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.
11:45 a.m.
Researcher, Mental Health and Addiction Services, Forensic Psychiatric Services Commission of British Columbia
Yes, I'm familiar with it.
Was there a question? I'm sorry.
11:45 a.m.
Bloc
Serge Ménard Bloc Marc-Aurèle-Fortin, QC
This first question was only to know if you knew of them.
Do you think that this is a good model for treating addictions?
11:45 a.m.
Researcher, Mental Health and Addiction Services, Forensic Psychiatric Services Commission of British Columbia
It's been shown in the literature to be a best practice.
11:45 a.m.
Bloc
Serge Ménard Bloc Marc-Aurèle-Fortin, QC
Yes, very well.
We may contrast the experience of Portage and that of Matsqui that you are surely familiar with.
Could you elaborate on how the two compare with each other and help us to decide if we should favour one over the other?
11:50 a.m.
Researcher, Mental Health and Addiction Services, Forensic Psychiatric Services Commission of British Columbia
I'm familiar with Matsqui and Portage, but I'm not aware of the comparison you're speaking about.
11:50 a.m.
Bloc
Serge Ménard Bloc Marc-Aurèle-Fortin, QC
All right.
Are you familiar with the Joliette Penitentiary for Women?
You seem to indicate that you are.
11:50 a.m.
Researcher, Mental Health and Addiction Services, Forensic Psychiatric Services Commission of British Columbia
Yes.
11:50 a.m.
Bloc
Serge Ménard Bloc Marc-Aurèle-Fortin, QC
When it was built, it received prizes for its architectural design. It was specifically designed to make that environment more humane, to facilitate the rehabilitation of inmates.
Could you tell us about this environment? Do you think that in fact the sought-after results were obtained in regards to the treatment of inmates, or do you have other information in the documentation you have on this subject?
11:50 a.m.
Researcher, Mental Health and Addiction Services, Forensic Psychiatric Services Commission of British Columbia
No.
11:50 a.m.
Executive Vice-President, Policy, Education and Health Promotion, Centre for Addiction and Mental Health
I'm not aware of the literature either, but I think the question you're trying to get at is whether the kind of environment provided in a correctional facility is amenable to helping people with their mental health and addiction problems, and whether that's the appropriate place for people to be, or would they be better off in hospitals or in other kinds of treatment places. Is that your question?
11:50 a.m.
Bloc
Serge Ménard Bloc Marc-Aurèle-Fortin, QC
In fact, is it documented that large prisons can offer these services because they might be a little more specialized or that, on the contrary, prisons should be kept to a smaller size?
11:50 a.m.
Researcher, Mental Health and Addiction Services, Forensic Psychiatric Services Commission of British Columbia
Regarding that question, my familiarity is with the literature. I don't think it directly answers that question, but it does recognize that mental health and addiction services are delivered differently to different sized jails and prisons. The issues of the services you provide to a jail population, because of their shorter term of incarceration and their sometimes unpredictable release, would be different from a federal correctional population, where their release is more predictable and they're often incarcerated for longer periods of time. Therefore, their attachment to community-based services and supports, family members, and social networks are often limited because of the amount of time they spend in custody.
I don't know if that answers your question directly.
11:50 a.m.
Bloc
Serge Ménard Bloc Marc-Aurèle-Fortin, QC
In any case, it is very difficult to provide answers to specific questions in that area.
Staff training is very important. What prior education should they require of applicants for a position in correctional institutions?
11:50 a.m.
Executive Vice-President, Policy, Education and Health Promotion, Centre for Addiction and Mental Health
My understanding is the Correctional Service already employs a number of psychologists and people with psychological training, but doesn't have many vacancies in those positions--trainers in assessment and testing, who assist people with their counselling and other kinds of programs; psychiatrists who assess needs for medication, for treatment, and those sorts of things; and social workers, people like that, to help clients in those areas. I think there's been some discussion, and certainly case managers are very helpful in terms of the transition out of the facility and back to the community, but as I said, if there aren't the services in the community for people, then having case managers doesn't help.
In terms of the services to be provided within the correctional facilities, on the mental health side those would be some of the people, and addiction counsellors as well to assist with addicted clients.
11:50 a.m.
Bloc
11:50 a.m.
Conservative
The Chair Conservative Garry Breitkreuz
Thank you very much.
We'll go over to the NDP now. We'll have Mr. Davies, please, for seven minutes.
October 29th, 2009 / 11:50 a.m.
NDP
Don Davies NDP Vancouver Kingsway, BC
Thank you for being here today. It's very helpful.
