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.
Bloc
Maria Mourani Bloc Ahuntsic, QC
Thank you, Mr. Chair.
I thank all our witnesses. I have a few short questions.
We considered many very theoretical points today. Yet, I am a very down-to-earth person, so I would like to bring the discussion down to the level of mortals.
Mr. Livingston, you spoke of a security environment with minimal isolation. I must admit that having worked in prisons, I have trouble seeing how we could do that. If you have a suggestion, it would be welcomed.
Researcher, Mental Health and Addiction Services, Forensic Psychiatric Services Commission of British Columbia
Generally, the guidelines suggest that you don't isolate someone without contact with people when you're trying to prevent and manage suicide. So if you're talking specifically about suicide, the level of risk should indicate the level of supervision that somebody receives.
The literature is very clear that isolating someone who is at potential risk for suicide is a contributor to the completed suicide. So staff interaction every 15 minutes, or every five minutes, and not replacing direct and meaningful staff interaction with technology, such as cameras, or with other correctional inmates who often serve as companions—
Researcher, Mental Health and Addiction Services, Forensic Psychiatric Services Commission of British Columbia
No, it's not from direct experience; it's from the literature, which is very rich. There has been a lot of work done in developing minimum standards in this particular area and studying the effectiveness of what approaches work well. This has been identified in the research and is unanimously supported by a range of international standards.
Bloc
Maria Mourani Bloc Ahuntsic, QC
If I am not mistaken, these are minimal standards, but it does not mean that they are already enforced. It might be that they are already implemented in our prisons as we speak. Is that right?
Researcher, Mental Health and Addiction Services, Forensic Psychiatric Services Commission of British Columbia
Yes, they could be. My report just outlines them. They could be already applied.
And it might be of interest to the committee that I'm aware that a recent federal-territorial-provincial committee on prisons and mental health has had a look at my report and has built it into a self-assessment guide to measure and monitor their system across Canada. It might be of interest to follow that up a little bit.
Bloc
Maria Mourani Bloc Ahuntsic, QC
At this time, Correctional Service Canada has a very specific management program for persons who are put into isolation. From the time a person is placed in isolation not only is she in her own cell—there are never two people in the same cell—, but a guard is present who makes rounds about every ten minutes. Furthermore, a corrections officer must make a daily evaluation of the inmate's condition.
I thought at first that you were talking theoretically, but it is possible that this is actually going on in prisons in Canada. That is my understanding. This would be the ideal situation, but you cannot tell us if it is not already implemented in some federal institutions.
Researcher, Mental Health and Addiction Services, Forensic Psychiatric Services Commission of British Columbia
No. As I said, I'm a novice in terms of what's happening on the ground, and I'm not an expert. I'm an expert on very little, especially having to do with the operations of corrections.
Bloc
Maria Mourani Bloc Ahuntsic, QC
My question is for Ms. Czukar. We were talking about conducting a diagnostic assessment of inmates. Have you heard of the Regional Reception Centre, in Quebec?
Executive Vice-President, Policy, Education and Health Promotion, Centre for Addiction and Mental Health
No, I don't know the specific reception centres. I know that there are, I think, five of them across the country and so on, but I don't know specific ones, no.
Bloc
Maria Mourani Bloc Ahuntsic, QC
Most federal penitentiaries have an intake process for inmates. An assessment is made of all inmates and they are directed to one or another prison depending on their security risk and their program needs.
Have you heard of the Regional Mental Health Centre, in Quebec?
Executive Vice-President, Policy, Education and Health Promotion, Centre for Addiction and Mental Health
No.
Bloc
Maria Mourani Bloc Ahuntsic, QC
I was listening to what you were saying and I have the impression that nothing or very little is going on at the present time in Correctional Service Canada. I referred to the Regional Mental Health Centre. The same facility exists in Kingston. This is really focussed on mental health. We find there psychologists, psychiatrists, social workers, parole officers, security officers, all these multidisciplinary teams.
