Evidence of meeting #43 for Public Safety and National Security in the 40th Parliament, 2nd Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was facility.

A recording is available from Parliament.

On the agenda

MPs speaking

Also speaking

Glenn Thompson  Secretary of the Board, Mental Health Commission of Canada

11:10 a.m.

Conservative

The Chair Conservative Garry Breitkreuz

I'd like to bring this meeting to order.

This is the Standing Committee on Public Safety and National Security, meeting number 43, and we're continuing our study of federal corrections: mental health and addictions.

Today we welcome Mr. Glenn Thompson, secretary of the board of the Mental Health Commission of Canada.

Welcome, sir, to our committee. We look forward to the input you will have.

The usual practice is to allow you an opening statement. You're the only witness today. If you need more than 10 minutes, I'm sure the committee would allow for that.

Do you have a statement prepared?

11:10 a.m.

Glenn Thompson Secretary of the Board, Mental Health Commission of Canada

I do, Mr. Chair, and I'm very happy to have that opportunity. I believe the members will have a copy of what I'm going to be saying as well. If they happen to want to follow along or refer back to it as we go along today, they'll be able to do that.

I want to say, first of all, that you've been very patient with us at the Mental Health Commission because you've invited us to come here, three of us. Mr. Préfontaine has worked very hard to try to get the three of us here. Judge Ted Ormston, who is the chair of one of our advisory committees, our chief operating officer, and I as secretary of the board were intending to come along. We haven't been able to find a date that you had and was possible for us. But I'll just say to you that if you have further interest after this meeting, Mr. Chair and members of the committee, in hearing more from us, I'm sure those other people will be able to make time for you individually, collectively, or however you'd like to do it. So thank you for inviting us.

I want to move right along, and I want to situate my remarks—as you would expect me to do, I think, since I'm from the Mental Health Commission—about mental health and addiction care for federally incarcerated offenders in the context of the work of the Mental Health Commission of Canada.

The MHCC, as I'll refer to it as a short form, had its origins in the report tabled by the Standing Committee on Social Affairs, Science and Technology. That report was tabled in May 2006 and was prepared under the leadership of someone many of you will know, the Honourable Michael Kirby, and his deputy chair for that committee, Dr. Wilbert Keon.

Appropriately titled “Out of the Shadows at Last”, this was the first ever—it's hard to believe for somebody like me who has worked in correctional services since 1960 and in the mental health field—comprehensive study of mental health, mental illness, and addiction services in Canada. Many of you may have seen that report. If you haven't, it's that thick. It's well worth referring to. It has a specific section referring to the federally incarcerated offender group and the work of the Correctional Service of Canada, which would be helpful.

Their process in that committee, the Senate committee, was to make proposals that would transform the systems and services provided for persons living with a mental illness and/or addictive behaviours in Canada. Some of you will know that about 60% of the people who have a mental illness also have a substance abuse problem. So the crossover is very high.

One of the 118 recommendations in that report proposed the creation of a Mental Health Commission. The purpose of this national, not federal, commission was to provide a body empowered to accelerate the development and implementation of effective solutions and to maintain a needed national focus on mental health issues. Again, if any of you know Michael Kirby, you'll know he makes it his business to keep a focus on whatever task he is given. In all of the activities of the commission, we strive to be a catalyst for change. So that's our byword. In the federal budget of March 2007, the federal government announced the creation and funding of a Mental Health Commission with Michael Kirby as its chair.

The commission was asked to focus on certain specific tasks. They are the development of a mental health strategy for Canada, the development of a knowledge exchange centre for this field, and the creation and implementation of a 10-year anti-stigma/anti-discrimination program. And then subsequently, the federal government asked the commission to establish a five-year research/demonstration project for homeless mentally ill persons situated in five cities in Canada. Some of you will be familiar with that activity, which is very much under way at the moment.

The commission itself has a 10-year life, so it will run on longer than do those demonstration projects in homelessness.

The commission has just published a phase one report concerning the mental health strategy. It is the product of an extensive consultation across Canada. All of you as members, I think, have received it. It's the product of an extensive consultation across Canada to determine what should be included in a national strategy.

Entitled Toward Recovery and Well-Being: A Framework for a Mental Health Strategy for Canada, this report provides a comprehensive, high-level platform for the next stage of development and consultation. This second phase will present the “how”--what should be in the strategy for Canada for mental health and justice, for example, the whole justice field. So this second phase is going to work on the “how” of the transformation, is expected to be completed by late 2011.

