THE STANDING SENATE COMMITTEE ON HUMAN RIGHTS
EVIDENCE
OTTAWA, Wednesday, January 31, 2018
The Standing Senate Committee on Human Rights met this day at 11:30 a.m. to study the issues relating to the human rights of prisoners in the correctional system; and, in camera, to study the issues relating to human rights and, inter alia, to review the machinery of government dealing with Canada’s international and national human rights obligations (consideration of draft reports -- topics: Export and Imports Act; gender based analysis).
Senator Wanda Elaine Thomas Bernard (Chair) in the chair.
[English]
The Chair: Before we begin, I would like all senators to introduce themselves. We’ll begin on my right, with our deputy chairs.
Senator Ataullahjan: Senator Salma Ataullahjan from Ontario.
Senator Cordy: Jane Cordy, senator from Nova Scotia.
Senator Andreychuk: Raynell Andreychuk, Saskatchewan.
Senator Pate: Kim Pate, Ontario.
Senator Hartling: Nancy Hartling, New Brunswick.
The Chair: Today, we will continue our discussion on the issues relating to the human rights of prisoners in the correctional system, and today we welcome, from the Mental Health Commission of Canada, Louise Bradley, President and Chief Executive Officer, and Anne-Marie Hourigan, retired judge of the Ontario Court of Justice and director, board of directors.
The floor is yours for your opening remarks, to be followed by questions from the senators.
Louise Bradley, President and Chief Executive Officer, Mental Health Commission of Canada: Thank you, Madam Chair. I’m absolutely delighted to appear before this Standing Senate Committee on Human Rights and talk about the care of inmates, specifically those with mental health challenges. It’s a subject that is very close to my heart, and I want to applaud you and your committee for focusing public attention on the human rights of prisoners.
First of all, I want to provide a brief overview of the Mental Health Commission of Canada in case some of you may not be exactly aware of who we are. The commission is an arm's length, not-for-profit organization that provides leadership, increased capacity and advice to policymakers on mental health and wellness issues facing Canadians. This includes federal, provincial and territorial governments, the public and private sectors and a vast network of stakeholder groups.
The current mandate includes a focus on substance use and addiction, suicide prevention, priority populations and engagement, and we are a trusted adviser and partner to many policymakers.
I myself have been advocating for a shift in our thinking about the mental health of inmates for a very long time. This dates back to my days when I was a practising registered nurse and later on as the head of a forensics and correctional health care service in Nova Scotia. In fact, I was involved in one of the first facilities to apply a recovery-oriented approach within a correctional setting. The changes the facility made include transferring health care services from corrections staff and administration to a health authority. Within that, we ended up hiring a part-time psychiatrist and a full-time nurse to do assessment and provide services, creating a mentally ill offender unit for inmates. I would be happy to elaborate on that during our discussion if you wish.
Recovery is a process in which people living with mental health problems and illnesses are actively engaged in their own journey of well-being. Recovery principles acknowledge that we live in complex societies with many intersecting factors. Recovery-oriented approaches support individuals in all their diversity as well as in the communities in which they live, whether that happens to be in a suburb or within a correctional setting.
Madam Chair, I am a huge believer that everyone deserves the hope, dignity and inclusion of the hallmarks of recovery, and that includes inmates — people whom the World Health Organization stresses are worthy of the same level of health care that all of us around this table enjoy.
That view wasn’t held very widely about 15 or 20 years ago, when I was doing corrections and forensics work in Halifax. I remember touring the unit for people living with mental illnesses and nothing about the facility was therapeutic. I suggested that we look at these individuals as patients who happened to be offenders, and corrections looked at them in quite the opposite way. That was supported by different pieces of legislation.
I’ll talk about this a little bit more as we go through, but I do think that a clash of cultures supported by legislation is one of the key factors in the difficulties we are facing in providing mental health services for offenders.
A recovery-oriented approach really did make sense in that setting. Locking people up and subjecting them to further trauma without appropriate treatment or supports is a recipe for disaster. Then, to re-enter the community without having received treatment and no follow-up supports places not only the individuals but the communities at risk.
I have also seen this first-hand through my work with Accreditation Canada as a surveyor and having spent several days surveying the health care services inside the former Kingston Penitentiary.
In Canada, more than 30 per cent of male offenders require psychological or psychiatric services and more than half of all women inmates have identified a mental health need. Another disturbing statistic is that of those sentenced to a federal penitentiary, as many as 80 per cent have a substance-abuse problem. The links between mental health and substance abuse are as common as they are complex, I’m afraid. Having a mental illness can make a person more likely to abuse drugs, or a person’s drug problems can trigger mental illness. Either way, these are frequent conditions among inmates in Canadian prisons. Research reveals that 38 per cent of incoming males meet the criteria for both a current mental disorder and one of a substance use disorder.
The Mental Health Commission of Canada has been tasked with identifying vulnerable populations, and research shows that these populations are overrepresented in the correctional system and in the use of seclusion and restraints.
As you may be aware, incarcerated indigenous inmates represent 18.5 per cent of federally sentenced populations, far out of proportion with their percentage of Canada’s population as a whole.
