Proceedings of the Standing Senate Committee on
Social Affairs, Science and Technology

Issue 19 - Evidence - June 7, 2005 - Morning Meeting


VANCOUVER, Tuesday, June 7, 2005

The Standing Senate Committee on Social Affairs, Science and Technology met this day at 9 a.m. to examine issues concerning mental health and mental illness.

Senator Michael Kirby (Chairman) in the chair.

[English]

The Chairman: Senators, we have with us today on our first panel Rennie Hoffman, who is a board member and treasurer of the Mood Disorders Association of British Columbia, Dr. Sabrina Freeman, who is the executive director of Families for Early Autism Treatment, Ian Ross, who is the executive director of the Crisis Intervention and Suicide Prevention Centre of British Columbia, Dr. Allan Burgmann, who is a professor of psychiatry at UBC, and Dr. Kristin Sivertz, who is the director of the mental health program and head of psychiatry at Providence Health Care's St. Paul's Hospital.

Mr. Hoffman, please proceed with your opening statement.

Mr. Rennie Hoffman, Executive Director, Mood Disorders Association of British Columbia: Thank you, Mr. Chairman.

Honourable senators, to paraphrase an old movie line, "It is a strange destiny that brings me to this place and time," I am not of the world of mental illness. For nearly 29 years I worked as a police officer with the Vancouver Police Department. My world was simple. Then, all I had to do was protect the public, maintain the peace and enforce a few hundred relevant statutes. The majority of my service took place in the Downtown Eastside of Vancouver, the most troublesome area in terms of violence, drug use and human despair. I patrolled there before, during and after deinstitutionalization of the mentally ill. Today, as executive director of the Mood Disorders Association of British Columbia, my world is more complicated.

Mood Disorders Association of British Columbia is a 23-year-old organization that was started and grew for the purpose of providing self-help support groups and education for consumers and their families and friends. It was a consumer-run and -directed organization. Last year, 15,000 to 20,000 people met in our groups. We are represented in all areas of the province and have had as many as 62 groups operating at one time. We are the largest provider of consumer self-help support in the province. We have a Cantonese group, an Aboriginal group and are laying the foundation for groups to begin in both the Punjabi and Hindi languages. Changes in funding structure have allowed us to expand to the youth market, with a new Moving Beyond program. Those same changes nearly caused the death of this organization.

The committee has recognized the common thread of peer support groups as valuable and their need has often been mentioned by contributors. NGOs like MDABC are a valuable part of the primary health care system and need to be recognized as such. It is vital that such continuing programs be included in the continuum of care for the mentally ill and that they not be devalued or extinguished because they cannot produce data that proves dollars saved. An agency that helps people avoid hospitalization or the need for consultation with a doctor or emergency room access provides value, perhaps more value than any reactive measures, at least in part because of the monies saved at the front end.

When I was walking the beat in the skid row area, it never occurred to me that there was any common excuse for the rampant drug use I saw every day. However, in the late seventies and early eighties no one had ever heard of co-morbidity. It is estimated that 50 per cent of illegal drug use is directly related to mental illness. I think that is a low estimate. Regardless, if the federal government is going to maintain the authority for the control of illicit drugs, they must also assume some responsibility for the damage done by the use of those substances. Enforcement of Criminal Code offences cannot be their only responsibility.

Many times in my former career, I arrested addicts and those who cared for them would ask that they be forced to take treatment by the court. Mental illness and addictions, while we speak of them in terms that indicate that a cooperative approach to treatment is possible, resist simultaneous attempts at control. A federally administered, national program for substance-abuse recovery could enable assessment of the relationship between mental illness and drug use and dependency. Such a coordinated federal program could provide a consistent venue for referral to a recovery program by federal court judges as well as an insiders' look at how causative mental illness really is to drug abuse.

I have submitted a brief with suggestions in other areas including those specific to policing and mental illness, but I must address the issue of stigma. Can we please eliminate the use of that word when discussing the problems surrounding life with mental illness? The situations that arise surrounding reaction to, behaviour toward and treatment of people with mental illness, both within and outside the health care system, are borne of ignorance, intolerance and fear. These are the same conditions that were identified and confronted by the black population of the United States in the last generation and by that same group of people in South Africa and the gay population in this generation. In those situations, the conditions were named prejudice and discrimination. They are no different.

Mental illness is lagging far behind in terms of our ability to treat it. The new UBC Hospital Mood Disorders Clinic and research centre as well as other research organizations offer much hope, and our organization looks forward to cooperating with them towards their ultimate success. However, their goals are, optimistically, long term. In the meantime, our current fragmented system is not working very well. I believe in the adage "Fix the problem, don't fix the blame." There is a need for a federal mandate to address a situation that is beyond provincial capacity and for federal leadership and co-ordination. The separation of responsibilities, originally described in the British North America Act, did not include responsibility for mental illness. In those times, there was no concept of the depth of this problem.

Your reports mention unknown or shadow mental illness connections in the families or friends of the members of this committee. When I began my connection with MDABC, I thought mental illness had no hold on my world. Since that day, I have discovered that my half siblings are all affected by depression. The son of my half-sister died by suicide last month. I have a bipolar brother-in-law and a sister-in-law who is depressive. I cannot remember the last conversation I had with a friend that did not include a revelation about the illness of someone close to them. My daughter-in-law is depressive and she is expecting my second grandchild. I know the odds.

As a police officer, I saw the effects of mental illness in many of the interactions I had over 29 years. As a member of Mood Disorders Association, I see now that mental illness may have been connected to nearly everything I did. As a grandfather-in-waiting, I am aware that, unless significant changes are made to address these serious situations, my descendants are in peril. I know about peril. Sometimes you cannot anticipate it. Sometimes it can be eliminated or overcome. We must affect the course of mental illness in this country. I have a special interest in doing so.

MDABC and I thank you for your special interest and for this opportunity.

The Chairman: Thank you very much.

We will next hear from Ms. Freeman.

Dr. Sabrina Freeman, Executive Director, Families for Early Autism Treatment: Good morning, honourable senators.

I am a sociologist by training and a long-time disability advocate by necessity. I am also the parent who spearheaded the landmark Auton disability rights court challenge to the B.C. government that won at the B.C. Superior Court and at the B.C. Court of Appeal but went down to defeat at the Supreme Court of Canada last November, effectively gutting the Charter of Rights and Freedoms and setting back disability rights immeasurably.

I understand that you heard a presentation on autism treatment neglect in Canada from my colleague in Ontario, Nora Whitney, who is the executive director of Families for Early Autism Treatment in Ontario. Hence, I will not revisit the points she made. However, it needs to be said that I wholeheartedly agree with her assessment of the situation, the nature of the treatment crisis and the necessary path to its resolution.

I am not here today to sugar-coat the situation of children with autism in Canada. This is not going to be another bland politically correct version of the autism situation in Canada where everyone goes home feeling good about how we are working together to make things better and how Canada is the greatest Canada in the world to live in and are we not all lucky to be Canadian. No. I am here to deliver only the blunt truth because I am outraged.

We live in a country where there is one group of children who are 100 per cent excluded from our health care system. This group is the children afflicted with the debilitating neurological disorder of autism. There is no medicare for them and Ottawa could not care less. The so-called universal health care system is a sham. A doctor tells a devastated mother of a child newly diagnosed with autism that medicare has nothing for the child. There is not even a category called "autism treatment." The provinces could care less. I am outraged beyond words, because every provincial government colludes to keep these children out of the health care system for their core health need, which is intensive behavioural treatment based on the decades of research done by Dr. Ivar Lovaas and colleagues in the field of applied behaviour analysis — treatment considered best practice in New York State by the New York State Department of Health and the U.S. Surgeon General.

I am outraged because when the B.C. Superior Court and the Court of Appeal saw the true discrimination in our nation's so-called universal health care system and the systemic breach of the Charter of Rights and Freedoms for children with autism, their rulings were appealed to the Supreme Court of Canada. Almost every provincial attorney general across the country, including the federal attorney general, intervened against these children's right to medicare for their core health need. I am particularly outraged that Irwin Cotler, self-styled champion of human rights, proved to be a supreme hypocrite by intervening against children with autism at the Supreme Court of Canada to extinguish their equality rights.

I am convinced that federal intervention in the court resulted in the loss of the Auton case, which gutted the rights of children with autism and the disabled in general. These children have very powerful enemies amassed against them.

On November 19, 2004, when the government won the Auton case against these disabled children, Trudeau's vision of a just society died. Section 15(1) of the Charter of Rights and Freedoms is not worth the paper it is written on for any disabled person, particularly children with autism and the mentally disabled.

The health policy technocrats and the bureaucrats will tell you that this is not about the children but, rather, that it is about stopping the courts from bankrupting our health care system; however, I am here to tell you that they are wrong. It is absolutely about children with autism and the fact that they are compared to children of a lesser God and have been relegated to the ministries of poverty and child protection in each and every province.

Systemic discrimination, the very way policy-makers think about the nature of physical versus mental disease, is the reason a social worker is illogically the contact point between government and the child afflicted with autism. Systemic discrimination is why government policy excludes this whole class of children from the health care system for their core health needs across the country. It is systemic discrimination that permitted every provincial jurisdiction and the federal government to send in their best lawyers to defeat the Auton case at the Supreme Court of Canada, to see that this travesty of justice remains in place.

The Supreme Court of Canada rules that government can pick and choose which treatments to cover and which not to cover, completely ignoring the fact that to deny the only effective treatment for autism is to exclude the child from medicare entirely. This is the key point that was missed by the government in Ottawa. It is not about comprehensiveness, it is about the principle of universality. Where autism treatment is concerned, the whole notion of universality in our health care system is a fraudulent promise.

So now, after the Supreme Court of Canada loss, it is open season on children with autism. Governments across the country are forcing parents of children with autism to privately fund their child's treatment until such time as parents have to sell their homes and eventually go bankrupt. Yes, the universe is unfolding as it should for Canada's policy-makers, where the mentally ill are excluded from medicare, relegated to poverty, and their families are following closely, soon to arrive at the same fate. Too bad, so sad is the message we painfully hear loud and clear. Just because you have a disabled child does not mean, we, the governments across Canada, have any obligation to provide the medically necessary treatment your child needs. Nevertheless, there are 63 licensed psychiatrists in British Columbia alone who have told government what treatment children with autism require for their core health, only to be consistently ignored until the court stepped in.

Here is the bottom line: If we are taxed like the nanny state, then the nanny most certainly better show up. If we are taxed to death because of our vaunted health care system, then we need a medicare system that includes everyone, not just the physically ill. But, no, in this country, the government taxes us like socialists but has the compassion of capitalists, with its power elite chronically infected with Rideau Canal disease whilst passing the croissants and gateaux, thinking to themselves that all is well across the land in what they imagine is the greatest country in the world. There is a term for this behaviour — it is called rank hypocrisy.

So what are the solutions? There are obvious solutions to this problem. We have the wallet — because the fiscally responsible thing to do is to fund medically necessary treatment for children with autism. Numerous cost-benefit analyses have already showed that funding this treatment will save considerable government dollars as compared to the massive costs of lifelong institutionalization. However, we do not have the will as a nation to seriously address this shameful breach of the social contract.

Now, as senators, you have the power of moral persuasion and the ability to get this on the government agenda. Nevertheless, I must say, in all candour, that I am not hopeful that you will be able to fix this problem because its roots are just too deep and systemic. The minute you begin the work, should you decide to take on the necessary fight to right this horrible wrong, you will be stonewalled every step of the way. The health policy technocrats of the Canadian Institutes of Health Research and the Canadian Coordinating Office for Health Technology Assessment in Ottawa will serve up their junk science to you. The health bureaucrats in Ottawa will give their professional opinion as to how the autism treatment found by two B.C. superior courts to be medically necessary is all wrong, that it is experimental. They will tell you it will ruin the country and will somehow bankrupt the health care system.

As part of my submission, I have provided you a book that I authored about the discredited made-for-court policy research that stands in the way of universal autism treatment. You should consider this an inoculation kit that exposes the fraudulent science produced by health policy academics for the specific purpose of defeating the Auton Charter challenge for medically necessary autism treatment.

Yes, senators, contrary to what health policy-makers and attorneys general will say, the sky will not fall if we do anything so radical as include children with autism in the national health care system. Medicare will survive. The floodgates will not open. The only change will be that children with autism will get the necessary treatment that is their due as Canadian citizens, not only the children of the rich or those with a home they will mortgage and eventually lose to autism treatment to pay for their child.

The provincial governments have profoundly failed these children. The Supreme Court of Canada has failed these children. The federal government has failed and betrayed children struggling to overcome autism. At this point, unless you can move mountains of corrupt government-owned academics and health policy analysts and technocrats and bureaucrats, children with autism are doomed in this country. They are doomed to live lives as constant wards of the state; or, if they are higher-functioning, they are deemed to be part of the homeless urban landscape joining the legions of mentally ill on the streets.

The picture for children with autism in Canada is very bleak as things stand now. Unless systemic change is made to include them in medicare for their core health need, they will continue to be the roadkill of Canada's health policy technocrats due to an ingrained ethos of health care rationing, which is always reflexively done off the backs of the mentally ill, the disabled and anyone else who does not fit the profile of "normally ill," otherwise known as the "physically ill."

As the recent Supreme Court ruling in Auton confirms, the systemic discrimination against the disabled is firmly entrenched in Canada's policy. If a league dispute at all revolves around health care like who should be in or out of it, we now know that the Charter of Rights is suspended, simply set aside by government and rendered meaningless.