For example, it will include what are eight distinct advisory committees, such as the one chaired by Judge Ted Ormston. Judge Ted Ormston will provide what the public government bodies, our staff, and those various persons, perhaps you yourselves, believe should be in sections of the report. It's certainly going to deal with the widest possible range of mental health and addiction matters, from children and youth to seniors, to addicted persons, to those who fall into the criminal justice system.

I trust that committee members will have that report. Mr. Préfontaine indicates that you received it.

The Toward Recovery and Well-Being report could be useful to this committee as you perhaps consider the value of a national mental health and substance abuse strategy for the Correctional Service of Canada. We believe that such a strategy could be useful in providing a sound framework for determining funding priorities, program development, and change within the Correctional Service of Canada. We encourage that if they do, or you do, recommend that they undertake having a national strategy for corrections, it be integrated with the national strategy that the Mental Health Commission is developing. It makes sense to have sub-strategies, if I can put it that way, across Canada. The last thing we need in this poor old mental health and criminal justice field is more fragmentation. We've got plenty of that.

Just as the general mental health and addiction service system is poorly integrated and with many challenges as clients move through it--maybe you have relatives, as almost all of us do, who have moved through the mental health system--we know how fragmented it is, so also is the criminal justice system faced with similar obstacles, but ones that are often even more substantial. A mental health strategy for the Correctional Service of Canada could be a good start.

Stigma, and the discrimination that emanates from it, is a hurdle that Canadians must overcome if the mental health and addiction service is to function to best effect. The commission's Opening Minds program was recently launched, and the campaign that goes with it is absolutely essential in raising public awareness about stigma and its impacts. Most of us who work at the Mental Health Commission don't think that the changes we're involved in and helping to promote are going to get very far unless there is a reduction in the stigma and discrimination against people in corrections.

Just as stigma is a large issue to overcome with the general public, the stigma and fear that attaches to criminal behaviour when combined with mental illness is a much greater challenge. It's our view that any program to transform mental health and addictions care for the Correctional Service of Canada will need to be accompanied by an anti-stigma program directed at staff and other inmates, as well as the general public.

You might be interested to know that the stigma program, the general one that we're operating, is focusing first on the area of stigmatization of youth and also the stigmatization of mentally ill people within the health care system. Our vice-chair, Dr. David Goldbloom, a very well-known doctor in Canada, a psychiatrist, would be the first to say that patients who come to hospitals for general care face a tremendous amount of discrimination from all levels of staff within the system. All of us have grown up with this kind of sense of apprehension about what to do about the mentally ill, and physicians aren't any different. They get relatively little training. For general practitioners in this area, when someone appears who has a mental illness, it's very difficult to know what to do, and to do it in a short time. If you have a broken arm, they're much more adroit at handling that.

So training and retraining will be vital aspects of system and service delivery transformation for mental health and addictions in the criminal justice system. We believe that a robust knowledge transfer and exchange program should accompany this training for it to have the most widespread and highest impact.

I know from my past work in the mental health field that the Community Living agency in Ontario, a very large agency devoted to helping people who are developmentally challenged, has a marvellous and very expensive website that people who are staff in institutions can go to and refer to documents written by other staff who write in layperson's language so that people can understand it, whether it's in the middle of the night or in the middle of the day when they're trying to find something out.

There are literally thousands of people who work in correctional services and the criminal justice system in Canada. We need to give them easier access to information that will help them do their work. The Mental Health Commission is not a traditional service agency. Its central methodology is to establish research demonstration projects, often in partnership with other agencies, in a wide variety of sectors as we search, or help others search, for better ways to structure the system and to provide service.

My personal experience with correctional services over the years has been that the system has shifted from one set of programs and beliefs to another without ever having sufficient research to know what has had the best effect. I watched it for twenty years while I was in the correctional services department in Ontario, and we went from industrial farms to treatment to educational programs. It was whatever the government of the day or the staff of the day thought might work best, but it was very poorly researched. That's been the history of correctional services in Canada.

Your committee, I think, has an opportunity to suggest that research demonstration projects become a key component of any major changes that may be instituted within the Correctional Service of Canada. For those persons faced with a serious mental illness under the responsibility of CSC, there are regional treatment centres. I'm sure you know about them, and I think you visited one of them just recently. However, we think it would be helpful to have an intermediate-level mental health facility for persons who've responded to treatment in the RTCs, one or the other of them, so that they're not shunted directly back into the regular criminal justice population of correctional services.