What is more shocking is that indigenous women make up roughly 32 per cent of the federally sentenced female population. That is an increase of 87.5 per cent over a decade, and indigenous women account for 70 per cent of self-injury incidents among federally sentenced inmates.
There is a clear need for increased mental health services for women. One of the key recommendations from the Ashley Smith inquest was that female inmates with serious mental health issues and self-injurious behaviours should serve their federal terms of imprisonment in a federally operated treatment facility, not a security-focused, prison-like environment.
Madam Chair, what should concern all Canadians is that mental health issues were identified in over 37 per cent of all use-of-force interventions in prisons.
As committee members, you likely already know the Nelson Mandela Rules prohibit the use of solitary confinement for prisoners with mental or physical disabilities when their conditions could be exacerbated. Yet, both policy and legislation in this country still allow for indefinite or prolonged confinement in segregation.
Recently, the British Columbia Supreme Court and Ontario Superior Court ruled that the use of indefinite administrative seclusion was unconstitutional. Justice Leask remarked that administrative solitary confinement:
. . . is a form of solitary confinement that places all Canadian inmates subject to it at significant risk of serious psychological harm, including mental pain and suffering, and increased incidence of self-harm and suicide.
While the courts are mandated to consider Gladue factors in sentencing, research shows indigenous inmates are more likely to serve maximum security time and experience use-of-force containment measures, segregation and self-injurious behaviours.
Now, I could rattle off a lot more statistics but I think I’ve made my point.
We have seen little to no improvement in justice and corrections in embedding a recovery focus for mentally ill inmates, and prison populations with people confronting these problems continue to grow. That is why my colleague Anne-Marie Hourigan, a member of the board of directors of the Mental Health Commission of Canada, and I are here today to recommend urgent action in several priority areas.
The first is the implementation of recovery-oriented care for inmates so that they can successfully reintegrate back into society. The commission encourages the development and implementation of recovery-oriented, trauma-informed alternatives to the use of seclusion and restraint. We want to see their use reduced and, eventually, hopefully become virtually unnecessary. This will require meaningful engagement with people with lived experience, including families and natural supports, as well as training, education and development of evaluation. This, in essence, requires a culture shift that isn’t going to happen overnight but, unless we begin that culture shift now, nothing will change.
Second, we urge the elimination of the use of seclusion and restraint, given their detrimental impacts on the dignity and respect of inmates.
I do want to make one point here in that there is a distinction between the need for solitude and the need for seclusion and, unfortunately, the physical infrastructure of most penitentiaries right now does not allow for use and being able to take advantage of solitude in a very loud and noisy environment.
Among many improvements that are needed, we want to see people with mental health problems and illnesses diverted out of correctional facilities into community-based mental health care; more money for meaningful evidence-based strategies that prevent self-injury behaviour within prisons; and enhanced cultural and spiritual opportunities for indigenous inmates, including healing lodges. We should ensure that everyone has a comprehensive mental health discharge plan upon release into the community.
Our third recommendation is to protect and promote the psychological health and safety of employees working in correctional institutions.
I will speak briefly about several of the mental health initiatives targeted for this group momentarily but, right now, I would like to share my time with Anne-Marie Hourigan, someone with extensive knowledge of these issues from her vast experience as a judge of the Ontario Court of Justice. Before retiring, she presided exclusively over criminal matters for 12 years. Prior to her appointment to the court, she practised criminal law in Toronto, both as a defence counsel and as a prosecutor for the Attorney General of Canada. During her 30 years in the Canadian criminal justice system, Ms. Hourigan worked with thousands of people affected by mental illness. She came to appreciate the direct and repeated correlation between the gaps in their mental health care and their appearance before the courts.
She retired early from the bench specifically to raise awareness of this issue. Ms. Hourigan has lectured extensively about the intersection between mental illness and criminal behaviour. She has also spoken about the need to embed mental health literacy into the education system to increase awareness, reduce stigma and promote early intervention and treatment. I invite her to share her insights into these issues.
Anne-Marie Hourigan, Retired Judge of the Ontario Court of Justice and Director, Board of Directors, Mental Health Commission of Canada: Thank you, Louise, for your kind introduction and, Madam Chair and committee members, for this opportunity to outline my experiences with incarcerated individuals living with mental health problems and illnesses, experiences that affected me so profoundly that I left bench four years ago to establish the Hourigan Foundation, which supported and promoted Canadian organizations empowering youth struggling with mental health and learning challenges.
My years on the bench convinced me that many of the people appearing before the court did not need to end up there. Countless young people who regularly appeared before me had simply fallen through the cracks in our mental health, education and social welfare systems. I saw that they might have avoided the criminal justice system if they had had access to appropriate mental health services and supports at key points in their life, before they got into serious legal trouble.
I could cite any number of stories that exemplify this. For instance, during my last years on the bench, I presided over a dangerous offender application for an accused person who had pled guilty to attempted murder. This type of application is extremely rare in the Canadian criminal justice system because, at the end of the day, the accused can be incarcerated indefinitely if certain strict criteria are met. The application took nearly three years to complete, and the evidence was lengthy. The Crown psychiatrist alone testified before me for two weeks.