Hence, the challenge before you is to change the political culture of this country, a culture that regards the mentally disabled as less worthy than the rest of us, with treatment needs that are less worthy than the rest of us. This is a profoundly impoverished aspect of our society and fundamentally wrong. The question is this: Who among us has the power, the resolve and the moral vision to end the injustice and the hypocrisy surrounding autism?

Children with autism are the proverbial canary in the coal mine in this country: Unless they are included in medicare, the promise of universal health care is the big lie and the promise of the Charter of Rights is empty. The just society promised by Trudeau is an illusion. For parents trying to save their children with autism, precisely the kind of credit-card medicine the Minister of Health pretends he is against, is their reality today.

I sincerely hope you can end this injustice, but all that I see in the many years of advocacy is that intransigent bureaucrats and malevolent policy analysts and technocrats are still firmly in charge and have no intention of changing autism policies. Despite this, I still believe it was important to come here today to deliver the blunt truth about the plight of children afflicted with autism. I think it is important for you to know that what we call universal health care in this country is really not universal at all.

The Chairman: Thank you, Sabrina.

Next we will hear from Mr. Ross.

Mr. Ian Ross, Executive Director, Crisis Intervention and Suicide Prevention Centre of British Columbia: Good morning. I am the chairperson of the Crisis Intervention Committee of the Canadian Association of Suicide Prevention, commonly known as CASP. This is the presentation folder that I brought this morning.

I am here to tell you about the CASP blueprint for a national suicide prevention strategy for Canada and its direct connection to building a continuum for individuals with mental illness.

Every year in Canada, approximately 4,000 individuals die by suicide. Many of those suicides are preventable.

I wish to tell you a story that has four chapters. The first chapter involves the crisis centre in Vancouver where I work as the executive director. The second chapter connects the crisis centre I work for to four other independent crisis centres across British Columbia. The third chapter connects the Distress Line Network of British Columbia to the Canadian Distress Line Network, which is made up of distress lines connecting all six regions of Canada into one network. The fourth and final chapter connects the Canadian Distress Line Network to the international accreditation network.

In the first chapter, the crisis centre in Vancouver is a voluntary organization committed to helping people help themselves and others deal with crisis. This pamphlet in your package is an overview of the crisis centre in Vancouver. We are an example of more than 100 crisis centres across Canada. We have an $850,000 budget. We have two main programs, one being a distress line in the Vancouver area that handles 24,000 calls a year. Eight per cent of those 24,000 calls are suicide related — which means that 92 per cent of our calls are not suicide related.

We also have a high school program. We go into the high schools and we talk to high school students about stress management, about coping skills and about suicide prevention. In the Vancouver area, we held just over 500 interactive workshops last year, involving about 15,000 high school students.

The key to our success in the crisis centre in Vancouver and crisis centres across the country involved the recruitment, training and management, in our case in Vancouver, of 260 volunteers supported by a small team of professionals. Twenty-six per cent of our budget comes from government funding, and we raise the rest, basically. Our board of directors, a non-profit board of directors, is very clear in underlining the fact that we do not want to be more than 30 per cent funded by government, in order to stay independent. Seventy per cent of our budget is raised by ourselves.

Our volunteers on the distress line and in the high schools are not therapists. They are highly trained individuals — and we train our volunteers to be good listeners. The power of being a good listener is amazing. We get people phoning in the middle of the night, people who cannot contact a family member or a loved one. Those people can contact our service, a free, confidential service, 24 hours a day. So, as I said, our backbone is our 260 trained volunteers plus a small professional staff. When an individual phones our centre, we listen to them, and then, as needed, refer them to therapists or to other services.

Since 1969, our centre in Vancouver alone has trained more than 5,000 volunteers, people who have learned to be good listeners and who have taken their good crisis intervention skills back to the community. We have people come to us and pay $110 to be a volunteer, because our training is quite extensive just for the material. Our training involves 75 hours. Some people do not make the training and actually cannot in fact carry through. Nevertheless, the power of using volunteers, not just to stuff envelopes, is obvious; these individuals are on the distress line front line across Canada. It is a very valuable service. I just wanted to highlight in that first chapter an example of one crisis centre.

The second chapter — the Distress Line Network of British Columbia. We realized that we had to be leaders in the crisis intervention, suicide prevention field, so we connected with four other crisis centres, independent crisis centres, in British Columbia. Through a community-development model, we have built a distress line network across British Columbia that is now being used as the model for the Canadian Distress Line Network. As I said, we use a community-development model. The community development model is a top down model, to decide what the structure will be. The second phase involves coming up with a consensus model as to decisions within that network. The third and final phase is where the power and the authority stays in the regions but there is a common set of standards or best practices used by all partners. So it is a model that has been tried and true in many organizations.

I worked in the Alzheimer's Society for 11 years and we used that model to build the structure in British Columbia, in Canada and internationally.

One of the keys for the B.C. Distress Line Network is an exchange routing system. That system allows a phone call that is coming into one centre to be bumped, if the original centre is busy, to the next open centre; if that centre is busy, the call is bumped to the next open centre. We have coverage 24 hours a day.

In the third chapter, this model in British Columbia we have built is now a model for Canada. In building a Canadian Distress Line Network, rather than looking at the 10 provinces and various territories, we have divided the country into six large regions, namely, B.C., Yukon, the Prairies, Quebec/Ontario, Atlantic Canada and the North. All six of these partners are working toward that third phrase of the community development model, where the power and the authority will stay in the regions but where common operating standards will exist across the country.

The reason I am here is to impress upon you the importance of Canada having a national suicide prevention strategy that connects with mental health strategies and various other strategies. I know you have talked with other colleagues across the country about this. The one implementation piece within the strategy relates to prevention and intervention. It relates to the fourth chapter, which is the trained volunteers on the front line, the Canadian Distress Line Network. In the package I have given you, there is an executive summary of the Canadian Distress Line Network. It is just one piece in this Canadian blueprint strategy for a national suicide prevention strategy. It has actually been very successful.

In closing, we need a recognition at the federal level in support of a national suicide prevention strategy for Canadians.

The Chairman: Thank you very much.

Dr. Allan Burgmann is next, followed by Dr. Sivertz. They are both with Providence Health Care.

Dr. Allan Burgmann, Clinical Assistant Professor, Psychiatry, University of British Columbia, Providence Health Care: Let me thank honourable senators for inviting both myself and Dr. Sivertz to speak about the crucial issue of mental health and addictions.

I wish to start off by saying that I agree with everything that has been said so far, all of the crucial issues that have been raised pertaining to specific issues of mental health. However, our presentation is going to focus specifically on mental health and addictions and how it interplays at Providence Health Care and St. Paul's Hospital.

Our hospital is seven blocks away from here. Seven blocks in the other direction is the Downtown Eastside, which has been recognized as the poorest postal code in Canada. The Downtown Eastside has been internationally recognized as well as nationally recognized as having the highest density of patients and individuals with three problems chronically. Those problems are a substantial substance abuse problem, a substantial mental health illness as well as major mental illness.

The psychiatric illnesses that are largely prevalent in the Downtown Eastside are psychotic in nature. They include, predominantly, schizophrenia, schizoaffective disorder and psychosis disorders generally generated by substance use. However, among the individuals who live in the Downtown Eastside, there are incidences of very severe mood disorders as well as dementia and post-traumatic stress disorder. The substance abuse problem that is down there is rampant. Any substance that you can think of that can be ingested, smoked or injected is used down there.

We once thought that heroin was a huge problem down there. Heroin has taken a distant back seat to stimulants such as cocaine, crack, and the evil crystal methamphetamine. Crystal methamphetamine is going to be the dragon that swallows us all if it is not contained. It destroys brains and generally causes permanent psychotic illness. The medical illnesses that are present in the Downtown Eastside are those of infectious disease — HIV illness, hepatitis A, B and C, as well as the antibiotic-resistant super infections, such as carditis, osteomyelitis and cellulitis are present in the Downtown Eastside. The other thing that is present is trauma from being beaten in the street to being raped to being basically members or victims of violent crime.

There are numerous reasons for the Downtown Eastside. However, primarily, it has come about as a result of the downsizing and closing of Riverview Hospital, where large numbers of psychiatrically ill patients were discharged from the hospital without adequate follow-up as well as adequate housing. These individuals were left drifting around the city. The only area of Vancouver that has affordable housing is unfortunately the Downtown Eastside. These people are vulnerable to being taking advantage of. They are also vulnerable to being enticed into using substances of addiction.

There is also the imbalance between harm reduction and drug treatment. The focus of our city's addiction strategy is harm reduction.

Crystal methamphetamine is a very easily manufactured and inexpensive drug. There are huge profits in it. Anyone can make crystal methamphetamine in their basement. Simply download the recipe from the Internet, buy the stuff from the Canadian Tire, and you are well on your way to trafficking in major drugs.

Dr. Kristin Sivertz, Physician Director, Mental Health Program, and Head of the Department of Psychiatry, Providence Health Care: Historically, mental health and treatment of major mental illness and addictions were done very separately. They really did not receive concurrent treatment. I would say that the new directions that we have been taking, and this is not just a provincial or Vancouver strategy, this is really national and international, is that there is much more recognition over the past five to ten years that psychiatric and addiction treatment cannot be separated. The regional focus on the need for increased training and expertise of all levels of health care providers is necessary for addressing this particularly complex and challenging patient population.

As we said, our focus today is looking at Providence Health Care and our interaction here and provincially.

Our strategic direction in shifting towards the concurrent treatment of addictions and mental illness was derived from necessity. It came from the pressure from the Downtown Eastside, where we had a tremendous flow of patients in through our front gate, in through our emergency room. We understood that we needed to have a unified treatment approach and we needed to build on the rather limited addiction services that were available within Providence Health Care. As a result, we developed much closer ties between psychiatry and the addiction service. However, again, I want to flag that our addiction services were very limited.

Crystal methamphetamine research is now part of our focus and we have an appointment of an addiction research chair and now an established division of addictions. We have had some expansion of our psychiatric beds and our capacity to deal with these very behaviourally disordered individuals. That is some of the goods news. However, we certainly need added solutions.

I would agree with one of my colleagues here who commented on the lagging of support services for mental illness. We need overall increased support for hospitals to allow for longer length of treatment. Nevertheless, we fully recognize that hospital treatment is just a flash in somebody's lifecycle, and we try to keep people out of hospital. Hence, we need increased community support and residential treatment away from the Downtown Eastside. We also recognize the need for an increased number of detox beds in the region so that patients can be triaged in hospital but moved out. We also need increased prevention programs within all areas of the community. I would support the earlier suggestion of a federal program to target support systems for addictions. Also, I would support the linkages to the self-help groups and I would flag not only MDA but also the B.C. Schizophrenia Society, SAFER, which is a suicide prevention network, and the crisis line that we have heard about.

We also need to increase low-cost housing for patients with persistent mental illness. We need strategies to be able to discharge them from hospital into a safer environment and increased support for policing by way of funding and adequate sentencing.

I will end my comments by stressing, once again, the incredible challenges of the interplay between addictions and mental illness.

The Chairman: Thank you all for your presentations.

Can you tell me in a couple of sentences what is Providence Health Care?

Dr. Sivertz: Providence Health Care is a group of several hospitals that have been amalgamated into one entity. They include St. Paul's Hospital, which is a major general downtown hospital, Mount Saint Joseph, which is another general hospital but with a focus on geriatric treatment, St. Vincent's Hospitals, which are extended care facilities, Holy Family Hospital, which is a rehab hospital, and Youville Residence, which is an extended care geriatric treatment. Providence Health Care covers the spectrum of hospitals.

The Chairman: That explains why I have not heard of it. I have heard of the individual hospitals, but I was unaware that you had gone through the same amalgamation as everyone else.

A couple of things you said quite surprised me. You said that, historically, if an individual had both a psychiatric illness and a drug dependency problem he or she could not receive concurrent treatment. Why?

Dr. Sivertz: I think that psychiatry regarded addictions as not part of their purview. Addictions were not part of the training or the treatment. Patients were generally told to go and get clean and sober, and then come back and we will assess your mental state. There was some degree of recognition 20 years ago that substances affect one's mental state and that it is hard to make a clear-cut psychiatric diagnosis in the face of serious substance abuse, but there was this tendency to see the treatment as being carved off separately.

Also, from the addiction side, there was a philosophy of all drugs are bad drugs. If you happened to be on medication for schizophrenia or major depression or major bipolar affective disorder, those medications were not acceptable in treatment centres. Psychiatry had a great deal of work to do.

The Chairman: What do you mean when you say they were not accepted in treatment centres?

Dr. Sivertz: They were not accepted because they were seen as mind-altering drugs. They were not seen as substantive medications necessary to control those illnesses. Remember that the biological model of psychiatry has been in ascendancy for about 30 years — it actually goes back 50 years — but the addictions approach was that all medications are bad. We had a lot of work to do to broker an understanding that major mental illnesses need to be treated with specific and ongoing medications. We have made huge steps and so both systems have moved closer together. I think there is willingness on both sides to work together.

The Chairman: Can you just enlarge a bit on what you mean by adequate sentencing?

Dr. Sivertz: Sentencing really targets the major traffickers. Again, that is a problem that we are seeing flagged first by our city. Perhaps my colleague to my far left is attuned to that.

The Chairman: People who traffic are getting far too light sentences; is that what you are saying?

Dr. Sivertz: The major traffickers — whereas, with respect to the people who are the end users on the street, policing and heavy fines and heavy jail sentences do not help those people.

The Chairman: Ian, a question on your long-term training program. Seventy-five hours is a lot of training. Is your program unique in the sense have you developed it here, or is it one that suicide and crisis centres across the country use? I have never heard of one that is that intensive.

