5.1      INVEST UPSTREAM TO ENSURE THAT PEOPLE WITH MENTAL DISORDERS AND ADDICTION PROBLEMS DO NOT END UP IN PRISON DUE TO A LACK OF COMMUNITY RESOURCES

[W]hen you’re dealing with mentally ill offenders..., the best way to prevent future criminality is to treat that mental illness, but we’re talking about a prison system and not a health system. The best way to ensure that these folks don’t come into conflict with the law, I suppose, is to make sure they’re getting adequate services and the treatments they need in the community before they enter corrections.^[46]

This excerpt from testimony by the Correctional Investigator accurately sums up the feelings shared by many witnesses we heard from in Canada, Norway and England. While our inquiry did not specifically address community mental health and addiction prevention initiatives, the Committee believes they are a key aspect of the issues it is concerned with. This first section therefore considers addressing the issues of mental health and addictions among inmates from a prevention perspective.

At the outset, the Committee wishes to state that it supports the decision by federal, provincial and territorial ministers responsible for the administration of justice who, at a meeting in Fredericton, New Brunswick on October 29 and 30, 2009, “acknowledged the need to address the increasing challenges related to mental health issues in the criminal justice system,” and agreed this topic would be a standing agenda item for their future meetings.[47] Cooperation among the various levels of government is central to an integrated mental health system that will prevent those suffering from mental disorders and addiction problems from ending up in prison inappropriately because of such problems.

5.1.1     The Need for Investment in a Mental Health and Addiction System and an Appropriate National Strategy in Collaboration with the Provinces and the Territories

It is estimated that every year, “about one in every five people living in Canada will experience diagnosable mental health problems or illnesses.” Research tends to show that these problems generally develop during childhood and adolescence (70% of cases).[48] These data are alarming, particularly as according to the Mental Health Commission of Canada (MHCC), “no jurisdiction in the country can lay claim to having a genuine mental health system in place. Rather, what generally exists is a fragmented patchwork of programs and services, many of which face a constant struggle to find adequate resources to meet ongoing demands.”[49]

According to the MHCC, “[a] mental health system must also be comprehensive. Being comprehensive means addressing the full range of factors that influence mental health and well-being for everyone living in Canada.”[50] It has to take into consideration the economic, social, environmental, cultural, family and individual factors that contribute to good mental health, including access to proper housing and stable income, and it must seek to reduce the factors that increase the likelihood of a person’s developing mental disorders, such as poverty, abuse of drugs and alcohol, violence and social isolation.

In order to prevent people with mental health or addiction problems from committing crimes as a result of these problems and being incarcerated in provincial or federal correctional institutions, we also have to ensure that community mental health services are both available and effective.

Like some of our witnesses, the Committee believes that to reduce the burden on CSC resulting from mental health and addiction issues, it is imperative that:

• Funding to the provinces and territories be increased for services and programs that tackle the structural and social determinants of mental health, primarily access to adequate housing and stable income;
• The capacity of the public health and social services network to meet the public’s mental health needs, in particular by facilitating access to treatment and support services, be strengthened; and
• Early detection of mental health and addiction issues be improved.

The Committee agrees with those witnesses who felt that it would be more cost-effective, in the long term, to invest in the risk and protection factors that affect the mental health of all Canadians, rather than continually increase funding for mental health services provided in correctional institutions. As noted by a witness in London, we must stop regarding imprisonment as a free resource, while associating costs with crime prevention.[51] On the contrary, research has shown that imprisonment is an expensive measure that is generally not suited to the care of people suffering from mental disorders. Imprisonment can facilitate the appearance of mental disorders, or contribute to their recurrence and the aggravation of symptoms, particularly as a result of the stress generated by the danger of intimidation and violence within institutions, separation from family and loved ones, and concerns related to eventual release.

In light of these considerations, the Committee recommends:

RECOMMENDATION 1

That the federal government, in cooperation with the provinces and territories, make a commitment to and a serious investment in the mental health system, in order to ease the identification of and access to treatment for people suffering from mental health and addictions before they end up in the correctional system.

In London, the Committee became aware of a recent report entitled Childhood Mental Health and Life Chances in Post-war Britain. Insights from three national birth cohort studies that illustrates the importance of investing in measures to support parents and families, and preschool programs for children with emotional and behavioural disorders.[52] This analysis of the three birth cohorts (1946, 1958, 1970) indicates that mental health disorders not treated in childhood or adolescence greatly affect life trajectories. The results demonstrate, among other things, that these individuals generally have a lower level of education than the population as a whole, have difficulty throughout life in finding and keeping a job, and are more likely to come into contact with the criminal justice system in adulthood.

Given the significant potential savings for the penal system and the reduction in the crime rate resulting from the early detection of mental health problems and the implementation of appropriate programs and treatment before adulthood, the Committee recommends:

RECOMMENDATION 2

That the federal government study the report entitled Childhood Mental Health and Life Chances in Post-war Britain. Insights from three national birth cohort studies and develop a national strategy, in collaboration with the Mental Health Commission of Canada and in keeping with provincial and territorial areas of jurisdiction, to deal appropriately with mental health problems experienced in childhood and adolescence, so as to reduce markedly the adult crime rate.

5.1.2     The Need for Greater Investment in Diversion Initiatives

Like many countries, Canada cannot ignore the connection between mental illness, addictions and the criminal justice system because of the growing number of individuals with such disorders who enter the criminal justice system and end up in correctional institutions. That said, it is important to emphasize that most people with mental health disorders do not come into contact with the criminal justice system. Moreover, an individual with such a disorder who commits a crime does not always match the stereotypical image of a criminal. In some cases, offences are the direct result of mental illness or a need to satisfy a drug dependency. Studies have clearly shown that mental health problems that go untreated increase the risk of contact with the criminal justice system, and that offenders with serious mental health issues are more likely to be charged and to reoffend more quickly thereafter.

The Committee agrees with a number of witnesses that diversion from the standard justice process is a favourable approach in these cases because it promotes early intervention, and makes it possible to reduce the frequency of these individuals coming into conflict with the law. As such, diversion is a key factor in reducing the criminalization and imprisonment of people with mental health and addiction issues.

Diversion programs can take various forms and can be used at various points within the criminal justice system. Police officers, prosecutors and courts have been using diversion techniques for many years now. As the first point of contact between an offender and the criminal justice system, police officers can play a key role in efforts to intervene in such cases. They are well placed to act quickly and refer an individual to a hospital, a psychiatric facility or a community resource.

The Committee also notes that Lord Bradley’s report stresses the need to implement and use diversion measures, and notes that strong partnerships are another key to success in creating pathways to treatment. It recommends, among other things, that police officers work closely with Crown prosecutors and court staff to share information with them, if applicable, on the offender’s mental health and addiction issues.

The Committee agrees with Lord Bradley and many witnesses that diversion is a key component of a system that respects the right of individuals to receive the healthcare services they need. In order to detect mental disorders and addiction issues and intervene as early as possible, the Committee believes it is essential to train police officers, Crown prosecutors and other participants in the criminal justice system to recognize symptoms of mental health and addiction problems and refer individuals to the appropriate community and healthcare resources.

The Committee accordingly recommends:

RECOMMENDATION 3

That the federal government work with provinces and territories in order to ensure that police officers, Crown prosecutors and other key players in the criminal justice system be trained to recognize the symptoms of mental health problems, mental illness and drug and alcohol abuse so that they can direct offenders to the appropriate treatment services.

The Committee realizes that some offenders will not satisfy the prerequisites for diversion, and must be remanded to a provincial correctional facility pending a court appearance. In such cases, these offenders should automatically undergo a psychiatric assessment to identify any mental disorders or addiction problems. Such an assessment would provide court staff with information to conduct a full review of each case and ensure that the offender receives the appropriate treatment and services. Assessments of mental disorders, including addictions, followed by treatment, would also help to address the revolving-door syndrome we heard much about.

In light of these considerations, the Committee recommends:

RECOMMENDATION 4

That the federal government work with the provinces and territories on early identification of mental health and addiction issues affecting offenders in remand, and secure access to treatment services for them in order to address conditions that are so often precursors to escalating crime and incarceration.

5.1.2.1   Drug Treatment and Mental Health Courts

Specialized courts such as mental health and drug treatment courts have been operating in Canada for some time now.[53] The Committee supports the work of such courts, which emphasize a therapeutic approach to treating offenders with mental health or addiction issues. Within a judicial setting, offenders taking part in these programs are referred to the appropriate primary or specialized healthcare services.

Drug treatment courts strive to reduce substance abuse, crime and recidivism through the rehabilitation of the offender. These courts facilitate treatment by providing an intensive, court-monitored alternative to incarceration. To access such treatment, an offender must plead guilty to the charges against him. In order to secure community support, the multidisciplinary team responsible for the case ensures that the offender has safe housing and, where appropriate, is in stable employment, attending school or receiving vocational training. In return, the offender undertakes to appear regularly before a judge who reviews his or her progress, and imposes sanctions or rewards good behaviour, as appropriate.

Mental health courts are also designed to meet the manifold and complex needs of offenders appearing before them.[54] Witnesses told us that the success of such courts and of participating offenders depends on close cooperation with community partners. According to these witnesses, the multidisciplinary teams attached to these courts have special sensitivity to the fragility of their clients and the stigma all too many of them face.

The Committee is concerned about what appears to be an insufficient use of mental health courts and its impact on the provincial and federal correctional systems. Offenders suffering from mental health problems serve a greater part of their sentences in institutions than those who are not mentally ill but were convicted for the same offence. As was explained to the Committee, this can be due to a variety of reasons. For example, offenders suffering from a mental illness often have difficulty adapting to the prison environment, thereby increasing the risk of inappropriate or violent behaviours. Additional time in prison can therefore lead to more time spent in segregation, increase the cost related to the use of expensive psychiatric medicine, the risk of altercations with correctional officers, and suicide.

The Committee was disappointed to learn that a lack of funds is hampering the establishment of drug treatment and mental health courts across the country, and believes that the use of specialized courts should be increased and that sufficient funding be provided in order to ensure that offenders with drug addiction and mental health issues receive the appropriate treatment at the right time. The Committee accordingly recommends:

RECOMMENDATION 5

That the federal government support the creation and funding of more drug treatment courts to divert offenders with addictions to treatment centres and mental health courts to divert those with mental health needs to appropriate services.

The Committee heard repeatedly that drug and alcohol addiction frequently coexists with mental health disorders within the inmate population, and that successive or parallel services are ineffective in treating concurrent disorders.[55] Best practices in the field reveal that it is better to treat such disorders simultaneously. While the Committee did not hear evidence about community courts, it believes their approach, offering simultaneous treatment of mental health and addiction disorders, could prove useful in treating those suffering from concurrent disorders.