This man’s life of crime began in elementary school, when he and some of his friends tried to burn down the school music room. He was bullied based on his race and became a bully himself. By 15, he had joined a gang. As an adult, he continued to commit serious criminal offences. He served sentences both in the provincial reformatory system and in the federal penitentiary system.
Testimony during the application revealed that, from childhood, this man had risk factors for mental health problems. These included a learning disability, a conduct disorder, ADHD, anger management issues and substance abuse. All had gone undetected or at least undiagnosed and been left untreated. Ultimately, the psychiatric evidence demonstrated that, among other things, he had a personality disorder with antisocial and narcissistic traits and a poly-substance abuse problem.
It was the opinion of the psychiatrist that there was a substantial risk he would re-engage in physical violence, involving severe or life-threatening physical harm to others. At the conclusion of the proceedings, I declared him a dangerous offender. He is now imprisoned indefinitely.
I can’t say with certainty that things would have turned out differently if he had received the help he needed earlier, both as a boy and as a young man involved in both the criminal justice and the correctional systems, but I think it’s a safe bet to say that it’s unlikely that he or his victims would be where they are today.
Madam Chair, his is a cautionary tale, to be sure, but one that is not unique. So many of the cases I saw involved youth and young adults whose learning, psychological and social problems were not addressed while they were still in the school system. Almost invariably, they engaged in behaviours that eventually brought them before the criminal courts.
I don’t pretend to have all the answers, but what I can say from my experience is that, if we fail to provide appropriate and adequate mental health supports when they are needed, upfront, when people are still young, stories like this will be repeated. Not just the directly affected individuals but all Canadians will pay the price.
I also believe it’s not too late to start providing the kind of care that inmates need while they are incarcerated, employing the recovery-oriented approach that Louise has outlined. I agree, as well, with her assessment that we need to rethink our approach to restraint and coercion. Studies confirm that violence is likely to increase in the absence of meaningful activities and where there are limitations on personal decision-making power and on private space, including the administration of psychiatric medications in common spaces.
Evidence also suggests that some Correctional Services settings tend to treat self-injurious behaviour by inmates as issues of compliance rather than of psychological distress.
In contrast, there are no studies that connect the use of seclusion and restraint with positively influencing the therapeutic treatment of individuals living with mental health issues or illnesses.
Madam Chair, it is important to recognize that the willingness and ability of organizations to invest in stable workplaces, including staffing levels, sets the tone for seclusion- and restraint-reduction initiatives. The ability of providers to impose seclusion and restraint measures epitomizes the power imbalance that characterizes their relationship with people with mental health problems and illnesses.
A principle of recovery-oriented mental health policy and legislation must be to always employ the least intrusive and least restrictive interventions possible. Research by the Mental Health Commission of Canada has found that, in some cases, seclusion and restraint have been virtually eliminated through the implementation of alternative approaches that are based on recovery principles and are sensitive to people’s past experiences of trauma.
Among the many valuable lessons drawn from the commission’s literature review is that we need to do a better job of systematically tracking incidents of seclusion and restraint within Canada and improve our data collection efforts. Equally important, we need to increase opportunities for psychotherapeutic services within correctional facilities. Just as the physical health concerns of inmates must be attended to while they are in custody, so should their mental health needs.
Further, in my view, the necessary transitions offenders must take as they progress, first through the judicial and correctional systems and then toward release into the community, should be seamless. Consistency of approach with the shared goal of successful and healthy reintegration into society must be the focus. In fact, it is my opinion that action toward recovery and the development of a comprehensive mental health discharge plan must be commenced from the moment a custodial sentence is imposed from the bench.
Federal terms of imprisonment are, by their duration, reflective of the important sentencing principles of denunciation and deterrence, but that does not mean that the equally important sentencing principle of rehabilitation should be overlooked. An inmate’s mental health care should not stop at the prison doors.
As a jurist, I also feel strongly that the courts need to adhere to the Gladue principle in sentencing offenders. Judges need to consider all reasonable alternatives to incarceration for offenders with serious mental health challenges, particularly indigenous offenders.
Until we take meaningful action in these areas, I think we can expect to continue to see alarming news headlines about potentially avoidable crimes and the warehousing of inmates with mental health issues, at great cost to the public purse and society at large. Prevention is always more cost-effective than incarceration. But much more than money is at stake. Beyond dollars and cents, common sense and human decency dictate that we help people who are ill to become well, not only to avoid prison time but to enable them to live fuller, more rewarding and productive lives.
Thank you, Madam Chair and committee members. I will turn it back over to Louise.
Ms. Bradley: I have a few final comments before questions.
I wanted to tell you about an e-mental health program directed to prisoners called Breaking Free Online. It targets substance abuse and it’s a digital recovery resource developed in the U.K. to supplement the recovery programs offered to inmates in that country. It has since been adopted by many other nations, and Breaking Free Online is a great initiative that we believe could be utilized here in Canada. It’s the only digital intervention to be accredited by the Correctional Services accreditation and advice panel.