There needs to be some intermediate level. A coherent strategy for those affected by mental health and addictions would afford an opportunity to build on the changes begun at the regional treatment centre in an intermediate environment with more support and with access to continued but less intensive treatment. Indeed, it might be beneficial for persons with a mental illness or a serious substance abuse issue to go to that kind of intermediate facility before discharge to the community, whether they come from the regional treatment centre or whether they come from a general correctional institution. It would provide a place to get people who have a mental health or substance abuse problem or both to be readied in a better way for the outside world.

If you look at it from a public safety point of view, it might very well make them less difficult, less dangerous, and less likely to reoffend, and certainly there would be an improvement in their care.

I think that kind of intermediate-level facility would provide an excellent opportunity as well for a demonstration project with rigorous research as a component of it, so we'd recommend that kind of facility, but we really wouldn't be strongly in favour of it unless it was heavily researched to see if it really does pay off. Between 2004 and 2008 in Ontario, the mental health services saw an increase of $220 million in their budgets. This still represented a decline in the proportion of the health care dollars spent on these vital services in Ontario.

In that same period, the spending on services for those with substance abuse issues in Ontario saw very little increase at all. While mental health systems have been studied exhaustively and in spite of thoughtful recommendations, governments have usually chosen to put their health care dollar elsewhere.

11:20 a.m.

Conservative

The Chair Conservative Garry Breitkreuz

Excuse me. Do you mind if I interrupt?

11:20 a.m.

Secretary of the Board, Mental Health Commission of Canada

Glenn Thompson

Not at all.

11:20 a.m.

Conservative

The Chair Conservative Garry Breitkreuz

We have your presentation here, and we have only about an hour left. Perhaps we could ask questions at this point.

11:20 a.m.

Secretary of the Board, Mental Health Commission of Canada

Glenn Thompson

Sure. That's fine with me.

11:20 a.m.

Conservative

The Chair Conservative Garry Breitkreuz

Would you mind wrapping up in the next minute or so?

11:20 a.m.

Secretary of the Board, Mental Health Commission of Canada

Glenn Thompson

That's just fine.

11:20 a.m.

Conservative

The Chair Conservative Garry Breitkreuz

Okay. It's been over 15 minutes already.

11:20 a.m.

Secretary of the Board, Mental Health Commission of Canada

Glenn Thompson

Okay. I'll wind up.

I think the last thing I want to say, then, is that strengthening the community sector so that it can handle many more minor offenders with mental illness and substance abuse issues, whether they are diverted from the courts or released from periods in the Correctional Service of Canada, is an absolute requirement if these troubled individuals are to stabilize successfully out of institutional care.

I recommend strongly to you that you look not just at institutional programs but at the correctional services programs that the federal service provides out in the community. Agencies such as St. Leonard's Society and Operation Springboard in Toronto, which I know well, are excellent examples of agencies that can support people once they come back into the community.

We're very pleased to be here with you to represent the commission, and I'm more than pleased, Mr. Chair, to engage in conversation. Thanks a lot.

11:20 a.m.

Conservative

The Chair Conservative Garry Breitkreuz

Thank you very much for your presentation.

We'll immediately go over to the official opposition. Mr. Holland, go ahead.

11:20 a.m.

Liberal

Mark Holland Liberal Ajax—Pickering, ON

Thank you, Mr. Chair.

Thank you very much, Mr. Thompson, for appearing before the committee today.

One of the things we've heard again and again, particularly from the correctional investigator, but also from a number of witnesses, is that our prison system is really being used to warehouse the mentally ill. And prisons, as they're currently structured, are a poor place to get somebody better.

You mentioned in your presentation the importance of early intervention and of catching problems before they escalate. Can you talk about two things? First, how do you feel that's working right now? How good a job do you think we're doing right now catching people early and making sure they don't begin to walk a dark path?

Second, from your personal reflections or experiences in the organization you represent, what impact does a stay in prison have on somebody who has a mental disability?

11:25 a.m.

Secretary of the Board, Mental Health Commission of Canada

Glenn Thompson

To take the second part of your question first, I'd say that the impact on anyone with a mental illness who's put in a custody situation is not likely to be a good one at all. Any correctional services agency in the world is faced with a tremendous challenge if a person is admitted who also has a serious mental illness. That person shouldn't be in the general correctional population. The correctional officers aren't trained to deal with those people. The institutional environment isn't a good one in which to deal with them, either.

