Thank you very much.
Good morning, Mr. Chairman and members of the committee.
It's an honour to have this opportunity to speak to you today about mental health and addiction services in correctional settings. My name is James Livingston, and I'm a researcher with the Forensic Psychiatric Services Commission of B.C. Mental Health and Addiction Services. The Forensic Psychiatric Services Commission is a multi-site provincial health organization in British Columbia that provides specialized hospital and community-based assessment, treatment, and clinical case management services to adults with mental illness who are involved with the criminal justice system. I'm also a PhD candidate in the School of Criminology at Simon Fraser University.
When individuals with mental health and substance use problems are detained, imprisoned, or are supervised in the community, opportunities arise for detecting untreated illness, reducing suffering, and improving quality of life. Too often this opportunity is missed.
Earlier this year I was commissioned by the International Centre for Criminal Law Reform and Criminal Justice Policy to undertake a study of international standards and best practices in relation to the provision of mental health and substance use services in correctional settings, including jails, prisons, and community-based corrections. The centre is an independent international institute based in Vancouver, British Columbia, with a mandate to promote the rule of law, democracy, human rights, and good governance in criminal law and the administration of criminal justice domestically, regionally, and globally.
The research I undertook involved an extensive review of published and unpublished literature and a synthesis of the standards and guidelines contained in over 200 relevant documents. The preliminary findings of this review were refined through consultation with a small group of prominent experts in forensic mental health and addiction services.
I would like to spend my time providing you with an overview of our findings, which are detailed in a report entitled Mental Health and Substance Use Services in Correctional Settings: A Review of Minimum Standards and Best Practices. This report has been published and is available on the website of the International Centre for Criminal Law Reform and Criminal Justice Policy.
Our review revealed that published standards and best practices regarding correctional mental health and substance use services generally cluster around five service themes, including screening and assessment, treatment, suicide prevention and management, transitional services and supports, and community-based services and supports. For each of these themes, both best practices and minimum standards are identified and discussed in our report.
For the committee's purpose today, I will focus on the minimum standards that were identified in our research. Minimum standards are conceptualized as the policies, procedures, and practices that have been identified as essential for addressing mental health and substance use problems in correctional settings. Generally, these standards are formulated on the basis of legal and ethical considerations, particularly those that concern human rights.
The first service theme identified by our report relates to screening and assessment. Published guidelines and standards unanimously assert that providing systematic mental health and substance use screening and assessment in jails and prisons is a necessary, essential service. Our review identified five minimum standards in this area--for instance, training all staff members who work with inmates to recognize and respond to mental health and substance use problems, and screening all inmates upon arrival at correctional facilities to identify emergent and urgent mental health and substance use problems.
The second service theme is treatment, which involves providing services and supports to individuals with mental health and substance use problems in order to decrease disability, decrease human suffering, maximize the ability for individuals to participate in correctional programs, and create safe environments for those who live, work, and visit jails and prisons. With respect to treatment, our review suggests eight minimum standards, such as providing inmates who have mental health and substance use problems with access to the same level and standard of care available to individuals in the community, and ensuring that written, individualized treatment plans are created and regularly reviewed for inmates with mental health and substance use problems.
The third service theme is suicide prevention and management. On account of the high rates of suicide in jails and prisons, organizations have made considerable efforts developing comprehensive guidelines, standards, and programs to prevent and manage inmate suicide.
Regardless of the size or nature of the facility, all jails and prisons should establish adequate suicide prevention and management programs. Our analysis of the literature suggests six minimum standards in this area--for example, training all staff members who work with inmates to recognize verbal and behavioural cues that indicate potential suicide, and how to intervene, and housing potentially suicidal inmates in safe environments that maximize interactions with staff and others and minimize experiences of isolation.
The next service theme involves transitional services and supports. For inmates with mental health and substance use problems, the transition between custody and community can be acutely stressful, psychologically distressing, and disruptive to their recovery and treatment. Our review has identified three minimum standards in this area, such as providing inmates who have mental health and substance use problems with written transition plans that identify available and appropriate community resources prior to their transfer or release from prison or jail, and ensuring that inmates with mental health and substance use problems who require continued pharmacological treatment are provided with a sufficient supply of medication that can last at least until they are able to see a community health service provider.
The final service theme identified by our review relates to community-based services and supports. The community corrections system has a significant role to play in ensuring that probationers and parolees have access to appropriate mental health and substance use services. Our review suggests five minimum standards in this area, including screening all probationers and parolees to identify emergent and urgent mental health and substance use problems, including potential suicidality, and ensuring that probationers and parolees with mental health and substance use problems have access to the same level and standard of care available to individuals in the community who are not involved with the criminal justice system.
In closing, we recognize there is no single blueprint for creating a correctional mental health and substance use service system. Implementation of minimum standards and best practices should be flexible, varying according the types of settings and population, as well as other contextual factors, such as geography and resources. However, the conceptual framework and the minimum standards and best practices outlined in our report provide a useful guide to inform decision-making concerning mental health and substance use services in correctional settings. Currently, the minimum standards described within our report are being considered for adoption by correctional authorities throughout Canada in order to assess the strengths and gaps of their systems in providing mental health and substance use services.
Thank you for this opportunity to share our work. Should the members of the committee be interested in learning more about the best practices and minimum standards described within our report, I can provide additional examples and elaborate on the process we undertook in our research.
I look forward to your questions and wish you all the best with this important study.