Community courts, like those in British Columbia and the United Kingdom, are based on the US model of community justice, which seeks to develop partnerships within the community and address the factors underlying criminal behaviour. For example, these courts deal with homelessness, mental health and drug and alcohol dependency. They provide for options similar to those of drug treatment and mental health courts with respect to, among other things, the requirement that the offender appears periodically before the judge in order to improve the likelihood of rehabilitation.

In light of these considerations, the Committee recommends:

RECOMMENDATION 6

That the federal government support the creation and funding of more community courts to divert offenders with concurrent mental health and addiction issues to appropriate health facilities.

5.2       RECOGNITION OF THE ADVANTAGES OF PARTNERSHIPS IN THE DELIVERY OF MENTAL HEALTH AND ADDICTION SERVICES WITHIN THE CORRECTIONAL SYSTEM

Many witnesses felt that without developing partnerships, CSC cannot alone handle the challenge of managing offenders with mental health or addiction issues. Such partnerships could include provincial and territorial administrations responsible for health and social services, community health resources and non-governmental organizations that can provide support for offenders and help them resolve their social and financial problems by, for example, finding them suitable housing and stable employment.

In Canada and abroad, the Committee observed promising practices in treatment and support for offenders with mental health and addiction issues both within institutions and in the community. The next section canvasses the various partnership models that were brought to the Committee’s attention during its study. It also contains related recommendations to improve the quality of healthcare services and support provided to federal inmates with mental health and addiction issues.

5.2.1     Healthcare Service Delivery Models in Norway, England and Wales

In most countries, including Canada, the delivery of healthcare services in prison is the responsibility of the correctional administration, rather than the health administration. In recent years, however, there has been a trend towards transferring the responsibility to health administrations. Norway, Australia, France and, more recently, England and Wales have adopted this approach.

5.2.1.1   The Norwegian Approach

Since 1988, healthcare services within the correctional system in Norway have been the responsibility of the Ministry of Health and Social Welfare, rather than the Ministry of Justice. Healthcare services for offenders are thus independent of the administrative and economic control of the correctional administration.

In 1994, the Norwegian government gave municipalities responsibility for delivering primary health care in prisons, hiring medical staff (nurses, doctors, physiotherapists) and referring cases requiring specialized care. As a rule, reimbursement for these services comes from government subsidies.[56] Since 2002, specialized health care in Norwegian prisons has been the responsibility of regional health administrations.

In Norway, offenders with serious mental illness are cared for not in prison, but in psychiatric hospitals run by the regional health administrations. Only offenders with less serious mental conditions are treated in prison by healthcare professionals from the municipality in which they are detained.

Municipal health administrations contract with local psychiatric hospitals and clinics for the delivery of appropriate health care. Under these contracts, the clinic or hospital provides specialized health services to offenders for which the municipality is responsible; the clinic or hospital assigns a psychiatric nurse, a psychologist or a psychiatrist to the prison.

That said, according to witnesses heard from in Norway, the system is not perfect. Municipal administrations are not always successful in securing the regular attendance of psychiatric staff in the prisons; in many cases, offenders who receive specialized treatment in psychiatric hospitals or clinics are returned to prison too soon. As a result, their mental health problems quickly resurface. Some experts feel that, in order to avoid this vicious circle, municipal administrations should develop additional contracts with hospitals and clinics that are able to handle offenders requiring specialized care.

Lastly, witnesses we spoke with in Oslo emphasized that Norwegian inmates have the same rights to healthcare services as the rest of the population (services are based on the principle of equivalence). Moreover, offenders have the legal right to free private health care if they do not receive appropriate and timely healthcare services within the correctional system. It is therefore in the interests of the Norwegian public administrations that in these cases have to pay for private health services to ensure that offenders receive the services they require in a timely manner.

5.2.1.2   England and Wales

Since April 2006, the National Health Service (NHS), which is responsible for providing health services to all British citizens, has had complete responsibility for the provision of healthcare services in prisons in England and Wales. The granting of this responsibility was motivated by the government’s desire to improve care within the correctional system and to emphasize that inmates, as an integral part of the community, should have access to healthcare services equivalent to those provided to all other British citizens.

The reform process began in 2000 with the transfer from the ministries of Justice to the Ministry of Health the responsibility for developing public policy on health care in the prisons. It followed the publication of numerous reports highlighting significant shortcomings in the delivery of healthcare services in prisons in England and Wales.

According to evidence gathered in England, the transfer of responsibility to the NHS has led to an improvement in the quality of care provided to inmates. Moreover, it has done much to facilitate the recruitment of healthcare professionals—including psychiatric nurses—within the correctional system.

According to the Director of Offender Health, Richard Bradshaw, the reform has also facilitated the transfer to psychiatric hospitals of inmates requiring specialized care. He also said that the prison and health authorities are working closely together to create healthcare wings and mental health centres with high security components in order to avoid managing mental health cases in prison.

5.2.1.3   Benefits of Transferring Responsibility for Healthcare Services within the Correctional System to Provincial Health Authorities

The approaches taken in Norway, England and Wales differ in detail, but they do offer some advantages with respect to access to high-quality care within the correctional system, and continuity of care for offenders in the community.

More specifically, the Committee heard that transferring responsibility for health care in the correctional system to health administrations:

1. Highlights the principle that inmates should enjoy a level of care equivalent to what is available in the community. According to some witnesses, the transfer confirms that inmates are full citizens: they should therefore have the same opportunities for access to health care as the general population. This approach is obviously beneficial not only for inmates, but also for prison staff and for society as a whole, since most inmates rejoin the community at some point.
2. Integrates training and research in the correctional setting with normal practice. Some witnesses we met with in England and Norway told us that the transfer makes it possible to more readily integrate inmate health with broader public health issues. In England, the training provided to health professionals and recent health promotion initiatives reflect this important change. These initiatives recognize the importance of using the time in detention to promote inmate health and thus the health of the population in general.
3. Prevents the isolation of health professionals. The health professionals we met in Norway and England all told us that belonging to a health administration rather than a correctional administration contributed to their feeling of belonging to the health network, and thus prevented professional isolation. For example, a witness we spoke with in England maintained that working in prison was once regarded as a form of professional isolation; it is now perceived as part of an exciting multidisciplinary approach that offers numerous opportunities for development.
4. Solves the correctional system’s difficulties in recruiting health professionals. In addition to offering competitive salaries to health professionals working in the correctional system, Norway, England and Wales have taken an approach that makes the prison environment more interesting for health professionals. According to witnesses we spoke with, since health professionals report to the administration that is also responsible for the health of all citizens, they can readily combine working in the prisons with working in hospitals and in the community. A health professional who agrees to work within the correctional system is thus not confined to that system, and can easily transfer to a hospital or community setting if he or she chooses.
5. Contributes to more integrated delivery of health care services in the institutional and community settings. In the opinion of many witnesses, integrating the care provided in the closed environment of a prison and in the open environment of a community facility makes it much easier to provide a continuum of care for offenders, particularly after their release into the community. Moreover, transferring inmates to hospitals or specialized clinics is much easier, since the administrations responsible for health care in prison are also responsible for health care in the community. In a system like Canada’s, continuity of care becomes more difficult, particularly because of the sharing of responsibilities for health among the federal, provincial and territorial governments, and the isolation of the mental health professionals employed by CSC.
6. Clearly establishes the role of health professionals within the correctional system. Many witnesses acknowledged that it can be difficult for health professionals employed by a correctional administration to give priority to rehabilitation and treatment objectives, as opposed to disciplinary objectives. According to these witnesses, the strategy adopted in Norway and England has the advantage of favouring a therapeutic approach in the correctional setting, which is better suited to the treatment of mental disorders and addictions. In Canada, CSC must contribute to protecting public safety by taking an approach that balances assistance to and control of offenders, in accordance with section 3 of the CCRA. In practice, health professionals can find it difficult to reconcile helping and controlling offenders in an environment that calls for multiple security factors to be considered. According to the Correctional Investigator, CSC psychologists “are primarily engaged in risk assessment as opposed to treatment and rehabilitation.”[57] This leads him to conclude that the challenge facing CSC in relation to the shortage of human resources for delivering mental health care “is one of focus and priority as much as it is one of numbers.”[58]

The Committee acknowledges that the adoption of a system similar to the one in Norway or England and Wales presents specific governance challenges in Canada because health care responsibilities are shared among the federal, provincial and territorial governments. We nevertheless believe that transferring responsibility for the delivery of health care within the correctional system to the provincial and territorial health administrations offers significant advantages, and deserves the attention of all levels of government in this country. The Committee therefore recommends:

RECOMMENDATION 7

That the federal government initiate discussions with provincial and territorial governments with a view to establishing partnerships and service agreements with hospitals for the delivery of health care services so that federal inmates have the same access to health care as other Canadians. Such partnerships would also provide continuity of mental health care when inmates are released into the community.

5.2.2      Strengthening the Capacity of Correctional Service Canada to Meet the Needs of Federal Inmates by Developing Partnerships as an Interim Measure

The Committee realizes that transferring responsibility for health care within the federal correctional system may take time. To strengthen its capacity to meet the needs of federal inmates and ensure that they can return to the community as law-abiding citizens, the Committee believes that as an interim measure, CSC should work to develop partnerships with hospitals and mental health services in the community. In addition to improving the quality of care, this approach would favour continuity of care for inmates following their release in the community.

5.2.2.1   The Need to Develop Agreements with Provincial and Territorial Health Authorities under which Inmates with Serious Mental Health Disorders would be Treated in Psychiatric Hospitals, rather than in Conventional Correctional Institutions

“A correctional facility is by definition a restrictive, coercive environment”[59] that affects the mental health of those detained. According to the evidence we heard, the prison setting can generate or exacerbate psychiatric disorders because of the stress associated with loss of freedom, restrictions on private space and contacts with friends and family, and the violence generally characteristic of prisons. On the latter point, studies clearly show that the prison environment generates competition for scarce resources, develops relationships of dominance and submission, and compels individuals to associate with others whose behaviour may be unpredictable.

For all of these reasons, the correctional environment often constitutes an obstacle to therapy; by contrast, the health care environment is much better suited to treating people in crisis who have serious mental illnesses.

To improve its capacity to meet the psychiatric needs of offenders in its charge, CSC has set up RTCs. While these do offer a more appropriate environment for treating people with a serious mental illness, they cannot meet the demand.

In its Quebec Region, CSC can also rely on an agreement with the Institut Philippe-Pinel (Pinel) in Montreal. Federal inmates requiring specific psychiatric care may thus be treated by health professionals associated with Pinel who visit them in detention, or while hospitalized following a transfer. Under this agreement, CSC has reportedly improved the quality of psychiatric care provided to inmates with serious mental illnesses. The agreement benefits the inmate, CSC and society in general. In the Committee’s opinion, it should serve as an example for more such partnership agreements.