While I was in correctional services in Ontario, we developed some separate institutions for those persons, such as the regional treatment centres. The Ontario Correctional Institute in Brampton is an example of that type of institution. If those people are in a correctional service institution, they need to be handled separately.

The best thing to do, if it's possible, is to get those people diverted when their first mental illness appears, before they are ever into a correctional services mode at all and before they've ever broken the law. As I indicated in my presentation, we're spending less on mental health care than we were several years ago in Ontario, and that's true across Canada. If we're not spending much, and we're not intervening at the time people are usually seen to be developing mental illnesses—at high-school age or in very early adulthood—time passes, and people often engage in the criminal justice system. Then departments like the Correctional Services of Canada are left to try to figure out what on earth to do and how to back out of the kind of tremendous deterioration that has likely occurred over that period of time. We need to intervene earlier and better. There are all sorts of programs available now that are being tried in some jurisdictions. They're not free. Schools, agencies, and communities have to work together to get those programs in place.

The diversion programs that have begun to happen in the last five years are absolutely terrific in getting that minor offender--who more often than not is somebody who got caught up in some illegal event because of his or her mental illness and kicked in a window or something stupid like that--diverted by the police, the crown attorney, or the court over to a mental health agency. That is happening very frequently now across Ontario and probably elsewhere in Canada. We would very much support that kind of program.

The head of one of the advisory committees for the Mental Health Commission, Steve Lurie of the Canadian Mental Health Association in Toronto, says they are receiving all sorts of people from the Toronto court system in that way. Also important is that they're using the backup service of the Centre for Addiction and Mental Health in Toronto when someone's mental health condition deteriorates beyond their ability to handle it. Just passing somebody off to a mental health agency isn't enough; there needs to be a coherent kind of system out there, or the person will be in difficulty.

11:25 a.m.

Liberal

Mark Holland Liberal Ajax—Pickering, ON

You mentioned jurisdictions that you felt were doing early intervention well. Can you talk about what those jurisdictions are? Specifically, what types of interventions are working. What do those interventions look like?

Second, I wonder if you could perhaps address the fact that the approach to somebody who commits a minor crime is often that you have to be tough on them; you have to give them a tough sentence and teach them a lesson. What I'm hearing you say is that if you do that with somebody who is facing a mental illness, you're going to create a much more serious problem that has much more additional cost. Eventually that person will get out and will probably commit a more serious crime.

Would that be a fair assessment?

11:25 a.m.

Secretary of the Board, Mental Health Commission of Canada

Glenn Thompson

Yes, I'd say so. The important thing is to recognize the serious mental illness at the earliest possible stage and do something about it.

A few years ago when a study was done in Canada, we found that people with a mental illness who are at high school age usually see their general practitioner five times over the course of two years before the diagnosis is made. A psychiatrist would tell us--if David Goldbloom was here--that a tremendous opportunity is lost in that period of time to get involved in positive treatment. So intervening early and diverting early is the answer for people when they are minor offenders. Don't let them get to the next stage if you can avoid it.

It's not always going to be avoidable. There are always going to be people with a serious mental illness in the Correctional Service of Canada and in provincial services, but we could reduce that dramatically. It's beginning to be done. The Canadian Mental Health Association in Toronto and Peel are good examples of diversion programs.

It requires the courts, the police—I know that some of you have police experience in your backgrounds—the judges, and the community agencies to all be engaged in partnership or it doesn't work. And staff have to be trained to handle this kind of clientele.

11:30 a.m.

Conservative

The Chair Conservative Garry Breitkreuz

Okay.

We'll move over now to the Bloc Québécois.

Ms. Mourani.

11:30 a.m.

Bloc

Maria Mourani Bloc Ahuntsic, QC

Thank you, Mr. Chairman.

Thank you, Mr. Thompson, for being here today.

I have two questions to ask. First of all, in relation to what you've just said. Recently we have met with people who have some knowledge of the mental health and drug treatment courts. I have noticed that these courts mainly deal with minor offences. For a more serious crime, people are referred to regular courts. Yet, whether people commit major or minor crimes, when they have mental health problems, they have mental health problems, period.

Do you believe these famous mental health and drug treatment courts should also deal with more serious offenders and refer to specialized hospitals where there is greater security rather than to Corrections?

11:30 a.m.