A research report co-authored by Professor John Weekes of Carleton and Dr. Samantha Weston of Keele University in the U.K. studied the impact of the program on inmates in several prisons in northwest England. The findings were published in Advancing Corrections, the prestigiousjournal of the International Corrections and Prisons Association. The study found that offenders using Breaking Free Online showed very significant reductions in substance use and underlying substance dependence. They also experienced significant improvements in many areas of recovery progression.
The final topic I would like to touch on is the mental health of correctional workers. Correctional services personnel tend to be considered as first responders, yet they work in unique environments with high-risk populations, many of whom have mental health problems and illnesses. This exposes prison staff to often traumatizing experiences. In March 2016, the House of Commons Standing Committee on Public Safety and National Security heard testimony that correctional services personnel experience higher rates of operational stress injury than almost any other group of first responders.
Clearly these workers cannot help inmates or do their jobs effectively if they suffer poor mental health themselves, so the commission is recommending the development of integrated mental health strategies that consider the psychological health and safety of both employees and inmates. These strategies should consider occupational health and safety systems, training, education, prevention, promotion, early intervention and reintegration.
The commission has developed numerous resources under the mental health strategy for Canada, and several initiatives are particularly relevant. I’ll mention a few very relevant ones here today.
The National Standard of Canada for Psychological Health and Safety in the Workplace is a set of guidelines, tools and resources to support organizations in promoting mental health and preventing psychological harm at work.
The second one is called the Road to Mental Readiness, which was actually something adapted from the Department of National Defence originally. It’s a training program that reduces the stigma that often surrounds mental health problems and illnesses and increases workers’ resiliency.
And last, Mental Health First Aid is a program that teaches people how to help someone else developing a mental health problem, experiencing the worsening of an existing mental health problem or a crisis. Just like physical first aid, it is provided until medical treatment can be obtained. Mental health first aid is given until appropriate support is found and until the crisis is resolved.
Ms. Hourigan and I would be pleased to talk about any of these comments, and we welcome your questions. Thank you so much.
The Chair: Thank you both very much for your testimony this morning. Now we’ll go to questions, and we’ll start with the two deputy chairs.
Senator Ataullahjan: Thank you for your testimony this morning. The prison inmate population has changed. We’re seeing inmates from very diverse backgrounds. Are we prepared to address the mental health issues of this diverse group of inmates? You have new immigrants, ethnocultural communities and different racialized groups. Were we prepared? Is there any best practice that you have seen in Canada? Is anyone getting it right? Is there anything we could learn from other countries?
Ms. Bradley: I don’t know specifically inside correctional settings. However, based on what we are providing to immigrant, refugee and ethno-racial populations in general, I would discuss sent the answer is no, not at all. It is something that, as a commission, we are starting to look at in general, in terms of providing mental health services to the IRER populations. It is at the very beginning stages. With mental health, in general, in Canada, the access to services is not good, so therefore I think that the challenges and the opportunities in diverse populations are all the more complicated and all the more difficult in order to obtain services. But given the vast numbers of people coming into Canada, it’s something we absolutely have to pay attention to. But up until now, very little has happened.
Senator Ataullahjan: Is your message getting across, your advocating? Is it resonating? The people who should be hearing this message, are they reacting to this?
Ms. Bradley: Certainly with the work we have done, we have produced a couple of documents that have, of course, been informed and written by people from the IRER community, and it has been very well received. The difficulty in a country where funding for mental health is probably the lowest out of the health budget of any developed country is it’s going to require a concerted effort. But certainly the work we have done has been very well received, and we are continuing on, but it’s going to be a long road, I suspect.
Senator Cordy: It was the Social Affairs Committee that recommended that we have a Mental Health Commission, so thank you, Ms. Bradley, for the work you and your staff continue to do in promoting good mental health for all Canadians and for finding solutions, and thank you, Ms. Hourigan, for the passion and belief you have in making things better for those who are mentally ill and doing so enough to give up your career on the bench. Thank you both for your work in this area.
Ms. Bradley, you spoke about a recovery-oriented approach and the importance of that, and you spoke in your speech about transferring from a punitive correctional system to providing health services. Could you expand on that a bit and tell us how it worked and how difficult it was to convince — you didn’t say what institution it was — but to convince the powers that be that this was necessary?
Ms. Bradley: I could go on quite a bit on that.
Let me start by saying it was the first province to have done that, and I was subsequently involved in a second one in a Western province, but it was then that I really did realize the complete shift in cultures, and on two different levels. One was in the development of a separate unit called the mentally ill offender unit. The philosophies were completely divergent, to the point that even the actual physical structure was completely different.
As an example, while we were building the facility, I went in one day just to observe what was happening, and I asked, “Why are those concrete slabs in the rooms?” They said, “Well, those are the beds.” I said, “Beds? How can they be beds? They are concrete slabs.” The builders and contractors tended to go to Corrections to get the direction at the beginning. I said, “But this is a hospital. We don’t have concrete slabs in hospitals as beds.” That began the discussion.
