very at-risk, very vulnerable, traumatized population of individuals.
Senator Stewart Olsen: My question involves what you actually do. Do you go and interview the people at risk in the institutions? Is that a part of your report, and who does that report go to?
Mr. Sapers: The Office of the Correctional Investigator of Canada, as mentioned, is an ombudsman for federally sentenced offenders. We receive complaints directly from inmates or from their families. We also can receive references from the Minister of Public Safety, and the legislation also provides that the office can conduct investigations on its own motion. So I have the authority and the discretion of what is investigated, how it's investigated, how it's reported and how the investigation is concluded.
We have a staff of investigators who last year spent approximately 400 days inside federal institutions meeting with offenders and staff, trying to resolve complaints that were brought forward to the office, if they were founded. If they weren't founded, we report back to the inmate that their complaint wasn't founded.
We will deal with 18,000 contacts in our toll-free line this year. We had about 7 million hits on our website this last year, and we will open up hundreds of individual investigative files. We will review about a 1,000 or 1,200 use-of-force files over the course of a year.
The nature of the investigation varies by the type of file and the type of complaint. Often, the issues are resolved at the lowest level. Our intent is to always try and resolve the issue as fast as we can and at the lowest level, so at the institutional level.
My office issues an annual report, which is tabled in the Senate and in the House of Commons. The office also has a legislative authority to issue special reports, and we have taken to doing systemic investigations and issue public interest reports based on the systemic investigations over the last few years. For example, we've recently issued reports around self-injury for women, around suicide in federal institutions, and around Correctional Service Canada's mortality review process.
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Senator Chaput: Thank you for such a clear and concise presentation, gentlemen. You are suggesting the creation of a national strategy designed to achieve better coordination between the correctional systems and the mental health systems at provincial, territorial or federal level. If the committee were to make a recommendation like that, should it, in your opinion, come with additional funding in order to meet the needs of that national strategy?
Mr. Zinger: Following one of our recommendations, the Correctional Service of Canada has developed a national strategy in cooperation with the provinces, the territories and the Mental Health Commission of Canada. We have a copy of the strategy that we can provide to the committee.
This is a working tool designed to strengthen cooperation between the provinces and territories and the federal government. The added value it brings is great. However, you raised the point, and it is an excellent one, that, while the strategy exists, it does not come with the funds or the resources to implement it.
Senator Chaput: Do you coordinate it?
Mr. Zinger: No. We made the recommendation and the service accepted it. They went ahead and developed this document in partnership with the provinces. It is mostly in order to try to enhance the coordination of services between federal and provincial levels and to develop best practices. The strategy is a very good one, but, as you say, it has not yet received any funding.
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Senator Enverga: Thank you for the presentation. I understand that you've been talking to federal offenders more regularly. While talking to these federal offenders, have you noticed or seen any pattern where they would not be there if they had early intervention, maybe if the provincial health care had taken care of them they would never be in that position? Have you seen any of those things?
Mr. Sapers: Senator, I appreciate very much your question, but it's very difficult to answer. I have opinions and impressions, but I'm also very cognizant of the fact that the men and women in federal penitentiaries have received a sentence from a judge. So they have been found guilty of an offence.
All of the issues that brought them to that point in their life should have been considered in terms of sentencing, even in terms of coming forward with laying an information or the decision of a Crown in terms of how to prosecute. Once all that has been done, it's really the role of Correctional Service Canada to manage the sentence and to deal with — they have the legal responsibility to deal with — the health needs, including the mental health needs, of the men and women sent to them by the courts.
I have dealt with cases personally that I have found very troubling and frustrating because I can't for the life of me understand how some of these individuals have found their way into penitentiaries, but that's well beyond the authority of a correctional investigator. They have been sent there by the court, and now it's up to Correctional Service Canada to deal with them.