Did you look into the federal prisons to see if these services were offered or not?
Executive Vice-President, Policy, Education and Health Promotion, Centre for Addiction and Mental Health
My understanding is that there is a great deal already provided, but that it's insufficient.
Executive Vice-President, Policy, Education and Health Promotion, Centre for Addiction and Mental Health
There are not enough of these services, and I understand that the testimony before this committee has been that about half of the people who are in serious need of services are not receiving them. So I'm not saying there's nothing happening, but from what others have told you who do know the system, it sounds like a lot of people aren't getting what they need.
Conservative
Bloc
Maria Mourani Bloc Ahuntsic, QC
I will be brief.
Earlier, you made a very important point: the link between mental health and violence. In your work, have you seen people with mental health problems capable of committing crimes due to psychotic hallucinations, and who are violent? What do we do with these people?
Executive Vice-President, Policy, Education and Health Promotion, Centre for Addiction and Mental Health
Yes, that does happen. And I think a lot of those people are the people we were talking about in prison. I think we've said that it can very well lead to someone being in the system. It's not always the case, and some of the people you find there are like that and some aren't.
Conservative
The Chair Conservative Garry Breitkreuz
Thank you.
We'll go over to the government side now. Ms. Glover, please, for five minutes.
October 29th, 2009 / 12:25 p.m.
Conservative
Shelly Glover Conservative Saint Boniface, MB
Thank you very much, Mr. Chair.
I want to welcome our witnesses here today. I take a tremendous interest in this area, and I have a few questions, but I'd like to start with Dr. Livingston's statement. You said, and it's not verbatim but very close, that treating those who want to be treated is easier than treating those who don't want to be treated.
The reason I take such an interest in that statement is because in my home province, we had the terrible tragedy of Mr. Li's events on a Greyhound bus where Tim McLean was in fact murdered and beheaded, and a number of other things occurred following his death. In that case specifically, Mr. Li was found not criminally responsible. However, we are all aware that physically he was responsible for this terrible crime.
In addressing your statement, I'm wondering if you ever feel that there are times or occasions when you believe that incarcerating people who don't want treatment in fact is essential for the interest of the public and for the interest of the individual. Can you comment on that?
Researcher, Mental Health and Addiction Services, Forensic Psychiatric Services Commission of British Columbia
Yes, and maybe I can provide you with a little bit of context around that statement. Like I said, I've been researching stigma for people who are legally mandated to attend treatment services in the community throughout B.C. and more specifically in Vancouver, including the downtown east side.
The difficulty with getting people to take psychiatric treatments when they don't want to, when their agency and choice are perhaps not respected around treatment issues, and when they are required to attend treatment appointments when they don't want to, is that it makes it very difficult to set out a course of treatment for these individuals.
Not only that, but their experiences with the mental health system—and that's what I research—aren't positive because of the coercive techniques that are used to have them comply with treatment. Their outcomes might be great in terms of clinical outcomes, but in terms of their experiences with the system, it's a whole different ball game. And it affects their future treatment and willingness to engage in treatment as well.
Conservative
Shelly Glover Conservative Saint Boniface, MB
Do you mean in the general population or in the prison system?
Researcher, Mental Health and Addiction Services, Forensic Psychiatric Services Commission of British Columbia
I follow two groups of people. One of them is in the general population. They are a civil mental health population who are on what some people call a community treatment order; in B.C., it's an extended leave. They are civilly committed to hospital and discharged to the community, but they are still required to attend treatment services.
The other half of my sample is a forensic psychiatric population. They're not an inmate population. They're not mentally disordered offenders; they're mentally disordered accused persons. They've all been found not criminally responsible on account of mental disorder. They spent some time at our forensic psychiatric hospital, were discharged to the community, and are now receiving compulsory community mental health treatment under the sections following section 672 in the Criminal Code. It's a conditional discharge.
Many of them have had histories of being inmates in the past, but I'm not specifically following an inmate population.