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.

On the agenda

MPs speaking

Also speaking

James Livingston  Researcher, Mental Health and Addiction Services, Forensic Psychiatric Services Commission of British Columbia
Frank Sirotich  Program Director, Community Support Services, Canadian Mental Health Association
Gail Czukar  Executive Vice-President, Policy, Education and Health Promotion, Centre for Addiction and Mental Health

Noon

NDP

Don Davies NDP Vancouver Kingsway, BC

Okay. I have two quick questions, and we will keep the answers brief.

Did I understand you correctly, Ms. Czukar, that corrections is paying 40% less to professionals in the corrections system than in the market in general?

Noon

Executive Vice-President, Policy, Education and Health Promotion, Centre for Addiction and Mental Health

Gail Czukar

I read in some of the previous hearings an example where someone was being paid, I think, $88,000 and was hired by another organization that was paying them $118,000. I am not sure if my math exactly adds up, but it's almost that.

Noon

NDP

Don Davies NDP Vancouver Kingsway, BC

That jibes, because in August and September I toured nine institutions in British Columbia, clustered in the Fraser Valley. There were vacancies all over the place for psychologists, occupational therapists, and substance abuse counsellors, because they just cannot attract them.

My last question is on 12-step programs. I found that there was a real lack of 12-step program presence in every institution I was in. There seem to be some barriers to that, because inmates are not necessarily the best population in which to conduct 12-step member-based programs.

Do you have any comment on ways to get the community involved in our prisons to help expose those prisoners to 12-step programs, which seem to have a lot of success?

Noon

Program Director, Community Support Services, Canadian Mental Health Association

Dr. Frank Sirotich

No, not specifically on 12-step programs, but there are models with regard to mental health services.

When people are under an Ontario Review Board order and they are transitioning into the community, the community providers actually will go into the forensic hospitals and work collaboratively with the hospital staff there so that there is greater continuity when the person transitions into the community.

Presumably, there could be parallels. That's with mental health. I could see parallels certainly being applied to an addictions context.

Noon

Conservative

The Chair Conservative Garry Breitkreuz

We'll go to Mr. Rathgeber now, for seven minutes, please.

Noon

Conservative

Brent Rathgeber Conservative Edmonton—St. Albert, AB

Thank you, Mr. Chair.

Thank you to all the witnesses for your interesting presentations.

Dr. Czukar, in response to a question that Mr. Holland posed to you, did I hear you correctly that your estimation or research had indicated only 12% of the Canadian prison population suffers from some form of mental illness?

Noon

Executive Vice-President, Policy, Education and Health Promotion, Centre for Addiction and Mental Health

Gail Czukar

No, those are not my figures. Those are the figures that I believe were presented here by previous witnesses. So I don't have any source for that, but I have read some of the previous testimony.

Noon

Conservative

Brent Rathgeber Conservative Edmonton—St. Albert, AB

That number appears low to me. I have heard estimates as high as 30%, but I suppose it depends how you define mental illness.

Does anybody know what exactly is included in that 12% figure? Is that as minor as manageable depression, or does it only include serious anti-social behaviour types of illnesses?

Noon

Researcher, Mental Health and Addiction Services, Forensic Psychiatric Services Commission of British Columbia

James Livingston

Depending on the population you're looking at, the country you're looking at, and the definition of mental illness or mental disorder, the figures range from 5% to 70% within the literature. And that is not just within a Canadian context.

Meta-analysis has generally ballparked the number from reviewing international studies at around 8% to 12%. I can't provide you with the inclusion criteria for how they defined mental illness within that 8% to 12%, but I can certainly provide research references for that.

12:05 p.m.

Conservative

Brent Rathgeber Conservative Edmonton—St. Albert, AB

So we're clear, is the 8% to 12% among those involved in criminal activity, or is that in the population generally?

12:05 p.m.

Researcher, Mental Health and Addiction Services, Forensic Psychiatric Services Commission of British Columbia

James Livingston

That's in prison populations. It also depends on how you define a prison population, because internationally it's defined quite differently.

12:05 p.m.

Conservative

Brent Rathgeber Conservative Edmonton—St. Albert, AB

That's not significantly higher than in the general population. I've read reports that indicate almost 10% of the population suffer from some form of depression.

12:05 p.m.

Executive Vice-President, Policy, Education and Health Promotion, Centre for Addiction and Mental Health

Gail Czukar

I think a serious mental illness, a psychosis, in the general population is 1% to 3%. Depression is much broader.

The figures generally are that one in five people in Canada will have a mental illness or substance abuse problem in their lifetime. That's a fairly well-accepted figure. In Ontario, I believe it's one in four.

It's somewhere between 3% and 20%. We're probably not the ones in a position to help you with the criteria for the way the Correctional Service is deciding who has a serious mental illness. The 12% to 20% is what I've heard the correctional officials give you.

12:05 p.m.

Conservative

Brent Rathgeber Conservative Edmonton—St. Albert, AB

Thank you. I think that underscores the importance of my point about what is being defined as mental illness when we float these figures.