Lastly, agreements also currently exist in Nova Scotia between correctional services and the provincial health administration for the delivery of health care to inmates sentenced to less than two years’ imprisonment. Apparently, these agreements have done much to improve health care in these correctional settings.

In light of all these considerations, the Committee recommends:

RECOMMENDATION 8

That Correctional Service Canada establish agreements with provincial psychiatric hospitals—that have suitable facilities to accommodate offenders without compromising public safety—to transfer some offenders who are posing a threat to themselves or others and who cannot be treated at regional treatment centres, along with financial compensation. These agreements should also allow correctional staff to be assigned to the facilities during a transfer in order to ensure public safety.

5.2.2.2   The Need to Develop Agreements with Provincial and Territorial Authorities and Community Organizations to Correct Shortcomings in Continuity of Care

Despite its efforts and accomplishments, CSC still experiences significant difficulties in terms of ensuring continuity between services provided within the correctional system and provincial services. This constitutes a major obstacle to the successful reintegration of offenders into the general population.

The Committee agrees with a number of witnesses it heard from that the development of partnerships with provincial health and social services authorities, and community organizations that can provide support to offenders, would likely improve the continuum of care for offenders with drug addictions and mental illnesses. It would also promote the resettlement of these inmates. According to Brenda Tole, retired warden, Alouette Correctional Centre, government and non-government organizations are generally very enthusiastic about creating partnerships with correctional services. Appearing before the Committee, Ms Tole noted:

Our experience is that a lot of those organizations, ministries, or other government agencies are quite willing to partner. They see the population as part of their community and they are quite willing to engage and do that. It’s just that correction tends to be an entity upon itself and sticks to itself and is quite closed.[60]

She maintained that such partnerships benefit the correctional services, inmates and society as a whole, because they facilitate the successful reintegration of offenders into the community. She also noted that partnerships are useful not only in the health field, but also in education, job readiness and vocational training.[61]

To strengthen CSC’s capacity with respect to continuity of care, while contributing to public safety and the resettlement of offenders in its charge, the Committee recommends:

RECOMMENDATION 9

That the federal government develop coordination of services between Correctional Service Canada and provincial and territorial health authorities to provide a continuum of care through warrant expiry.

RECOMMENDATION 10

That Correctional Service Canada explore and arrange community partnerships for training federal offenders (through Habitat for Humanity, for example).

5.3       THE NEED TO BETTER RESPOND TO THE SITUATION OF ABORIGINAL OFFENDERS

In 1996, the Royal Commission on Aboriginal Peoples described the special situation of Aboriginal peoples in Canada. The growing overrepresentation of Aboriginal offenders in Canada’s penitentiaries supports the Commission’s view that the justice system does not adequately respond to their particular needs. As the following data show, the situation of Aboriginal people remains critical.

• The incarceration rate for Aboriginal people increased from 815 per 100,000 in 2001/02 to 983 per 100,000 in 2005/06;[62]
• At the end of March 2009, Aboriginal people comprised 17.3% of federally sentenced offenders, compared with 2.7% of Canada’s adult population;[63]
• One federal offender in five is of Aboriginal origin.[54]

The plight of female Aboriginal offenders is even more alarming:

• They represent 31.4% of the female inmate population;[65]
• The number of Aboriginal women in detention has been rising steadily over the last ten years. From 1999-2000 to 2008-2009, it increased from 84 to 157, or 86.9%.[66]

The circumstances of the care and treatment of Aboriginal offenders are both complex and multidimensional, presenting a substantial challenge for CSC. For example, Aboriginal offenders:

• Have a higher rate of recidivism than other offenders;[67]
• Are often overrepresented among offenders in segregation;[68]
• Have a much higher incidence of mental disorders and addiction issues than non-Aboriginal offenders;[69]
• Are younger upon admission into custody than non-Aboriginal offenders;[70]
• Serve more of their sentences in the institution before initial release, as compared with other offenders;[71]
• Are more inclined to have gang affiliations; and[72]
• Have more health problems, including FASD and PTS syndrome.[73]

A number of systemic and contextual factors are also causal in terms of offences committed by Aboriginals: placement in residential facilities, the intergenerational cycle of violence, unemployment, low education levels, poverty, low pay and poor housing.[74]

5.3.1      Correctional Service Canada’s Commitment to Aboriginal Offenders

Under sections 79 to 84.1 of the CCRA, CSC is required to respect the cultural differences and specific needs of Aboriginal offenders in the discharge of its mandate, and more specifically in the delivery of services and programs. Commissioner’s Directive (CD) 702, issued in 1995[75] and revised in 2008[76], also sets out procedures for the rehabilitation and reintegration of Aboriginal offenders through effective casework. Under CD 702, CSC undertakes to adopt a holistic approach towards Aboriginal offenders in order to promote understanding of traditional Aboriginal spirituality. This approach also encourages cultural dances and ceremonies and the consumption of traditional and country foods.[77]

To address the numerous challenges related to Aboriginals within the federal correctional system, CSC has developed the following initiatives:

• Strategic Plan for Aboriginal Corrections 2006-2011 (approved in 2006);[78]
• Strategy for Aboriginal Corrections Accountability Framework (implemented in 2009-2010);[79]
• Template for Results Reporting and Monitoring.[80]

Although more than four years have elapsed since the approval of the Strategic Plan for Aboriginal Corrections, the gap continues to widen between program and casework results for Aboriginal offenders and other offenders. The OCI remains dissatisfied with CSC’s efforts. It maintains that “previous good intentions reflected in CSC policies and strategies have been inadequately operationalized, leading to disappointing results.”[81] In his 2008-2009 Annual Report, Howard Sapers notes:

Over the years, my Office has made a series of findings and recommendations to challenge the Service’s thinking and its resolve to make significant and sustainable progress in the area of Aboriginal corrections. Many of our recommendations have yet to be fully implemented. As a consequence, the gap between Aboriginal and non-Aboriginal offenders continues to widen, the situation for Aboriginal people under federal sentence deteriorates, and the Service revises and updates frameworks and strategies without apparent results.[82]

5.3.2      The Need to Improve Correctional Service Canada’s Capacity to Work Effectively with Aboriginal Offenders

The steady gap between outcomes for Aboriginal and non-Aboriginal offenders raises serious questions about CSC’s ability to take responsibility for the former.[83] Like a number of witnesses, the Committee believes the situation is not only critical, but is demanding of urgent attention. This situation is all the more critical because the inmate population is likely to increase with the passage of federal legislation designed to create more severity in sentencing. To increase CSC’s capacity to respond to the needs of Aboriginal offenders, the Correctional Investigator has long been proposing a change in its governance structure. He has urged the Minister of Public Safety to direct CSC to appoint a deputy commissioner for Aboriginal corrections in order to pay special, targeted attention to Aboriginal offenders. The Minister has yet to accept this suggestion. The Committee believes this recommendation should be implemented, together with all those made by the Correctional Investigator in his 2008-2009 annual report. The matter is further addressed in section 5.15 of this report.

The Committee is also concerned that existing CSC programs for treating mental disorders and addiction issues constitute an inadequate response to the cultural and spiritual needs of Aboriginal offenders. The Committee accordingly encourages CSC to review its current programming with a view to incorporating a more traditional and religious component for these offenders. In the Committee’s view, attaching increased importance to the Aboriginal context in existing programs could make them more effective in reaching Aboriginal offenders. Lastly, the Committee hopes that CSC will take the opportunity to implement more programs for Aboriginal people in order to assist in their recovery.

During the visit to the Okimaw Ohci Healing Lodge, a good many witnesses drew the Committee’s attention to the crucial role of elders and spiritual advisers in the success of programs for Aboriginal offenders. They encourage offenders to repair broken links with their culture, their families and their communities. The Committee hopes CSC will make greater use of the services of elders, and invite Aboriginal communities to participate in the development and delivery of programs for Aboriginal offenders.

The Committee accordingly recommends:

RECOMMENDATION 11

That Correctional Services Canada (CSC) review its current mental health and addictions programming to ensure that it meets the cultural and religious needs of Aboriginal offenders, who make up a disproportionate percentage of the Canadian inmate population, and a disproportionate percentage of inmates facing mental health and addiction issues; that CSC implement, together with local Aboriginal communities, more mental health and addiction programs addressing the specific needs of Aboriginal offenders. In addition to contributing to the development of these programs, local Aboriginal communities should also contribute to the delivery of these programs to ensure maximum success.

While the Committee is aware that CD 702 allows cultural ceremonies, like sweat lodge ceremonies, it maintains nevertheless that CSC should increase the use of such healing methods. The Committee therefore recommends:

RECOMMENDATION 12

That Correctional Service Canada expand the use of sweat lodges and other Aboriginal healing methods and refrain from using denial of same as a disciplinary measure.

Lastly, although the Committee realizes that traditional and country food[84] is sometimes permitted in institutions, it maintains that CSC should encourage this practice. The Committee therefore recommends:

RECOMMENDATION 13

That Correctional Service Canada encourage healthy dietary practices for all offenders and where practical consider diet options for Aboriginal offenders including traditional and country food.

5.3.3      Correctional Service Canada’s Obligation to Work with Aboriginal Communities (ss. 81 and 84, CCRA)

Under section 81 of the CCRA, the Minister of Public Safety may enter into an agreement with an Aboriginal community for the provision of correctional services to Aboriginal offenders, and for payment of the cost of such services.

A number of witnesses consulted during our study stressed the importance of participation by Aboriginal communities in the correctional process. According to them, the reintegration of Aboriginal offenders is possible only if Aboriginal communities take an active part in CSC initiatives.

Since the healing lodges authorized under section 81 of the CCRA promote a traditional holistic approach to service delivery, the Committee is disappointed that 18 years after the coming into force of this section of the Act, there are only four independent Aboriginal healing lodges in Canada. It is all the more alarming to note that there are no healing lodges for Aboriginal offenders operated by Aboriginal communities. The Committee finds it difficult to understand why CSC has been so slow to act in this regard, and hopes that the $33 million capital outlay for Aboriginal corrections in 2009-2010 will lead to the establishment of new healing lodges.[85]

Section 84 of the CCRA also requires CSC to involve Aboriginal communities in planning for the release of inmates to such communities. The Committee is disappointed in the fact that more frequent use is not being made of section 84 to have Aboriginal communities take part in the parole process.

Like many of its witnesses, the Committee is convinced that transferring responsibility to Aboriginal communities will likely contribute to the recovery and well-being of Aboriginal offenders with mental health disorders and addiction problems. According to Ms. Tole, “You can’t get much worse than what we’re doing. In terms of managing that population, we really can’t.”[86]

In light of these considerations, the Committee recommends:

RECOMMENDATION 14

That Correctional Service Canada make greater use of agreements concluded with Aboriginal communities under sections 81 and 84 of the Corrections and Conditional Release Act, and establish the required capacity.