Senator Patterson: I'd like to direct this question to Mr. Sapers. You commended this committee for Out of the Shadows and the creation of the Mental Health Commission of Canada. As you know, in 2012 the Mental Health Commission released a national Mental Health Strategy, which included recommendations to improve mental health in the criminal justice system. Then, at the federal-provincial-territorial level, also in 2012, the heads of correction released a comprehensive Mental Health Strategy for Corrections in Canada, which I understand includes a whole range of mental health issues, including health promotion, screening and assessment, treatment and services, suicide prevention, staff training and community supports.
I heard you say that it may well be time for the creation of what looks to me like another high-level body to coordinate. I'd like to ask you: Could it not be duplicative of what is already happening on the ground and taking up more funds in process and bureaucracy from areas where we've heard funds are already sorely needed?
Mr. Sapers: Senator, it's always a fear that these things become bureaucratic and develop a life of their own and divert funds.
Let me also say that my office had input into both the federal-provincial-territorial national strategy on mental health and corrections and input into the strategy document issued by the Mental Health Commission of Canada. I respect very much the work of the Mental Health Commission of Canada, and I appreciate very much the effort of the FPT ministers and heads of corrections in the development of that mental health strategy. But the Mental Health Commission of Canada has a much broader mandate than the criminal justice system, and the strategy is just that. It's a strategy and it's largely aspirational. In spite of the efforts of the FPT ministers and the heads of corrections, it's not coordinated, not monitored, not evaluated. It is there. It exists, and that's a good thing. But there's nobody tapping anybody on the shoulder and saying, "So what are you doing about it?" That's why I have concluded that it may well be time for that kind of a body to exist, one that has as its focus the intersection between mental health and criminal justice and has the ability to, for example, review the implementation of the World Health Organization optimal model for care as it will be applied to the federal offender population in Canada and come to an independent conclusion, based on clinical expertise and worldwide experience, whether or not the optimal model of care is being properly and correctly implemented.
The Chair: Senator Wallace.
Senator Wallace: Mr. Sapers has already addressed the issue that I was going to raise in response to Senator Patterson.
The Chair: Senator Cowan, to be followed by Senator Eggleton to conclude the questioning.
Senator Cowan: To follow up on that, we've heard a lot of evidence that other bodies might have the capacity to do this, that their mandate is broad enough to do this and that there's a strategy that would enable somebody or some body to do this. But the point that I was trying to make in bringing forth this bill — and I think the point that you are making in your last few comments — is that having some aspirational strategy to do something is different from actually doing it. Would you agree with me that there is a need to have some body — it may not be a new entity; it might be an existing entity — with the mandate, the resources and the will to do the things that I think all of us agree need to be done but aren't being done? Would you agree with that?
Mr. Sapers: Senator, simply put, yes, I would. Whether it be a new body or an existing body with an enhanced mandate is not so much my concern. My concern is that this issue receives additional focus, attention and coordination.
Senator Eggleton: Earlier when Mr. Head was here I pointed out the evidence that was put on the table yesterday from CAMH that the suicide rate in the federal corrections system is seven times the national average. I cited him the cases of Ashley Smith and Edward Snowshoe and this whole question of solitary confinement.
He came back with an answer that they really don't call it solitary confinement, but they call it segregation. I was trying to determine what the difference is between the two. The only thing I gathered was that there might be more professional mental health help given to these people, but they are essentially in the same cells and the same kind of solitary confinement or segregated area. Do you have any comments about the issue in general and about that specific definition or difference?
Mr. Sapers: Thank you, senator.
In Canada at the federal level we refer to that kind of isolation as segregation. Frankly, it is more than just semantics. Segregation in Canada at the federal level is governed by a fairly rigorous legal and policy framework, but there are always questions about who is segregated, for what reasons, and who makes the decision about segregation and release from segregation.
Some of the things that distinguish segregation in Canada from, let's say, solitary confinement in Hollywood is the application of that legal and policy framework. That said, the use of segregation in Canada is troublingly high. We do not have limits, so there can be indefinite segregation, in spite of the law that says segregation should be used on a least-restrictive basis. And we don't prohibit the segregation of people with known, significant serious, diagnosed mental illnesses or for those who are at risk of suicide or self-injury. In fact, when we studied the last 30 suicides in federal corrections, we found that nearly 50 per cent — 14 of the 30 suicides — took place in segregation cells.
