zinger mental health in federal corrections_key challenges and lessons learned

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Mental Health in Federal Corrections:Key Challenges and Lessons Learned

Mount Royal UniversityCalgary, Alberta

Ivan Zinger, LL.B., Ph.D.Executive Director and General Counsel

Office of the Correctional Investigator

May 25, 2011

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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 CorrectionalInvestigator (OCI): Role and Mandate

The Office of the Correctional Investigator (OCI) acts as anOmbudsman 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) hasacted 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 ConditionalRelease Act.

TheActgives the OCI broad authority and the responsibility toinvestigate 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 directlyinvolved in the day-to-dayaddressing of inmatecomplaints. On average, theOffice receives 6,000 offendercomplaints annually.

In 2009-10, investigatorsspent in excess of 330 days infederal penitentiaries andinterviewed more than 1,600offenders.

The Office received 30,000contacts on its toll-freenumber and conducted over1,400 use of force reviews.

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AREASOFCONCERNMOSTFREQUENTLYIDENTIFIEDBYOFFENDERS(2009-10)

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CSC Obligations to Provide PhysicalHealth and Mental Health Care

Pursuant to s. 86 of the CCRA, CSC shall provide everyinmate with essential health care and reasonable accessto non-essential mental health care that will contribute tothe inmates rehabilitation and successful reintegration intothe community.

CSC is further obligated to consider an offenders state ofhealth and health care needs in all decisions, includingplacement, transfer, segregation, discipline and communityrelease and supervision (s.87, CCRA).

CSC policy on Mental Health Services (CD-850) statesthat a continuum of essential care for those suffering frommental, emotional or behavioural disorders will be providedconsistent with professional and community standards.

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Prevalence of Mental Health Concerns

Proportion of federal offenders with significant, identified mental health needs hasmore than doubled between 1997 and 2008.

According to an evaluation of the CSC Computerized Mental Health IntakeScreening System (ComHISS), implemented in FY 2009/10, 36% of offenders hada significant mental health diagnosis at admission requiring some level ofpsychological or psychiatric services.

In 2010, it was estimated that 35% of federal offenders had been diagnosed witha 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 forwomen 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 infederal 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 theirillness through disruptive behaviour, aggression, violence, self-mutilation, suicidal ideation, withdrawal and refusal/inability to

follow prison rules and routines.

Symptoms of mental illness are too often considered to bemaladaptive acting out behaviours and frequently subject tosecurity or use of force interventions, and disciplinary measures.

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Mental Illness and Prisons

Managing offenders with MH issues in prison createsprofessional and operational dilemmas related to conflictingpriorities and objectives:

security vs. treatment;

inmate vs. patient;

assistance vs. control; and,

prison vs. hospital.

Correctional staff are ill-equipped to recognize and deal withoffenders with significant MH issues.

Confidentiality/privacy concerns sharing information betweencorrectional 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 houseoffenders 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 withmentally 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 theMinister of Health, initiate discussions with their provincial/territorialcounterparts and non-governmental stakeholders regarding how tobest engage the Mental Health Commission of Canada on thedevelopment of a National Strategy for Corrections that would

ensure a better coordination among F/P/T correctional and mentalhealth systems.

2. I recommend that the CSC undertake a broad consultation withfederal/provincial/territorial and non-governmental partners to reviewthe provision of health care to federal offenders and to proposealternative models for the provision of these services. Thedevelopment of alternative models should include publicconsultations.

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Concluding Remarks

The federal offender profile can be used as a barometer togauge the successes and failures of key Canadian publicpolicies. With a prevalence of 36% of serious MH issues atadmission, the profile reveals significant gaps in access tocommunity mental health services and support.

No single agency or jurisdiction has control or ownership overthe issue of mental health. Leadership of FPT Ministersresponsible for PS and Health, as well as the MHCC, will becritical 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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