Mr. Ross: Ours is particularly rigorous. It is 36 years in the making. We are accredited by the American Association of Suicidology, and as such there are very specific requirements to acquire and maintain that accreditation. One of the pieces in our strategy is to have a Canadian accreditation process. At the moment, we get people from Washington, D.C., in our centre, or wherever they are in Canada, and they have accreditation. So it ties in to the number of hours you need to train volunteers to be able to be accredited.

The Chairman: That is impressive. If I were in Halifax, would I get the same training program?

Mr. Ross: If you are accredited to the American Association of Suicidology in Halifax, yes, it would be very similar. We are basically trying to come together with best practice on what works and what does not work. We have various professionals. Dr. Jennifer White has done quite a bit of work on best practice in suicide prevention; we have used a lot of those best practices in our training.

In terms of our national strategy, we want to put some resources into talking about what works and what does not work. Quebec has a whole different situation with their suicide prevention distress line network. Quebec received quite a bit of money to help them with their suicide prevention strategy, and they created some very good training manuals for their volunteers and staff and basic best practice standards. We do not really hear about that because we are all very busily focussing on our agencies and our province and the Canadian Distress Line Network is trying to pull that together for crisis centres so we are learning and talking to each other about what works and what does not work.

The Chairman: Sabrina, thank you for your review of the Auton case. Many of us were as surprised as you were by the Supreme Court decision.

I wonder if you can clarify one thing for me. In one of our earlier reports, we included a discussion of autism. I was quite surprised at the fact that my office got several phone calls or emails from families with an autistic child essentially saying that they did not think that a discussion of autism should be in a report that dealt with mental health, mental illness and addiction. In other words, it should not be viewed as a mental illness. Frankly, I was very surprised at that. You are obviously much more in touch with that network than I am. What is the issue around that?

Ms. Freeman: The World Health Organization, the DSM-4, the ICD-10 and all the accepted diagnostic schedules show autism as a neurological disorder. It is a mental illness. People do not like the term "mental illness" in connection with have a neurological disorder — but mental illness as opposed to physical.

However, when you think about it, it is a very strange differentiation we are making. In terms of CP, the brain is involved but it has physical manifestations. There are those who just do not want to talk about mental illness; they do not want to be with "those" people. It is that ridiculous.

The Chairman: That explains why. I was not upset, I was just stunned. I would not have expected to get that response. Thank you for that.

Rennie, what is the "Moving Beyond" program?

Mr. Hoffman: "Moving Beyond" is the name of the particular youth group that we sponsor or support.

The Chairman: It is not a specific program, per se?

Mr. Hoffman: Not yet.

The Chairman: When you look at the problems in the Downtown Eastside, any of you who have been associated with it — and I think it was pointed out by the people from Providence that you have both an addiction problem and a mental illness problem — is there any evidence to suggest what came first? In other words, is the addiction problem the result of someone having a mental illness and then self-medicating, or does someone develop an addiction problem out of which a mental health problem grows? Can you make any cause and effect either way?

Mr. Hoffman: I do not think you can make a cause and effect at this time. That is why I have asked for federal intervention to try and make that link definitively. When I first started down there, heroin was the drug to be feared and there were several heroin addicts. Since deinstitutionalization, and I do not offer this as a corollary, but since deinstitutionalization the drug world in the Downtown Eastside has exploded. I do not know what the link is.

The Chairman: Do either of you two want to comment on that question?

Dr. Burgmann: I think you cannot tease it out. I think that some people do self-medicate because of depression or any number of illnesses. Unfortunately, people generally start experimenting with drugs at a time where a lot of the major mental illnesses start to make themselves known. There can be this unmasking phenomenon.

For example, with respect to the individual who starts dabbling in cocaine and then develops schizophrenia, it is not that the cocaine caused the schizophrenia but rather that the disease appeared perhaps a year or two earlier than it would have without the use of cocaine.

I do not think you can actually say that A caused B or that B caused A. It is just a mix.

The Chairman: Is the 50 per cent number that one of you used about right, in the sense that roughly 50 per cent of people who are addicts also suffer from a mental illness, or do we have any sense as to what the co-morbidity percentage is?

Dr. Sivertz: This is debated nationally. In the Downtown Eastside, the percentage is extremely high. The co-morbidity levels that flow into the emergency room at St. Paul's probably run at least 65 per cent to 70 per cent. My colleague quoted that as many as 80 per cent of the people in the Downtown Eastside may have co-morbidity. It is hard to actually tease out those numbers. We are making a real effort to flag that with all of our admissions or assessments at St. Paul's.

Across the country, co-morbidity levels are not necessarily that high — even in major centres like Toronto or Montreal. However, our levels are very high.

The Chairman: What makes the Downtown Eastside so unique?

Dr. Sivertz: I think it is the addition of crystal methamphetamine, which seems to be a potent enough psychosis-inducing agent that even people with relatively stable brains who might go in and out of intoxication with cocaine may tip off the edge into psychosis and end up in hospital because it takes weeks for their brain to begin to clear. So it is a very potent driver of psychosis.

Senator Cordy: Ms. Freeman, we all watched the Auton ruling with close attention. I used to be an elementary schoolteacher and certainly have watched it very, very closely. You gave an excellent and very clear presentation as to what should and should not be done. You spoke about autistic children being 100 per cent excluded from the health care system.

What we are finding as a committee is that people with mental illnesses are in fact being excluded from the health care system because the services they need are not covered by medicare. I will not go into that.

I spoke in Nova Scotia to parents of autistic children, and they have discovered that there is a lack of counselling for them as families. One particular father spoke to me — he has two autistic children — and said his first child was diagnosed with autism just shortly after his second child was born. He had a great deal of difficulty dealing with it. He became depressed, so then his wife was dealing with one new baby, one autistic child and a depressed husband. He had no support for that. Is that common or is there support for families?

Ms. Freeman: I do not think that is the major problem. I think what happens is that people become get depressed — and I am not talking about clinically depressed. People get very unhappy when they have a child with autism, or two children with autism, because they know there is something that can work but they cannot get access to it. It is like being at a pet store with your nose against the glass but not being able to get the puppy in the window.

The problem is that in most situations they know that the choice, if they have a choice, is losing their home unless they declare bankruptcy. Many Canadians do not even have that choice because they do not own their own home. If you are lucky you have a mortgage you can borrow against.

In the first place, it is a shock to learn you have a child with autism — and you have to get over it and you have to go through it, although denial is a very healthy thing when you are trying to get treatment for your child because what happens is it allows you to be motivated to get the pieces in place in order to get the child what the child needs. However, there is an enormous financial burden, particularly on fathers, because they feel they have somehow failed if they cannot come up with $60,000 a year. Obviously, the average Canadian cannot come up with $60,000 annually, especially considering our taxation rates. This is wrong. It is absolutely wrong. It has to be changed.

What is creating the rationing — and this is true not just for autism but for all mental health — rationing the unelected health technologists who get paid huge money from the government. I do not know if you know, but the Canadian Coordinating Office for Health Technology Assessment, which is good at rationing health care for drugs — for example, for a drug for schizophrenia to be approved in Canada it has to be deemed as not experimental. There is a tendency, for anything more expensive, to be called experimental. Well, CCOHTA get $42 million a year from every ministry of health across the country, including the feds, to do unbiased research. They are not doing that. Their job is to ration health care. In British Columbia, they get $10 million a year directly from the Ministry of Health to ration health care. So you are not getting true unbiased research. That is one of the ways the government can ration mental health care. They use these health technologists, some of whom are tenured professors at the universities across this country.

Senator Cordy: How do we keep the issue of autism in the forefront? During the court case, most people were very aware of what was happening. You are certainly a champion for the cause — and there are many champions. Jo-Lynn Fenton from Nova Scotia was on Parliament Hill and presented to unfortunately a small number of parliamentarians.

However, the farther removed we are from the court case, how do we go about letting Canadian people know that short-term funding — because dollars and cents unfortunately is the name of the game — of programs for children suffering from autism have such long-term benefits?

Ms. Freeman: Actually, an Ipsos-Reid poll showed that 89 per cent of Canadian voters thought this therapy should be in medicare. This is an issue of politicians and unelected bureaucrats intrinsically discriminating against mental illness. We were the first ones to test the fact that we are totally excluded.

I see a future more and more of rationing on the backs of the mentally disabled and the mentally ill.

This country needs legislation. We need a federal mental health parity act, similar to the U.S. Mental Health Parity Act, 1996. That legislation makes it illegal for any insurance company to discriminate against the mentally ill and disabled for treatment. That is number one — we need our own Canadian-made act. However, unfortunately, the provincial governments will probably not go for that — given they fund health care. It will take the federal government doing the right thing, despite the screaming and yelling of the provincial governments, to pass a mental health parity act that has teeth, in terms of withholding transfer payments in cases of discrimination. That is number one.

Second, we need the Canadians with disabilities act. This needs to be a federal act once again that makes it illegal for governments across this country, not just individuals, but governments, whether it is municipal governments or provincial governments, to discriminate based on disability of all kinds, mental and physical.

The third thing we need is legislation respecting education, so that disabled children are not at the mercy of school districts across this country and unelected bureaucracies that have has too much power. We are too trusting. We have this concept that we have inherited from the British that government is good and people are good and we are all good people. That does not work when you are dealing with a vulnerable minority. That vulnerable minority needs legislation with teeth to protect it from the tyranny of the bureaucracy.

I am a sociologist. What I see in Canada today was predicted by Max Faber, who did most of his work in the 1800s, the tyranny of bureaucracy. We have to stop it and we need legislation to protect people, citizens.

Senator Cordy: The numbers suffering from autism are growing rapidly.

Ms. Freeman: It is the perfect storm. It is 1:166 now, the epidemic. Eventually, the health policy technocrats are going to realize that they are spending an awful lot of money on institutionalizing people — the ones that we cannot throw out and have living on the Downtown Eastside — receiving acute care, which is costing the government a lot of money too. Every time a patient goes into a psychiatric unit, it costs a lot of money.

Eventually, they will have to look at best practice. Eventually, they will do the right thing, after we have flushed generations of children with autism, because it will be too expensive. All these health policy technocrats care about is rationing health care. They also care about not spending too much government money.

Eventually, it is going to work, but why do it in 20, 30 years, why not do it now as the morally right thing to do?

Senator Cordy: Mr. Hoffman, I was interested in your comments that we not refer to it as a stigma but rather as a discrimination or prejudice. You gave some very good examples in your presentation of the issues of discrimination or prejudice. You also talked interestingly enough about your family situation and the number of people you have spoken to who have a family member or whom themselves are personally suffered from mentally illness. On this committee, we found the same thing, when we were deciding on our next topic of study. As we went around the table, we discovered that we all had a family member or a friend who is suffering from a mental illness.

Despite that, one would think that the numbers of people who are familiar with those suffering from mental illness would indeed reduce prejudice or discrimination but it does not seem to be happening. What do we do?

Mr. Hoffman: I think Ms. Freeman started the ball rolling. I am currently looking for a textbook case to put before the courts under the charge of discrimination or prejudice. Those people who have family members or friends with mental illness are also the same people who work in a society that they know to be prejudicial towards mental illness. I think that our leaders, in this particular case our medical health leaders, need to step up to the plate as well. Discrimination will cease in the public arena when it ceases in the medical arena. If people who go to hospitals for mental illness are treated appropriately and treated with the same dignity as people with physical illness, it will send a huge message to the rest of society.

Senator Cordy: Mr. Ross, I am interested in your suicide prevention programs. Your training program seems to be using best practices, and indeed that makes people very aware of the situation. Do you have suicide prevention programs in the high schools or in the junior high schools?

Mr. Ross: From grade 8 to grade 12. However, we are only able to address the ones that we have enough volunteers to go in for. So we are doing 500 interactive workshops a year. We could be doing 800 interactive workshops a year. With respect to younger kids, there are a lot of elementary schoolteachers who want us in there for the 5, 6, 7 grades. There just are not enough volunteers to cover it all.

Once our front-line volunteers have 100 hours on the distress line they are eligible to go into classrooms and talk about stress management, coping skills, suicide prevention. We are trying to bring the word "suicide" out into the public. The stigma around mental health certainly includes suicide. People talk about contagion with suicide, so you cannot really talk about it, but 4,000 deaths a year is too many, and many are preventable. How do you talk to the media about being responsible about not showing means and those kinds of things?

We are trying to talk to younger children about coping skills, about managing stress, and about the taboo word of suicide. As you know, many high school students will actually consider suicide, and about one in ten will attempt. So it is a really high number.

Senator Cordy: Do you keep in touch with other provinces in terms of what they are doing?

Mr. Ross: We do. With Canadian Distress Line Network, that is one of the main reasons we want to connect, because there are good programs in various provinces and we are not really pooling our resources. There is no clearinghouse unless we do it. The national suicide prevention strategy will be done with awareness and understanding, prevention and intervention, and then moving on to knowledge development.

Senator Callbeck: In terms of the crisis centre, you mentioned volunteer training. I believe you said you had a small professional staff?

Mr. Ross: Yes.

Senator Callbeck: How many would be on that staff?

Mr. Ross: In the Vancouver crisis centre, we have 10 full-time staff and seven part-time staff. The stress line probably has six or seven staff — those would be people with at least a master's degree in counselling. They are there for the volunteers 24 hours a day. It is similar to the community health model, where community health nurses provide well-baby care and the doctor is only brought in when needed. That is the kind of model we are trying to use with our 260 volunteers on the front line. When there is an intervention required, the paid staff comes in and resolve that intervention.

Senator Callbeck: You said, I believe, that 26 per cent of your funding comes from government.

Mr. Ross: Right.

Senator Callbeck: How do you get the rest of the money?