This is a high-risk population often going into those cells, and in spite of the rigour around which segregation is supposed to be managed, we find gaps in that management.
The Chair: In concluding, I'd like to ask you a question relating to the overall statistics. The numbers you've given us are obvious, and I certainly understand them. Is there any aspect of our determining numbers in the following category of: Have we become better at identifying underlying mental disorders?
Secondly, over the last 20 years, what would be the change in identified mental challenges within the general population?
Mr. Sapers: Thank you, senator. I will certainly supply you with the comparative statistics. The ones that are in my head are about the prison population. The ones that I rely on my staff to provide me with are from the general population.
I can tell you that Correctional Service Canada has done a much better job of identifying and assessing. They've implemented a computerized assessment process. They do a much better job of screening. We know much more about the health needs of the incarcerated population. So, of course, there's a concern that the rate of mental illness hasn't really increased. What has increased is our knowledge about the rate of mental illness inside our system, and that, in part, may be true.
The other side of that discussion, though, is that there are still things that we don't routinely screen or count.
So, for example, we don't screen or count cognitive impairments, intellectual impairments, traumatic brain injury, FASD. These things are under-reported. If you look at the entire range of mental health issues that are present in prison, we still don't have what I would say is a rock-solid, accurate picture. We do know what the trends are, even if you account for a little bit of that growth by simply doing a better job of screening, the trends are still very alarming.
The Chair: Thank you very much. If you do have figures, please send them through the clerk of the committee. That would be most appreciated. With that, I want to thank you, on behalf of the committee, for your testimony before us today.
I want to welcome our witnesses for this final session of today. We have with us in session, from the John Howard Society of Canada, Executive Director Catherine Latimer; and by video conference, I want to welcome Kim Pate, Executive Director of the Canadian Association of Elizabeth Fry Societies.
I will invite Ms. Pate to present first, because she's at the end of a line and I want to make sure the technology holds as long as possible in that regard.
I will remind our colleagues that this session will end no later than 12:30, and the one-question-per-senator rule on successive rounds will hold.
With that, Ms. Pate, I would invite you to present to the committee.
Kim Pate, Executive Director, Canadian Association of Elizabeth Fry Societies: Thank you very much, Mr. Chair. I want to thank the committee very much for inviting me to participate on behalf of the Canadian Association of Elizabeth Fry Societies, an organization that is very familiar with this issue because of our work across the country with victimized, marginalized, criminalized and institutionalized women and girls.
In reviewing the legislation, it is difficult to take issue with the legislation per se because, in fact, all of the efforts to ensure that we have appropriate mental health services for individuals to both prevent them from being criminalized, and then to address their issues once they are criminalized and once they're released into the community, are all excellent.
What I'd like to focus on, though, is that when the Standing Committee on Public Safety and National Security reviewed this issue and issued their report in December of 2010, they came up with a number of recommendations that it strikes me it would be very beneficial to urge action at this stage, rather than the development of another commission that may possibly end up duplicating the current Mental Health Commission.
The recommendations, just to remind the committee, that the standing parliamentary committee came up with when they were looking at mental health, drug and alcohol addiction in the federal prison system were fundamentally about the very same issues but focused on action, most of which has not occurred. They focus, in particular, on recommendations around prevention and how to invest in the community to ensure that appropriate resources are in place to prevent individuals from ending up in the mental health system at all, to prevent people from developing addictions.
They also visited other countries, and in particular stressed the importance of models like the Norwegian model, where there is a very strong health and social welfare focus. In fact, both in the Norwegian model and in England and Wales, the U.K. models, it was very much the ministries of health that were responsible for the provision of services, not just to those in community who were not criminalized but also to those who were in prison as they were integrated into the community.
Those models of that kind of intervention were recommended by the parliamentary committee and are the very same sorts of recommendations that have evolved from the inquest into the death of Ashley Smith that the Correctional Investigator has made, that our organization and my counterpart, the John Howard Society, have also made.