What are the most common mental illnesses you would find in a federal prison? I would ask you, also, to separate them by men and women.
11:55 a.m.
Researcher, Mental Health and Addiction Services, Forensic Psychiatric Services Commission of British Columbia
I think the question is twofold. What the most common detected mental illnesses are is one question. What the common underlying, undetected mental illnesses are would be another question. With my familiarity with the literature, I can't separate it by men and women, although the profiles would be much different.
The correctional system tends to concentrate on more severe types of mental illness in terms of their identification, which would be schizophrenia and other psychotic disorders. The less severe depression and anxiety disorders might not be picked up on the radar in terms of the screening and assessment, perhaps because of a lack of available services to address those underlying problems. I can't give you exact figures for that particular question. I'm sorry.
11:55 a.m.
NDP
Don Davies NDP Vancouver Kingsway, BC
Through my amateur research, it's my understanding that substance abuse is actually listed in the DSM-IV and is in itself a mental illness. When we separate substance abuse from other forms of mental illness, we don't mean to say that they're not all mental illnesses. But it's helpful to have that dichotomy, because they have different treatment plans, and I suppose that they indicate themselves differently.
Do you believe there is a linkage between those mental illnesses, whether they're detected or not, and the committing of the crimes for which those people are in jail?
11:55 a.m.
Program Director, Community Support Services, Canadian Mental Health Association
Certainly with regard to substance abuse, the literature would indicate that there is a connection with substance abuse. It is a criminogenic risk factor in terms of recidivism. The literature on psychosis and psychotic symptoms has been mixed.
More recently, actually, there was a meta-analysis that was undertaken that seemed to suggest that psychotic symptoms, such as “threat/control-override” delusions, a belief that somebody is going to harm the individual or that their mind or body is being controlled by another being or source, could increase the person's risk, although not substantially.
11:55 a.m.
Executive Vice-President, Policy, Education and Health Promotion, Centre for Addiction and Mental Health
Certainly the evidence is clear that people with mental health problems are not more violent than the general population in general. It is important to remember that, because while we are talking about great need in the correctional system for services for people with mental illness and addiction problems, I think that saying they are there because of those problems is a dangerous way to go. Then we conflate two things.
On this question, I think we really have to separate mental illness and substance use. Many people are in the correctional system because of their substance use, which may or may not be an addiction issue. We know that alcohol is implicated in many crimes in the sense that violence tends to result from alcohol. Alcohol causes huge social problems, which is one of the reasons the CAMH does a lot of work on alcohol policy and lowering blood alcohol levels and those kinds of things.
We know that there is a great connection between alcohol, violence, and people being in correctional facilities. There are other people who are there because of the consequence of their drug use. So it may not be a violence issue. It tends to be people on harder drugs, who have stolen to support those habits. They're not as prevalent as alcohol-related problems. When it comes to mental illness, I would not say that mental illness causes people to be criminal.
11:55 a.m.
NDP
Don Davies NDP Vancouver Kingsway, BC
Don't misunderstand me; I wasn't meaning to suggest that mental illness is a cause. You made a linkage to violence. That was not in my mind at all.
What I'm trying to find out is whether there is a link between underlying mental health issues: anxiety, depression, paranoia, feelings of insecurity, all the way down to things such as post-traumatic stress disorder, which I know is epidemic in women's institutions, as well as FASD, which I know is not mental illness but is something that I think lessens impulse control. In a lot of cases, are those some of the underlying contributors to why that person is in prison?
The reason I ask that is because it would seem to me, then, that if we are not accurately diagnosing and treating those issues in the corrections system, are we doing what we can to reduce the recidivism of those people when they come out? If there's no linkage, then I guess we don't have to diagnose or treat them in prison, do we, because there is no linkage. But I happen to believe there is.
That is what I was getting at. I wonder if that helps flesh it out, and I would invite any comment on that.
Noon
Researcher, Mental Health and Addiction Services, Forensic Psychiatric Services Commission of British Columbia
My comment as a student of criminology and sociology is that your question is very complex and it sort of hinges on the social determinants of both mental illness and crime, which are very related. Poverty, marginalization as such, living in impoverished neighbourhoods, and those sorts of things are related to both of those problems.
But going back to your question about increasing recidivism because of the lack of mental health services in correctional settings—if I could paraphrase it—not providing people with mental health and substance abuse treatment is detrimental to their participation in correctional programs that are focused on reducing those sorts of things you talk about.
We know that by providing people with mental health treatment they're able to better participate in the programs that are specifically designed for recidivism in correctional settings.