5.4       THE NEED TO IMPROVE CORRECTIONAL SERVICE CANADA’S CAPACITY TO MEET OFFENDERS’ HEALTHCARE NEEDS

Much can be learned from the Aboriginal approach to health. In accordance with this holistic approach, mental health is an integral part of a person’s physical, emotional and spiritual well-being. Thus, investment in the general health of all inmates would help improve their mental health and overall well-being. It is also essential to realize that the health of inmates is an important public health issue: most will return to the community at some point, and correctional staff move back and forth between the institution and the community.

The Committee also believes, in accordance with international law, that inmates, as human beings, are entitled to enjoy the best possible state of health.[87] It should be noted that the sanction of imprisonment is deprivation of freedom, and not the loss of fundamental human rights.[88] The Committee therefore recommends:

RECOMMENDATION 15

That Correctional Service Canada ensure that offenders have the same medical care as citizens generally.

RECOMMENDATION 16

That Correctional Service Canada ensure that access to medical care is provided to offenders in a timely manner.

RECOMMENDATION 17

That Correctional Service Canada work towards a psychologist/patient ratio of no more than 1:35 at all federal institutions.

RECOMMENDATION 18

That Correctional Service Canada add substance abuse counsellors at every federal institution.

RECOMMENDATION 19

That Correctional Service Canada add psychiatric nurses and nurses at every federal institution.

RECOMMENDATION 20

That Correctional Service Canada ensure timely access to dental care at every federal institution.

RECOMMENDATION 21

That Correctional Service Canada place a renewed focus on individualized treatment for all offenders with diagnosed mental health conditions, including addiction issues.

RECOMMENDATION 22

That Correctional Service Canada work towards ensuring that adequate one-on-one counselling services are commenced forthwith upon diagnosis, and delivered in a timely fashion and in sufficient weekly amounts as prescribed by the treating psychologist or counsellor.

RECOMMENDATION 23

That the federal government require offenders who have assaulted staff members or other offenders with biological substances to undergo, in the interest of the health and safety of those assaulted, all the necessary tests to diagnose the presence of any infectious diseases.

5.5       IMPLEMENTATION OF THE CORRECTIONAL SERVICE OF CANADA’S MENTAL HEALTH STRATEGY

According to the Correctional Investigator, CSC has, since 2004, been slow to implement all components of its mental health strategy, and the delivery of mental health care has not changed significantly since that date. Like most witnesses, the Committee supports all the objectives of the strategy, and believes that implementing it in full would enable CSC to respond appropriately to the needs of federal offenders in its institutions and in the community. The Committee believes that action by CSC in this regard is critical, and therefore recommends:

RECOMMENDATION 24

That the federal government invest additional resources for the full implementation of the Correctional Service of Canada’s mental health strategy.

Objective 1   Mental health screening and assessment of offenders upon admission

This objective is fulfilled by CSC’s Institutional Mental Health Initiative (IMHI). The IMHI was given temporary funding of about $21 million in Budget 2007, and permanent funding of some $16 million in Budget 2008. It has only very recently been implemented, however, and the Committee is concerned that screening and assessment upon admission may still be inadequate. Evidence given to the Committee while touring the correctional institutions confirmed that full psychological screening, when needed, is not taking place for all offenders upon admission into custody. Testimony by James Livingston, indicates that published standards and directives unanimously support systemic assessment and screening for mental health problems.[89]

Given the importance of screening for mental disorders upon admission to an institution, the Committee believes CSC should give priority to Objective 1. By doing so, it will thus be in a better position to correct the numerous shortcomings in the delivery of mental health services, and improve the quality of care. The Committee therefore recommends:

RECOMMENDATION 25

That Correctional Service Canada (CSC) make mental health screening upon admission a priority and that the federal government continue to fund this component of the mental health strategy. CSC should also require a full psychological assessment of an offender if recommended by a health care professional after the aforementioned screening.

Objective 2   Primary mental health care in all institutions, including counselling, support, treatment and maintenance

This is also an IMHI objective; it was funded in Budget 2008, and has been given the same permanent funding as objective 1. Its goal is to promote and maintain good mental health for all offenders, using a multidisciplinary approach. Mental health guidelines pursuant to this objective were distributed to all staff on December 21, 2009 in an effort to prevent suicide attempts, provide timely care and help offenders deal with mental illness in the correctional environment. The Committee wishes to emphasize that it supports CSC’s efforts in achieving this objective.

Objective 3   The development of intermediate mental health care units for offenders suffering from mental health disorders that require mental health care within the institutions

The Committee finds it difficult to understand why this third objective has yet to be funded. In the absence of the resources needed to develop intermediate mental health care units, CSC is unable to meet its obligation to provide offenders with adequate mental health care. Moreover, numerous witnesses decried the lack of intermediate mental health care within the federal correctional system.

The Committee is concerned about the plight of inmates who receive no care, or limited care, because CSC must concentrate its mental health resources on inmates suffering from more serious or chronic mental illness. Such cases demonstrate the importance and urgency of developing intermediate units for inmates who do not meet the criteria for admission to an RTC. The intermediate units could also assist CSC by providing a safe transition for inmates who have to go back to the institution after spending time in an RTC.

Given these findings, the Committee recommends:

RECOMMENDATION 26

That Correctional Service Canada establish and fund intermediate mental health services and intermediate care units, depending on offenders’ needs in each correctional facility, in order to care properly for offenders with mental health problems who do not meet the admission criteria of regional treatment centres and in order to provide care for offenders transferred from a regional psychiatric centre; and so that offenders do not feel compelled to enter voluntary administrative segregation to protect themselves from other offenders.

Lastly, during its visit to Whitemoor, in the United Kingdom, the Committee toured a unit for offenders with personality disorders. All the caseworkers we met were encouraged by the progress of the offenders receiving care in this specialized unit, which takes a multidisciplinary approach to this type of mental illness. While some witnesses mentioned the high operating costs of the program and found that it was still too early to assess its overall effectiveness, the Committee believes it would be useful to establish such a unit in Canada to treat offenders with such disorders. Accordingly the Committee recommends:

RECOMMENDATION 27

That Correctional Service Canada implement innovative, multidisciplinary units for personality disordered individuals, based on the Whitemoor, U.K., model.

Objective 4   Enhance Correctional Service Canada’s regional treatment centres

This objective seeks to improve the services provided in CSC RTCs so that they are of the same calibre as those provided in forensic psychiatric hospitals in the community. While this objective is as important as the others, funding for it in Budget 2007 was limited. The Committee supports this objective as being consistent with the right of offenders to attain the best possible state of health. In the hope that this objective will receive permanent funding, the Committee encourages CSC to pursue the efforts made so far to secure the accreditation of its RTCs, to ensure professional development of its staff and to maintain newly signed contracts with psychiatrists.

Objective 5   Enrichment of mental health support in the community

This objective of CSC’s mental health strategy seeks to ensure continuity of care for offenders, with no interruption, from the institution into the community. It is pursued by CSC by means of the Community Mental Health Initiative (CMHI), which seeks to ensure the establishment of new positions for mental health professionals in 16 such facilities, the provision of specialized services for offenders in the community through mental health consultancies, and mental health training sessions for front-line staff. Five-year funding for this initiative was included in Budget 2005, but ended in March 2010. CSC is still trying to obtain permanent funding for this objective, believing that if the government is slow to provide funding, the result will be:

• Significant staff retention challenges, since approximately 50 employees are funded through the CMHI budget;[90]
• Reduced capacity in the community, which would take time to rebuild, given the need to establish new contracts and hire new staff;[91]
• Reduced services for high risk and high needs offenders in the community.[92]

The Committee encourages the government to provide permanent funding for the initiative at the earliest possible date, in order to avert the risks listed above.

Moreover, the Committee recommends:

RECOMMENDATION 28

That Correctional Service Canada cover the cost of all medication prescribed to treat mental illness of offenders on conditional release in the community through warrant expiry.

Objective 6   Provision of mental health training for all mental health professionals and correctional staff

This objective relates to CSC efforts to establish a program to train staff and mental health professionals to recognize the symptoms of mental illness, and provide effective and timely care. Although over 1,600 CSC employees and community partners were trained in 2008-2009, the Service must persevere in efforts to train all its employees.[93] The Committee wants to encourage CSC to continue its training efforts in order to strengthen its capacity to meet the needs of offenders with mental health disorders.

5.6       AN APPROACH TO DEAL WITH DRUGS IN PRISON THAT PUTS TOO MUCH EMPHASIS ON CONTROL, AS OPPOSED TO TREATMENT OF ADDICTIONS

The CSC drug strategy emphasizes three key elements: prevention, treatment and care, and control. According to CSC, the strategy seeks to cut supply and demand by preventing the entry of illicit drugs into its institutions, preventing drug use, and providing substance abuse programs for inmates. The strategy also seeks to create a safe environment for staff and inmates. On August 29, 2008, the Minister of Public Safety announced an expenditure of $122 million over five years to support CSC efforts in this area.

CSC maintains that the purpose of the strategy is to encourage inmate rehabilitation by implementing substance abuse programs. However, Ivan Zinger, Executive Director and General Counsel, OCI, informed the Committee that the funding approved for this strategy was all directed towards drug control efforts—teams of drug detector dogs, intelligence activities, ion scanners and x-ray machines—to the detriment of substance abuse programs and harm reduction initiatives.[94] The Committee would like CSC to take an approach that balances control, rehabilitation and prevention in combating drug use. Moreover, according to Sandra Ka Hon Chu of the Canadian HIV/AIDS Legal Network, CSC’s desire to eliminate all drugs from its institutions is praiseworthy, but unrealistic.[95] The Committee also noted in Norway and England that drugs are a sad reality in the correctional environment.

According to Ms. Ka Hon Chu, the CSC’s approach is harmful to inmate health, public health and the implementation of initiatives to reduce the problems caused by drugs.[96] In her opinion, CSC should establish a needle exchange program in all federal correctional institutions. She considers this program to be more effective in reducing the transmission of infectious diseases than the methods currently used by CSC, that is providing bleach to inmates for disinfecting needles and methadone treatment. She also urged the Committee to recognize that relapse is almost inevitable in prison and that, when relapse occurs, offenders are more likely to share contraband syringes, increasing the risk of contracting and spreading blood-borne diseases.