We would urge that the committee look to not just the creation of a commission but in fact to provide resources to ensure that there are once again more stringent national standards in this country for health care, social services, as well as education, and that there are agreements developed with provinces and territories that are strengthened that include national standards around the provision of health services for those who are in the community but also those who are criminalized.
I'd also like to pay particular attention to the recommendations made by that committee with respect to Aboriginal peoples. It's not lost on us at this point that, again, one of the recommendations that came out of the inquest into the death of Ashley Smith was that there be new resources developed of the sort that were recommended by that committee. But, to date, there has only been a contract signed for two beds within the Brockville institution, and only one of those is filled; and that woman is requiring, in addition to the usual psychological supports, particular supports because of her Aboriginal heritage, her experience in residential schools, her experience of sexual and physical abuse.
So we'd very much underscore the recommendations made in that report with respect to the need for particular Aboriginally focused healing approaches for Aboriginal prisoners.
I would also like to point out — and I apologize, I was hoping to try and access the feed — I do know one of the recommendations that was also made, and that this bill would point to as requiring, is more intermediate care beds in the federal prison system. There has been a recent announcement by Correctional Service Canada that they have more intermediate care beds, but that has really been a declassifying of certain beds to make it easier for them to move prisoners around.
I would end there. I look forward to the questions on the other recommendations made within that report for the very strong need for oversight and accountably, the need to revisit the drug interdiction approaches that were seen by all those involved in providing mental health and addictions services as, in fact, causing more difficulty and helping to create more mental health issues.
I invite the committee to consider the recent research that's being done on the impact of environment on the development of addictions and mental health issues.
I look forward to the questions of the committee, and I thank you very much for accommodating my inability to be in Ottawa today.
The Chair: Thank you very much, Ms. Pate.
Catherine Latimer, Executive Director, John Howard Society of Canada: I, too, would like to thank the committee very much for extending an invitation to the John Howard Society to appear on this important bill to establish a Canadian commission on mental health and justice.
The John Howard Society, as many of you know, is a charity committed to effective, just and humane responses to the causes and consequences of crime. We have more than 60 offices across the country, many of which are offering support for those battling mental illnesses and who may or may not have been involved in the criminal justice system.
At the outset, let me say that we support Bill S-208. I think there is a real need for more information, more collaboration and more focus on those very challenging problems that are in the nexus between criminal justice and mental health. This intersection is a complex and challenging area that our justice system, our health system and our society is not adequately addressing. Too many people are defaulting into the criminal justice system for want of timely, accessible, community health care resources. Our criminal laws have concepts of mental capacity and mental illness that were developed in the 1840s and fail to take into account developments in neuroscience, brain injuries and aging that may affect capacity to frame a criminal intent or control behaviour.
Prisons, as you've heard from the previous two witnesses, are becoming our largest residences for the mentally ill and they're not really designed or equipped to deliver the needed treatments. I was going to get into a number of statistics that would emphasize and show the expansion of the needs of mental health in the prisons, but since both Commissioner Head and the Correctional Investigator have given you those, I will move on.
We are also extremely concerned about the absence of the therapeutic capacity in federal prisons to really address these issues. This is compounded by the announced closure of the Shepody Healing Centre at Dorchester, which is the regional treatment centre in Atlantic Canada, and the loss of that regionally needed acute care capacity. So 50 beds that were available for serious mental illness are going to be closed. We saw the closure also of the treatment centre in Ontario and we're still looking at the reallocation of resources for services of that.
We find that far too many prisoners with mental health issues end up in administrative segregation, which we believe is inhumane and a violation of prisoners' Charter rights. Further, those who were subjected to administrative segregation for extended periods of time are at high risk of developing mental illnesses, and no one wants our prisons to actually worsen mental health and mental problems for people who are confined there.
Returning mentally ill patients back into the communities after imprisonment also can be challenging to make sure that the mental health needs and the intersection between the federal organizations and the provincial care of health is well met, timely and appropriate in terms of the way those needs are being met in the community.
In conclusion, we think for complex problems like mental health and justice, where parts of the solution are at different levels of government and different disciplines, it would be a significant asset to have a commission on mental health and justice with a broad mandate that could really focus action on delivering in those key areas.
