Thank you.
I want to focus now on the issue of mental health in corrections.
First, it's important to remember that the Correctional Service of Canada is legislatively mandated to provide health care to offenders through the Corrections and Conditional Release Act. Federal offenders are excluded from the Canada Health Act, and they're not covered by Health Canada or provincial health systems. The Correctional Service must, therefore, provide health care services, including mental health care services, directly to federal offenders, including those residing in community correctional centres. The CCRA states that the health care services provided must conform with professionally accepted standards.
In the last decade, Canada has experienced a significant increase in offenders with mental illnesses entering federal penitentiaries. In fact, federal penitentiaries in Canada probably house the largest populations of the mentally ill in this country. The Correctional Service is now in the position of having to manage offenders who require a high degree of professional mental health service and care. The ability of the Correctional Service to effectively and humanely manage this increasing and challenging population is being tested to its limits.
Mental health problems are up to three times more common amongst inmates in correctional institutions than amongst the general Canadian population. More than one in ten male inmates and one in five female inmates have been identified at admission as having significant mental health problems. That's an increase of 71% and 61% respectively since 1997. A recent snapshot of federally incarcerated offenders in Ontario indicated that 39% of the Ontario offender population was diagnosed with a mental health problem--a staggering challenge for any correctional authority.
The Correctional Service has been aware of this challenge for a long time. In fact, in July of 2004 it approved a mental health strategy that identified serious gaps in services and promoted the adoption of a continuum of care for initial intake through to the safe release of offenders into the community. At that time, my office concurred with the Correctional Service's identification of the gaps in mental health services and endorsed its strategy.
In December 2005, the Correctional Service secured funds to strengthen the community component of this strategy. My office welcomed the news of these new investments--approximately $6 million per year for five years--into community mental health. We also were pleased when the Government of Canada included in its March 2007 budget some new but temporary investments--approximately $21 million over two years--to address the lack of a comprehensive mental health intake assessment process and to improve primary mental health care in CSC institutions. The March 2008 budget provided ongoing funding for these initiatives, another approximately $16 million.
Despite these important investments, totalling over $60 million to date, I continue to be disappointed by the very slow pace of change and by the lack of real, demonstrable improvements in the level of mental health services and support provided to offenders with mental disorders. There's no doubt the Correctional Service has had some success in the last two years--for example, in the implementation of a new mental health training package for front-line staff, the development of a mental health screening system at intake, and the implementation of an enhanced discharge planning initiative. However, the overall situation for offenders suffering from mental health disorders has not significantly changed since my office first reported to Parliament about this troubling situation in 2004.
The problem faced by the Correctional Service is largely one of capacity to respond to an increasing number of offenders with significant mental health issues. This problem is compounded by the inability of the Correctional Service to recruit and retrain and retain trained mental health professionals, and by security staff who are ill-equipped to deal with health-related disruptive behaviours.
Keep in mind that the Correctional Service of Canada is probably the largest employer of psychologists in the country. That said, there are some regions where as many as four out of ten psychology positions remain vacant. There are incredible challenges in recruiting and retaining health professionals.
For example, the majority of a psychologist's day within the Correctional Service of Canada is spent conducting mandatory risk assessments to facilitate security for conditional release requirements rather than treating or interacting with offenders in need of their clinical help.
Those offenders who have acute needs or who require specialized intervention may be sent to one of the five regional treatment centres; however, this is only if they meet the admission criterion that they possess a serious and acute psychiatric illness. Typically, however, the offender is monitored at a regional treatment centre only to be returned to the referring institution after a period of stabilization. Driven by volume, the regional treatment centres have become a revolving door of referrals, admissions, and discharges.
The overwhelming majority of offenders suffering from mental illness in prison do not generally meet the admission criteria that would allow them to benefit from the services provided in the regional treatment centre. They stay in general institutions, and their illnesses are often portrayed as behavioural problems or--if you think back to that situation report I read to you--they are labelled as disciplinary as opposed to health issues. This is especially true for offenders suffering from brain injuries and for those with fetal alcohol spectrum disorder.
I am particularly concerned by the persistent and pervasive use of segregation to manage and isolate offenders with mental disorders in federal penitentiaries. Placing the mentally ill into a system not designed to meet their needs is cruel. It becomes brutal when they are forced to navigate a system that is not only one they do not understand but also one that profoundly misunderstands them.
The mentally ill suffer from illogical thinking, delusions, paranoia, and severe mood swings. In the correctional environment, mentally ill offenders do not always comprehend, conform, or adjust properly to the rules of institutional life. Irrational and compulsive behaviours associated with their individual affliction can result in verbal or physical confrontations with staff or other inmates, which often lead to institutional charges and long periods in administrative or disciplinary segregation. Mental illness can lead to a vicious cycle in correctional settings.
Simply placing an offender in ever more restrictive conditions of confinement and isolation is not an effective correctional or mental health intervention. Prolonged periods of deprivation of human contact cannot but adversely affect the mental health of offenders, and it's counterproductive to their rehabilitation.
After conducting investigations, my office often discovers that placements in segregation are often the result of disruptive behaviour resulting from a prevailing mental health condition. It's a classic Catch-22: when the intervention fails, the response is to do more of the same.
The practice of confining mentally disordered offenders to prolonged isolation and deprivation must end. It is not safe nor is it humane. A case in point is the death of Ms. Ashley Smith. Ashley Smith died on October 19, 2007, at the age of 19 at Grand Valley Institution for Women. She died in segregation, having never been the subject of a comprehensive psychological assessment during her 11 and a half months in federal custody.
In my report of June 20, 2008, amongst my 16 recommendations, I recommended that the Correctional Service immediately review all cases of long-term segregation where mental health issues were a contributing factor to the segregation placement; that it amend its segregation policy to require that a psychological review of an inmate's current mental health status, with a special emphasis on the evaluation of the risk for self-harm, be completed within 24 hours of the inmate's placement in segregation; and that it immediately implement independent adjudication of segregation placements for inmates with mental health concerns.
It's been almost a year since I submitted that report to the correctional services, and while there have been some, there have been too few concrete steps taken to respond to these recommendations. I understand that the Correctional Service will shortly publicly release its response to my 16 recommendations flowing from this investigation into the death of Ashley Smith. I look forward to this detailed and robust action plan. I hope it will address my recommendations and reduce the likelihood of future preventable deaths in federal custody.
I will now ask Dr. Zinger to discuss the issue of program access and substance abuse.