Dr. Peter Ford also points out that the spread of blood-borne diseases in correctional facilities has very serious public health consequences, because offenders are at some point released and could spread their diseases into the community.[97] He added that “[t]he long-term health costs of this are very considerable. It costs about $20,000 to treat somebody with hepatitis C” and that “[c]orrections is going to find itself looking after people with terminal liver failure, and this is a very expensive prospect.”[98]

In light of these considerations, the Committee recommends:

RECOMMENDATION 29

That the federal government explore all program options available to reduce the skyrocketing rates of HIV/AIDS and hepatitis C that pose a serious threat to public health both in prison and when offenders are released back into the community, and that assessments be undertaken to evaluate which program options are most effective at reducing the spread of infectious diseases in the context of the Canadian correctional system.

RECOMMENDATION 30

That Correctional Service Canada encourage and expand the use of 12 Step programs to deal with addiction issues, including the increased use of outside community groups to assist.

RECOMMENDATION 31

That Correctional Service Canada encourage the creation of drug treatment units in federal institutions.

RECOMMENDATION 32

That Correctional Service Canada allocate additional financial and human resources for drug treatment, harm reduction and prevention.

RECOMMENDATION 33

That Correctional Service Canada allocate additional funding to drug treatment programs at all federal correctional facilities.

RECOMMENDATION 34

That Correctional Service Canada establish programs to treat offenders who have both mental health and drug abuse problems simultaneously.

RECOMMENDATION 35

That Correctional Service Canada (CSC) continue to examine ways of strengthening drug interdiction monitoring activities and, in keeping with the recommendations made by the CSC Independent Review Panel, that CSC take a more rigorous approach to drug interdiction in order to create safe and secure environments where offenders can focus on rehabilitation.

5.7       THE PHYSICAL INADEQUACY OF SOME INSTITUTIONS

During its visits to federal institutions, the Committee noted the frequently poor conditions in which CSC staff work and federal offenders are detained, mainly as a result of the obsolescence of correctional institutions.[99] Of the 57 institutions operated by CSC, a good many were built in the 1800s and early 1900s—Kingston (1832), Dorchester (1880), Saskatchewan (1911), Stony Mountain and Collins Bay (1920-1930)—or in the mid‑1900s—Joyceville (1950) and Archambault (1960s). Only four correctional institutions have been built since the mid-1990s. The average age of the institutions is about 45 years.[100]

Apart from the high maintenance costs of the aging infrastructure, the Committee heard that these structures also pose a risk to the safety of staff and inmates and can hamper the delivery of correctional programs and services.

5.7.1      Penitentiaries that are Decrepit, Crowded, Noisy and Devoid of Natural Light

According to witnesses, the architecture of correctional institutions built in the 1800s and early 1900s is often a hindrance to modern correctional interventions, and is unsuited to the complex profile of today’s inmate population, characterized by, among other things, a growing number of inmates who have committed violent crimes or are affiliated with criminal gangs. Witnesses also noted that some institutions today hold four or five subgroups of incompatible inmates that have to be kept apart for security reasons.

Here is what the Correctional Investigator had to say about the care of inmates with mental health disorders in CSC’s older institutions:

Many of the older penitentiaries in this country, some of which were built in the mid to late 19th century, simply lack the design and infrastructure capacity to meet the needs and challenges of a rapidly expanding population of mentally disordered offenders. Staff cannot do their best, nor are offenders suffering from mental illness well served when they are housed in conditions that are decrepit, crowded, noisy, and devoid of natural light. The impact of these conditions of confinement on offenders whose thinking, learning, and/or emotional responses are impaired, delayed, or damaged can have deleterious and degrading effects on their mental functioning over time.

We no longer live in a time when penitentiaries are designed to be solitary and confining places with minimum human contact. Modern correctional practice requires modern infrastructure. Places of confinement should not purposely add to the pain of incarceration, nor should their design hinder the delivery of correctional interventions.[101]

The architecture of some institutions also interferes with creating a proper balance between passive security (electronic barriers, camera surveillance, checkpoints and so on) and active security (encouraging interaction with inmates to get to know each other better, and thus prevent incidents and actively contribute to their rehabilitation). This is a serious consideration, because interaction with inmates is an important factor in the safety of both inmates and staff. Some witnesses also maintained that frequent, positive interaction with inmates increases the likelihood that inmates will talk to staff about plots or problems between inmates. Ruth Martin, a physician who works with inmates, also noted that “[o]pen communication with staff and administration can reduce the development of a negative subculture.”[102]

During its study, the Committee also learned that most inmates are placed on waiting lists before gaining access to the programs and treatment specified in their correctional plan. This is attributable to, among other things, a lack of caseworkers and lack of space for program delivery that meets staff and inmate security requirements. This is all the more serious in that most inmates do not have timely access to appropriate programs. Those admitted late generally have their release into the community postponed; others are released without the benefit of all the programs and treatment considered essential to their rehabilitation.

Given the inefficient, inadequate and expensive infrastructure of many of CSC’s correctional institutions, the CSC Review Panel, tasked by the government in 2007 with reviewing CSC’s operational priorities, strategies and business plan, recommended that the federal government invest in the construction of a new type of regional penitentiary complex.[103] These complexes would include minimum, medium and maximum security sectors and share correctional services and space for the delivery of programs, and mental health and medical care.

In his testimony, the Panel Chair, Robert Sampson, spoke of the need to address the physical infrastructure in order to meet the needs of a prison population dealing with mental health or addiction problems.[104] Appearing before the Committee, CSC Commissioner Don Head[105] supported Mr. Sampson’s position, pointing out that changes to the institutions’ infrastructure were needed to facilitate the delivery of related programs.

Our visits to correctional institutions convinced us of the need for infrastructure changes in order to facilitate correctional measures. These changes are also essential to ensure conditions of detention that are conducive to the recovery of inmates with mental disorders and addiction issues.

In light of these observations, the Committee recommends:

RECOMMENDATION 36

That the federal government support the renewal and modernization of the federal correctional system’s aging infrastructure.

RECOMMENDATION 37

When building new facilities, that Correctional Service Canada provide toilets and windows in every cell with access to sunlight and fresh air where possible.

RECOMMENDATION 38

When new infrastructure is built, that Correctional Service Canada ensure that therapeutic considerations are taken into account.

5.7.2      The Need for New Specialized Mental Health Units

At the Shepody Healing Centre in the Dorchester Institution, the Committee observed a glaring lack of space for the delivery of mental health care. Dr. Louis Thériault, who has been a psychiatric consultant for more than 10 years at the Centre, noted that it is simply unable to meet the growing demand for additional beds or co-dependency units.[106] In his presentation, he reminded the Committee of the importance of having access to appropriate spaces to manage individuals experiencing mental health problems who are in crisis. Similar problems were observed in the other psychiatric care units the Committee visited.

The Committee therefore recommends:

RECOMMENDATION 39

That the federal government build more expanded psychiatric care units. It must also ensure appropriate sub-units, and space both for private interviews and to deliver one-on-one counselling.

The former Deputy Commissioner for Women at CSC, Elizabeth Van Allen, also noted a shortage of space at the new regional institutions for women in terms or the delivery of programs and services for offenders with complex mental health challenges. She stated:

We have a challenge with our infrastructure’s capacity to deal with our mental health offenders. For our women in minimum and medium security, we have a good program in place. Our structured living environments work well. … It’s more difficult when we have to deal with women who have behavioural challenges stemming from more complex mental health needs. Unfortunately, working with these women requires a more secure environment. We have five regional facilities. The secure units are relatively small, and that poses challenges. That’s an area we will have to work on in the coming years.[107]

The Committee also noted that CSC does not have any independent psychiatric facilities for federally sentenced women. Such facilities would make it possible to accommodate female offenders with complex mental health challenges, in keeping with Ms. Van Allen’s concerns. The Committee therefore recommends:

RECOMMENDATION 40

That the federal government take action to address the fact that Correctional Service Canada currently has no stand-alone psychiatric facility to accommodate and treat women serving sentences of two or more years who are affected by complex mental health issues.

The Committee is also concerned that the regional mental health centre located around the Archambault facility cannot accommodate high-security offenders. As a result, a number of offenders with mental health problems are sent to the Special Detention Unit (SDU), where conditions are harmful to their mental health. In the Committee’s opinion, offenders at Archambault should have access to services similar to those available at the regional psychiatric centre in Saskatoon. The Committee therefore recommends:

RECOMMENDATION 41

That Correctional Service Canada modernize the Archambault Regional Mental Health Centre by building, outside the current location, a maximum security psychiatric facility to treat all mental health problems. This facility could be similar to the Regional Psychiatric Centre in Saskatoon and the treatment philosophy could be based on the approach used at the Shepody Healing Centre in Dorchester or at Ila institution in Norway.

5.8       CREATING AN ENVIRONMENT CONDUCIVE TO REHABILITATION

The atmosphere in the correctional facilities visited in Norway differs from that in most of the facilities visited in Canada. Members of the Committee noted that some facilities are more like schools than prisons given the colour of the walls, the paintings and sculpture on display, the poetic messages on hallway walls and the friendly interaction between guards and offenders. Even at maximum security facilities, the guards do not use security equipment as a rule—Kevlar vests or extendible batons—when interacting with offenders. The guards do however still have access to a full range of highly sophisticated security equipment for use when needed. The equipment is stored in a locked room near the detention units.

At CSC medium and maximum security institutions, offenders usually follow a strict schedule with various services provided (meals etc.). At the facilities in Norway, including maximum security ones, offenders live in units where they have to get along with others and do household duties such as cleaning, vacuuming and cooking. This is similar to the approach at CSC minimum security facilities. The approach gives offenders the opportunity to assume responsibility for their self-care, to apply basic life skills and to counter inmate apathy.

On the whole, the Committee was impressed by the approach used in the correctional system in Norway. It was also surprised to learn that instances of violence against prison guards are extremely rare in these institutions. This is an approach favoured by Ms. Tole, retired warden of Alouette Correctional Centre in British Columbia. Appearing before the Committee, she pointed out that a more structured environment can be much more unsafe for correctional staff:

It is a fallacy that the more structured the environment, the safer it is. It isn’t. The more confined, structured, and authoritarian the environment is, the more difficulty they have in living within that environment, and they tend to produce much more in the way of management problems. As a result, it’s not a safe environment. It’s unfortunate when institutions move more and more towards that—more technology, more security, more restrictive movement—because what you actually generate is a very dysfunctional population that presents a threat to the staff.[108]

Most of our witnesses also agreed that offenders fare better when they have positive and frequent interaction with qualified personnel. Amber-Anne Christie, a former inmate and research assistant with Women in 2 Healing, stressed that the environment and the physical design of correctional facilities are significant factors in offender rehabilitation. She stated before the Committee:

The way the prison [Alouette] was being run was more like a rehabilitation centre than a prison. It was amazing. Not only was there a library and a gym there, there was a native elder there to talk to. As well, there was drumming and dancing every Tuesday night. As a mother myself, I have to say that it helped me to remember the things I was giving up, and I know that the other inmates dealt with their problems and reacted differently because there was a baby there.