We do support the bill, but we would encourage an expansion of its scope to include brain injuries, cognitive impairments and their implications for crime, the criminal justice system and corrections.
I welcome any questions you might have.
The Chair: Thank you very much.
I will now open the floor to questions from colleagues.
Senator Cowan: Thank you for your presentations this morning. They're very helpful to us.
I would like to ask Ms. Latimer about this closure of the beds in the RTC that was mentioned by Mr. Sapers and Dr. Zinger in their presentation a few moments ago. As I understand it, 500 of 700 beds were closed and those beds, as he said, were full. So it's a reallocation of resources, but those people didn't disappear and they are not receiving the care and treatment which they should be receiving. Is that your understanding?
Ms. Latimer: That is certainly a concern. I share the Correctional Investigator's concerns about whether those acute needs will be adequately addressed with the closure of these facilities.
Certainly I'm most familiar with what happened after the closure of the regional treatment centre in Ontario, where they tried to move inmates into different locations to be dealt with. The inmates with less acute needs are still in a matter of transition from Collins Bay to Bath, so they haven't actually landed at their home institution yet, which is very destabilizing to people who are suffering mental health issues.
What's most concerning are likely the 10 most seriously acute inmates who were moved into what was formerly the segregation unit at Millhaven, a facility which the Correctional Investigator looked at and found grossly inadequate as a treatment unit for those particularly serious mentally ill offenders.
I think there is a real problem with the capacity generally of correctional services to deliver on this, and I think it behooves all of us to help correctional services to raise awareness about the limits of their capacity in the hopes that that will lead to improvements in getting really seriously ill people transferred into other facilities and improve their capacity to deal with the remainder of them who must stay within the facilities.
The Chair: Ms. Latimer, did I understand you correctly to say that the 500 beds have not been eliminated but reassigned in terms of identity from acute to a different level of care?
Ms. Latimer: Ms. Pate may have more to add about the 500 beds and the reclassification, but I was actually looking at the closure of these regional treatment facilities, the one in Ontario and the one in Dorchester prison which provided 50 beds for the most acute and seriously mentally ill inmates there.
The Chair: Ms. Pate, did you have anything further?
Ms. Pate: I'm most familiar recently with what's happening at the Regional Psychiatric Centre in Saskatoon. As you may know, I'm currently the Sallows Human Rights Chair at the University of Saskatchewan College of Law. I do know the University of Saskatchewan is extremely concerned about their capacity to continue to assist in terms of the forensic support they've been providing through the psychiatrists, psychologists and the other supports and the research that has been done historically through the University of Saskatchewan at the Regional Psychiatric Centre.
Essentially what has happened is the beds have been decommissioned as acute mental health care beds, or psychiatric hospital beds, and in fact recommissioned as penitentiary beds alone. One of the arguments made for that to us was that it would in fact make it easier to keep people in the institution and not have to transfer them.
It's being argued as part of the challenge that was posed by the way that corrections handled individuals like Ashley Smith. However, it doesn't fundamentally change how they're going to deal with the individuals. It just means they're reallocated not as treatment beds and it also means that resources that already weren't available because most of those individuals were in isolation or segregation to begin with will be less likely to be available.
There is significant concern how that will roll out. The decision has just recently been taken, so how it will end up impacting down the road is not clearly known. But what is clear is everybody who is involved, including those working within the institutions, have grave concerns about the lack of resources they will have to assist individuals and the fact that we'll likely see the use of more chemical restraints and physical restraints. We're already seeing increases in self- injurious behaviour.
Senator Seidman: Thank you both very much for your presentations.
Yesterday we heard from the Mental Health Commission and CAMH about the existing programs, strategies and approaches. One of the things that the Mental Health Commission and I think CAMH also put forward is the importance of a whole-systems approach to dealing with these issues.
Ms. Pate, you spoke a little about the Norwegian model and the U.K. model, which you said were prevention- oriented, investing in the community. I would appreciate it very much if you could tell us a bit about that.