Dr. Livingston, with respect to your model and best practices, how realistic is it that mental health issues can be treated in the prison system? As you know, the prison system is highly regimented, highly regulated; there are rules upon rules. Society generally has not been particularly successful in treating mental illness, so how realistic are these best practices and this conceptual framework you refer to? How realistic will its success be in the highly structured system of corrections?

12:05 p.m.

Researcher, Mental Health and Addiction Services, Forensic Psychiatric Services Commission of British Columbia

James Livingston

I definitely take your point. The correctional environment is certainly difficult for delivering mental health and substance abuse services because of the inherent tensions within the environment.

Having said that, others have done it, and there are innovative models. Within the last few years, the U.K. has developed a different model for providing services to prison populations. They've taken the responsibility away from prison authorities, and the National Health Service now provides prison-based mental health services.

There are innovative models for doing it, and it's being done in other jurisdictions.

12:05 p.m.

Conservative

Brent Rathgeber Conservative Edmonton—St. Albert, AB

We have a couple of minutes. Can you tell me about some of those innovative models? What is happening in the corrections system in Britain that has been successful in treating mental illness inside prison walls?

12:05 p.m.

Researcher, Mental Health and Addiction Services, Forensic Psychiatric Services Commission of British Columbia

James Livingston

There are innovative models from the U.S. as well, so it's not just the U.K. There are psychiatric in-reach teams, in which mental health service providers go to prisons to provide services.

There are people called trans-agency coordinators. They are responsible for coordinating and funding services between corrections and mental health environments. It's someone who is sort of a “boundary spanner”, administratively.

There are also cross-training programs between correctional staff and mental health staff so they build up mutual respect and learn different skills in different environments.

This is all detailed in the report I mentioned. There are innovative models throughout the U.S., and other jurisdictions as well.

12:05 p.m.

Conservative

Brent Rathgeber Conservative Edmonton—St. Albert, AB

Thank you. I'll read up on this.

With regard to my last question, can addictions and mental health issues be treated concurrently, or does one have to get addictions under control before entertaining mental health treatment?

12:10 p.m.

Researcher, Mental Health and Addiction Services, Forensic Psychiatric Services Commission of British Columbia

James Livingston

I will briefly address that.

I'm not a clinician, so I couldn't tell you, based on a clinical view. The research supports integrated concurrent disorders treatment as a best practice and so supports dealing with both problems at the same time. I don't know sequentially how that happens in practice clinically, but it's certainly a best practice, and the national treatment strategy that was identified by my colleague certainly endorses such an approach for people who have concurrent disorders.

12:10 p.m.

Conservative

Brent Rathgeber Conservative Edmonton—St. Albert, AB

Dr. Czukar, in the 30 seconds I have left, do you have anything to add?

12:10 p.m.

Executive Vice-President, Policy, Education and Health Promotion, Centre for Addiction and Mental Health

Gail Czukar

I feel very honoured, but I am not a doctor. I just want to be clear. I am a lawyer and a psychologist.

I would say it's very important to treat addictions and mental illness together. The addiction is frequently a kind of symptom of the illness, so expecting someone to get their addiction under control without addressing the underlying mental health problem or the underlying trauma, or those kinds of needs, isn't going to work.

12:10 p.m.

Conservative

Brent Rathgeber Conservative Edmonton—St. Albert, AB

Thank you very much, all of you.

12:10 p.m.

Conservative

The Chair Conservative Garry Breitkreuz

Thank you.

The analyst has just pointed out to me that in the Sampson report of 2007, they report that 12% of men and 26% of women offenders are identified as having very serious mental health problems.

We will now go over to the Liberal Party again. Mr. Oliphant, please, for five minutes.

October 29th, 2009 / 12:10 p.m.

Liberal

Rob Oliphant Liberal Don Valley West, ON

Thank you, Mr. Chair.

Thank you, all three, for being here, especially Ms. Czukar. I think today's a big day in your organization, with the closing of the 1001 campus, a campus I've actually spent many hours at. I think it's great you're here today. I hope you get back in time. You won't, but it's a big day in the life of your organization.

I also want to thank Dr. Sirotich for your work in your organization. Often the prison populations are forgotten in mainstream studies about everything, whether it's income security, education, whatever. Your organization has kept the prison population on the radar within the broader mental health field, and that's very much appreciated.

I don't know the work of Mr. Livingston, but I'm now learning about it, and I think there is some interesting modelling for the federal system that we can take from B.C.

I want to make sure I'm getting some points, because my time is limited.

What I am hearing overall is this. Both from what you've written in the past and what you've said today, you have made six points: an emphasis on crime reduction with a concentration on the social determinants of both health and crime behaviour; an assessment diagnosis model that is appropriate for all people within the criminal justice system; diversion processes including court and other diversion processes to get people out of the penitentiary system earlier; a continuum of care, which begins right from arrest and remand all the way through sentencing to release; capacity-building, both on the infrastructure and the programs as well as on professionals and caregivers; risk reduction models that should be incorporated into the prison population, not left out; and upon release, community programs and integration and continuing care.

That's what I'm hearing. First, is there something major I'm missing in what you're presenting today?

12:10 p.m.

Executive Vice-President, Policy, Education and Health Promotion, Centre for Addiction and Mental Health

Gail Czukar

I didn't hear you mention treatment in the facilities--