Mr. Ross: We are United Way members. I do not know if it is sophisticated, but we have a well-thought-out model for raising money. We are trying to get three- to five-year funding, so it is long-term funding. There are foundations, and there are thousands of individuals who write us a $30 cheque a month. The 5,000 alumni who are volunteers who have gone on to other things in their lives really appreciate what they learned, learned to be good listeners, and they give back. We have basically a variety of funding sources, which is absolutely critical.

Senator Callbeck: You mentioned individuals and foundations. What about corporations?

Mr. Ross: Telus and B.C. Hydro give us regular dollars. To build the 1-800 suicide prevention network, the employees of B.C. Hydro gave us $125,000 and then some ongoing money to keep the network going. We are receptive to funding wherever we can get it. Obviously, we would not take it from everybody. We would not take alcohol and tobacco dollars for our high school programs and that kind of thing. So we have to be careful there.

Multi-year funding is very helpful; we do not want to exceed 30 per cent of our budget from government, whether it is local, provincial or federal. We want to maintain that independence. It is a philosophy that we are trying to encourage across the country.

Senator Callbeck: You mentioned going into schools — grades 8 to 12. You said something about talking to younger children. Would you like to get involved earlier?

Mr. Ross: I have three children, and they could have used something when they were in elementary school. What we are really talking about is enabling someone to cope and understand and to learn. There is a peer counselling group to connect grade 7s and grade 11s. In British Columbia, elementary school goes to grade 7; high school is grades 8 to 12. Hence, when that grade 7 student goes into grade 8, he or she has a buddy in grade 11 for the year. Those peer connections connect to our coping strategies and stress management workshops. We work together.

We also are doing workshops for parents — and that has been successful — talking about issues like suicide or distress management with their children. We found that focusing on the student was only a halfway measure. Hence, we have added teachers and parents into the picture, and it is actually improving things.

Senator Callbeck: Do students only get your program in grade 8, or do they get it every year?

Mr. Ross: The schools that appreciate our free service have us come in regularly. We are trying to have contact with kids at least three times in high school.

Senator Callbeck: Dr. Burgmann, you talked about an imbalance between harm reduction and treatment. What do you mean by that?

Dr. Burgmann: Over the last three to four years, the city has embraced harm reduction policies — harm reduction is the new buzzword with regard to addictions. Harm reduction involves needle exchange programs, to prevent transmission of HIV, methadone programs, to get people off heroin and on methadone, so that there is some stability in their lives.

The problem is that the people who are getting clean needles and who are on methadone are not getting any ongoing treatment to get them off the methadone, to help them to become clean and sober and functioning people, working and out of the Downtown Eastside. That is the neglected pillar of the four-pillar approach Vancouver has adopted.

Senator Callbeck: Mr. Hoffman, you talked about being in the police department for 29 years. In your opinion, should police training involve learning about how to deal with the mentally ill?

Mr. Hoffman: Senator, I addressed that in my brief. The answer is, yes, they need more training, but only in the context that the public in general and front-line doctors and health care staff need more training in mental illness. I make the point in the brief that it has been observed that policemen are the first line of psychiatrists when they enter the door — which is a correct statement. However, they would prefer not to be. If there were another agency that was as available at 2:00 o'clock in the morning on the Granville Street bridge, it would be the first one to call.

I know that targeting police in their dealings with mental illness is de rigueur right at the moment. I am on three committees looking at that very subject. It has been my experience, and I have had considerable, that the system fails after the policeman has had the contact and not during the contact with the police.

Senator Callbeck: You say the system fails after the contact?

Mr. Hoffman: Yes, senator. There have been many times, and this is not slight against anyone in particular, where I have observed, under my limited powers of the Mental Health Act, that an individual was a danger to themselves or to someone else. Under the guidelines, I had the power of arrest, and made the arrest, and had the person transported to a hospital for psychiatric assessment. In many cases, the patient was out of the hospital before my report hit the hospital desk. There is a resistance to taking the word of an untrained police officer or an ill-regarded police officer in an assessment of mental illness.

Not only that, given those limited guidelines of only referring or arresting someone who is a danger to themselves and others, it leaves a huge gap in our ability to deal with the rest of the mentally ill population. There are instances where someone who is threatening suicide has been ejected from psychiatric assessment because when they get to the doctor he or she does not see those same signs.

Policemen do need more training, but they need more training in everything. The rest of our society needs more training in mental illness as well.

Senator Callbeck: Ms. Freeman, certainly you have made a very strong case and certainly I agree that we have to do more for children with autism.

Senator Trenholme Counsell: I will leave autism out, because I think it is a profound neurological disorder, one that we have to think a lot about and do a much better job with. I am a physician who has helped to treat and find treatment for children with autism.

I get very upset when I hear anyone say that mental illness is being left out of the health care system in Canada. It is not. There is a great deal of care and help within the system. It is publicly paid for through the health and social transfer. Whether we are talking about psychiatrists or inpatient care or about mental health clinics, it is being paid for by our taxes.

We have to do better in caring for those who are sick, whether the illness is an addiction or a genetic illness, a biochemical disorder of the brain. Should there be a long-term emphasis — given limited funds — on doing much more in early childhood development, on parenting, on early detection, intervention and diagnosis, at the very first sign of a chemical disorder or a dysfunctional family and a child in trouble?

Dr. Sivertz: That is a good question. Those of us who work in mental health support activity vis-à-vis prevention or at that end of the spectrum and helping families where there are early signs. I would also point out that even the best of preventive programs and picking up cases early on do not necessarily prevent the evolution of serious illness. I would equate it to any other major medical illness. For example, if rheumatoid arthritis presents early, it often runs a very severe course. If depressive illness presents earlier than age 10, it often runs a difficult and challenging course. Support and identification are important, but it may not prevent the rolling out of that illness through a lifetime.

On the addiction side, perhaps early intervention and early education — we would like to think that perhaps more prevention is possible on that side than with the genetic mental illnesses. Therefore, I support prevention and early identification, but it may not solve all the problems.

Mr. Hoffman: We have some programs in British Columbia to identify mood disorders. There is an annual depression screening day. Last year, of the 5,000 people who attended, 1,500 people were screened as having depression. The problem is not identifying the illness; the problem is to do about it.

Your comments about tax dollars being invested in the system are correct; however, those tax dollars do not seem to get to the people who really need them.

I do not think there is enough emphasis put on treatment after diagnosis. Oftentimes, the only person our constituents see are their family doctors. There are fewer per capita psychiatrists in this province than there were in 1975. Hence, while there are many programs to find the illnesses early, there is very little to do about it after they are found.

Senator Trenholme Counsell: Teachers are often aware that there is a problem, but they may hesitate to open up the discussion, or they may not have time even to think about it, which is often the case. Teachers are far too stressed. Nevertheless, the signs usually appear very early, and if the parents will not face it, the teachers are the ones who see it right in their face, five days a week. I do not know how, however, how we can help teachers communicate this to someone who is going to do something. I talk to so many teachers, many of whom sense a problem. Of course, they may not be able to diagnose the problem — but I am a great believer in prevention to the extent that we can. Early diagnosis is so important.

In terms of what you are seeing on the street — crystal methamphetamine and its consequences — if we can develop strong kids who have the willpower and the strength of ego, the hope and so on, there will be fewer and fewer of them trying drugs like that. That is long term, however.

Senator Cook: Our committee hopes to make a series of recommendations based on what we have heard as well as recommend a national mental health strategy. I am optimistic that together we will do something that is of worth to the most vulnerable of our people, people suffering from mental illness and depression.

Mr. Hoffman, I wish to ask you a question about the Moving Beyond program. You indicated that the changes that allowed you to do this nearly caused the death of this organization. Was that purely financial, or was it a challenge of resources? What prompted that statement?

Mr. Hoffman: It was for the most part financial. For many years, the Mood Disorders Association of British Columbia was funded by the provincial health ministry. Three years ago approximately, there was a structure change and MDA was instructed to approach the five health regions for the very same money that they received from one source. The five health regions of British Columbia are not unified in their approach to health questions. I am told that they do not even have a common computer system so that they can share information.

That presented great challenges for a consumer-run organization. The benefit to the old system was that Ed Rogers and Vicky Rogers, themselves consumers, the board of directors of MDA, all consumers, were not faced with the questions of making defensible decisions regarding the spending of that money or keeping adequate records, if you will, of their services. They concentrated solely on running self-help groups, what we used to call "peer groups" up until the time that the health regions told us that that name was designed for something else and that we could not get any money for peer groups.

Our product has always been self-help groups, peer group interaction, and it works very well. The health regions do not see a financial defence of self-help groups and as such MDA is forced to find other programs that it can administer at this stage, in order to prop up the one thing that they do very well that works for them.

Senator Cook: So where are you now with your Moving Beyond youth program? Is it operational?

Mr. Hoffman: It has been operational for about a year now. We are advertising with a view to expanding that program. When MDABC was funded by the one provincial group, their mandate was consumer support and family support for adults.

Senator Cook: In your conversation with Senator Trenholme Counsell, you highlighted the lack of trained professionals — that is, psychiatrists. In this piece, do you see a role for a nurse practitioner? In my province of Newfoundland, we have nurse practitioners working in primary care with mental health. Do you see a role for nurse practitioners in this area, to alleviate some of the professional shortages we are seeing?

Mr. Hoffman: I see a role for any trained professional who can assist in dealing with people with mental illness. Absolutely. If nurse practitioners approach the status of the family doctor in terms of diagnosis and being able to prescribe treatment, absolutely.

Senator Cook: So partnerships will help us get to where we want to go?

Mr. Hoffman: Very much so.

Senator Cook: Ms. Freeman, I come from the second smallest province in this country, Newfoundland. I want to share a story with you. The Autism Society of Newfoundland and Labrador is about to have a groundbreaking for an autism facility, all because of the efforts of one woman with an adult autistic son. It is being built on the perimeter of our university. The site is an old Irish farm that has been there for a couple of hundred years. I asked my friend a couple of weeks ago where were we with this and she said that the government money has come through from ACOA, which is a federal agency speaking to the needs of Atlantic Canada. The centre will be called Shamrock Farm Centre for Autism. I do not know all the details, but I know that it will cost $1 million. It was driven by a mother of an autistic child, in a way a consumer.

It is a good news story, the fact that we have recognized it and we have done it in a small corner of this country. I do not know if you are aware of it or not.

Ms. Freeman: Ironically, the provinces with the least money seem to somehow take the best care of their most vulnerable. Prince Edward Island, which obviously does not have a large population, was the first to provide treatment for their autistic children — not the amount that is needed, but half the amount that is needed without a court case. Then we have Newfoundland, which was next in line, which provided treatment; again, not what was needed, but we are talking baby steps here, second without a court case. It seems to be the larger provinces that dig their heels in. In my opinion, the attitude is one of who do you think you are, get back in line, you are just the consumer, you are the parent of the consumer, you are just noisy. In fact, not only do these large provinces seem to have this attitude, but they have legions of bureaucrats, so even when there is a politician who wants to do the right thing, who has better access, the consumer or the bureaucrat working for the politician — almost every initiative that has been done in big provinces gets undone by the bureaucracy. I will give you a perfect example.

During the Auton case when we had two spectacular wins at the lower court, spectacular wins, they had to do something because there was no stay of their decision. So through a lot of back room politics, trying to circumvent the bureaucracy, they managed to get a joint funding mechanism that would pay for a third of the treatment — $20,000, of the $50,000 to $60,000, the parents do not have to come up with. Well, before the pen was dry with the November 19 defeat, the bureaucracy was already trying to undo that to get rid of the funding to go back to a contractor model so that they would take the power away from the consumer.

The bottom line is that the contracted model is what gets us into trouble. The system is public health care, but the physicians are private. They have billing numbers. Without that mechanism, there are no standards. What happens is that without competition the treatment turns into babysitting. We have seen this happen before, and I am seeing it happen again.

As we sit here, again in British Columbia, it is happening because once again the big provinces have that infrastructure and the bureaucracy does not want to give away power. That is what this is about. In the small provinces, you do not have an entrenched bureaucracy — it is a very small number of people. The people can actually get to the politicians much more easily. It is much easier to get to your premier in Newfoundland or in P.E.I. than it is in British Columbia or Ontario. That is where the problem is.

The Chairman: I have to tell you how accurate you are. You are dead right on that. We should tell you that Senator Callbeck is both a former health minister and a former premier of P.E.I. As you can see, she is readily accessible.

Ms. Freeman: Well, I tell the truth.

Senator Cook: Well, mine is a good news story; I wish everyone could see the centre. It is a farm set in front of rolling hills on the back of the new health science complex. We just have one tertiary care hospital also. The Shamrock Farm Centre for Autism will be a working farm. There will be horses; there is a pond. It is a dream come true and our provinces has bought into it.

Ms. Freeman: Except that we cannot differentiate housing and residential care for treatment. They are two different things. In fact, what you need in your province, for children from 18 months or 2 years, is home based, science based, best practices early intervention, so that the vast majority of children are never going to get to the Shamrock Farm Centre. The idea is to create children who are going to become taxpayers rather than wards of the state. The data are very clear that a large number of those children will go on to be independent. Those who are not independent will not cost the state as much because they are much more capable.

We have kind of a macabre joke in British Columbia, where we know some of these children who are getting ready to be cut off — we call them the $300,000 men. We know that in a year or two they are going to cost the taxpayer $300,000 a year, because the government is too stubborn to give maybe $60,000 or $70,000 for treatment for these people. So $60,000, $70,000 versus $300,000: To most bureaucrats, $300,000 makes more sense because it was their idea.

Senator Cook: I understand your frustration with medicare. Mr. Chairman, that is a challenge for all of us to pick up. The formulae within medicare are not standard across this country.