Ms. Pate: With both the Norwegian model and the U.K. model, the responsibility for administration of mental health and addiction services rests with the ministries responsible for those areas, whether those individuals are in the community and criminalized or not criminalized, as well as those in prison. So the accountability is up the line to the appropriate mental health services.
The reason usually used here for that not happening is because in federal penitentiaries it is the split in jurisdiction. However, in Saskatchewan we have the perfect example of where that has been done for some time, but the mixed mandate whereby security was always trumping mental health has been an ongoing issue.
If in fact all of the mental health services and addiction services were accountable to provincial health services — according to what they can be right now, section 29 of the Corrections and Conditional Release Act allows for the transfer out of prisons into appropriate health facilities for individuals. We've been arguing, and on the very few rare occasions it has happened, for individuals being moved out of prisons and into mental health facilities.
The contract that Correctional Service Canada signed in Brockville, with the St. Lawrence treatment centre, is only for two beds, but there certainly could be the capacity to have more of those resources. Individuals who go into mental health facilities — including here in Halifax where I am, and the Nova Scotia hospital attached to the prison here — and have mental health issues do immeasurably better, even going from being actively psychotic and suicidal to within 24 hours, maximum, we usually see a marked improvement. It was the head of psychiatry who first had asked us to become involved in Marlene Carter's case, the woman who is at Brockville. Even though he was the head of psychiatry, he was very clear that whenever it came to security, security needs always trumped therapeutic needs at the regional psychiatric centre.
It has become very clear that the models in the U.K. and Norway, where the accountability is completely within health services and therefore the impetus is also to keep people in appropriate mental health services — transfer them into the community and continue to support them in the community so there's continued supervision and support when they're there — has been a far more effective way to prevent people from ending up in prison and to assist those who end up criminalized and in prison.
Senator Eggleton: I've been asking questions about segregation, the people that have appeared here, because of the CAMH statement yesterday that the suicide rate in federal corrections system is seven times the national average. And now the Correctional Investigator tells us that in fact 50 per cent of the suicides that do occur in the corrections system are occurring in segregation.
Ms. Latimer, you say in your statement that "far too many prisoners with mental health issues end up in administrative segregation, which we believe is inhumane and a violation of prisoners' Charter rights." What would you do that's different?
Mr. Head, when he was here this morning, said that they do provide more personal contact to people in segregation, but I still don't sense that there has been very much movement in changing this system to any degree that would cut down these mental health issues, particularly for those that go to the state of suicide as in the case of Ashley Smith or Edward Snowshoe. Could you comment on what you would like to see changed here?
Ms. Latimer: There are some really solid alternatives to keeping people in segregation because they have a mental health issue. I think the prison structure could be organized so that you had structured living units and other ranges or groups of cells where special attention is being paid to the mental health issues and not having these people in segregation.
It is the segregation that actually compounds their mental health issues. Even for people who do not have a mental health issue, if they're in segregation for any period of time, they start to develop hallucinations and psychosis and come closer to self-injury and suicide.
We can do a lot better, and I think it just takes some creative thinking about how to organize it so that it is really questioned whether segregation is the appropriate place, and let's get some other services online. As Ms. Pate pointed out, they don't even need to be in a federal correctional facility if we could transfer them into a better living arrangement somewhere else.
The Chair: Ms. Pate, do you have anything further to add?
Ms. Pate: Yes. I would say that it starts far before the segregation placement, in fact. Ashley Smith was not identified while she was alive as having mental health issues. Fundamental to one of the problems of individuals ending up in prisons is that their behaviour is seen through the lens, not surprisingly because they have been criminalized, of criminality.
So behaviour in a mental health setting that is seen as symptomatic of a mental health condition or psychiatric disorder is viewed as bad behaviour because it's seen through the lens, not surprisingly again, of criminality once they're in prisons. Individuals who end up with behaviour that is seen as problematic end up in segregation, and I would say in most cases not because people are mean-spirited.
Even though the United Nations has clearly identified that the placement of individuals with mental health issues in segregation at all, for any length of time, is torture, according to the convention against torture, the reality is if we don't look at the whole picture, then we don't look at the fact that it's the individuals coming in who can't adapt well to the prison setting who end up as classified as hard security.