Then there was the overarching philosophy in the forensic unit where we had Corrections staff, because the exchange was that we would provide health care services to the super jail in Halifax and Corrections would provide security staff to the forensic hospital, with the supposition that we were both experts in the respective areas. Particularly in the use of seclusion and restraints, we really came to loggerheads. I refused to have any kind of restraints in the hospital. Then there was the use of uniforms in a hospital by security staff. This was a therapeutic setting. I could go on and on, but it was very clearly a very different way of looking at things.
Then, to complicate matters, the pieces of legislation, the provincial Correctional Services Act, the provincial Mental Health Act and the Criminal Code, provided that the administrator of the hospital took the lead on how things were run, but the Correctional Services Act was a direct . . .
Senator Cordy: Is this the facility in Burnside?
Ms. Bradley: Yes, it is.
Senator Cordy: Ms. Hourigan, you spoke about the young person who went through the system and there was no one there to help them, and it should have started early on with the education and health systems. I used to be a teacher, and I remember phoning for help for students. It would be, “In six months’ time. We’ll put them on the waiting list.” If it’s a six- or seven-year-old, six months is 10 per cent of their life. That’s a long time. Could you talk about that?
Also, you mentioned there are no studies that connect the use of seclusion and restraint with positively influencing the therapeutic treatment of individuals. I think, in fact, there are studies that show it is detrimental to them.
Could you speak on both those issues?
Ms. Hourigan: The dangerous offender was 36 at the time he was sentenced before me, but we began examining his life when he was six, I think. That’s exactly what happened to him.
Two things happened. Many of his issues were not even recognized. It’s wonderful that you were a teacher who was attuned to issues your student was facing. Many of his issues were not recognized within the school system. Once he got a bit older, around 12 or 13, the issues were identified, but once again, he had to fall into line and wait 18 months for a psychological assessment and even longer for a psychiatric assessment. In the meantime, he’s in the community and he’s offending. His offences became more and more serious, to the extent where he was convicted of attempted murder.
The frustration I saw in dissecting his life as a dangerous offender — his life was dissected before me — and I had the advantage of hindsight — and it was a sad tale — to see all the cracks where there was an issue that, one, was not identified or, two, was identified but the treatment didn’t occur for some period of time. That left him to be without support and services. His mental health and substance abuse problems were exacerbated, and he reoffended.
It was a frustrating exercise for me as a judge to see that he came through many systems; it was not just the educational system but the correctional system, because he was in prison, and the social welfare system. Because of where he was situated in the city of Toronto, he was in touch with that system, and his needs were not adhered to there. So it was a very frustrating situation.
In terms of your second question, I agree. The evidence shows there is no positive influence to the therapeutic needs of an offender by placing them in seclusion or using restraints. As a judge, my perspective is not just with the dangerous offender but with any offender I’ve sentenced to prison, and if we are able to identify a mental health need at the time of sentence — and I took great care to order psychiatric and psychological assessments of offenders who appeared before me. I knew their issues, and then I’ve sentenced them to jail and attached all the exhibits to their jail papers so that they would go to prison and it would be their road map. My hope, when they went out the side door into custody, was that they would get the therapeutic help they needed in the reformatory or the penitentiary so that they could successfully reintegrate into society. Time and time again, I kept seeing them come back before me with no help while in the institution.
So when I talk about a seamless transition, my hope is that in the court system, the judge can identify the concerns, they can be followed up in the institution, and a release plan can be made with community support so they are reintegrated. There are many cracks in the system, and hopefully the work of the commission will help not only inmates in the institution but workers and staff in the institution to be more attuned to the mental health needs of the inmates so that maybe this won’t happen again.
Senator Andreychuk: Thank you both for the information.
It sounds like an echo to me; I’ve heard before what we need, over and over again. I felt I was back on the bench listening to you. It is the same problems. We wanted the resources for kids early. In fact, you said “school,” and I would have said “preschool.” If we had done our jobs there, maybe it would be less of a problem.
Then the other issue is the release out. You’re saying to start the day they come in with a plan, and part should be employment.
You’ve talked about all the cracks in the system. That’s not news; that’s what people within the system continually bring forward. I’m optimistic, but I’m pessimistic. I’m optimistic about the people like you who work, care and are doing the best you can, but you say there are cracks.
Is there some magic bullet I can find that goes right through and connects everything, or is it that maybe you’ve hit on something we should be advocating for more resources at the front and really truly put them there, along with the exit strategy, and then maybe the stuff in between will be dealt with because it will be known?
We keep making assessments, and they take time and eat up resources. Then we do another assessment in another environment. Schools do assessments, et cetera. So we have gaps and time on assessments, and by the time we get to it, they are on to the next phase in their lives. I think over and over again that if only that child had received the resource, it might be different, but we kept seeing patterns come through, and it’s troubling me that the same patterns are still there.
How do we break it? Because I think a lot of people, legislators and committee reports have come through. How do we do something, either grab the attention of the government differently or the people of Canada differently? The good reports trap us into caring and the words come, but the actions seem to fall off later. I’ve got that off my chest.
Ms. Bradley: I’m afraid there is no magic bullet. You are absolutely right that services need to be started. The social determinants of health need to be considered early on.
