Correctional institutions in Canada, like those in many countries, including Norway and England, accommodate large numbers of inmates suffering from mental disorders and drug and alcohol addiction. In Canada, some 80% of offenders serving prison sentences of two years or more have problems with drugs and/or alcohol. Approximately one in ten male inmates (12%), and one in five female inmates (21%), suffer from serious mental disorders upon admission to a federal correctional institution.[1]

This is not a recent development. Research has clearly shown that the correctional community, here as in elsewhere, is in poorer health overall than the population at large. The House of Commons Standing Committee on Public Safety and National Security (hereafter the Committee) is concerned however about the scope of this phenomenon within Canada’s federal correctional system, and the lack of resources to enable Correctional Service Canada (CSC), which is responsible for the custody of offenders sentenced to two years or more, to meet the growing mental health and addiction needs of federal offenders.

This report contains the Committee’s observations and recommendations based on its review of the policies, practices and programs adopted by CSC to provide treatment and support for federal offenders affected by mental disorders or addiction. The review highlighted the urgent need for an expansion of CSC’s capacity to meet the growing needs of these offenders. The situation demands decisive federal government action; the Committee believes this should include the immediate allocation of additional financial resources to CSC for this purpose. The CSC should in turn give priority to improving how it deals with mental health disorders and addiction issues. This is a public safety issue because offenders who fail to receive appropriate treatment while in custody are more likely to reoffend after release, thus threatening the security of all Canadians.

That said, the Committee agrees with those who have testified before it that as far as possible, people suffering from mental disorders and addictions should not end up in detention because of these problems or the lack of community ressources. Correctional institutions should not be serving as hospitals by default. In general, prison is not suited to caring for people affected by such problems. Indeed, mental health experts agree that the prison environment is harmful to mental health. Moreover, because of the constraints inherent in the prison setting, therapeutic interventions are complicated and expensive.

Like its witnesses, the Committee has concluded that CSC alone cannot cope with mental health and addiction problems in prisons. The criminalization and incarceration of those suffering from mental disorders or addictions is part of a broader context in which various players—government and non-government agencies—are active: the healthcare, social services and justice sectors. To avoid imprisoning people inappropriately because of their mental health disorders or addictions, all participants in the system have to work more closely together. Governments will have to establish a comprehensive, integrated and efficient mental health system based on promoting mental health and preventive care, early detection of mental disorders and addictions, access in the community to effective care and treatment and, as appropriate, the reintegration of those affected.

The Committee’s study has also shed light on the need for rapid intervention, well before those concerned come into conflict with the law. When a crime is committed, there must be a capacity to assess the mental health of the accused in order to refer him or her to appropriate healthcare and support services and acquaint court officials with the accused’s requirements. The Committee shares the view of most of its witnesses that such an approach is more consistent with the rights of those suffering from mental disorders and addictions and could generate substantial cost savings in the long run. Imprisonment is expensive and generally unsuited to caring for those rendered vulnerable by mental disorders and addiction issues.

1.1       THE COMMITTEE’S MANDATE AND PROCEDURE

The Committee decided in April 2009[2] to conduct a study of mental health and addictions in the federal correctional system, after examining relevant information on the tragic death of Ashley Smith, a young woman of 19 who committed suicide in 2007 while detained at the federal Grand Valley Correctional Facility in Kitchener, Ontario.[3]

The Committee’s mandate was to examine the policies, practices and programs adopted by CSC to meet the needs of federal offenders suffering from mental disorders and addictions, and to study best practices in the field.

From June 2, 2009 to April 1, 2010, the Committee held ten public hearings in Ottawa and approximately 10 informal sessions at correctional institutions in Saskatchewan, Ontario, Quebec and New Brunswick during which it gathered evidence from representatives of CSC, the Office of the Correctional Investigator of Canada (OCI), the departments of Public Safety and Justice, the Mental Health Commission of Canada, the Canadian Mental Health Association, the Centre for Addiction and Mental Health, the John Howard Society of Canada, the Canadian Association of Elizabeth Fry Societies and numerous experts and stakeholders in the correctional, addictions and mental health fields, including a number of specialized tribunals.[4]

In Canada, the Committee visited as many correctional facilities as possible during the time available to it. Generally speaking, the institutions visited were of various sizes and security levels and represented a good balance of traditional correctional institutions, Aboriginal healing lodges and regional mental health centres. However, the Committee did not visit any correctional facilities in the Pacific Region, and visited only one institution for women.[5]

The Committee also wanted to place its findings and observations in an international context by travelling to Norway and England, where members spoke with experts and stakeholders in the mental health and addiction field and examined the practices adopted in those countries to address addiction and mental health problems in correctional settings. The Committee wanted to determine whether there were any lessons to be learned from approaches adopted in those countries, more specifically with regard to the provision of mental health and addiction services in prison. Throughout its international travel, Committee members spoke with criminologists, health professionals working in correctional settings, institutional heads, prison guards and persons responsible for correctional services oversight (ombudsmen). Members also visited three prisons for men and a forensic psychiatric hospital.[6]

The Committee’s overseas travel was highly productive, thanks to the input of all the experts and caseworkers it had an opportunity to meet, and the best practices it observed in the delivery of health care in a correctional setting.

In fulfilling its mandate, the Committee also consulted relevant research, in particular the report by Lord Bradley, who was commissioned by the British government in 2007 to conduct an independent inquiry into the care of those with mental health problems or learning disabilities in the criminal justice system. It also reviewed the report by James Livingston, Mental Health and Substance Use Services in Correctional Settings: A Review of Minimum Standards and Best Practices, as well as the Framework for a Mental Health Strategy for Canada, developed by the Mental Health Commission of Canada (MHCC). The Committee also noted the excellent work done by the MHCC since it was established in the spring of 2007 to diminish the stigma and discrimination faced by Canadians living with mental illness and addictions.[7]

Lastly, throughout its study, the Committee noted the dedication and professionalism of staff who work on a daily basis—and often in substandard conditions—with offenders incarcerated at the correctional institutions of Canada, Norway and England, and the vital contribution of CSC volunteers to public safety.

1.2       STRUCTURE OF THE REPORT

This report contains five chapters, including this introduction. Chapter 2 outlines the constitutional division of powers with respect to the correctional and health fields in Canada. Chapter 3 provides some information about the capacity of CSC to address the mental health and addiction needs of offenders. Chapter 4 discusses the prevalence of mental disorders and addictions in the federal correctional system, the vulnerability of offenders affected by such problems and the challenges faced by CSC in the management of its inmate population. Lastly, Chapter 5 includes Committee observations and recommendations designed to correct the deficiencies pointed out by the witnesses it heard from throughout its study.