Public Safety Committee on Oct. 29th, 2009

[Shelly Glover, Conservative, Saint Boniface, MB]

Do you believe that some of those clients you deal with pose a significant threat to the public and perhaps at times to themselves if they don't get their treatment, and that sometimes incarceration is an alternative to ensure the safety of both the general public and themselves?

[James Livingston]

I wouldn't say so specifically about my population, because once again, it's not an offender population, but is placing people in a correctional institution an alternative? Yes, it's an alternative. There are other alternatives as well. I don't think it's the only alternative.

[Shelly Glover, Conservative, Saint Boniface, MB]

I agree. I'm just asking if you think it is ever essential to do that.

[James Livingston]

It is, most definitely. Incarceration and a correctional system exist to protect the public, as well as to respect human rights and for general purposes of deterrence. There are a lot of sentencing principles in play here. One of them has to be that there is that sort of alternative for people who commit serious violent offences.

[Shelly Glover, Conservative, Saint Boniface, MB]

Very good. Thank you.

[Gail Czukar]

The thing you're talking about is actually something that's the subject of the Ontario Mental Health Act. It's the mental health act that allows people to be committed to psychiatric treatment if they are a danger to themselves or others. We incarcerate people in correctional facilities when they've been convicted of a crime, so it's a separate matter. We don't convict them and incarcerate them in order to treat them against their will.

[Shelly Glover, Conservative, Saint Boniface, MB]

I agree with that. We don't always incarcerate them in prisons, either. There are other forms of institutions where they are held, and it's potentially to protect their safety and the safety of the public.

I wanted to address you, Doctor. I have a great respect for a fellow by the name of Jonathan Garwood in my home province, who works in the same agency that you're presently working in. We've spoken a few times about traditional teachings. My mother is a Métis woman; I am a Métis woman. She worked at the jail for kids in Manitoba and brought many of the traditional teachings to the jail.

I'm curious to know your view on whether the traditional teachings are helpful. Are there any documented cases in which they were actually helpful or effective in helping to treat people who were diagnosed with mental illness or addiction in the prison population? What, if any, effects are there?

[Dr. Frank Sirotich]

I'm afraid I'm not aware of any.

More broadly, some of the recommendations within the literature talk about tailoring services to a person's particular cultural background, whatever it may be, so it's specific to that. It's tailoring the service to that cultural background. It really applies within the criminological literature to the notion of the responsivity principle. Whatever the treatment is, it has to be tailored to the needs of the person so that it's actually effective, but I don't know specifics. I can't actually--

[Shelly Glover, Conservative, Saint Boniface, MB]

Does anyone else have any experience with traditional teachings and its impacts, if any, on treatment?

[Gail Czukar]

We offer aboriginal services. We work quite extensively in that area, and I agree with what my colleague Mr. Sirotich has said, which is that it's important to be culturally sensitive. Traditional teachings may well communicate with people we can't reach any other way, so I think they're important. I'm just not sure what's behind your question.

[Shelly Glover, Conservative, Saint Boniface, MB]

I'll answer that very quickly.

[The Chair, Conservative, Garry Breitkreuz]

Please be very brief.

[Shelly Glover, Conservative, Saint Boniface, MB]

I actually tutored for the Native Brotherhood in Stony Mountain Penitentiary in the late 1980s. I found that having traditional teachings before commencing studies and those kinds of things had an impact. I also spent 19 years policing and saw how traditional teachings sometimes did affect the way we saw behaviour among the people we dealt with. That's why I wondered about your experiences.

Thank you.

[The Chair, Conservative, Garry Breitkreuz]

Mr. Kania, please.

[Andrew Kania, Liberal, Brampton West, ON]

Dr. Livingston, you did mention the U.K., but I'm going to first quote from page 23 of your report. You say:

England and Wales has recently adopted an innovative model for ensuring that health authorities uphold their responsibility of providing treatment services and supports to inmates with mental health and substance use problems.... Limited evidence suggests that this approach improves standards of care.

You may be aware that we are travelling to London in a couple of weeks. On behalf of the committee, can you please advise us as to what you are aware of specifically with respect to this system, what has worked, what has not worked, and what other ideas you may have to change it?

[James Livingston]

Thank you for the question.

The problem that this particular “solution” addresses is a system-level problem with creating parallel correctional mental health services with other community-based services. Who pays for it? Who's responsible for it? This solution places the onus and responsibility on health for addressing prisoners' mental health and addictions issues.

Inmate mental health and addictions is a community health problem. It's a public health problem, and I think this innovative model not only shifts the direction, authority, and responsibility towards those who are fully capable of providing the service but also it allows for an expansion of the continuity of care for people who manage the rest of the system. So it's a system-level innovation in terms of how to manage and fund prison-based mental health services.

Specifically, I wouldn't know what you should be attending to, and I'm very happy to hear that you're travelling there to hear their experiences. I know it's a fairly recent thing, so they might be going through some growing pains. I look forward to reading about what you find.

[Andrew Kania, Liberal, Brampton West, ON]

Are you currently aware of any problem areas for their system, or as a separate question, is there something in particular that's better about their system than ours, other than what you've said?

[James Livingston]

No.

[Andrew Kania, Liberal, Brampton West, ON]

Okay.

[The Chair, Conservative, Garry Breitkreuz]

Ms. Czukar, did you want to respond?

[Gail Czukar]

I've had experience, not in London but in Birmingham, visiting a prison there, where a unit was operated by the local mental health trust. Their experience was that they found it very difficult to deliver the services properly because the mental health treatment unit was located in a new part of the prison that was accessible to people with physical problems. So while it was supposed to be a 34-bed mental health unit, at least half those beds were occupied by people with physical health problems. They weren't really qualified to treat those people, but that was the only place they could get anything, any kind of help with their problems. They just found that the prison culture was not conducive to their being able to deliver their services in the way they needed to, so it wasn't being particularly effective.

Plus, it was a prison for about 1,400, mostly young men. They had 34 beds, about half of which were occupied by people with mental health problems, and that was way, way, way too few for that population. So they had a big problem.

[Andrew Kania, Liberal, Brampton West, ON]

Ms. Czukar, you made a comment about the creation of mental health problems in prisons. So how is that occurring specifically, and what should be done to avoid that?

[Gail Czukar]

I mean, we've established that I don't have the on-the-ground experience that some members of your committee do. The conditions in prisons, where you have a lot of people living together, you have isolation from support systems and so on—the hallmarks of large institutions—as well as the correctional culture would suggest that there are going to be mental health problems. Those are the kinds of conditions that would produce those problems in many people, but would exacerbate problems that someone might come with already, if they were already depressed or anxious or had any kind of past experience with trauma, in particular, or psychosis. So those kinds of conditions are very likely to create mental health problems.

[Andrew Kania, Liberal, Brampton West, ON]

Okay, so what should we do about that?

[Gail Czukar]

Partly, to the extent it's possible, change the culture, deal with the stigma of both correctional officers and other inmates about what it means to have a mental health problem. I think we're starting to address some of that issue in the society generally. It would be nice to see that translate into correctional cultures. It would be good to offer the treatment to the people who need it and assist them with their problems.