If we are looking at the mental health of incarcerated offenders, to get right down to one thing that could be done that could help, elsewhere in society mental health services are provided by people with training. This doesn’t necessarily mean everyone needs to see a psychiatrist or a psychologist; there are peer support workers and others. But in the correctional setting, I’ve seen people with very serious mental illnesses languish at best and suffer unbelievably in a cell by themselves. If you do get an assessment, you may have to wait for a week or two until the psychiatrist shows up, and then so what? What happens then? It is not provided by people who have any kind of training or background, and that’s not good for either.
In my mind, I’ve seen a change. It was a painful process, but I have seen a change for the better when incarcerated individuals are provided services by people who know what they are doing in a therapeutic setting. People who are mentally ill in a correctional setting and leave with nothing leave far worse than when they went in. So if nothing else, I think that has to change.
Ms. Hourigan: In terms of your question about the youth and where they start this journey, and picking up on what Louise said, I think the issue is accessibility and availability of services. It needs to start, as you say, from preschool when they are three or four years old and there is an issue that’s identified. The services need to be there.
The services also need to be there at the other end in the penitentiary. There is no reason why a penitentiary or reformatory or any institution cannot be therapeutic, in my opinion. It’s punitive by its nature. As a judge, I’m sentencing someone to jail and the deterrent aspect is they are taken away from society and their liberty is taken away, so the punitive piece is addressed by the fact they are incarcerated, but there are these outstanding identified issues. Why can’t we deal with the therapeutic piece while they are there under our care and under our auspice?
My hope is that there are more accessible services and greater availability in the whole scheme, from three-year-olds right up to seniors in our population. But certainly there is absolutely no reason, speaking of inmates, why that therapeutic array of services can’t be available to them.
Senator Andreychuk: The Young Offenders Act that was brought in was certainly touted to put preventive services first, and in fact the charge shouldn’t be laid if an alternative could be found. Has that had any effect? I’m hearing that there are no services at that point so that the alternatives are pretty scarce, and we’re back to confronting a judge and dealing with it.
Ms. Hourigan: Certainly, with the Youth Criminal Justice Act, as it is in play now, it’s the philosophy for a judge sentencing a youth to look for alternatives to incarceration, to look to the community for support and resources and to divert them from the criminal justice system. As a Youth Court judge sitting in Youth Court, I would do that all the time, as would my colleagues. The issue would be what resources are out there in the community to provide them with the help they need. There are some, but again, it goes back to the issue of availability and accessibility of services. There have to be more.
Senator Hartling: Thank you both for being here and having the courage to keep working on this in different ways, and for you, Ms. Hourigan, to do different work to build on some of these issues, and Louise, for your ongoing commitment.
I come from the community and worked in mental health before. Visiting prisons, it was disheartening to see how many people with mental health issues are there and the tragedy of that, because, with the closing of other types of institutions — not to say we should bring all those back — that seems to be the place that people end up. Especially Black people, indigenous people and other people maybe aren’t getting the services they need.
What do you say would be some of the alternative community-based services that we might be able to implement before? I know we definitely need to work with the young and early interventions. What other programs besides prisons could we implement and encourage in our society to work with people who have not only mental health issues but who also have issues with the criminal justice system so that we keep society safe and help those who need the help?
Ms. Bradley: Well, certainly I think the diversion courts are doing a lot to help people from going through that system in the first place.
I can speak to my own experience with programs in the forensic setting where people who have been found not criminally responsible on account of a mental illness would have otherwise ended up in a federal penitentiary for the crimes they had committed. We developed a community treatment program, and it was such that we were able to provide people with the right expertise to walk with them through the community program, to stay with them, to help them. In the general system, it’s called an Assertive Community Treatment Team program, ACTT, and it’s similar to that. It’s people who have an understanding of the Criminal Code requirements, what a conditional release actually means and gradual reintegration into the community. To have someone institutionalized for even just a year — God forbid the ones that are in there over 10 years — reintegrate into the community, just to open the door and let them walk out, we wonder why there is such recidivism. We did it for the forensic population, and the return rates were very low. I do think that similar community programs could be provided that provide for the safety of the community and the care and treatment of the individuals.
I don’t know if any of you have seen John Kastner’s documentary. It outlines very nicely what support within the community can do to someone who has committed murder, and it remains quite successful. I think a similar philosophy and approach could work in correctional settings as well.
Ms. Hourigan: In my experience in Ontario, we have Mental Health Courts, and my recommendation ongoing would be that they sit more frequently and be more widespread across the province. I took my turn sitting in the Mental Health Court when I sat on the bench for 12 years, and it was fulfilling because offenders were diverted from the criminal justice system because their mental health issue was identified, and they got the help they needed in the community. Again, the crack in the system is that they were diverted from the criminal justice system because they were allowed to stay in the community and get the help they needed, but oftentimes the resources were not always there.
However, there are tireless mental health support workers and youth support workers in the province of Ontario whom I can speak of personally, who work within the criminal justice system for this type of person who has a concurrent mental health issue and criminal behaviour. There is hope and there is precedent for it, but I go back to the fact that there needs to be a buttressing in the community in terms of more supports and programs so there is some teeth to that diversion.
