Evidence of meeting #37 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 treatment.
A recording is available from Parliament.
Liberal
Rob Oliphant Liberal Don Valley West, ON
Continuum of care. I should have added it to the treatment.
Executive Vice-President, Policy, Education and Health Promotion, Centre for Addiction and Mental Health
Okay. I think that's extremely important.
You mentioned diversion, but we haven't really talked about this very much. Diversion, prior to people getting into any involvement with the criminal justice system, is obviously what we would be most concerned with, because as soon as someone is involved in the criminal justice system--whether it's at the provincial level, the kind of court support work that Frank has been very involved in, and others--we have added a whole lot of problems to that person's life as well as significant costs to the system. So a well-resourced system of mental health and addiction services generally is what's going to help with all of the things that you've mentioned: assessment, diagnosis, continuum, capacity-building, risk reduction. That's really the best answer to a number of these things.
Liberal
Rob Oliphant Liberal Don Valley West, ON
And that is different from the viewpoint of the Sampson report. One of its focuses on mental health has to do with a reward and punishment system for people within an already stretched system, in which I would say we don't have the capacity or the professionals, but we also haven't figured out how to get people assessed and in treatment.
I'd like some comments on your understanding of a reward and punishment system for people who engage in treatment versus mandatory programs and the human rights issues that go with them.
Conservative
Liberal
Executive Vice-President, Policy, Education and Health Promotion, Centre for Addiction and Mental Health
Oh.
Well, maybe I'll start, but I'm sure my colleagues have something to say about this.
You're contrasting a reward and punishment system with mandatory...?
Liberal
Rob Oliphant Liberal Don Valley West, ON
With mandatory...or a third alternative that maybe this committee needs to understand. I believe CMHA has questioned some of the stuff around reward and punishment, but I don't know what the theories are, what the research is with respect to treatment options.
Executive Vice-President, Policy, Education and Health Promotion, Centre for Addiction and Mental Health
You're talking about compulsory treatment?
Executive Vice-President, Policy, Education and Health Promotion, Centre for Addiction and Mental Health
There is no easy answer to that. We know that treatment that is non-coerced tends to be more effective, tends to help people if they recognize that they have a problem and want help with it.
That having been said, there are provisions in the law, of course, for treatment without consent under very limited circumstances. In the code, it's in order to make someone fit to stand trial, and those are the only circumstances in Ontario in which you can treat someone, under the law, without their consent. It's a basic human rights issue.
Conservative
The Chair Conservative Garry Breitkreuz
We're way over time. I'm sorry; we'll have to go over to Mr. McColeman. You should have started with that question.
Mr. McColeman, please.
Conservative
Phil McColeman Conservative Brant, ON
Thank you, Chair.
Thank you very much for coming today. It is a great learning experience to hear from experts such as yourselves. I'm looking forward to reading the report that you, Dr. Livingston, have put together.
You mentioned in your opening comments the suicidal tendencies of people with mental illness. Are there any hard statistics around the rate of attempted suicide or suicides in our correctional facilities?
Researcher, Mental Health and Addiction Services, Forensic Psychiatric Services Commission of British Columbia
I'm sure there are, but they don't come to mind right now. The research generally recognizes the elevated risk among prisoners of suicide and self-harm—behaviours that have been covered in my report as well—and attempted suicides; however, the figures escape me currently.
Conservative
Researcher, Mental Health and Addiction Services, Forensic Psychiatric Services Commission of British Columbia
The bodies of research from which I've mentioned that elevated risk are outlined in the report.
Conservative
Phil McColeman Conservative Brant, ON
Okay.
From your comments, Ms. Czukar, regarding the community-based programs and the stigmatism around mental illness, it appears to me that our society in general has a much larger role to play in treatment and the destigmatization of people with mental illness, first; and then concerning those who have that combined with conviction for criminal activities.
In your work, do you have ways to assist at the community level? I would think that in some ways the result—someone moving to criminal activity—might be avoided.
Executive Vice-President, Policy, Education and Health Promotion, Centre for Addiction and Mental Health
I wouldn't want to identify mental illness with criminal activity in quite that way.
I think, though, that it's important to distinguish between stigma on the part of the general public, say, and those who work in hospitals, who work in facilities, and so on. We know from research that unfortunately people who work in the system, health workers, are among the worst stigmatizers around. We actually have programs—we have a program called “Beyond the Label”—that we do with people who work in the system.
In the correctional facilities, it's much worse. It's a huge stigma for correctional workers to talk about their own mental health and their own mental illness and the difficulties they might be having, let alone their attitude towards prisoners. When we talk about stigma, it's important to start with ourselves and with the people we are trying to take care of first, because stigma on the part of people who are working in the system, whether it's the correctional system or the health system, translates pretty directly into self-stigma on the part of people who need help or people who are in prison.
I don't want to take more time on this, but I can't emphasize enough the importance of dealing with stigma with respect to prison officials and prison workers as well as inmates. That would be a very important place to start.
Conservative
Phil McColeman Conservative Brant, ON
About the question of the vacancies we have among the professional people involved in our correctional system, do you believe there are enough people wanting to work in the system? If the remuneration were comparable, let's say, to another offering somewhere out there, do you think these jobs would be taken, or do you believe that you have to actually pay someone a premium to work in a prison system?
Researcher, Mental Health and Addiction Services, Forensic Psychiatric Services Commission of British Columbia
I'll talk just generally about that as well. This is also related to stigma, and health professionals feel the stigma. I work in the Forensic Psychiatric Services Commission in B.C., and the stigma inherent among forensic psychologists and forensic nurses dealing with this particular population is very difficult, from the standpoint of recruitment and hiring practices.
I can't be more specific about that, but if the committee wants to know a little more about stigma, I've been doing stigma research for the past four years for people on compulsory community treatment in B.C. and in the forensic psychiatric system, and certainly among the health professionals it's a big issue as well.
Conservative
Phil McColeman Conservative Brant, ON
It strikes me, thinking very simplistically, that we have job openings here, and there's a reason why they're not being filled. Is the reason money, or are there other reasons? Perhaps that stigma factor is much larger than we really know.
Researcher, Mental Health and Addiction Services, Forensic Psychiatric Services Commission of British Columbia
I can't say specifically, but I can tell you that delivering treatment to people who want to be treated is easier than delivering treatment to people who don't want to be treated. That's certainly a factor as well.
Conservative
Phil McColeman Conservative Brant, ON
I appreciate those comments. Those are things we'll need to focus on as we study this issue, in terms of how we staff up and recruit the proper people. It will be interesting to talk to officials as we visit institutions.
Thank you.
Conservative