I was released from prison in October 2005, and I have not been back since. I will be the first to say that this exact prison changed my life. I had been in many prisons before, but this prison treated me like I was a person and not a number.[109]

According to Dr. Ruth Martin, enhancing offenders’ self-confidence, engaging them in decision-making and focusing on their strengths rather than their weaknesses are essential to the success of correctional services.[110]

Finally, since the atmosphere and physical design of correctional facilities are decisive factors in offender rehabilitation, especially for those with mental health and addiction issues, the Committee recommends:

RECOMMENDATION 42

That Correctional Service Canada develop a values-based vision as part of its mission to encourage healthy living in the correctional setting and mutual respect among offenders and staff. These values would be posted in all common areas and updated regularly by inmates and staff.

RECOMMENDATION 43

That Correctional Service Canada ensure adequate access to physical exercise and outdoor exercise.

RECOMMENDATION 44

That Correctional Service Canada ensure that all psychiatric units meet acceptable standards, including cell size, lighting, common areas, etc.

RECOMMENDATION 45

That Correctional Service Canada reduce barriers between correctional officers and inmates to establish, where possible, an atmosphere most conducive to rehabilitation.

RECOMMENDATION 46

That Correctional Service Canada have petition boxes installed in correctional facilities to allow inmates to submit confidential written requests to institution wardens, who would be responsible for responding to every reasonable request.

The international community has made a commitment to protecting the human rights of offenders by instituting a number of international human rights instruments, such as the Convention against torture and Other Cruel, Inhuman or Degrading Treatment or Punishment and the Standard Minimum Rules for the Treatment of Prisoners (SMR).[111] The SMR are likely the most broadly recognized international standard regarding offenders’ rights. In becoming a signatory to them in 1975, Canada undertook to apply the minimum rules in the management of its correctional clientele. In so doing it also recognized that offenders retain all their human rights, except their right to freedom of movement, and that they must at all times be treated humanely and with respect for their human dignity.

Rule nine of the SMR states:

Where sleeping accommodation is in individual cells or rooms, each prisoner shall occupy by night a cell or room by himself. If for special reasons, such as temporary overcrowding, it becomes necessary for the central prison administration to make an exception to this rule, it is not desirable to have two prisoners in a cell or room.

In accordance with this rule, CSC internal policies provide that single cell occupancy is the most appropriate method for offenders for correctional purposes.[112] Yet CSC does not choose its correctional clientele and it sometimes departs from this principle, as many other correctional administrations do here and elsewhere. Such departures have an impact though, as studies have demonstrated that the overpopulation of institutions results in:

• Increased tension and violence and compromised safety of personnel, offenders and visitors;
• Greater risk of the spread of infectious diseases;
• Accelerated progression of certain illnesses; and
• Reduced ability of correctional administrations to meet offenders’ needs, including health care, treatment, education and training.

Appearing before the Committee, the Correctional Investigator stated that the rate of “double occupancy” in CSC institutions has increased significantly in recent years and is currently about 10% of the federal inmate population.[113] As of February 15, 2009, 1,313 offenders were double bunked in 657 cells.[114] Here is what the Correctional Investigator told the Committee about overpopulation:

The Correctional Service of Canada right now has empty cell capacity of maybe between 800 and 1,000, scattered across the country. So if you were to take a very high-level look and you say, gee, we’ve got empty cell space, so if more people come into a penitentiary, we must be able to accommodate them, you might be able to draw that conclusion.

The reality is that with the mix of the offender profile, with the issues to do with gangs, with the mentally ill, with the special concerns of women or Aboriginal offenders, that capacity isn’t in the right place at the right time; it’s not available. We have overcrowding, particularly at medium security, where the vast majority of offenders spend the vast majority of their time.[115]

In light of these observations and with the recent adoption of federal legislation that could increase the federal inmate population, the Committee recommends:

RECOMMENDATION 47

That the federal government uphold the United Nations’ Standard Minimum Rules for the Treatment of Prisoners, to which the Government of Canada is a signatory, which states: "Where sleeping accommodation is in individual cells or rooms, each prisoner shall occupy by night a cell or room by himself,” as it is widely accepted that double bunking and overcrowding exacerbates mental health and addiction problems faced by inmates, as well as their ability to rehabilitate and reintegrate into society.

5.9       GAPS IN THE TRAINING OF CORRECTIONAL STAFF

Staff training is recognized in the CSC Mental Health Strategy as an essential factor in providing services and programs that meet the needs of offenders with mental health issues. In his 2008-2009 report, the Correctional Investigator states that CSC has made progress recently in this regard by creating a new online mental health training kit for front-line workers.[116] CSC also informed the Committee that it had recently introduced a two-day mental health training session for staff working at parole offices and halfway houses. Despite these promising initiatives, many witnesses, including CSC employees, stated that CSC has not done enough in this regard.

The Committee did not fully review the content of the training currently available to CSC employees. The evidence indicates however that correctional officers who work with federally sentenced offenders on a daily basis cannot recognize the symptoms of mental health problems and illness, despite their best intentions. They have difficulty dealing with the inconsistent behaviour associated with mental health disorders and cannot respond appropriately to the offenders in question.[117] Some witnesses, including the Correctional Investigator, noted that the compulsive and irrational behaviours associated with mental health disorders are often interpreted as acts of violence and are addressed through security measures rather than treatment.[118] As highlighted in the next section, administrative segregation is often the default response in such cases.

Given the importance of training for managing correctional clientele, the Committee was surprised to learn that corrections officers at RTCs do not receive specialized training. The Committee agrees with the Correctional Investigator that CSC must recognize the importance of mental health training by immediately providing suitable training for staff at RTCs.

In the Committee’s opinion, CSC should also provide improved training as soon as possible for staff working with offenders in traditional facilities on a daily basis. Staff training should focus on the recognition of verbal and behavioural signs of mental health disorders and on responding accordingly to offenders’ needs.

In view of these observations and since staff training is fundamental to the effective and humane management of offenders with mental health and addiction issues, the Committee recommends:

RECOMMENDATION 48

That Correctional Service Canada make its mental health training activities a priority so that all employees working with offenders in an institution or in the community can gain familiarity with the symptoms of mental illness and treatment methods for offenders with mental health problems.

RECOMMENDATION 49

That Correctional Service Canada introduce specialized mental health training for correctional officers, program officers and parole officers who work in mental health units or regional treatment centres.

Finally, given the limitations of traditional training that usually includes printed training material, Glenn Thompson, Secretary of the Board, Mental Health Commission of Canada, suggested that an electronic training tool be created that CSC employees could consult at any time. He stated:

Nowadays there should be something online for the correctional services staff that they can refer to any time, on the job or even in their home environment, training materials that are electronically available. People don’t remember everything from a two-week course or a three-month course, or whatever it might be, and they need to refer back and think about it as their experience goes along. Today, they maybe had to supervise a person who had a schizophrenic condition. They may want to go and think about that and read about it and find out more about what other people have learned to do in that kind of situation.[119]

The Committee agrees with Mr. Thompson that such a tool could improve the correctional officers’ responses. The Committee therefore recommends:

RECOMMENDATION 50

That Correctional Service Canada create mental health training material that is available electronically so that correctional employees can consult it at any time, at work or even at home.

5.10    INAPPROPRIATE USE OF ADMINISTRATIVE SEGREGATION

While administrative segregation is seen as an essential tool for crisis management, the Committee learned that CSC uses it too often to deal with offenders with mental health issues.

5.10.1    Statutory Framework

The CCRA authorizes CSC to use two types of segregation: disciplinary and administrative. Disciplinary segregation is a severe form of punishment that can be used for offenders found guilty of a serious disciplinary offence.[120] This is the most severe punishment authorized under the CCRA. It is limited to 30 days but can be extended to 45 days in the case of multiple disciplinary offences.[121]

Administrative segregation is a last-resort measure intended to prevent an offender from associating with other offenders.[122] An administrative segregation order must be based on one of the following three grounds:

• To prevent behaviour that could jeopardize the safety of any person or the security of the penitentiary, including employees and other inmates;
• To allow for an investigation that could lead to a criminal charge or a charge of a serious disciplinary offence under subsection 41(2);
• To provide services to the inmate whose safety would be jeopardized in the general inmate population.[123]

Unlike disciplinary segregation, there is no limit on the duration of administrative segregation, although the CCRA provides that an inmate must be returned to the general inmate population as soon as possible.[124] Some witnesses argued that administrative segregation often runs on for too long. In his 2008-2009 report, the Correctional Investigator expresses concern over the high number of offenders placed in administrative segregation for 60 days or more. It has been demonstrated repeatedly that risks to health increase over time. The Committee agrees with the Correctional Investigator that “[t]he practice of confining offenders with mental disorders to prolonged periods of isolation and deprivation must end. It is not safe, nor is it humane.”[125] Moreover, an extended period of segregation can also delay an offender’s rehabilitation and release due to the interruption of correctional programs.

It should be noted that the case of an inmate placed in administrative segregation must be reviewed regularly pursuant to section 33 of the CCRA and sections 19 to 23 of the Corrections and Conditional Release Regulations (Regulations). The Regulations provide that, the day after the inmate is placed in segregation, the institutional head must confirm the confinement order or order that the inmate be returned to the general prison population. This requirement also applies for offenders in voluntary confinement. When the institutional head confirms the administrative segregation order, a segregation review board within CSC must conduct a hearing within five working days of the order and every 30 days thereafter. The CSC regional head or designated regional staff member must also review the inmate’s case after 60 days in administrative segregation to determine if segregation is still justified.

5.10.2    Administrative Segregation as a Default Option

Offenders with mental health problems who have irrational, impulsive and compulsive behaviour are often involved in altercations with staff and other inmates. In such cases, the staff’s inability to recognize symptoms of mental illness leads to decisions based more on security and repression than on treatment and intervention.

The Committee is concerned that CSC has not acted more quickly to establish intermediate care units to treat these offenders in units suited to their needs. The Committee agrees with its witnesses that establishing such units would address serious weaknesses in the current management of this population. Such units would provide a safe place for offenders requesting segregation because they do not feel same among the general population. These units would also help offenders who do not meet the regional treatment centre admission criteria and have to remain in the correctional facility, where mental health resources are limited. For offenders returning from a stay at a regional treatment centre, such units would also provide for a gradual and safe transition from the therapeutic and clinical setting of the regional treatment centre to the general inmate population. According to the Correctional Investigator, the use of segregation as a substitute for intermediate mental health care cannot be justified in any case.[126] The Committee therefore recommends:

RECOMMENDATION 51

That Correctional Service Canada give priority to admitting into intermediate care units (newly created by Committee recommendation 26) offenders with mental health problems who would normally be subject to administrative segregation to protect them from other offenders.