Senator Hartling: Thank you very much. It seems the will has to be there, and the openness, for people to understand. What you think of the idea of attitudes around these issues?
Ms. Hourigan: In terms of the public at large?
Senator Hartling: Yes.
Ms. Hourigan: I think that’s a component to it too. I go back to the preschoolers, as the senator was talking about. There needs to be education and awareness from the bottom up — and not just teachers but parents of kids and the public at large — in terms of what a mental health issue looks like and plays out to be and what resources are available in the community. I think there really needs to be education. I think that’s a great point in terms of people recognizing not only what someone is dealing with as a mental health challenge but in what direction they can point them to for resources that are available.
Ms. Bradley: The work of the commission in stigma reduction over the last 10 years can be used in good stead in this situation as well. I know only too well, having been on the receiving end of concerned community members when a forensic patient has been released into the community, that the “not in my backyard” syndrome is alive and well. We try to use it as an opportunity to educate, but stigma requires more than mental health literacy. It is not an area of focus that we have targeted, for a number of reasons, but I do think that the research and what we have learned over the last 10 years could be utilized to help in that situation.
Senator Hartling: Thank you.
Senator Pate: Thank you to both of you for all of your work, dedication and contributions. It is much appreciated, and I’m very happy you are here to join us.
I want to focus on some of the provisions of the legislation that could possibly be used because one of the things this committee is looking at is how the current legislation might be used to actually achieve some of the things you are talking about.
I was really happy, Louise, when you mentioned the work you did with the East Coast Forensic Hospital because that’s one of the units we have heard about before. Some people listening might think we are talking about propping up the system and providing more resources, because even with Mental Health Courts, we know that in fact it has created an industry capture of more people coming in, when really those resources invested in the community might be better spent.
Section 29 of the Corrections and Conditional Release Act allows for corrections, the federal system, to contract with provincial and territorial health services. In fact, as you well know, that was supposed to happen more than 10 years ago with the East Coast Forensic Hospital and has never come to be. Instead, Corrections has invested more and more resources in the prisons. For instance, in the prisons for women, they have some of the best mental health units, but most of the women who have mental health issues never get there; they end up isolated or segregated in a maximum security unit or in segregation.
The Ashley Smith inquest talked about the importance of providing those services in the community — getting people out of segregation, getting them out of the prison, using section 29. It strikes me that we have not seen a lot of focus on that in terms of successive governments.
You mentioned the need for a culture shift. I know that in your 2012 document, Changing Directions, Changing Lives, you actually made recommendation 2.44 —you probably have it at the tip of your tongue — where you talked about the need to increase mental health systems in the community to provide services and supports to individuals in the criminal justice system. Is that what you were thinking of, the section 29 arrangements, so people could be actually moved from the federal prison system into provincial systems by virtue of existing exchange of services agreements?
Secondarily to that, section 87 of the Corrections and Conditional Release Act requires Corrections to actually take into account mental health issues when they’re releasing people. So that’s another place; the community teams you were talking about could be contracted instead of it resting with parole officers, who often don’t have that training. As successive investigations, inquiries and inquests have shown, there is an inability of Corrections to actually not allow security to trump therapeutic interests. Repeatedly, that has been shown, even in situations where they have duly designated environments, because they didn’t set them up the way you set up the East Coast Forensic Hospital.
Do you see that as a way forward, to use section 29 to get people out? Also, might investing in community to divert — as opposed to Mental Health Courts, which only take certain individuals — be a better investment long term?
Ms. Bradley: Certainly I don’t think that was the specific thought behind that, but it could work. The thought behind it, as I responded earlier, was to ensure that mental health services are provided in a manner and by people who have expertise in this area.
I recall that happening sometime after I had left that position, so I’m not exactly sure what happened. However, I can tell you that when we had the exchange of services between Corrections staff providing security to the forensic hospital and us providing health care services to the correctional centre, I was somewhat accused of providing a Cadillac service because the amount that was being spent on health care services by Corrections in the province was about one quarter of what we eventually ended up spending. This was by providing a level of service — as I said, the World Health Organization says incarcerated people have a right to the same level of service. In order to bring that level of service up, we ended up spending considerably more.
I don’t know if that played a part in it, because the costs would be considerably higher, but I do think that it could work. The whole culture between security versus therapy is one that is really hard to thrash out. Working together I think is the only way to do that.
Senator Pate: When you are talking about the costs, I know of individuals — one in particular — who go in and out of that unit, who first spent 10 years in segregation in a federal penitentiary where the Parliamentary Budget Officer costed it at more than $500,000 per year. So the cost per diem was higher, but my understanding was that in terms of the overall cost, there was a reduction in cost long-term in terms of how long people would have spent in segregation and prison if they hadn’t been in the mental health unit. Is that accurate?
Ms. Bradley: I would think it is accurate, but I’m not sure that’s costed out and thought about in that way, which is part of the culture. As I say, I’m not sure whether or not that was a factor. However, I do know that to provide health care services from a health authority, the budget is considerably higher than the health care budget within a correctional setting.