Even in the supported living environments and units that have been set up — and there have been some excellent ones set up in the penitentiaries for women — these individuals never get there because they are classified as higher security. It really does underscore the need to look at alternatives.
I can give you three examples where we have had no segregation units available to correctional authorities, and they've managed. When I worked with young people, the head of the institution decided that — and the UN said it should never be used for youth — no young people should be placed in custody. So he said that any staff member who wanted to isolate a youth in a quite quiet room, as it was euphemistically referred to, didn't get a chair and had to stand outside the door and interact with that young person. They cut the use of that mechanism down to several hours from sometimes several days or weeks.
In the federal prison system when they were revamping Dorchester several decades ago when I was just starting out in this work, working with men, they didn't have a segregation unit for a period of time and they developed ways for staff to intervene with individuals that would de-escalate issues.
In the women's context, when they were closing the prison for women, they were initially going to move women into the segregated area of the Kingston Penitentiary. The women fought that. They still wanted to close the prison for women, but they actually went without not only the segregation area but a maximum security area for almost three years. We have at least those three examples of which I am directly aware where they can manage without the use of segregation. But once it's available, it is almost certainly the default that is used for those with mental health issues, not because of mean spiritedness but because it's the easiest way to monitor them.
Senator Nancy Ruth: To both of you, we know that many women in prison have a history of being sexually assaulted and trafficked, et cetera, and some men in prison are the perpetrators. How could a commission on mental health and justice or a national action plan on violence against women help with these issues and these people?
Ms. Pate: I think taking violence against women seriously remains an ongoing issue in this country and around the world, quite frankly. An action plan to demand that women and children be protected — the issue of what's happening to indigenous women and girls, now that I'm in Saskatchewan, it's like in your face every single day. It is a blatant example of how we have withdrawn the protection or never provided the protection of the state, and then we deputize, essentially, women and girls to protect themselves, tell them it's their fault, it's their responsibility to protect themselves. Then, when they act to protect themselves, we almost immediately leap in and criminalize them.
Of the number of women in prison, 91 per cent of indigenous women and about 80 to 82 per cent of women overall have histories of physical and/or sexual abuse. An action plan to intervene to ensure that their needs are met would not only be useful, helpful and constitutional, it would also advance the provisions of section 77 and section 80 of the Corrections and Conditional Release Act, which act requires that Correctional Service Canada look specifically at particular approaches to women and indigenous peoples. Add to that the sentencing provisions of the Criminal Code 718.2(e) and the decision of the Supreme Court of Canada in Ipeelee to say that those processes should also be applied to those who are on conditional release and long-term supervision orders, and I think an action plan is important, but most important is for it to be put in place. I would love to see national standards so that the provinces and territories and the federal government are responsible for maintaining those standards in terms of provision of social service, health care and education. This would help prevent people from being victimized, marginalized and then being imprisoned and criminalized.
Ms. Latimer: I don't have much to add to what Ms. Pate said except that I think we need to focus on prevention. This would be prevention against child sexual abuse and a variety of other things. Hopefully the commission will be able to look at that as well.
Senator Enverga: Thank you for the presentations. My first question will be to Ms. Pate.
My ears caught your words saying that we need action right now, action with less talking, something like that. Does it mean that you're happy with the organizations that we have right now and we just need to focus on action? Is that what you're saying?
Maybe Ms. Latimer could also make a statement about that.
Ms. Pate: We certainly do need action. At the very least if, coming out of this, in addition to the recommendations being made for a commission or an enhanced Mental Health Commission, there is a decision to impose national standards. Canada is a rich country. There is no reason why every man, woman and child cannot be not fed, clothed, educated and provided with adequate services so they don't end up victimized, missing and murdered or in prison, those kinds of national standards.
I'm very focused because I'm in Saskatchewan this year, this being the birthplace of many of these kinds of approaches, but we really need to ensure that we have those national standards and that the federal government is ensuring through taxation agreements and mechanisms like this that those national standards are upheld and that services are equally available to all people throughout Canada.