Secretary of the Board, Mental Health Commission of Canada

Glenn Thompson

I think it might be a pity at this early stage of the development of mental health courts to have them try to deal with all comers, the most difficult kind of person. If someone has committed a murder and they have a serious mental illness, they're going to have to be handled in a very high security environment as they likely are a dangerous person. So there's no getting away from the fact that, for public safety and for deterrence, some people are going to be in a very secure facility. The general court system needs to learn how to handle those people rather than expecting all courts, all mental health courts, to become the refuge for everyone who appears who has a mental illness. So I wouldn't recommend having the mental health courts at this stage of their development try to do that.

But the general court system needs to have--and it's a must that they have--much more ability to call upon psychiatric assistance when they're making sentences and making recommendations for where the person will be placed. And then, of course, the provincial system or the federal system has to have the adequate assessment process right at the beginning of a person's entry into their system to know where to put them, to know what kind of care to engage them in.

I might just say, because I was involved in the provincial system for 20 years, that all of these people come from somewhere to the Correctional Service of Canada. They don't come from the courts directly there. They're always in a provincial institution for some period of time. If those institutions aren't dealing adequately with them--and most often they're not--then we've lost a tremendous distance with those individuals before they ever get to Correctional Service of Canada.

So just imagine that I have a serious mental illness and I'm in Toronto Jail. I spend a year there waiting for my trial and processing. Who knows what happens to me in terms of my mental health condition, but it's not likely to get better during that period of time.

So fixing the services for mentally ill and substance abuse persons in the federal system isn't enough. We have to fix it for the whole of the correctional system, and I guess I would say we need to see it as an integrated system.

11:30 a.m.

Bloc

Maria Mourani Bloc Ahuntsic, QC

There is one thing I do not understand, Mr. Thompson. You say that people with mental health conditions are not likely to get better in jail. From what I've understood about mental health courts they proceed to a type of diversion, so that these people may access tailored resources. So, why not refer them to mental health courts? Is it a funding issue?

11:35 a.m.

Secretary of the Board, Mental Health Commission of Canada

Glenn Thompson

I would say that it's a numbers issue. The number of mentally ill people who have committed serious crimes is probably quite large in Canada. If that were to happen, the courts we have at the moment would be absolutely swamped tomorrow, and they wouldn't be doing the job they're now doing to divert the minor offender who has a mental illness. It's not that we don't need improved services to assess and refer people with a serious offence; it's that the mental health courts, as they exist now, would be swamped.

11:35 a.m.

Bloc

Maria Mourani Bloc Ahuntsic, QC

In another vein, you spoke a great deal of having a national strategy, earlier on. It came up a number of times in your presentation. But mental health, in fact health in general, is a provincial area of jurisdiction, not federal.

We went to Oslo and the United Kingdom. I believe you have a good knowledge of their systems. People with mental health problems who have committed offences are dealt with by the health care system. Of course the provincial-federal issue does not exist over there.

The major question I'm asking but to which no one seems to have responded to date, perhaps you will be able to, is the following: while respecting provincial areas of jurisdiction in mental health and addictions, how can we implement, here in Canada, a system like what exists in Oslo, for instance, which I found very interesting?

11:35 a.m.

Secretary of the Board, Mental Health Commission of Canada

Glenn Thompson

The mental health strategy that we contemplate has to be built to attract the buy-in of the provinces, the funder of the health care system. Our chair, Michael Kirby, and the members of our board are working hard to keep the federal, provincial, and territorial governments engaged. That's why we have five representatives from provinces on our board of directors. Four of them are deputy ministers.

So you're absolutely right: having that buy-in is an imperative for us. We're lucky to have the Deputy Minister of Health Canada on our board. Not through any work of mine but through work of others, there's been a good design for connecting the work of this national strategy, making it a Canada-wide affair that has the engagement of funders at all levels.

11:35 a.m.

Bloc

Maria Mourani Bloc Ahuntsic, QC

I am a person—

11:35 a.m.

Conservative

The Chair Conservative Garry Breitkreuz

We'll have to wrap it up. Just briefly, please.

11:35 a.m.

Bloc

Maria Mourani Bloc Ahuntsic, QC

I am a very down-to-earth woman. Let us put aside concepts of a national strategy and focus rather on the daily operations in custodial settings. Federal penitentiaries, for instance, must currently manage the Corrections and Conditional Release Act. Given the various provincial health care laws, they find themselves caught somewhere between a rock and a hard place.

Do you believe the federal government should allow for provincial health care laws to be applied in federal penitentiaries and reimburse the provinces afterwards? What exactly should be done? That is my final question.