Mental Health in Federal Corrections: Key Challenges and Lessons Learned

Mount Royal University Calgary, Alberta

Ivan Zinger, LL.B., Ph.D. Executive Director and General Counsel Office of the Correctional Investigator May 25, 2011

Presentation Outline
1. The Office of the Correctional Investigator 2. Delivery of Heath Care in Federal Corrections 3. Prevalence of Mental Health Concerns 4. Offenders with Mental Health Concerns 5. Key Challenges 6. Concluding Remarks

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The Office of the Correctional Investigator (OCI): Role and Mandate

The Office of the Correctional Investigator (OCI) acts as an Ombudsman for offenders serving a sentence of two years or more. Independent monitoring and oversight of federal corrections. Accessible and timely investigation of offender complaints. Determines whether the Correctional Service of Canada (CSC) has acted fairly, reasonably and in compliance with law and policy. Makes recommendations to enhance accountability in corrections. Established in 1973, the Office was formally entrenched in legislation in November 1992 with the enactment of the Corrections and Conditional Release Act. The Act gives the OCI broad authority and the responsibility to investigate offender complaints related to decisions, recommendations, acts or omissions of CSC.
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OCI Operations
The Office has 32 staff, the majority of which are directly AREAS OF CONCERN MOST FREQUENTLY IDENTIFIED BY involved in the day-to-day OFFENDERS (2009-10) addressing of inmate complaints. On average, the Office receives 6,000 offender complaints annually. In 2009-10, investigators spent in excess of 330 days in federal penitentiaries and interviewed more than 1,600 offenders. The Office received 30,000 contacts on its toll-free number and conducted over 1,400 use of force reviews.

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CSC Obligations to Provide Physical Health and Mental Health Care

Pursuant to s. 86 of the CCRA, CSC shall provide every inmate with essential health care and reasonable access to non-essential mental health care that will contribute to the inmates rehabilitation and successful reintegration into the community. CSC is further obligated to consider an offenders state of health and health care needs in all decisions, including placement, transfer, segregation, discipline and community release and supervision (s. 87, CCRA). CSC policy on Mental Health Services (CD-850) states that a continuum of essential care for those suffering from mental, emotional or behavioural disorders will be provided consistent with professional and community standards.
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Prevalence of Mental Health Concerns

Proportion of federal offenders with significant, identified mental health needs has more than doubled between 1997 and 2008. According to an evaluation of the CSC Computerized Mental Health Intake Screening System (ComHISS), implemented in FY 2009/10, 36% of offenders had a significant mental health diagnosis at admission requiring some level of psychological or psychiatric services. In 2010, it was estimated that 35% of federal offenders had been diagnosed with a mental illness, had a current medication order for psychotropic medication, or were receiving ongoing psychiatric evaluation or psychological intervention. In 2009, the prevalence rate of mental health concerns the Pacific Region for women offenders was estimated at 70%. Incidents of serious self-harming behaviour in federal prisons (e.g. head banging, slashing, use of ligatures, self-mutilation) are rising (doubling between 2006 and 2008); one in four women offenders has a history of self-harm. On average, 11-13 federal inmates commit suicide annually. The rate of suicide in federal custody is approximately 7 times higher than the national average.

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Offenders with Mental Health Concerns

Offenders with a diagnosed mental disorder are typically afflicted by more than one disorder (90%), often substance abuse (80%). Offenders with mental health problems are more often: Victims of violence, intimidation and bullying. Placed in administrative segregation. Classified at higher security levels. Unable to complete correctional programs. Released later in their sentences. Offenders with mental health issues may exhibit symptoms of their illness through disruptive behaviour, aggression, violence, selfmutilation, suicidal ideation, withdrawal and refusal/inability to follow prison rules and routines. Symptoms of mental illness are too often considered to be maladaptive acting out behaviours and frequently subject to security or use of force interventions, and disciplinary measures.
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Mental Illness and Prisons

Managing offenders with MH issues in prison creates professional and operational dilemmas related to conflicting priorities and objectives: security vs. treatment; inmate vs. patient; assistance vs. control; and, prison vs. hospital.

Correctional staff are ill-equipped to recognize and deal with offenders with significant MH issues. Confidentiality/privacy concerns sharing information between correctional staff and health care professionals.

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Challenges for Federal Corrections

System is facing serious capacity, accessibility, quality of care and service delivery challenges: Limited capacity and resources to address growing MH needs. Lack of bed space at CSC regional psychiatric facilities. Lack of intermediate mental health care capacity. Segregation too often remains only alternative to house offenders with acute mental health symptoms or who self-harm. Aging and inappropriate infrastructure. Recruitment and retention of mental health care professionals. Training for front-line staff in recognizing and dealing with mentally disordered offenders. Limited capacity to address chronic self-harm. Relief for stressed and fatigued staff.

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Two OCI Recommendations

(A Preventable Death, 2008 Ashley Smith)

1. I recommend that the Minister of Public Safety, together with the Minister of Health, initiate discussions with their provincial/territorial counterparts and non-governmental stakeholders regarding how to best engage the Mental Health Commission of Canada on the development of a National Strategy for Corrections that would ensure a better coordination among F/P/T correctional and mental health systems. 2. I recommend that the CSC undertake a broad consultation with federal/provincial/territorial and non-governmental partners to review the provision of health care to federal offenders and to propose alternative models for the provision of these services. The development of alternative models should include public consultations.

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Concluding Remarks
The federal offender profile can be used as a barometer to gauge the successes and failures of key Canadian public policies. With a prevalence of 36% of serious MH issues at admission, the profile reveals significant gaps in access to community mental health services and support. No single agency or jurisdiction has control or ownership over the issue of mental health. Leadership of FPT Ministers responsible for PS and Health, as well as the MHCC, will be critical to ensure all players and stakeholders work together. The MHCC Mental Health Strategy will need to include a strong Criminal Justice component to ensure that those who suffer from

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