Ms. Freeman: We do not have it — autism treatment is not included in medicare.

Senator Cook: So then we find a way to get in.

Ms. Freeman: We have to get persons with autism included. We talk about amending the Canada Health Act, but the politicians all say to us that it is political suicide to do that. Our response is that there needs to be a mental health parity act.

The bottom line is that we need to create legislation to change this. We cannot rely on the goodness of men and women. If you exchange the word "autism" for "black" or "Aboriginal," you will understand what I mean. We cannot rely on that.

Senator Cook: You advocate federal legislation, and you clearly outlined it to my colleague Senator Cordy. This comes from a no-wherever position. If it is not possible to get the federal legislation to be a reality, is there a place in the strategy that would address the needs in whole or in part, if we were to take baby steps, or would you hold out for federal legislation or nothing?

Ms. Freeman: Unfortunately, we have been fighting within the provincial framework — because the medicare system is administered provincially.

Senator Cook: That is our problem.

Ms. Freeman: Yes. We have been fighting for 10 years province by province. We are getting nowhere. In the same way as the Prime Minister took a stand on same sex marriage — he said you cannot pick and choose when it comes to the Charter — we have to be fair and equal in this country. If you can take a moral stand on same sex marriage, you have got to be able to take a moral stand on the rights of disabled people and mentally ill people. You have to. Why should gays and lesbians have rights that are more legitimate than the most vulnerable in our society? Mr. Martin cannot pick and choose with the Charter.

Senator Trenholme Counsell: Under the Canada Health and Social Transfer, the federal government transfers funds to the provinces — and it is never enough money; I understand that. However, if your child goes first to a family doctor and then to a paediatrician, maybe a neurologist, that is all covered. In terms of the early intervention services that any child with a problem gets — I know they are not enough that is funded under the Canada Health and Social Transfer. That is important. That money is under it is not the Canada Health Act; it comes under the Canada Health and Social Transfer payment to each province from the federal government. So there is coverage.

Ms. Freeman: I am not here saying we need more money. That is not the issue here. The money needs to be used efficiently and it needs to be earmarked. For children with autism, in terms of early intervention, you cannot have generic early intervention; it is inefficient and it does not work.

Senator Trenholme Counsell: No, but I am just saying certainly our colleague, as Senator Callbeck would understand this, there is a lot of money going into all of these things, not enough to cover behavioural services.

Ms. Freeman: I would disagree. I actually think there is enough money in the system today to cover this completely. It is being mismanaged to the left and to the right. I will give you an example.

Senator Trenholme Counsell: What is happening in Europe?

Ms. Freeman: In Europe, it depends on the country. France is in the Dark Ages, because they come from a different psychoanalytic philosophy. If you have a child with autism in England, you are in much better shape than you are in Canada. There is absolutely no doubt about it. Other countries are going that way slowly. Norway and Sweden are better. I do not know what the situation is in Germany. Obviously, we are talking about a completely different situation in the Third World.

Here is the issue. In the United States, for example, from age three a child is all of a sudden the responsibility of the school district. The school districts did not know what to do about this, because all of a sudden a child needs an analysis, so parents sued down there. Seventy-five per cent of court cases down there won. All of a sudden, from age three, every child would receive $60,000, $70,000, sometimes $80,000 for treatment from the school system. Now, it is not that it is an educational issue, but because they did not have a health care system, that is how the parents did it.

Parents of 18 months olds, in wondering what to do about their children, sued health care providers. In New York, actually, they won a class action suit. New York State Department of Health established clinical practice guidelines — best practices — and children receive it.

They also have Medicaid waivers in United States. What they do is they redefine a child as being poor and dependent, because the child does not bring in an income, and then they get a Medicaid waiver which pays for treatment.

We have a health care system. We do not need to do these gymnastics. We just need to make sure that the health care system — that money is apportioned to the right place, because there is an awful lot of inefficiency in the system right now. I mean, the school districts have a huge amount of money.

Senator Cook: Mr. Ross, you say you were involved in a pilot for Canada to develop a national suicide prevention strategy and to create a Canadian Distress Line Network and an accreditation process for the volunteers who work with you. Is there a place for this within a national mental health strategy?

Mr. Ross: Yes. We felt that we as leaders in crisis intervention and suicide prevention have to really stand up and draw out the continuum that can be connected to a national mental health/mental illness strategy. Ours is to focus on a continuum with all the services that are involved, and many of those services are mental health services. Our strategy is something that we focus on because we have a national mandate for suicide prevention. We see our continuum as very malleable or flexible, to fit into other structures.

Until the mental health strategy becomes a reality, we thought we really cannot wait with our focus. In November, at the national conference in Edmonton, we approved our document. We met last week in Ottawa and were working on the implementation piece and the money involved in what it would take to pull a strategy like this off. So that is where we are with this strategy.

Senator Cook: So we work toward a seamless delivery of services?

Mr. Ross: That is it.

Senator Cook: In terms of addictions and mental health being an integral part of the other, how do you see seamless delivery taking place? How do you see that happening? Is there a need for capacity building here? What are the gaps? Where do we need to move so that we can be as one with those two issues?

Mr. Hoffman: That is a really tough question. I struggled with that when I was doing my report. I have struggled with it since the day I walked in the door. There is definitely a disconnect between the approaches to both issues. I do not know if an answer even exists at the moment, because the people who are the experts in addiction have limited understanding of the issues surrounding mental illness, and vice versa. We have been talking about it for quite some time, I agree. However, there has been very little done in the way of action or cross-training or whatever has to happen so that one body can approach both problems and deal with them. I think there needs to be a curriculum strategy set up for that, yes. As well, there needs to be much more assessment of the correlation between the two.

I have a report on my desk from the Internet, the headline of which reads: "Marijuana Causes Mental Illness." It is the result of a study done in the United States commissioned by some people who obviously had their own agenda. The study does say that there is a correlation between marijuana use and mental illness. It says that marijuana causes mental illness. The report never did differentiate whether the chicken came first or the egg came first.

Senator Cook: I will just end by saying that it took us 10 years to establish a collaborative nursing program in our province and the people who are part of that program now think it was always there. We move forward.

[Translation]

Senator Pépin: In the documents you have tabled with us, you promote suicide prevention nationally. Several countries have this type of strategy. Canada is joining them in moving in this direction.

On page 14 of the document, you dwell upon the importance of a suicide prevention program as well as on local, regional and provincial differences. You also make mention of several strategies depending upon the group targeted, be it the Inuit, the Metis, the mentally-ill or gay and lesbians. You emphasize those groups that would be more at risk.

The question that comes to my mind is the following: Would it be preferable for us to have a pan-Canadian national strategy, in other words that the federal government develop a standard plan, or national standards and that afterwards the provinces set up their own programs.

Which would be the best method in order for us to have a similar strategy throughout the country? Do you believe that that would be the way to go about this or is there some other more effective method?

[English]

Mr. Ross: I think we have come up with a strategy that includes people from the North, from Iqualuit, from Quebec, from New Brunswick. The Canadian Distress Line Network team, which is a council that has actually developed this whole project, has a blueprint strategy that has been developed considering different populations that may have higher suicide rates or lower suicide rates.

We are trying to build a structure that will include everybody. Every province and every region will have access to one common way of operating, which is a huge challenge because I know there are various provinces that are ahead of other provinces in, say, school-based programs compared to distress line services. We are at the process right now of trying to define distress and define crisis and the whole idea of the model — whether a professional picks up the phone or a volunteer picks up the phone. That is an issue that we have wrestled with and we have come down to believe that there is a real value in utilizing volunteers who are supported by professionals. We have looked at that and we have wrestled with that.

In British Columbia, there is a nurses helpline. The various provinces have those helplines. Professionals answer the phone 24 hours a day. I think it is a $10-million service that British Colombians have. That is a good service. However, we think there is room for a volunteer-answered line that is supported by professionals. It is different than, say, the Kids Help Phone, which is a good service that is being answered all across the country out of Toronto. They have a $10-million budget, and they provide that service for kids who want to get professional service.

In developing the blueprint, we have looked at that whole strategy and tried to figure out where our distress line network fits in. It will vary from province to province on how it is rolled out. We want to have common standards, common best practices that we in fact agree to.

In that community development model, where you start from the top down to develop a network, in the second layer you look at how do you operate within a very diverse group like we have in Canada. In the third and final phase, the power and the authority stay in the regions. In this phase, however, there is a common national strategy and commons national standards that then will be tied into a Canadian accreditation process, which we hope will become beyond Canadian. Our goal for the accreditation process is that it will become international, as opposed to American or Canadian. The fourth chapter of my presentation was to talk about the Canadian Distress Line Network and connecting to an international accreditation system. We have to think of where we fit within an international system.

I do not know if that answers your question.

Senator Gill: I wish to ask you some questions about Aboriginals. There are Aboriginals on the streets here in Vancouver — and probably quite a few in jail, too, if here is anything like Saskatchewan and Manitoba.

Mr. Ross: Aboriginals are over-represented in the jails, yes.

Senator Gill: Does your organization offer services to Aboriginal people?

Mr. Hoffman: Senator, we have and have had for some time an Aboriginal self-help group in existence. It is administered by one of our board members, who is also an Aboriginal.

Mr. Ross: From our perspective, we have obviously a focus of Aboriginals on the Canadian Association for Suicide Prevention board. Because of the high suicide rates of Aboriginal populations, First Nations populations, and other populations like gay/lesbian, we really have to focus on those services because we want to provide access to our services that are common. With the First Nations in B.C., we helped the Squamish Nation on the North Shore, which is right across North Vancouver from here, build their own crisis line using our material. The crisis centre in Vancouver is the backup to their line when they do not have volunteers and staff to man that line.

My background is not First Nations. A lot of First Nations people, Punjabis, Asians, et cetera, also live in British Columbia, so there are lines that we connect to and we are the backup for a lot of those lines.

We have First Nations people on our board of directors. Our board obviously decides on general policy and direction of the organization. It is critical that we do not kind of miss out any group.

We can learn a lot from First Nations and the way they operate. At our national conference two years ago in Iqualuit, Nunavut, we learned a lot about how they deal with suicide. Some of their best practices we can actually use. It is very important.

Senator Gill: You are of the impression that it has been divided province by province, north and south, and this kind of thing.

Mr. Ross: In British Columbia, I worked for the Vancouver Crisis Centre. We are one of five partners in the B.C. Distress Line Network. In Canada, we divide Canada into those six regions and each of those six regions is now at the table and we are trying to work on it. The big cities we have enough business, but if you think of the other parts of the province, other than Vancouver, other cities, it is very important that we have a pan-Canadian strategy for how we talk to each other, how we communicate, how we build best practice.

The Chairman: I want to thank all of you for attending here. We took more of your time, but that always seems to happen.

I would invite our next panel to come to the table: Mr. Howard Sapers, who is the Correctional Investigator of Canada, which effectively is the prisoners' ombudsman, and Ms. Natalie Neault, the director of investigations with the Office of the Correctional Investigator of Canada.

They have given us their annual report, as well as a handout. I just looked at some of your statistics, and they blew my mind.

Howard, please proceed.

Mr. Howard Sapers, Correctional Investigator of Canada, Office of the Correctional Investigator Canada: Mr. Chairman, I was appointed Correctional Investigator for Canada last April. With me is one of our two directors of investigation, Nathalie Neault. I will be running through the presentation and Nathalie is here to answer all the difficult questions. I would not leave home without her.

I want to thank you first of all for this undertaking and for inviting us. Mental health and corrections has been a particular interest of mine and a focus of my office for many years. This is an opportunity we would not miss, and so we thank you for the invitation.

I will very quickly just go over the function of the Office of the Correctional Investigator, established under section 167(1) of the Corrections and Conditional Release Act, CCRA. The office is an ombudsman, Mr. Chairman, as you said, for federal offenders. My office investigates and attempts to resolve offender complaints that affect offenders individually or as a group. We do have the mandate to not only respond to complaints but also to investigate under our own motion. The decision on whether to proceed with an investigation lies exclusively with my office as does the manner of that investigation. We have a responsibility to make recommendations to the correctional service on their policies and procedures, their acts or their omissions.

There is a staff in the office of about two dozen. That staff last year dealt with about 8,000 complaints. They visit correctional institutions on average about once every three months — and I am talking about every correctional centre in the country. In the past fiscal year, the staff spent about 425 days inside those institutions meeting with staff and with inmates. They held about 2,500 individual meetings with inmates in those correctional centres. Hence, the workload is tremendous. There is a tremendous body of experience in the office.

Our mandate primarily is to be an objective and neutral investigator to determine whether the decision or the action of the correctional service is in compliance with CCRA and whether the policies and procedures as they are applied are fair and reasonable and according to law.

CCRA follows many of Canada's international agreements to provide essential health care. The act specifies that an offender will have the benefit of reasonable access to mental health services that will contribute to his or her successful reintegration into the community. In fact, section 86 of the CCRA act states that the service shall provide every inmate with "reasonable access to non-essential mental health care that will contribute to the inmate's rehabilitation and successful integration into the community."

There is not a lot of consistent accurate historical data on mental health and corrections. We do have some statistics to share, and we do have some experience, but I can tell you that one of the deficits is finding consistently collected information that is analyzed in a neutral way.

We do know a few things. Incarcerated offenders have a substantially higher prevalence of mental disorders when compared with the general public. Not only is the prevalence higher for incarcerated offenders but the rate of mental disorder is increasing. A comparison between admissions to federal institutions in 1967 and then again in March 2004 indicates that there has been a 60 per cent increase in the number of offenders with mental disorders. It breaks down as follows: 57 per cent for male and 65 per cent for female. The prevalence increases to nearly 84 per cent if we include substance abuse in those figures.

