Mental Health Care Treatment for Inmates in Federal Correctional Institutions Inquiry – Debate Continued


Inquiry: Mental Health Care Treatment for Inmates in Federal Correctional Institutions Senator Jane Cordy June 26th, 2013

On the Order:

Resuming debate on the inquiry of the Honourable Senator Callbeck, calling the attention of the Senate to the need for improved mental health care treatment for inmates in federal correctional institutions, and the benefits of providing such treatment through alternative service delivery options.

Hon. Jane Cordy: Honourable senators, I rise today to speak to the inquiry of the Honourable Senator Callbeck calling the attention of the Senate to the need for improved mental health care treatment for inmates in federal correctional institutions and the benefits of providing such treatment through alternative service delivery options.

I want to thank Senator Callbeck and also Senator Runciman for raising this issue in the Senate. Prison population trends and prison expenditures have shifted considerably over the past six years. Since 2010, the federal prison population has increased by 6.8 per cent while expenditures on federal corrections has seen a 43.9 per cent increase since 2005-06.

The 2011-12 Annual Report of the Office of the Correctional Investigator attributes the trend of increased prison population and expanding expenditures to several factors: first, the expansion of a range of mandatory minimum penalties for certain offences; second, the abolition or tightening of parole review criteria; third, the reduction of credit for time served in pretrial custody; and fourth, the restricted use of conditional sentences.

This all comes at a time of increased budgetary constraints resulting in facilities shutting down and reductions in staffing levels. We are finding that as the prison population grows at a rate that our current infrastructure is struggling to maintain, there are considerable concerns with overcrowding. The practice of double-bunking is now commonplace. This is where two inmates are housed in cells designed for one. Double-bunking is certainly not the best situation for those with poor mental health.

I mention the fact that our federal prison facilities are under increasing capacity strain as this is a major contributing factor to the gaps in mental health care delivery within our federal prison system. The Correctional Investigator identified several priorities to meet inmates' mental health needs, and at the top was the need for more mental health professionals and the need to take steps to retain these professionals, as turnover of health care staff in the prison system is extremely high. Some have referred to the turnover rate of health care staff, particularly those dealing with mental health, as a revolving door.

There is a growing need for proper mental health treatment of inmates in our federal prisons, as the Correctional Investigator highlights in his 2011-12 report. He states that 45 per cent of the total male inmate population and 69 per cent of the female inmate population have received some form of mental health treatment while in prison, including for substance abuse problems. The Correctional Service of Canada has reported that between 1997 and 2008 the proportion of inmates identified at admission with mental health issues doubled. Thirteen per cent of male inmates and 29 per cent of female inmates were identified as having poor mental health.

Prison is not always the best environment for the well-being of an inmate with a mental illness. The prison environment often triggers mental health issues that manifest in violent outbursts, aggressive behaviour, suicidal tendencies, or, honourable senators, the inability to follow prison orders and rules. Other options have to be explored as the current prison system does not have the financial or staffing resources to treat the growing prevalence of inmates with mental health issues.

The Correctional Service of Canada has made progress in many aspects of mental health care within the federal prison system, but many gaps still exist. The Correctional Investigator has made several recommendations to fill these gaps, including the need to recruit more mental health professionals and the need to prohibit long-term segregation. Twenty-four-hour-a-day, seven-day-a- week health care coverage should be provided at all maximum, medium and multi-level institutions. The range of alternative mental health service delivery partnerships should also be expanded.

We have heard of one example of an alternative treatment option administered through the St. Lawrence Valley Correctional and Treatment Centre in Brockville. The institution is run by the Royal Ottawa Health Care Group and provides treatment for male offenders in a hospital environment while providing maximum prison-level security.

I applaud Senator Runciman for his pioneering work in helping to establish the St. Lawrence Valley Treatment Centre, and I support his continuing efforts to establish a similar facility for female inmates. It does not make sense to me why more of these types of partnerships are not more common across Canada. It does not make sense to me why there is so much resistance to an idea that is shown to work. Inmate recidivism rates dropped by 40 per cent for those who received treatment at the St. Lawrence facility. No one has committed suicide while undergoing treatment at the facility, and no one has ever escaped.

As stated in the Correctional Investigator's 2011-12 annual report:

Even today while CSC is legally required to ensure the essential health needs of federal offenders are met, it is not legally required to be the provider of those services. It is common practice for inmates with acute physical health care needs — for example, chemotherapy, dialysis, medical emergency — to be treated in outside community hospitals. However, for some reason, there is much more internal resistance in analogous cases of offenders requiring acute, specialized or complex mental health care services or treatment.