The Committee is also very concerned about offenders placed in segregation as a way of managing their self-destructive behaviour (suicide attempts and self-mutilation). Depriving an offender of human contact is considered detrimental to rehabilitation and in fact exacerbates suicidal and self-mutilation behaviour. The Committee encourages CSC and its employees to use intervention methods first to calm offenders.

The Committee agrees with the Correctional Investigator who states in his June 2008 report, A Preventable Death, that administrative segregation should never be used as punishment or as a way around disciplinary segregation. Since administrative segregation is not a punitive measure, the offender must have the same rights, privileges and detention conditions as other offenders.

The Committee therefore recommends:

RECOMMENDATION 52

That Correctional Service Canada use administrative segregation in only the most limited circumstances, under very strict regulations and as a last resort.

RECOMMENDATION 53

That Correctional Service Canada ensure that when administrative segregation is used, it is in its mildest form, on a graduated basis and of the shortest duration possible in order to achieve the desired outcome.

RECOMMENDATION 54

That Correctional Service Canada recognize that administrative segregation is not conducive to the treatment of offenders with mental health diagnoses and that human contact is essential to their rehabilitation and, where possible, facilitate their treatment with a health-care approach.

5.10.3    Seeking Innovative Solutions

The Committee noted that, in both Norway and England, segregation is seen as a necessary evil in dealing with a crisis. However, in England, offenders are systematically evaluated before being placed in segregation to identify underlying mental health issues. This is a promising approach that seeks to promote the well-being of offenders with mental health issues. England and Wales also have a centre providing close supervision of dangerous and troublesome offenders who refuse to or have difficulty obeying prison rules. These centres are an alternative to placing these offenders in segregation for extended periods. During its visit, the Committee observed that these centres take a humane approach in managing difficult cases, with an emphasis on offender rehabilitation. During its study, the Committee also learned that some prisons in England and Wales never use segregation to manage their inmate population.

Johanne Vallée, CSC Deputy Commissioner, Quebec Region, noted that a regional advisory committee was created in that province to find alternatives to long-term segregation. A peer program was also created as an alternative for offenders who do not want to leave segregation. Dr. Ruth Martin pointed out that at some centres offenders are placed in special units rather than segregation. In these units, the offenders benefit from the daily assistance provided by counsellors, psychiatric nurses and community workers.

The Committee is convinced that correctional facilities that use innovative alternatives to segregation provide an environment that is more conducive to the rehabilitation of offenders with mental health issues. Indeed, all offenders would benefit from a therapeutic environment conducive to their well-being and good mental health. The Committee therefore encourages CSC to find alternatives to segregation in the correctional system.

In view of these considerations, the Committee recommends:

RECOMMENDATION 55

That Correctional Service Canada (CSC) examine the use of segregation for offenders with mental health problems in order to develop alternative solutions for this clientele. In order to do so, the CSC must take into account the opinions of wardens, front-line workers, including correctional officers, and best practices in other countries that have reduced the use of segregation.

5.10.4    Independent Adjudication to Address Accountability and Transparency Problems at Correctional Service Canada

The Canadian Charter of Rights and Freedoms (hereafter the Charter) applies to and plays an important role in the correctional system, especially for the protection of inmate integrity. Various provisions of the Charter have been incorporated into the CCRA in order to uphold offenders’ human rights. Under the CCRA, CSC must provide for the humane custody and treatment of its correctional clientele. This guarantee is especially important in the correctional setting where the clientele is most vulnerable.

Several major studies[127] and numerous recommendations have called on CSC to use an independent adjudication process to review the placement of inmates in administrative segregation. Yet neither CSC nor the Minister of Public Safety has acted on these recommendations. The Committee is disappointed that CSC has ignored the recommendations of corrections experts. We believe that an independent mechanism is necessary not only to ensure the transparency of CSC decisions, but also to identify any violation of these offenders’ human rights. The Committee fears that there may be abuse without such a mechanism. The Committee therefore recommends:

RECOMMENDATION 56

That Correctional Service Canada immediately conduct an independent review of all cases of long-term administrative segregation and have an independent outside agency validate and assess the review of these cases.

5.11    RECOGNIZING THE IMPORTANCE OF CORRECTIONAL PROGRAMS FOR THE REHABILITATION AND SAFE REINTEGRATION OF OFFENDERS

It is widely recognized that it is in society’s interest as a whole for correctional services to respond appropriately to the needs of offenders in their custody. These needs pertain to mental health problems, addictions and any other problem affecting their ability to function in the community as law-abiding citizens. In this regard, research has shown that correctional programs that address criminogenic factors are effective in reducing recidivism, which makes them a strategic investment. CSC’s internal documents show that, for every dollar invested in correctional programs, CSC saves four dollars in incarceration costs.[128]

CSC currently relies on a number of correctional programs, including programs for anger management, violence prevention, sex offenders and addictions. According to the evidence heard in Canada, Oslo and London, CSC is a leader in this field. Moreover, a number of the prison programs offered in Norway, England and Wales are based on CSC programs.

As stated above, while all CSC institutions offer correctional programs, a number of offenders do not have timely access to them due to insufficient human or financial resources or lack of space. At all the institutions visited, there are long waiting lists for programs. According to the Correctional Investigator, there were 13,353 men and women in federal correctional institutions as of May 10, 2009, 3,190 of whom were in basic correctional programs. “This means that in every region of the country there were dozens and dozens of offenders waiting for program assignment, with unmet needs in terms of their correctional plan.”[129]

5.11.1    The Need to Immediately Increase Funding for Programs

CSC currently spends about $37 million per year on correctional programs: this covers training, quality control, management and administration costs.[130] Correctional programs addressing criminogenic factors account for just 2 to 2.7% of the total correctional budget. A number of witnesses lamented this state of affairs, pointing out that without increased funding it will be difficult for CSC to provide inmates with access to programs that can address the social inadequacies at the root of their criminal behaviour.

Appearing before the Committee in Ottawa, CSC Senior Deputy Commissioner Marc-Arthur Hyppolite stated that CSC had recently received additional funding[131] for the implementation of a new Integrated Correctional Program Model (ICPM), which has been in trials in the Pacific Region since 2010. Like other witnesses who appeared before the Committee, Mr. Hyppolite seemed confident that the upcoming implementation of this framework will enable CSC to improve access to correctional programs for all federal offenders and reduce dropout rates. CSC has every hope that the ICPM will:

• Give inmates access to programs much earlier in their sentence;
• Allow CSC to accept more offenders into programs on an ongoing basis;
• Help CSC ensure that offenders participate in and successfully complete programs in a timely manner.

The Committee hopes that this CSC initiative will be successful in giving offenders timely access to the programs included in their correctional plan. The Committee maintains however that this initiative alone is insufficient. Like a number of our witnesses, the Committee concludes that without a significant increase in the budget for correctional programs, CSC will not be able to effectively respond to help offenders reintegrate safely in the community.

Since CSC sending on correctional programs addressing factors contributing to crime is currently inadequate, the Committee recommends:

RECOMMENDATION 57

That Correctional Service Canada substantially increase its budget for correctional programs addressing factors contributing to crime, including drug and alcohol abuse and mental health problems.

In order to maximize investments in correctional programs and offender rehabilitation, the Committee is also of the opinion that CSC should use peer counsellors more extensively. This approach relies on the participation of offenders to bring about change in other inmates with similar problems. This method can be very effective for rehabilitation. Using peer counsellors might also improve CSC’s ability to meet offenders’ needs relating to mental health and addiction. The Committee therefore recommends:

RECOMMENDATION 58

That Correctional Service Canada provide for the training and increase the use of peer counsellors.

5.11.2    A Need to Expand the Range of Programs Offered to Federal Inmates

The Committee supports all the programs currently offered in the federal correctional system. The evidence gathered from inmates, corrections officers and professionals indicates however that CSC should expand its range of correctional programs. Similarly, the Committee agrees that the period of incarceration must be fully utilized to engage offenders in obtaining the necessary tools for their successful reintegration in the community as law-abiding citizens. The Committee therefore recommends:

RECOMMENDATION 59

That Correctional Service Canada increase the use of craft rooms and workshops and expand the range and number of creative, recreational, arts and music programs as well as other therapeutic programs.

The offenders who took part in the Committee’s study reported very positive experiences with some CSC programs. Some noteworthy programs brought to our attention included those based on animal therapy such as the Horses as Healers program at the Okimaw Ohci Healing Lodge, located in the Necaneet First Nation, in Maple Creek, Saskatchewan, and the farm prison program currently offered at six correctional facilities operated by CSC.[132]

Research shows that attachment to an animal has an overall favourable impact on the person physically, psychologically and emotionally.[133] Programs based on animal therapy can reduce depression and anxiety, develop self-esteem, and assist in the learning of compassion and various social skills including respect for others, discipline and a sense of responsibility. In the correctional setting, interaction with animals can also be a calming influence for inmates and staff, fostering an atmosphere that is more relaxed and conducive to rehabilitation. The results of an evaluation of the dog training program at the Nova institution for women showed that it: “builds the offenders’ self-esteem, produces positive changes in the institutional environment, and changes the community’s perception of women inmates at Nova Institution.”[134]

A literature review conducted by CSC concludes that animal therapy programs not only help participants by improving their behaviour and learning about discipline, as well as their sense of cooperation and respect for others; they also help the staff of correctional institutions since the presence of animals makes the atmosphere more relaxed and encourages communication among inmates.[135] Finally, society as a whole would benefit from these programs since the participating inmates would learn skills that would serve them well in the labour market and would reduce the rate of recidivism.[136]

Animal therapy programs have proven effective and all participating inmates believe that these programs have undeniable benefits at the human level. For this reason, the Committee has difficulty understanding why CSC decided to terminate the farm prison program at penitentiaries by March 31, 2011. Like many of our witnesses, the Committee is convinced that CSC is on the wrong path in this regard and maintains that CSC should actually increase the number of programs based on animal therapy.

In view of these considerations, the Committee recommends:

RECOMMENDATION 60

That Correctional Service Canada restore its prison farm program, which is an excellent rehabilitation tool, also serving as animal therapy.

RECOMMENDATION 61

That the federal government, acknowledging the imperative nature of preparing inmates for reintegration into the community, recognize the unique rehabilitative needs of offenders struggling with mental health and addictions, and put a greater focus on rehabilitation programs that have offenders working with living things, which research has shown has a calming and restorative effect on inmates, and helps them develop qualities that offenders often lack, like a sense of self worth, respect and empathy, as well as essential life skills like a sense of responsibility, dependability and teamwork, and that Correctional Service Canada explore and implement the use of pet therapy programs and other therapeutic use of animal husbandry.