Let me put that in some context. We are dealing with about 12,500 federally incarcerated offenders. About 400 of those would be women. In general across Canada, there is probably an incarcerated population of about 30,000. That would include provincial jails, remand centres and, of course, the federal institutions. I do not know what the community corrections caseload is for the provincial systems. There are about 7,500 and 8,000 federal offenders under supervision in the community at any one time. Hence, when I talk about percentages, that is the population base I am referring to.

Since 1997, there has been an almost 80 per cent increase in admissions for offenders who were on prescribed medication at the time that they were taken into the correctional centre.

The Chairman: By "prescribed medication," do you mean medication for mental illness, or do you mean medication for other conditions, such as high cholesterol, or whatever?

Mr. Sapers: It is an increase of all medications. One of the difficulties we have is getting that kind of a breakdown from the service.

Overall, 14 per cent of inmates, just prior to their incarceration, had recent psychiatric or psychological treatment — 14 per cent. Mentally ill offenders are typically afflicted with more than one disorder, often psychiatric and substance abuse, and they present a need for a broad range of services. I am sorry that I do not have an accurate estimate of the co-morbidity.

As part of the intake assessment, an offender admitted into a federal institution will be assessed on the following factors: mental ability and functioning, diagnosis of a mental disorder, prescribed medication, and psychiatric hospitalization. These factors are assessed by asking questions directly to the offender through a file review. There is a lot of potential for error and gaps.

The current mental health assessments deal with the following: Is there an immediate risk to the offender or to others? Is there a need for psychotropic medication? Does the offender require inpatient psychiatric treatment? These current mental health assessments are referral-driven and these three criteria will determine whether the offender can benefit from mental health services at a treatment centre.

Correctional Service of Canada — CSC — does have treatment centres in all five of its regions. These centres provide risk assessments when the offender is identified according to those criteria as being an immediate risk. They admit the offender on a short-term basis only, to change or adjust their medication and also provide inpatient treatment for an offender who is diagnosed with a psychiatric disorder.

CSC currently has bed space in their treatment centres to respond to the needs of less than 6 per cent of the inmate population. The service's own estimates are that the need is for about 12 per cent. So, current capacity is less than 50 per cent of identified need. Keep in mind that that need is identified again largely through self-reporting. So our experience is that it is vastly underestimated.

CSC also has recognized that two of their treatment centres, the Regional Treatment Centre in Kingston and the Shepody Treatment Centre in Dorchester, New Brunswick, are hindered in their ability to provide adequate treatment for inmates because of their physical configuration. They need to be replaced by appropriate facilities and be accredited.

During our visits to institutions, we see an increasing number of offenders in federal institutions who have fallen below the radar screen and who have been transferred to their parent institution without their mental health needs being fully assessed. We see these offenders predominantly in segregation units of maximum security institutions. For those of you not familiar with federal corrections, that population, those in segregation in maximum security institutions, would have the most restricted access to programs, to visit, to exercise. They are under lock-up 23 hours. It is a highly restricted environment.

Those offenders tend to be intellectually challenged or they present behavioural problems, learning disabilities and/ or symptoms of attention deficit hyperactivity disorder, ADHD, or fetal alcohol spectrum disorder, FASD. These categories are of course not mutually exclusive. Data obtained from youth facilities across Canada estimate that about 22 per cent of adult offenders would likely be diagnosed with FASD — 22 per cent.

These offenders are unable to complete regular programs, they are preyed upon by other offenders, they end up in segregation, they have limited coping skills and they are usually classified as maximum security. They do not have the ability or skills required to focus and concentrate in order to complete regular programming. They are very vulnerable and their segregation is usually for a much longer period of time than others in segregation. They are usually referred to see the psychiatrist, who typically finds no evidence of a psychiatric disorder, per se, and identifies these individuals as exhibiting a behavioural problem. These offenders therefore do not meet the criteria that would allow them to benefit from services provided in treatment centres, so they stay in the general institutions. They have limited coping skills, which may cause them to withdraw, self-injure, set fires, attempt or commit suicide, and in some extreme situations assault others or guards.

When mental health needs are not addressed, offenders tend to spend more time in segregation. They are usually overclassified. This clearly has financial implications as well as program implications and release implications. The reality is that maximum security institutions do not have the necessary resources to meet these extreme mental health needs.

Given the prevalence of mental disorder among offenders and the high number of waivers — and when I say "waivers," these are offenders who would otherwise be eligible for a conditional release hearing, a parole hearing, a day parole or full parole eligibility — what happens is that many of these offenders with mental disorders will waive their right to a hearing, which means they will not be considered for parole or release, which means they will be kept to their statutory release date, which means they are typically released into the community with less supervision than they otherwise would have received, less assistance.

It is not necessarily true that the longer an offender stays in custody the more access he or she would have to programs. In fact, the whole purpose of parole is to facilitate the timely reintegration of offenders at the most appropriate and earliest opportunity.

In any case, given the prevalence of mental disorders, the number of waivers signed by offenders, my office questions whether some offenders are in fact giving a voluntary and informed consent to relinquish their legal right to a review by the parole board. There were over 2,700 waivers last year. We are seeing more and more offenders being kept to their statutory release date, and this is particularly true for Aboriginal offenders.

For the past fiscal year, there were a number of security incidents involving inmates. We do not have good information on how many of these incidents were specific to offenders with mental disorders. We also do not have very good historical data. However, last year there were 280 self-inflicted injuries, nine attempted suicides and 10 suicides in federal corrections. The despair experienced by certain offenders is to some extent reflected in the number of self-inflicted injuries and suicides. Correctional Service of Canada recognizes that women in federal institutions have a higher rate of self-mutilation and attempted suicide than do their male counterparts. The CSC research branch found that more than two-thirds of women in maximum security had previously attempted suicide, compared with 21 per cent of maximum security males. So it is about three times.

The prevalence of infectious disease we believe is also related to mental health issues and addiction. The HIV infection rate inside institutes is estimated to be up to 10 times higher than in the general population. CSC themselves acknowledge that the hepatitis-C infection rate is 30 times higher. In some institutions, they claim that it is 30 per cent; however, medical health professionals inside the institutions have told me that the hep-C infection rate in an institution can be as high as 60 or 70 per cent.

We should not be so quick to dismiss the significance and importance of assessing substance abuse disorders as part of a comprehensive assessment of mental health needs for offenders. Our legal responsibility towards harm reduction and minimizing risk to public health also extends within the walls of correctional institutions. We cannot lose sight of the fact that the majority of offenders will reintegrate into the community at some point. Effective control of infectious diseases in correctional facilities is essential to protect the health of inmates, staff, and the community at large.

There was a pilot project a year and a half ago in the Pacific region. The pilot project was initiated to conduct mental health assessments on every inmate and identify at the front end of their sentence their management and treatment needs. Over the course of the 17 months of the project, there were 259 offenders admitted into their regional reception centre. Sixty-eight offenders, or 29 per cent of those assessed, had immediate mental health needs requiring immediate intervention, including the need for further assessment. Substance abuse disorders were not considered. So again, we think that if you included substance abuse the numbers would be significantly higher. The pilot project reinforced the need for front-end assessment of mental health needs for offenders.

To summarize, inmate mental health disorders are several times that of the Canadian population. There has been no standardized systemic assessment of mental health needs for offenders. There needs to be a comprehensive strategy for the detection and management of mental health needs for federally sentenced Canadians.

A recently released report entitled A Health Care Needs Assessment for Federal Inmates in Canada, which was published in the Canadian Journal of Public Health last April, reinforces that the prevalence of mental health disorders in Canada is two to three times that of the general population. The report also supports the need for systemic assessments of mental health needs of offenders and the need for a comprehensive strategy to detect and manage the mental health needs of offenders.

The good news is that CSC has developed a mental health strategy that promotes the adoption of a continuum of care from initial intake to the safe release of offenders into the community. This strategy calls for the significant investment of funds and resources into four main areas: intake assessment; requirements for treatment centres; mental health units or interim care units in certain institutions; and community mental health support for the safe reintegration of offenders.

My office was pleased to hear that CSC has received funding for the community component of this strategy. We are also informed, however, that no funding has been allocated for the other three essential components of the mental health strategy.

Hence, what you have is a commitment of funds for the back end of the system. When offenders are being released, there is assistance to help on the community side. Unfortunately, that assistance may not be very well informed because no new resources are allocated into the assessment and treatment side. So offenders are being released with support but we may not be sure entirely what the support is that will be required.

My office very much supports the community mental health initiatives to assist in the safe reintegration of mentally challenged offenders. We cannot stress enough the importance of funding the front end of the process. Without a comprehensive clinical intake assessment of federal offenders, CSC has no reliable information as to the mental health needs of the offenders in their care. This, in itself, raises questions as to how the service can develop community mental health programming to support these offenders without knowing what their specific needs are.

While we support the creation of intermediate mental health units in existing institutions, we also want to raise a caution against these units evolving into quasi segregation under the guise of mental health treatment. There is a need to clearly define the role and mandate of these units and to allocate the professional resources and programs to meet offenders' mental health needs as well as to implement the legislative safeguards to ensure administrative fairness and the least restrictive measures consistent with public safety.

In terms of population management, Correctional Service of Canada is increasingly subdividing the offender population into small subpopulations. Unfortunately, there are not always administrative and legislative safeguards as to the review of their placement into these more segregated often higher security kinds of environments. We are concerned that this may happen with these intermediate care centres under the guise of mental health.

I would like to end my formal presentation by quoting the Canadian Human Rights Commission in their recent review of the systemic human rights abuses regarding federally sentenced women. While this quote is specific to their review dealing with federally sentenced women, it can be extrapolated to deal with the entire offender population. What the Canadian Human Rights Commission said is this: "No matter how good a strategy may be on paper in responding to the needs of federally sentenced women, it is unlikely that the correctional service will be able to protect human rights without enough resources, applied appropriately, in carrying out the strategy."

Access to health care, and mental health care in particular, is a fundamental human right. It is protected in law and it is not being accomplished in the current environment.

The Chairman: Thank you — I guess it is thank you for that unbelievably depressing picture. When something is as bad as your comments today would suggest, one is inclined to first say that maybe we should just start over, so let me ask you a question.

What are the pros and cons of the CSC saying that they are simply not going to provide this service anymore, that they will contract it out to the provinces, who after all provide most of the other health care services, certainly health care services for inmates that are not done in a penitentiary? Why would the feds not simply contract it out, since they are clearly not capable of doing it?

Mr. Sapers: I will take a quick shot; however, I did say that Nathalie would answer the difficult questions.

It is hard to pick a starting point in responding to that. There is a division of responsibilities between an offender sentenced to less than two years and an offender sentenced to more then two years. Of course, the province has the primary responsibility for the provision of health services. The issue is that the system is faced with all kinds of arbitrary divisions and dichotomies. Offenders are not seen as individuals, as people with a variety of needs. So as opposed to providing a continuum of care that would be directed towards the individual needs of people, we see service being provided and treatment being provided and custody being provided based on a whole set of historical and arbitrary distinctions and divisions.

The flip side of that is that there are partnerships, and some of these partnerships are effective. There are treatments provided by provincial health care systems that are effective and that do operate under contract to the service. CSC does contract out for a variety of health care services, including psychiatric, dental, a number of things. So that does happen.

The difficulty is that the service is not in the position often to make the decision about what they should be even contracting out for because they do not do the assessments at the front end. When psychology staff are involved, they are typically involved in risk assessment, in terms of the offender's behaviour inside the institution or his or her potential behaviour once released.

The Chairman: So they are doing more of a behavioural assessment?

Mr. Sapers: Instead of doing treatment intervention. That is right.

Ms. Natalie Neault, Director of Investigations, Office of the Correctional Investigator Canada: At this point, we would welcome any intervention on the part of the service to provide mental health services to that dichotomy of offenders who are not being captured at the front end, and particularly those with learning disabilities, because they are not being assessed at the front end, have difficulty following orders from the officers and thus end up being charged, in segregation, and receiving a disciplinary sanction. They receive no treatment in segregation, and then we find them being released to the community.

The Chairman: And then surprise, surprise, they recommit; right?

Ms. Neault: Exactly.

The Chairman: It is hard to imagine a better description of a revolving door than the one you just gave.

[Translation]

Senator Pépin: I must admit that I am not surprised. From the little I know about the Correctional Service, when I listen to you describe all of the problems and the number of inmates with psychological problems, it is true that the general population is ignorant of this reality. People do not know that the majority of inmates have mental problems, but there are other people, within the Correctional Service, who are aware.

I do understand that you do not have the necessary means nor staff. Is there a will within the Service to do something, to go after the funding needed to bring about changes? I know that the staff is swamped because they must take care of security. But we know that the root of the problem is that these are patients who have psychological or mental problems.

Ms. Neault: I believe that, definitely, there is a will on the part of the Correctional Service to offer services to this segment of the population, but as you have just said, the priority in these institutions is security.

The money will not go to inmate rehabilitation; that has virtually disappeared. If we look at the number of temporary absences, the number of hours of work assigned to inmates in medium security facilities, there is hardly nothing.

The priority is to ensure that inmates are not a threat to public safety, which is expected and normal. But to the detriment of what? We seem to forget that these people belong to our community and will return to it.

This is perhaps not the most positive segment of the community, but we must not forget that it is just a matter of time before these people return to the community.

The ombudsman's office receives requests from employees who deal with inmates in isolation in maximum security facilities. They keep telling us month after month that these inmates should be sent to the treatment centre, and the treatment centre tells them that they do not have a structure in place to accommodate maximum security inmates.