There continues to be a stigma and prejudice to mental health illness in society. The Correctional Service of Canada is not immune to these same prejudices and stigmas. Inmates exhibiting symptoms of mental illness are all too often reacted to with force or punishment, mostly in the form of solitary confinement or segregation. One does not need to be an expert to know that these tactics are not treatment. We all continue to read about the very sad situation of Ashley Smith; the system failed her and her family.

As the prison population grows at a rate that our current infrastructure is struggling to maintain, there are considerable concerns with overcrowding and the effect it has on inmates with mental health issues. The practice of double-bunking is now commonplace and, as I mentioned earlier, double-bunking can be a very negative situation for those who are mentally ill. Overcrowding and segregation can be triggers for inmates with mental health problems to lash out and become harmful to themselves or front-line staff who work with them. The safety of inmates, staff, correctional officers and ultimately the public is jeopardized as prisons become overcrowded and resources for mental health treatment are diminished. This can result in many of those who are released from prison leaving in worse condition than when they went in.

Prison was meant to be a last resort. However, that does not seem to be the case anymore; prison is increasingly used as an only resort. More and more people identified with mental health problems are finding themselves in the federal correction system.

Honourable senators, it is in the public's best interests to provide those inmates with a level of care that ensures proper treatment. As I said earlier, the increased prevalence of poor mental health among inmates in a prison system under increasing financial pressures leaves many inmates in worse shape when they are released than when they were admitted to prison.

At a time when prison population is growing, mental illness prevalence among inmates is growing, facilities are closing down, facilities are becoming overcrowded, and budgets are being cut, we need to look at alternative solutions to mental health care in our inmate populations. Partnerships like the one at the St. Lawrence facility with the Royal Ottawa Health Care Group are necessary and should be encouraged.

Due to budgetary and personnel strains, the Correctional Service of Canada is unable to provide the proper treatment to all those inmates who require it. The safety of inmates, our front-line correctional services staff and the public is at stake when inmates go untreated or are left in situations that trigger reactions from the inmate.

Honourable senators, if those inmates who are mentally ill do not receive the professional help and care that they need while in prison, what will become of them when they are released? It is more likely that they will come to harm themselves or will be returning once again to the prison system.

We can do better.

The Hon. the Speaker pro tempore: Will the Honourable Senator Cordy accept a question?

Senator Cordy: Yes.

Hon. Catherine S. Callbeck: I thank Senator Cordy for speaking on this inquiry. She was on the Standing Senate Committee on Social Affairs, Science and Technology, as I was, when we did the report on mental health. Our major recommendation was to set up a mental health commission, which the previous government announced and this government carried through on.

I think the honourable senator will agree with me that the commission has been doing tremendous work. However, I just became aware the other day that the commission was given a 10- year life, and it is halfway through its mandate now. I know that caused me a lot of concern. I wonder how the honourable senator feels about that commission only having five more years.

Senator Cordy: Senator Callbeck is absolutely right in that we both served on the Standing Senate Committee on Social Affairs, Science and Technology that brought forward that report on mental illness. It was a Liberal government that said it would implement the recommendation to set up a mental health commission, but an election took place. The Conservative government brought forward the recommendation. We know Senator Kirby became the first Chair of the Mental Health Commission. As the honourable senator says, they have been doing great work.

Like the honourable senator, I am troubled to hear rumours that this is a 10-year plan and that, after 10 years, the commission will be gone. That would truly be unfortunate for all Canadians, because we know the numbers of people — one in five Canadians who will at some point in their lives suffer from poor mental health. We know children and youth with mental health issues are falling through the cracks.

We know that services being provided to inmates who have poor mental health are just not what they should be, and we know that some prisoners who are going into jails and correctional services are leaving without having received any help at all.

When I had been doing work on this very issue of prisoners with poor mental health who would be hurt by an omnibus bill, I learned that there is a shortage of staff dealing with mental health issues in the correctional services. The numbers of mental health professionals are far lower than they should be, and when people get in working within the system, they find that the resources are not there and they are leaving. That is a Catch-22 situation, because we are unable to keep staff in the correctional services who are dealing with mental health and mental illness. It is a revolving door and that is unfortunate.

The idea that the Mental Health Commission could be gone within 10 years is truly troubling, Senator Callbeck.