Public Safety Committee on June 2nd, 2009

[The Chair, Conservative, Garry Breitkreuz]

Your time is up. I'm sorry.

We'll now go to Mr. Rathgeber, please, for five minutes.

[Brent Rathgeber, Conservative, Edmonton—St. Albert, AB]

Thank you, Mr. Chair.

Thank you to both witnesses for your attendance here this morning.

Sticking with Mr. Ménard's questioning regarding programming and human resources, why, in your view, is Corrections Canada having such a difficult time recruiting and retaining psychologists and other competent staff to deal with the programs you say are so sadly missing? Is it a money issue? Is it a professional development issue?

[Howard Sapers]

First of all, let me say it's uneven across the country. In some regions and in some areas it's easier than in other areas. You have more problems in the Prairies than you do, for example, in British Columbia; more problems in Ontario than perhaps you do in Quebec. So there are some regional differences.

Part of it is because working conditions and remuneration packages aren't entirely competitive with what else is available to those folks with those skills; part of it is because of the absence of dedicated budgets for professional development and for constant training; part of it is because you've got provincial systems where people need to maintain professional licensing requirements, and they vary, and if folks are being transferred from place to place within the Correctional Service, because it's a federal system, their licences may not transfer with them, and there are different standards of practice. So it's a very complex environment, and it shouldn't be underestimated.

I will say this. It's not for lack of trying. The Correctional Service tries hard to recruit and retrain those people.

[Brent Rathgeber, Conservative, Edmonton—St. Albert, AB]

In your opening comments, Mr. Sapers, you said that the overwhelming majority of offenders suffering from mental illness in prisons do not generally meet the admission criteria that would allow them to benefit from the services provided in the regional treatment centres.

Are there comprehensive and/or precisely defined admission criteria for mental health programs? Who makes that assessment?

[Dr. Ivan Zinger]

Certainly the regional treatment centres focus on the offenders who are in the most acute and serious state of their mental health illness, to the point that they can be certified under provincial mental health legislation. The challenge is that it is a significant portion of the inmate population. Certainly there is an even larger population that suffers from mental illness that does not meet those criteria. For example, they are not out of touch with reality, but they may have serious anxiety disorders. They may be dealing with depression. They may be dealing with suicidal ideation but are not being suicidal at the immediate time. The treatment centre just tries to target the most acute ones and tries to stabilize them so they can return them to their home institutions.

[Brent Rathgeber, Conservative, Edmonton—St. Albert, AB]

Is the test for having access to a regional treatment centre being certifiable under the appropriate provincial mental health legislation?

[Dr. Ivan Zinger]

Not necessarily. I believe the committee will be visiting four of those regional treatment centres. Certainly you will be able to talk to the clinical directors of those regional treatment centres.

[Howard Sapers]

Maybe I can give a little bit of a quick perspective on that. At the regional treatment centres—there are five of them across the country—the bed space is equal to about 5% or 6% of the population. The Correctional Service of Canada, when it did its own census, estimated that this is enough for about 50% of folks who would meet the definition of a diagnosed, significant mental illness. So if they have 600 beds, they should have 1,200 immediately just to meet the needs of those folks with significant, diagnosed mental illness. They are not necessarily certifiable, but they have significant, acute mental illness and could get the benefit of a hospital setting to deal with or stabilize that mental illness.

[Brent Rathgeber, Conservative, Edmonton—St. Albert, AB]

I think I only have about a minute left.

I want to talk about your concern regarding the pervasive use of segregation to manage and isolate offenders who have mental disorders. Those were your words. I don't disagree that prolonged isolation is not an appropriate mental health intervention and doesn't lead to rehabilitation. But isn't there often a more immediate concern with respect to a mentally ill offender, and that's his or her personal safety? Isn't that why they will often find themselves away from the general population?

[Howard Sapers]

If there's a safety issue, there are many interventions. The problem with segregation is that it's a 23-hour lock-up in conditions of deprivation, which are the most austere conditions the Correctional Service has. If people are at significant risk of self-harm, you may also put them on suicide watch. You may put them under direct observation. You may increase the frequency of security rounds for the cell they're in. You may move them into a hospital or health care setting. You may transfer them to an outside hospital. You may put them into one of those regional treatment centre beds we were talking about. There are lots of other options.

Unfortunately, what we see is this cycle. People act out. The behaviour is dealt with, but not the underlying cause. The acting out causes them to be segregated as an administrative or punitive measure to deal with their acting out behaviour. The underlying cause is not dealt with. It doesn't do anything to deal with the behaviour. That's what happened to Ashley Smith for 11 and a half months.

[Brent Rathgeber, Conservative, Edmonton—St. Albert, AB]

Thank you very much.

[The Chair, Conservative, Garry Breitkreuz]

We'll go to Mr. Kania, please.

[Andrew Kania, Liberal, Brampton West, ON]

Thank you.

On page 6 of your report, you indicate that one out of ten male inmates and one out of five female inmates have mental health problems. On the next page you indicate that 39% of the people in the Ontario offender population have been diagnosed with mental health problems. In your comments you said that the system is heavily burdened and is operating well past its capacity for mental health problems. In essence, what you're saying is that there's a high percentage of persons with mental health problems. The system cannot provide them with treatment when they're incarcerated. Presumably they're released without such treatment. Is that all accurate?