Senator Pépin: The root of the security problem is the fact that these inmates are ill. I believe that if we were able to deal with the security risk problem, then it might be a little bit easier. There must be some way of doing things differently.

Ms. Neault: Absolutely, but within the risk evaluation aspect, there is a need to evaluate the needs of the inmate in order for him to be able to follow the programs.

We know, for example, that those inmates afflicted with ADHT are not able to process information the way other people do.

We need to adapt the programs in order for them to be able to participate. From there, they could leave isolation, be declassified to medium security, and eventually they would feel safer and more receptive to the idea of integrating the community and eventually being members of the community who, hopefully, could contribute to it.

Senator Pépin: I met with people from the Correctional Service and they told us that these inmates are placed in isolation because they take fits. They can be placed in isolation for several days because there is no other way of controlling them. Even parliamentarians are not aware of what goes on.

Changes were made to the prison for women when there was a story, a scandal that was made public, and everyone reorganized and the situation improved. I hope that we are not simply waiting for another similar disaster to happen.

I am very happy that you have come here, because in our report we could most certainly open the door to facilitating certain changes.

[English]

Mr. Sapers: To directly address your question regarding the will to do something, the executive committee of Correctional Service of Canada had endorsed that four-point strategy that I referred to. They have only received new funding for the last part. So the will is clearly there because they have adopted the whole strategy.

They need to do three things: First, they need to go back and get the funding and the new resources to implement the other three components — which is in part a political discussion; second, CSC needs to address its governing structure around mental health, their management of mental health within the system, and they need to develop a governing structure that gives it the same priority, frankly, that security receives in terms of the management of CSC; and third, they need to seriously commit to training their staff at every level in terms of sensitizing the service to the mental health needs of offenders so that distinctions can be made as to whether you are dealing with a mental health crisis or a security crisis when you see an inmate who is acting out.

[Translation]

Senator Gill: To begin with, I would like to know what your profession is. What is your level of responsibility? Do you carry out surveys with offenders, with inmates or surveys relating to the behaviour of the staff vis-à-vis the prisoners? What are the results of your surveys? I imagine that what comes out of these surveys is that certain things should be corrected?

Ms. Neault: As the ombudsman we study the complaints we receive from inmates. However, if we decide of our own initiative to carry out an inquiry, there must be violation of the law or of the policy of the Correctional Service in the daily dealings of the Correctional Service with inmates.

There are three criteria that guide us in deciding whether or not to launch an inquiry. First of all, was there a breach of the Correctional Service of Canada Act and release from custody? Second, was there a violation of Correction Service policy? Thirdly, it sometimes happens that there is a complaint that does not involve the law or the policy, but in the end, there is a question as to whether the decision taken was fair and if we should on that basis launch an inquiry.

When the law has been broken, we have as ombudsman the authority to make recommendations to the director of the facility.

Before leaving each facility, we meet with the managers and staff in order to attempt to resolve as many problems as possible at that level. During our meeting with management, we make our recommendations, and when an aspect of the law is involved, we automatically recommend that management make to change in its practices. As a follow-up to the meeting, we put in writing our understanding of the conversation and our recommendations. We repeat our recommendations and await the answer of the director of the facility to see if he plans on correcting the situation or what the shared position is.

Senator Gill: Are you able to verify, concretely, if the correction was made or if the necessary follow-up was made with the inmate?

Ms. Neault: Absolutely, senator. We visit the various facilities every three months. If we made a recommendation, you can be sure that during our next visit to the facility, we will check and see what was done. If no measure was taken, we approach the director and then there is a gradual process that is followed with regard to the complaint.

For example, if the investigator is not able to resolve the problem with the facility director, then the problem is referred to the director of investigations. I then meet with the regional deputy commissioners every six months and this is my opportunity to bring up the matter of our recommendations. The executive director then meets the deputy commissioners, in other words the joint commissioner and Mr. Sapers who regularly meet with the Correctional Service commissioner.

Senator Gill: Does the investigation service that you manage exist in all of the provinces? I imagine that you are only recognized in British Columbia, is that the case?

Ms. Neault: No, we are a Canadian ombudsman and we cover all of the facilities in the country, in other words 54 federal prisons.

Senator Gill: From here?

Ms. Neault: From Ottawa. Our office is in Ottawa and we travel to all of the penitentiaries in all of the regions of the country.

Senator Gill: Is it easy for inmates to communicate with you? I imagine that there are punishments that are handed out inside prisons... are you accessible? Are all inmates informed, upon arriving, of their rights, of the various possibilities?

Ms. Neault: There are two questions here. We are very accessible. Our 1-800 number is available and inmates can access our service. If our line is busy, we have an answering machine and we check our messages daily. We return the call and often we set up an interview with the inmate during our next visit to the facility.

We visit the facilities every three months, as I indicated. We have what we call open visits. Our upcoming visit is posted in the facility. Every inmate wishing to meet with us for one reason or another has the opportunity to see us and we then decide if we wish to undertake an investigation or not.

Senator Gill: Do you have statistics on the aboriginal inmates we have in our prisons? I know that there are a lot of them, in fact in Manitoba, in Saskatchewan — I am not too sure of the situation in British Columbia — but do you have a large clientele? I imagine the answer is yes.

[English]

Mr. Sapers: The best estimate we have right now is that while the Aboriginal population of Canada is about 3 per cent, it is about 18 to 20 per cent of correctional centres on average. In some centres, particularly in the Prairie region, it is much higher than that. In some centres, it is as high as 70 per cent. We received over 8,000 complaints last year. We did a very rough calculation and I think about 20 per cent of complaints were from self-identified Aboriginal offenders. So that proportion seems to be about right — the relationship between the offender population and the complaining population. However, the fact that we received 8,000 complaints from an incarcerated population of about 12,500 indicates that there is a general awareness of our office and they do utilize us.

One of the unfortunate realities, though, is that my investigators often solve the same problem again and again and again. We solve the same problem a thousand times a year when it comes to classification issues or program access issues or issues of just basic administrative fairness. When these persistent problems challenge us, we have the ability not only to deal with them at the administrative level, but also I issue an annual report, which is tabled in both chambers. That report will include recommendations. Those recommendations are often dealing with those very persistent problems. In fact, last year for the first time there were four recommendations directed to the minister directly, not CSC, because CSC has either been unwilling or unable to address the issues over several years.

I can tell you that I have just signed off on the draft of that report. Once the minister receives it, she is compelled to table it within 30 sitting days. That report will be forthcoming.

Again, you will see that there are some persistent issues that were not resolved at the institutional level or at the regional level.

The office also has the ability to issue a special report, which to date we have not done.

[Translation]

Senator Gill: You know, we are often told, and I believe, based upon our experience, and you could confirm this, there in fact are not that many crimes that are committed in First Nations communities or by First Nations people. However, there are a lot of people — and the proportions are not equivalent — in prison who are not criminals, who are simply there because they made mistakes that are condemned by society, but not in a criminal way. They are not criminals.

In your experience and based upon your work, what are the causes of their incarceration?

Ms. Neault: Those offenders who are incarcerated committed a Criminal Code offence and were given a sentence by the legal system. It is difficult for me to know if they truly did commit the act in question.

The Correctional Service regularly informs and reminds us that those people are there because they committed a crime. If you take, for example, the case of aboriginal inmates or even that of women, there is a whole problem with regard to the classification scale that is used. It is a scale that is divided up or validated on the basis of male inmates. It does not apply to women per se. This fact has come up repeatedly through the research work that has been done. The scale does not take into consideration the cultural differences of aboriginal inmates.

According to the scale as it exists today, aboriginal and women inmates tend to be classified at a higher proportion than that which is standard and incarcerated in maximum security prisons where their movements and their access to the program is much more limited. We repeatedly see that aboriginal and female inmates do not have the same access to programs and are refused temporary absences. They tend to be placed in maximum security prisons whereas the majority of good programs for Aboriginals are offered in minimum security establishments.

They are deprived of these programs because they are not available to them there. For them, the possibility of returning to the community is reduced compared to the situation of non-Aboriginals.

Senator Gill: Mr. Chairman, in my region, for example — it happens less often now, but it still does occur — there are people who are incarcerated because they did not respect a section or some regulation dealing with hunting or fishing, whereas what they did is allowed under aboriginal law. And under the law in general, it is prohibited to fish at certain times of the year, in order to protect migratory birds, for example, and people wind up in prison for that kind of infraction. That is what I wanted to say. Are you able to pinpoint those cases?

Ms. Neault: I must tell you that no. I am really unable to make any comment in that regard. As the ombudsmen, we try to be as objective as possible in our investigations, and unless an inmate complains specifically about his sentence or file, we have no active way of determining why he was put in prison.

What interests us is knowing if he is being treated fairly, if he has access to what the law allows him as well as the Correctional Service policies. It is not the case with regard to mental health.

[English]

Mr. Sapers: Senator Gill, I do acknowledge, though, the point that you are making. First, I will say that many of the types of offences you were speaking of would attract jail time as opposed to prison time, so my staff would not see those individuals in jails. Not every provincial correctional system has a similar feature, an ombudsman, for those offenders to go to. Often, the offenders are there for very short periods of time.

That being said, I happen to have a belief that crime is relatively evenly spread across Canadian society, which means that there is not just one kind of Canadian that commits crimes — many kinds of Canadians commit crimes. However, if you were to look at our prison population, you would think that crime was the exclusive domain of the under-educated, the impoverished, the mentally ill, and often those from Aboriginal and other minority groups. Hence, the correctional population does not really reflect the general population nor of the population that is responsible for committing crimes. There are mechanisms in place that tend to select those who end up behind bars.

Senator Cordy: I wish to speak about the four-point strategy. Community mental health support for the safe reintegration of offenders is the only one that has received funding — and I will talk about that one in a moment.

However, with respect to the clinical intake assessment, how can you work on the back end without first dealing with the front end and finding out who in fact requires care in the mental health field?

Am I correct that, in order to do the assessment, it requires asking questions, which is basically self-reporting? Is there an inclination on the part of the offender to downplay any mental illness he or she may have? Alternatively, the offender may be unaware of an existing mental illness. Do you run into that at all?

Ms. Neault: Absolutely. There is still a proportion of the offender population that has no education. There are still prisoners who cannot read or write. As well, given prevalence of learning disabilities, their difficulty in processing information, offenders may not readily answer the questions as asked.

In a recent meeting with the National Parole Board, they told me that more and more they are really not sure whether offenders who attend before them understand the process. That is not unique in terms of the parole board; I think offenders have that difficulty at all levels of the process.

A proportion of offenders right now does not have the ability to process the information; they do not have the knowledge or the education to recognize their own mental illness and thus would under-report it. This identification at the intake process is very much subjective. The process depends on what the parole officer sees before her or him and assesses as needing one of the three criteria that Mr. Sapers identified.

Senator Cordy: In the way the questions are asked.

Is there a high prevalence of learning disabilities among the corrections population? I think I have read anecdotal evidence that indicates a high prevalence.

Ms. Neault: We see a growing proportion of offenders with low-functioning ability and who present learning disabilities. Unfortunately, we cannot provide specifics because CSC is not capturing that. That is not one of their intake assessment measures; therefore, there is no information out there except for the pilot project that looked at ADHD and FADS.

Senator Cordy: Are literacy levels looked at?

Ms. Neault: The service has a policy in place for offenders to complete grade 10. That is one of the objectives an offender must attain; it is usually part of the correctional plan for the offender. It is usually a mandatory process.

Mind you, the education process in the system is fairly standard, which is problematic for offenders with learning disabilities. That population may not be able to take part in the regular schooling program that is available. In fact, we find them being unable to take any regular programs.

Senator Cordy: So the schooling programs in the institution are basically a one size fits all?

Ms. Neault: It is — as are their accredited programs and their working opportunities. Everything is designed for the average-size-built learning abilities male.

Senator Cordy: If we had more information, statistics and research, that indicated a high level of learning disabilities among the inmate population, a high rate of illiteracy in the prison system, would that go some way toward adjusting programs? The school system has made great changes over the past number of years, to become more inclusive, to meet the needs of all students. That is not to say that the school system is necessarily meeting them, but it is certainly making every attempt to do that.

Ms. Neault: Yes, you are right, that definitely taking place in the community with respect to children with learning disabilities; however, we are not seeing that in the correctional system.

Senator Cordy: With respect to the high number of people who are waiving their rights to hearings for parole, when they are released there is no support whatsoever for them in the system, in the community. There is no oversight, I guess; is that correct?

Ms. Neault: A parole officer will determine the level of supervision an offender requires. Even for an offender who has served a full term, the parole officer is the only supervision.

On warrant expiry date, the service has made it clear that they have ended their liability, their legal responsibility to offenders.

Mr. Sapers: I just want to add that there is a real irony in this. Parole, as I said, is to assist the timely and safe reintegration of offenders into the community. Those offenders who are granted parole earliest are those who obviously present the least risk to reoffend. That means that those who are at the most risk to reoffend are kept longer in custody; they might even be kept to their warrant expiry date under a detention order, which means that they get less support in the community. Hence, you have this irony of those offenders with the greatest needs receiving the least support.

Senator Cordy: Very much so — and no oversight at all.

I wish to talk now about the community mental health support to offenders on release. How is this going to work, because this is in fact the one part of the four-point strategy that is being funded? Will it be on a volunteer basis, or will the individual have to report every week? How is it going to work?

Ms. Neault: It is very much at the early stage. CSC received its funding last week; it was confirmed two weeks ago. As to how that will translate into available services in the community — and there is no doubt that they want to make a link between the parole supervision and the various mental health services available in the community — has yet to be defined.

Senator Cordy: In order to determine how it is going to work, who will they be communicating with?