I’m not sure that they have thought about the cost of the use of seclusion and restraint in terms of the actual finances and the human toll that it takes. I know that the work we have done at the commission on seclusion and restraint has been limited to health care settings. It can and should be expanded to correctional settings but to date we have only been able to focus on health care settings.
Senator Pate: Is that because of inadequate funding for the commission?
Ms. Bradley: We haven’t been given the mandate, and with the mandate, of course, comes the funding to do that. It is an area I consider as vulnerable populations, and despite what is in the national strategy, it’s certainly an area that we have not focused on very much for a number of reasons, but largely it has not been identified as an area of focus for our mandate and in the funding formula that goes along with it.
I will hasten to add that we would very much welcome it, because we do see this as an extremely important part of the mental health fabric of Canada, and we have the expertise and the ability to be able to bring that together and address it.
Ms. Hourigan: I would say in response to your comment about community resources as opposed to the Mental Health Courts that community resources certainly cast a wider net in terms of servicing people with mental health needs in the community. I stand by my position that someone shouldn’t have to commit a criminal offence to get the mental health help they need, and that’s what I saw time and time again in the court. So augmenting and supporting community resources and putting the funds in that area would go a long way to servicing all Canadians.
The Chair: We’ve gone a bit over our time, but we have a bit of flexibility. There is one further question from Senator Cordy.
Senator Cordy: When I see the statistic that 30 per cent of male offenders have a mental health need, 50 per cent of female inmates have a mental health issue and 80 per cent of those who are sentenced to federal institutions have a substance-abuse problem, we know that sometimes those with mental illness will use drugs to self-medicate. It might be an illegal substance but probably easier to get than a prescription for dealing with it. How do we use these statistics to make changes? It blows my mind that they’re that high, but we keep seeing them over and over again. It just seems that if governments are going to look at those statistics, it would be a pretty easy decision to make that you’ve got to put more funding in for more mental health support within the prison systems.
Ms. Bradley: Well, let me put it this way: The commission also has a document that’s called Making The Case For Investing in Mental Health in Canada, and it outlines very clearly that the need to increase funding for mental health services overall is very clear and that if we don’t do something, then in 30 years’ time we’re going to be talking about the expense to Canada growing exponentially. The evidence is there, and I do believe that what is happening is a term that’s called structural stigma. That is not something that we do to each other on a day-to-day basis, but I’ve been at budget tables when I have been arguing for a community mental health program and my colleague has been arguing for a da Vinci robot. Who do you think got the money?
We need to address the whole issue of structural stigma. We probably didn’t have the foresight to think about this particular group at the commission 10 years ago. We targeted four different populations and, in retrospect, we should have targeted policymakers, politicians and other decision makers because you’re absolutely right: these statistics are astounding. Why aren’t we doing anything about it? Particularly for people who are incarcerated, it is really easy to lock them up and throw away the key, quite literally. It is an extension of what we are seeing in mental health, and until we can get past that whole idea of whether these people really are worth it, I’m not sure that we’re really going to be able to address it.
But you’re right, the statistics are there, and the statistics are there for the general mental health population. I think people who are incarcerated with mental illness are doubly, if not trebly, stigmatized.
Senator Cordy: We did hear this when we were doing our study on mental health and mental illness: the division of health care dollars let alone when you turn it into the Correctional Service. You have cancer, heart and mental illness. And if it’s cancer or heart problems, they might die, so the mental health gets pushed off. The problem is that it got pushed off this year and the next year and the next year. This is what was happening.
Ms. Bradley: I often say mental illness is a terminal illness. We lose more than 4,000 people every year in Canada, and we have for the 10 years. I get that the opioid crisis is a huge tragedy, but you’re talking about 2,500 people dying last year has now become a crisis, while for each of the last 10 years there have been 4,000 registered mental health-related deaths, not including the ones that are not registered, and that is not a crisis. What is happening?
Senator Pate: It’s thanks to the work of the senators before some of us came here that the work of the Mental Health Commission even exists, so thank you to those colleagues as well.
One of the things you mentioned is Breaking Free Online, and I wanted to note that in Canada, no prisoners have access to anything online, whether it’s educational opportunities or ways to contact their children or their families. So this would be an impediment to that program, then, I presume.
Ms. Bradley: I actually raised that with the person, because I haven’t really looked at that particular program in any depth, but a colleague of mine who is an expert in this field from New Zealand told me about this program. He said there is a way of providing computer access where they can only access that particular program. So there are ways of going about that.
Senator Pate: Yes. I understand that as well. I’m a total techno-twit, but I’m told there are all kinds of things that can be done on computers, but they’re not being provided. There is no vocational programming now, or secondary education. These are things people could be doing, paying for courses themselves and taking them, but because we have that antiquated approach, there is no access. I wanted to check that I was correct and that was online and there would have to be that policy change as well.
Ms. Bradley: Yes.
The Chair: Thank you very much for coming and presenting to us this morning, and thank you to all the senators for their questions. You have certainly helped us understand these issues a bit more. I like the idea of further understanding structural stigma, and you’ve highlighted the need for a cultural shift and helped to bring awareness for our study. We appreciate that.
Senators, we will now begin our in camera session.
(The committee continued in camera.)