[Dr. Ivan Zinger]

There's a bit of a lack of data in terms of the percentage of the inmate population with mental health illnesses. What we do know, based on the data we have, is that over the last decade that number has doubled. There's a more specific definition with respect to how you define mental illnesses. It can be very narrowly defined or broadly defined.

Because there is not such a clear definition, there's certainly recognition that, given that the numbers have increased so dramatically, the services provided to those inmates have not matched that increase over the last decade. My office certainly believes that too many offenders do not receive the appropriate level of care they deserve to manage their illnesses. That's true in regional treatment centres, but even more so in institutions where many of those suffering from mental illnesses do not get the appropriate level of care.

We've been calling for intermediate care units, and just to give you a bit of an idea of what the concept is, it's to have in the institution a unit that provides a therapeutic environment staffed with health care professionals such as psychiatric nurses and psychologists who can monitor and provide support to many offenders, who, again, do not meet the criteria for the regional treatment centre, yet deserve a good follow-up. We have a lot of people who self-injure. Those people can certainly have very high needs and are not necessarily certifiable or in acute phase, but they need some support. Those intermediate units or therapeutic environments would go a long way to address their needs.

[Andrew Kania, Liberal, Brampton West, ON]

So there's a segment of the population that's simply not receiving the treatment they require, based on what you're saying.

My second question follows up on something Mr. Richards said. For those people who are not receiving the treatment they require, what job skills would be appropriate to teach them, to assist them when they are eventually released, if they don't receive the adequate treatment in the first place?

[Howard Sapers]

I just visited one of the treatment centres myself and had that very discussion with their management team. Of course, their challenge is that they're trying to prepare people for new vocational work and other institutional work, and these people have cognitive impairments or other mental health issues that prevent them from being able to do that work in a reasonable way.

We're also seeing a growing part of the population that's aging, and the process of incarceration itself exacerbates the aging process. So we're seeing more people who are having age-related cognitive impairments who also have the inability to become fully engaged in the coming regime of vocational training.

The range of skills required are the ones you can imagine, in terms of being able to listen to and follow instructions, timeliness and time management, health and safety--all the range of skills that you would want that would be transferable employment skills, really, in very many employment situations. One of the reasons, though, that this segment of the population has come into conflict with the law to begin with is because they don't have those skills. Many of them don't have the cognitive ability to gain those skills.

Again, you put them into a bit of a cycle where they're not eligible to participate in a program because they don't have the basic literacy or competency to get into the programs, and they don't have the cognitive ability to even get the educational upgrading. They're the ones who end up not progressing through the system and spending more time in higher security levels, and often because they act out, more time in segregation, etc. It's perverse, but often the most needy offenders are the ones who often receive the least intervention.

[Andrew Kania, Liberal, Brampton West, ON]

So you'd agree that they would first require adequate mental health treatment, before they would be able to master the training required to obtain job skills.

[The Chair, Conservative, Garry Breitkreuz]

A brief response, please.

[Howard Sapers]

For those where there is a treatable diagnosis, yes, but keep in mind we're not talking about the brain-injured.

[The Chair, Conservative, Garry Breitkreuz]

Thank you.

Our final questioner is Mr. MacKenzie.

[Dave MacKenzie, Conservative, Oxford, ON]

Thank you, Mr. Chair.

I'd like to thank both of our witnesses today. I think they have provided us with a great deal of information in a very independent way.

I have just a couple of tiny things. We talked about the interdiction efforts to stop drugs coming in. Although it appears to be 1%, it's really a 10% reduction in the population. It's 10.8% versus 11.8%, but if you look at the pure numbers, it's a 10% reduction.

[Howard Sapers]

Yes.

[Dave MacKenzie, Conservative, Oxford, ON]

The other part is this. I think my friend was talking about, and correctly so, the HIV/AIDS and the hepatitis C. Is there not a problem in that the inmate population does not necessarily consent to testing on the way in to the prison, or even during their time in the prison, whether or not they have been infected?

[Howard Sapers]

There are issues to do with testing and with stigma and with how that information is used. But even given that, we do know that the current estimate for hepatitis C infection rates across the system is about 30%. In some institutions it's considerably higher.

I must say that the Correctional Service of Canada has implemented an education and awareness program about the importance of testing that seems to be having some positive impact in terms of both HIV and hepatitis C.

[Dave MacKenzie, Conservative, Oxford, ON]

I didn't mean that in any negative sense. It's just that it is a factor that makes it somewhat difficult to perform that testing.

My other comment, which perhaps you could respond to, is that you've indicated that the change has occurred--or perhaps is more prevalent--in the last ten years. But about perhaps 20 years ago, provincial institutions for mental health issues began to be dismantled across the country, and for good reason, for a variety of reasons.

Are we not now at the point where we're kind of losing the battle, if it is....? These folks might earlier have been treated in a mental health facility. Now they get caught up in a criminal justice system, and ultimately in a federal justice system. It's almost, when we look at it, unfair to those folks; they should have received treatment long before they got to federal corrections.

I don't know the solution, but that to me just seems to be a big part of why we're in the position we're in.