Women inmates in provincial and federal facilities are often mothers. According to CSC, about two-thirds of women in their custody have children under the age of five, and most of them are single mothers. The incarceration of these women has a huge impact on their children. Research has shown that “young children who are forcibly separated from their mothers suffer long-term developmental and emotional damage.”[137]

To counter the harmful effects of imprisonment on children, a number of countries have developed mother-child correctional programs. Under a number of programs, children born in prison remain with their mother for a certain period of time. Other programs allow children to stay with their mothers in detention under certain conditions. CSC established a mother-child program in 1996-1997. For a long time, this was a pilot project; CSC officially established it in 2001.

Commissioner’s Directive No. 768 states that the mother-child program is designed to create a supportive environment that fosters and promotes stability for the mother-child relationship. Under this directive, CSC identifies two levels of participation in the program: full-time residency and part-time residency, where the child stays with the mother on weekends, holidays or school vacations. The upper age limit for full-time residency is four years (at the fourth birthday) and twelve years (at the thirteenth birthday) for part-time residency. Exceptions to this rule may be considered upon written request; the request must be approved by the Deputy Commissioner for Women and the Regional Deputy Commissioner.

Under the Commissioner’s Directive, the institutional head is responsible for ensuring that all decisions are made in the child’s best interests, including safety and physical, emotional and spiritual well-being. The former Deputy Commissioner for Women, Ms. Van Allen, also pointed out that the institutional head usually consults with child protection authorities before making any decisions relating to inmates’ children.

Although the program is currently available at the five institutions for women, just one inmate was registered as of November 5, 2009.[138] Ms. Van Allen pointed out that few women have participated in the program since its inception. The Committee hopes that CSC will maximize the use of this program in the future in order to encourage and support women in its custody in terms of assuming their responsibilities as mothers while they are inmates.

In speaking with inmates, the Committee also noted that a number of them were fathers. CSC should also encourage and support these fathers in terms of their responsibilities as parents either by providing parenting skills programs or by encouraging visits from their children.

In the opinion of the Committee, all of these practices would serve to recognize the importance of the parent-child relationship in terms of the well-being and mental health of mothers, fathers and children alike. That said, for all decisions regarding children, CSC must also continue to guarantee that their safety, health and development are not jeopardized.

In view of these considerations, the Committee recommends:

RECOMMENDATION 62

That Correctional Service Canada create a parenting skills program for offenders in institutions by creating partnerships with community and government organizations. This approach could include educational training for children of various age groups, conflict management, weekend family visits, improving children’s reading skills and increasing the number of prison units accommodating mothers and their children.

Finally, the Committee is aware that CSC currently administers five programs for sex offenders: three national programs, high intensity, moderate intensity and low intensity; the Tupiq program that is tailored to Inuit culture; and the program for women sex offenders. Some witnesses argued that the current programs are not suitable for sex offenders with concurrent problems such as mental health issues. The Committee therefore recommends:

RECOMMENDATION 63

That Correctional Service Canada develop and deliver core programs for sex offenders who have developmental delays, bi-polar disorders or other similar limitations that currently make access to present core programming inappropriate.

5.12    ENSURING A SAFE TRANSITION BACK INTO THE COMMUNITY AND REDUCING THE RISK OF RECIDIVISM

In his introductory remarks, Mr. Livingston, noted that “the transition between custody and community can be acutely stressful, psychologically distressing” for inmates with mental health problems. To offset this and to facilitate the rehabilitation of these inmates, research has shown that correctional services must provide them with transition plans that clearly identify available community resources and, if applicable, that ensure that offenders have a sufficient supply of medication to last until they are able to see a community health service provider.

The statistics we received for the Quebec region indicate that the recidivism rate following release is twice as high for offenders with mental health problems as for other offenders.[139] To counter this trend, CSC must ensure that offenders receive treatment and programs suited to their needs along with sufficient support in the community. Here is what Graham Stewart, former executive director, John Howard Society of Canada, had to say in this regard:

If we don’t make a change, if we can’t bring together the proper treatment, if we don’t have the proper reintegration support for people re-entering the community, you can be sure that being as vulnerable as they are, having the difficulty they have day by day in their lives, they will be back at the door in short order—and not necessarily for serious crimes.[140]

To increase offenders’ chances of success and in the interest of public safety, the Committee concludes that CSC should immediately expand its community correctional services. It should also work on developing links with outside public programs that could offer treatment services and adequate support to offenders on conditional release.

In light of these considerations, the Committee recommends:

RECOMMENDATION 64

That Correctional Service Canada increase the number of half-way beds for men and women to ensure adequate beds in every province and territory.

Like many witnesses, the Committee is of the opinion that the transition from detention to the community would be greatly facilitated by correctional practices that encourage the participation of families, friends and community groups in the correctional setting. In the opinion of the Committee, the participation of persons and groups able to provide appropriate community services and to support offenders as they take control of their lives and health is an important factor in the successful reintegration of offenders. The Committee therefore recommends:

RECOMMENDATION 65

That Correctional Service Canada encourage and increase family visits and re-connection to family, friends and community.

RECOMMENDATION 66

That Correctional Service Canada expand the interaction with community programs, resources and groups to vastly increase both the community involvement in, and the type, number and quality of programs within, the correctional institutions (e.g., sports teams, drama programs, teachers, etc.).

RECOMMENDATION 67

That Correctional Service Canada expand the access of offenders wherever possible and desirable to community resources, programs and visits, in the community.

5.13    PROBLEMS RECRUITING AND RETAINING HEALTH PROFESSIONALS IN THE CORRECTIONAL SETTING

The information gathered by the Committee during its study indicates that CSC has a critical shortage of personnel to meet the needs of federal inmates with mental health and addiction issues. As a result of this shortage, which varies in intensity among regions in Canada,[141] offenders do not receive appropriate care; often they must wait for the services and programs included in their correctional plan. This could delay their release date, or worse, the offender could be released without the treatment and programs needed to increase their chances of success in the community.

According to the evidence gathered, CSC finds it especially difficult to attract and retain health professionals. This can be attributed to various factors including:

• The general shortage of health care workers;[142]
• The complex and difficult environment of penitentiaries due in part to the profile of the correctional clientele;
• The location of institutions;[143]
• The more limited opportunities for development and ongoing training;[144]
• The reluctance of physicians, psychiatrists and psychologists to give up private practice and become employees;[145]
• Professional isolation;
• Compensation that is not competitive.[146]

The Committee learned that CSC has attempted to address these issues through partnerships with university departments of medicine, psychology, social work and criminology. These partnerships allow students to do work terms and conduct research at correctional facilities while offering CSC staff opportunities to share their experience by teaching university courses.

Committee also had the opportunity to visit the Regional Psychiatric Centre (RPC) in Saskatchewan and speak with the staff there. This is the only example of a public/private partnership in the federal correctional system. The RPC is built on land owned by the University of Saskatchewan and is the result of cooperative planning between the Province of Saskatchewan, the University of Saskatchewan and CSC.[147] The RPC differs from other regional treatment centres in the importance it attaches to teaching and research. According to evidence we gathered, the RPC is a sought-after employer and CSC does not have any difficulty recruiting mental health professionals for this Centre.

Despite CSC’s success in recruiting mental health workers for some institutions, the Committee agrees with its witnesses that, without additional human resources, CSC will not be able to meet the challenge of managing correctional clientele with mental health and addiction problems. This clientele could also increase as a result of the anticipated increase in the federal correctional population following the enactment of legislation that imposes stiffer sentences for certain offences.[148] To ensure that the correctional clientele that requires mental health and addictions programs and treatment receives the appropriate care, the Committee believes that CSC must develop and implement a new recruitment and retention strategy.

Given the importance of having specialized personnel to provide health care in general and mental health care in particular, the Committee recommends:

RECOMMENDATION 68

That Correctional Service Canada develop an attraction and retention program for psychologists, nurses, psychiatric nurses, occupational therapists, social workers and other necessary professionals, including paying market salaries.

RECOMMENDATION 69

That Correctional Service Canada provide for dedicated budgets for the ongoing training of health professionals in order to make the environment more attractive to them.

5.14    A NEED TO IMMEDIATELY IMPLEMENT THE RECOMMENDATIONS OF THE REPORT, A PREVENTABLE DEATH, BY THE OFFICE OF THE CORRECTIONAL INVESTIGATOR

The tragic death of Ashley Smith in 2007 was upsetting to the correctional community and the public in general. It called attention to the urgent need to improve both the quality of mental health care services provided in correctional facilities in Canada and CSC’s ability to do this.

The Correctional Investigator’s report regarding Ms. Smith, A Preventable Death, highlights CSC’s failures with regard to this inmate in particular, as well as many systemic problems in general. The Correctional Investigator lamented the lack of mental health resources and the lack of an independent external review mechanism for cases of segregation. He also pointed to the lack of coordination between correctional services and federal, provincial and territorial health care. The Report of the Ombudsman and Child and Youth Advocate of New Brunswick pertaining to the services provided to Ashley Smith also pointed to the gaps in health care provided to offenders with mental health problems.

In August 2009, CSC responded to the recommendations of the Correctional Investigator, describing in general terms what it intended to do to address the weaknesses identified. In 2010, an updated progress report was released in which CSC expressed its support for eight of the 15 recommendations pertaining to it. While the Committee considers this a positive sign, it maintains that CSC must immediately implement all the recommendations made in the independent and impartial study conducted by the Correctional Investigator. The Committee therefore recommends:

RECOMMENDATION 70

That Correctional Service Canada immediately implement all of the recommendations made by Howard Sapers, Correctional Investigator, in his report entitled “A Preventable Death,” released in June 2008.

5.15    FOLLOW UP ON RECOMMENDATIONS OF THE ANNUAL REPORT OF THE CORRECTIONAL INVESTIGATOR 2008-2009

The Committee wishes to begin by acknowledging the important work the Correctional Investigator does to ensure that offenders receive fair and humane treatment in the federal correctional system. In his latest report, he makes 19 recommendations and addresses systemic problems in CSC’s application of corrections legislation and policies.

The concerns raised by the Correctional Investigator are similar to the issues the Committee has identified in its study. Mental health, self-harm, health services, correctional programs, types of segregation, Aboriginal offenders, federally sentenced women, deaths in custody and gaps in dynamic security are among the various concerns raised in his report. It is unfortunate that CSC has not yet implemented all the Correctional Investigator’s recommendations, which in the Committee’s opinion would increases CSC’s ability to deal with the many issues relating to the makeup of its prison population. The Committee therefore recommends:

RECOMMENDATION 71

That Correctional Service Canada implement all recommendations of the Office of the Correctional Investigator 36^th Annual Report to Parliament (2008-2009) not contained herein.