Mr. Sapers: We have asked CSC for a detailed implementation strategy and action plan, but we have not received it yet. We have been briefed by them on their general approach. We cannot speak for CSC on that. If we had the information, we would share it. We do not have the information.

Senator Cordy: Will you have a say? Will they seek your opinion?

Mr. Sapers: Let me answer that question two ways. They may not ask for our opinion, but they will get it. I hope we will have a say.

Senator Trenholme Counsell: What percentage of mental disorders is related to drugs? What percentage is a reflection of increased diagnosis generally? To me, it is not an indication of an increase in actual mental illness. Is there any breakdown in terms of drug-related psychoses?

Ms. Neault: In looking at the prevalence, the statistics would indicate that 84 per cent of offenders have a mental disorder, if we include substance abuse. If you remove substance abuse, the statistics would indicate that 43 per cent of offenders have a mental disorder. However, as has been indicated even in the presenters this morning, there is a significant proportion of offenders who suffer from both psychiatric and substance abuse.

Senator Trenholme Counsell: Would that 43 per cent include a reactive depression to the fact that they are being admitted to a correctional institution? Is it fair to ask whether they were depressed previously? I would think there is apt to be depression associated with incarceration.

Ms. Neault: I would say no, senator.

Senator Trenholme Counsell: You are saying that this is a diagnosis that was with them at the time of the crime or whatever?

Ms. Neault: This information is available from CSC. Their intake assessment identifies mental disorder based on the criteria that we have identified on page 6.

Senator Trenholme Counsell: Do we have another one?

Mr. Sapers: Page 6 indicates the factors they are assessed against.

To revisit those numbers, we believe that, upon admission, about 15 per cent, based on Correctional Service of Canada's own statistics, had recent psychiatric or psychological intervention. We also think there is a 60 per cent increase in those offenders who may have had a mental disorder at some time. The mental disorder may have been diagnosed at one time, but they may not be under active treatment at the time of their intake.

We also know that depression can be a factor leading to self-mutilation, attempted suicide and committed suicide. However, unfortunately, we do not have a lot of historical data on the self-mutilation and the suicides to be able to give a comparison that would allow us to tie it to those intake statistics.

Another huge factor related to the fact that the correctional population has changed somewhat over the last decade is the increasing deinstitutionalization by provincial governments. Many of those individuals come into conflict with the law and end up in jails and prisons.

I do not think that there is any one single factor; however, we do know that the increase in offenders with mental health needs is very real and very dramatic.

Senator Trenholme Counsell: What percentage of the prison population attempts suicide?

The Chairman: There were 19 last year.

Senator Trenholme Counsell: What percentage is that, though, of the population?

Ms. Neault: Two thirds of women, 71 per cent of women, attempted suicide in maximum security institution versus 21 per cent of men. That is strictly in maximum security settings, however.

Senator Trenholme Counsell: You do not have a figure for the whole population?

Ms. Neault: No, I do not have that.

Senator Trenholme Counsell: If you look back, let us say, a quarter of a century, 25 years, has there been a marked change for the better in terms of the philosophy of corrections in terms of the rehabilitation approach?

Mr. Sapers: Canada, I believe, has one of the finest correctional systems in the world. It is more evidence-based, more humane and more professional than almost anyplace else. That being said, it is a huge system with lots of dark corners and with still much to learn. Unfortunately, we do not apply what we have known and what we have learned. All kinds of things get in the way of applying that evidence to correctional programming.

So, yes, I think things have gotten better, but that is, of course, a relative statement. We still have a very high rate of incarceration. We still over-incarcerate Aboriginal Canadians. We still are abusing some very fundamental rights when it comes to security classifications and access to treatment. The service continues to act, I believe, in defiance of the law in terms of applying the least restrictive measures, with a whole host of policies, not the least of which is an arbitrary placement into maximum security for a certain class of offenders for two years.

So while things are better, we have a very long way to go. Unfortunately, we do not always react well to the research and we see that the service gets very defensive about making changes in policies when evidence is generated that is contrary to their operations.

Senator Trenholme Counsell: I was hoping to hear something more optimistic, but that is all right.

I wish to talk about the four-point strategy, specifically, national requirements for treatment centres. In New Brunswick, where I come from, we have the Shepody Healing Centre at the Dorchester Penitentiary. Is the healing centre a maximum-security institution?

Ms. Neault: It is medium security.

Senator Trenholme Counsell: Are those healing centres developing across the country?

Ms. Neault: There are five treatment centres, one in every CSC region. They are designed to provide mental health services to those who have been identified with a psychiatric disorder. We would like to think that they have been developed, given that there is only one per region to provide services to all levels of security. However, that is not necessarily the case. The one in the Prairies, the one in the Pacific, the one in Ontario, are providing services to maximum security inmates. When it comes to Shepody, that is not the case.

At Atlantic Institution, 12 offenders had been ongoing, long-term segregation cases, who, according to the psychological staff, presented definite symptoms of mental illness. Staff tried repeatedly to get those individuals admitted to the Shepody Healing Centre, but the Shepody Healing Centre said that they did not have the structure to be able to admit maximum-security offenders. Given that there is only one healing centre in that region, what do you do with these offenders? Moving them out to another region away from their community — which is often all the support they have, and that in itself is very often very limited — is not consistent with the whole purpose of being able to reintegrate these individuals. They remain in segregation units, seeing a psychologist once a month to make sure they are not suicidal.

Policy requires that an inmate in segregation be seen by a psychologist once a month. Psychologists would prefer to see these individuals on an individual basis, because oftentimes they cannot take group programming, particularly not when they are in segregation. However, there is a waiting list as long as my arm in terms of offenders who want psychological services, and there are very limited resources. There are two psychologists for a population of nearly 300 inmates.

Senator Trenholme Counsell: Is it correct to say that it is not the will but it is the budget?

Ms. Neault: It is the budget and the structure as well. In terms of Shepody, there are a number of concerns for Shepody. Correctional Service of Canada recognizes that the structure of this facility needs to be changed. They need a new facility. We have been told for years that a construction project has been approved, but it has yet to occur.

Senator Trenholme Counsell: No, that is partly because of the historical nature of the old building — which is a very hot subject right now.

Are the literacy programs — and I have been part of them — limited to minimum- or medium-security institutions?

Ms. Neault: Maximum-security offenders and those in segregation can take what is referred to as schooling through cell studies — the professor provides homework for the offender to do in his cell. However, again, these literacy programs are designed for the average offender who has the ability to learn.

The service has found and we found that individuals with ADHD and FAS do not have the ability to integrate the information; as such, they need programs that are designed to meet their needs. That is just not the case — which is not surprising, given that the service is not capturing those disabilities at the front end of the process. They do not really know how many offenders present with ADHD or FAS.

Senator Callbeck: More has to be done to sensitize the staff to people with mental illness. What training do staff get right now? For example, what training does a new guard get before going to, say, Springhill?

Ms. Neault: We have not done an overall review of the training available to officers. However, there is the basic correctional officer program, which is a couple of weeks at one of the training centres they have in each region; that program is primarily focussed on security. That program teaches things such as when to apply handcuffs, how to escort an offender, how to do a strip search, et cetera. We are not saying that this is not necessary training; it is.

However, to bring the mental health issue into it, if the offender who has learning disabilities cannot respond appropriately to being given an order, he will be charged — that is the reality — and he will be subject to a disciplinary sanction.

Senator Callbeck: In other words, the guards are getting next to nothing in terms of how to deal with mentally ill people?

Ms. Neault: If they are getting training, I am not aware of it in terms of a mental health perspective.

Senator Callbeck: You talked about 8,000 complaints. How many of those have been investigated, roughly?

Mr. Sapers: Every complaint that comes into the office is treated as a legitimate complaint. Many, as you can appreciate, end up falling away, for a number of reasons: They may be out of our jurisdiction, they may in fact be frivolous, or they may come from somebody who is a chronic complainer to the office — which speaks as well to mental health issues.

The number of actual investigations is probably half of the complaints that come in. As well, as I said, last year there were just shy of 2,500 meetings with inmates across the country, those meetings being part of the investigative process. The investigative staff will meet with the individual offender and then they will deal with the administration in that correctional centre.

The operating philosophy for the office is to try to resolve the issue at the lowest, quickest possible level. A complaint might be as simple as, "I was transferred to this institution, but I do not have any personal effects yet." The investigation will involve confirming the inmate's complaint, finding out why the personal effects have not been delivered, and then meeting with the institutional staff to try to resolve it. A complaint could be a much more complicated issue, as well, dealing with a rather significant abuse of a legal or a human right.

In addition, the office reviews all use-of-force incidents. There are about 1,000 what is referred to as purposeful use-of-force incidents, where, because of a security issue, staff has to do a cell extraction or something to that effect. Use-of-force incidents are videotaped, including application of handcuffs or use of gas to quell a disturbance. The videotape will be reviewed by my office to determine whether the use of force was compliant with the law and policy.

Ms. Neault: About 30 to 40 per cent of the complaints we receive are premature. What I mean by that is that the offender has made no attempt to try to resolve the issue at the institution. CSC has its own internal grievance process. We often advise the offender to follow that process.

However, in reality, we investigate a lot more than we should. As it stands now, CSC's internal grievance process is about six to eight months behind at the national level, in responding to grievances, and therefore we tend to be involved more than we should. Their own internal process is not meeting their legal mandate — which is that there be an objective and proper response in trying to resolve the issues, so they do not become larger issues. Therefore, we do investigate things that we typically would tend to refer back to service, because of their inefficient grievance process.

The sad thing about offenders who have mental disorders is that they do not tend to complain, they do not tend to call us. How do we know about them? Our policy is that every time we visit an institution we go the segregation unit and speak to all of the offenders, to review their cases — because that is the population that tends to be forgotten. It is entirely voluntary on the part of the offender, however.

There was one case that left an extreme impact on me. As I was walking through a maximum security institution, I saw a man being escorted to health care. He had blood all over the place because he had self-injured. When I spoke to him he told me that he wanted to see his family. As well, he said, "I have not seen the psychologist, because he does not have time to see me. I have been in segregation for four months. I keep on telling them I want to do better. I want to take programs, but there are no programs for me."

That is why we go to the segregation unit. That is how we find out about those cases.

Senator Callbeck: You said that it was mandatory to complete grade 10. In terms of the inmate who has difficulty reading and cannot do the course work, do they just stay in their cell?

Ms. Neault: There is not any program that I am aware of that is designed for those individuals. If they have to write anything, usually they will ask another inmate to write the letter for them or to complete an application for them.

When I say it is mandatory, the service requires it, but if the offender really does not want to take the available program — some of them say, "I am too old to go to school" — the institution will not impose it physically. However, the consequences are that the inmate's pay will be reduced to what they call the "unemployment pay," which means will earn $2.50 a day.

A growing proportion of the inmate population — the same as in the community — is increasingly an elderly population, so they present special needs. I know of an offender who wanted to buy an A535-type cream to rub on his back. He told me that it takes two days' pay just to purchase one tube of cream. He wanted to be able to earn more. Not all offenders are refusing to work, not all offenders are unmotivated. Some offenders want to contribute to their families in the community. The most an offender can earn per day is $6.90, but there are restrictions. Only a certain number of offenders per institutions are entitled to receive that level of pay; otherwise, the institution will not meet its budget.

There are many variables. However, it is the offenders who are mentally ill and who are unable to take programs that earn $2.50 a day.

Senator Callbeck: You mentioned that your last report included four recommendations. What were they and has there been any action taken?

Mr. Sapers: The four recommendations are this: First, that there be a full accounting for all of the recommendations made by Justice Arbour, coming out of the Prison for Women hearings in Kingston about 10 years ago. We do not believe the service has fully implemented the recommendations, although they say they have. There are some significant gaps. They have been documented by other observers, not just by our office, most recently, in fact, the Canadian Human Rights Commission.

CSC, subsequent to our recommendation being directed to the minister, committed to publishing a full accounting of how they have responded to those recommendations. Ten years, in our opinion, is far too long to respond to those recommendations, again given that we are talking about the violation of human rights when it comes to things like custody classification and discrimination against certain classes, particularly Aboriginal women.

We also recommended that the service immediately implement a prison-based needle exchange program to deal with the public health risks associated with the growing infection rate of hepatitis-C and HIV. There are several jurisdictions in Europe that have prison-based needle exchange programs. They work, in the sense that infection rates are down and the release of healthy inmates has increased. There have been no reported increases either in the incidence of drug abuse within prisons or in the use of syringes in assaults, which has been an issue that has been raised but primarily by the union.

We also recommended that the Correctional Service of Canada immediately appoint a deputy commissioner responsible for Aboriginals. The executive management table of the Correctional Service of Canada unbelievably does not include a senior executive responsible for Aboriginal offenders. This has been a long-standing recommendation of our office, and the service continues to reject the recommendation.

A number of years ago, in response to a tragic and serious incident, CSC made a policy change — which resulted in the following. Instead of evidenced-based placement in security levels, instead of looking at the carefully constructed scale that assesses risk, to determine the security level for an inmate — and please remember that this scale was developed in response to the law that says the least restrictive option must always be used — the service arbitrarily decided that anybody sentenced to an indeterminate sentence, to a life sentence, would automatically be placed in maximum security for two years. That means that the individual would have restricted access to programs, restricted movement, all of those things that go along with a maximum security classification. This is contrary to law and policy — and it is, we believe, a significant violation.

The service has continued to stick to its guns and the minister has asked the service to be more accountable for that decision. There is a change in the way that that policy is being implemented but the policy has not been rescinded. We continue to believe that the service is operating outside of the law on that regard.

The Chairman: Thank you both for attending here today, for however depressing it may be, for painting such a realistic picture.

The committee adjourned.