Ms. Latimer: I agree that we do need action, but we also need informed action and coordination. I think a commission like this could serve a very valuable purpose.
For example, the government indicated, when it was going to respond to Ashley Smith, that it was going to consult more broadly. It would have been ideal if there had been a commission with expertise that could help inform the response to Ashley Smith about the problems in segregation and some of the other things, which were totally missing from the government's response. So if there was an easy mechanism that could fill what we know to be gaps in knowledge and understanding, this would be great.
Senator Raine: Thank you, both of you, for your insight here.
In 2012, the federal-provincial-territorial conference released a report on a mental health strategy for corrections and mental health. I understand, from hearing from you, that there are jurisdictional issues about where the best places and services can be delivered for individuals who get caught up in our justice system. That federal-provincial strategy is looking at mental health and justice issues.
My fear with another commission is it starts to focus on justice issues and mental health when really we need to deal with cradle-to-grave mental health and prevention, as you said. I would like your take on if that strategy is working. Obviously it's relatively recent, so there must be a long way to go.
Ms. Latimer: It's my sense that the problems in the justice system dealing with mental health are getting worse. So if there is a strategy in place, it's not actively delivering the improvements that many of us would like to see in the way people are dealt with in mental health and the criminal justice system.
You point out the federal-provincial split between responsibilities, which always creates some problems, particularly when prisoners are being released from federal institutions and you have to align them with the services, even getting health cards when they're being released. They're often released with two weeks of medication, and if they don't have a good reintegration strategy they're often left in the lurch without a continuation and a continuity of care. So even basic things we're not doing as well as we could or should.
Ms. Pate: I would agree with that. The situation certainly for women, with which I'm most familiar, is not getting better. In individual cases we've been able to achieve some individual progress, but it doesn't appear to be a well- implemented strategy. I think there is lots of room for improvement. I would agree with something from cradle to grave. Senator Kirby, as he then was when he did the report on mental health issues, I think the recommendations coming out of his commission as well still stand the test of time in terms of needing to be implemented.
Senator Cowan: I think I understand your views on it. We may have some disagreement or discussion about the appropriate vehicle to bring about these needed changes, but I take it from your evidence that there's no disagreement with the need to actually do something, take some concrete action to investigate, coordinate and actually do something about these problems, which I think we all have understood from the evidence aren't getting better; they're getting worse. This is not only in the correctional system but in the justice system and our communities at large. Would you agree with that?
Ms. Pate: Yes, I do agree with that. I think the most recent research coming out showing that the environment in which someone is placed is vital to both dealing with addictions and mental health speaks volumes to the need to look to non-carceral mechanisms and early intervention, and linking it to other approaches like financial, economic reforms, as well as social justice reforms and social assistance in housing.
Ms. Latimer: If I can add, there are emerging areas we don't know much about: trauma, brain injury, whether it's organic or traumatic. Those affect behaviour. It would help those of us who are trying to support successful reintegration to know what the impact is and how you need to support people who have brain injury who are coming back into the communities. There's not a lot of information on that. There is all kinds of terrain where additional information would be extremely helpful.
The Chair: I'm going to come back to the question of clarification I asked following Senator Cowan's first intervention, and that was on what I heard was the 500 beds were cancelled or eliminated. I asked whether they were transferred. I want to refer to statements in the press on March 5 of the Correctional Service which said that 515 acute care beds were being transferred to intermediate psychiatric care, and Dr. Zinger referred to the same transfers. It was that that I was trying to get at. Your points about how to use them, the needs and all those other issues I certainly understand, but that was the issue I was trying to clarify.
I want to thank you both. Some of us wish we were in Nova Scotia with you, Ms. Pate, but maybe we will get there soon. We have bipartisan support for that, do we not?
Ms. Latimer, I want to thank you as well.
I also want to really thank my colleagues for the focus of their questions today. We got a remarkable number of questions in. We got all questions in and done in the time covering the three panels that we had here today. I want to acknowledge my colleagues in that regard.
(The committee adjourned.)