Public Safety Committee on Nov. 5th, 2009

[Dr. Peter Ford]

These are hard figures to get. We were planning to do another study in 2002 of the same sort in a medium-security prison and were within two days of starting when Corrections shut us down and wouldn't let us do it. What I can tell you is that in 1994 we did a study, and 12% of inmates said they had injected during the course of their prison sentence. In 1998 we asked the same question, and the figure had gone up to 25%.

We think, and I think Corrections agrees, that part of the problem was the random drug screening that was introduced. That meant it was impossible for people to smoke marijuana and get away with it, because it kicks around in the urine for up to two weeks after use, whereas cocaine is gone within a few hours, and so is most of the metabolite of heroin. So there are some maneuvers that clearly have increased risk in the prisons in a rather indirect sort of way.

The other thing that increases harm is cell searches that remove the few syringes there are. Sometimes two or three ranges are using the same syringe, which may be hidden behind a brick in the shower area. So there are major problems.

Are people injecting more? I don't know that, but I'm certainly not seeing any less communicable disease.

[Mark Holland, Liberal, Ajax—Pickering, ON]

I think it's disgraceful that this was shut down, because the reality is that we have to get at this. I think we have a massive problem with infectious disease in our prisons. The reality is that those problems then spill into the general population. I think people deserve honest answers, particularly when the actual use of drugs is either unchanged or when, as I've said, in one instance random testing has shown it has gone up.

Ms. Pate, we had Mr. Jones before committee. He was echoing many of the concerns we heard from the Correctional Investigator, from Madam Arbour, and many others. He gave us a quote that said the direction the government is heading in with respect to its crime agenda and corrections “contradicts evidence, logic, effectiveness, history, justice, and humanity”. He essentially was saying the same things that Jackson and Stewart said, that we're heading to the American disaster. Would you agree that this is the trajectory we're headed along right now?

[Kim Pate]

Yes, I would. And if the committee doesn't already have a copy of the report that Human Rights Watch International did—and it's five years old, I think, now—where they talked about the number of people with mental health issues being higher in prisons than in any mental health institutions in the United States, it would be very useful, because I think a lot of these issues are also canvassed there, in addition to the excellent report done by Michael Jackson and Graham Stewart.

[Mark Holland, Liberal, Ajax—Pickering, ON]

Now, you also referenced in your comments the problems we have getting public answers to what happened with Ashley Smith, the correctional investigator expressing real frustration with the lack of action that has been taken.

Would you agree with his conclusion that the changes that need to be made in the wake of what happened with Ashley, and the lessons that should have been learned there, haven't happened, and that in fact we're seeing similar cases to what happened to Ashley play out in our prison system and we can expect similar tragedies if action isn't taken?

[Kim Pate]

I do agree with that. Yesterday I saw two of those women. In fact, the woman who I mentioned would be another one of those women had she not been released earlier in the summer. And there are other women, as well, who I mentioned. So I'm very happy, if there's an opportunity, to provide more details about some of those women.

We have had a few cases we've been able to try to get close to court. And very positive for those women, their situations have changed, but there's always someone else who can come in and end up in that same position, unfortunately.

So yes, we need broader-based systemic change, which can be achieved by looking at some individual accountability mechanisms. The correctional investigator talked about getting rid of the management protocol, which is something this committee should look at as well. It's a super-max designation. The women in those categories are all aboriginal women right now, and they're women with significant mental health issues. So I think we need to be examining the interplay between the translation of needs into risk factors.

Also, looking at and examining Ashley's case, I have been told by people both within and outside of corrections who have examined her situation—not just within the federal sphere—that every single incident where she acted outwardly in a threatening way towards staff was something that was predictable and provoked, despite the official position as put forth. In fact, there were very real periods of time when there weren't outbreaks, but that's not what gets documented in files. Most of the files document everything negative that happens within the prison for an individual prisoner.

[Mark Holland, Liberal, Ajax—Pickering, ON]

You indicated those examples and that you might be able to provide them to committee. I think that would be very helpful.

The last question, because I think it may be the only question I have left to be able to ask, is about the recommendations of Madame Arbour. The correctional investigator has been very critical of Correctional Services of Canada for not implementing a number of them, but one specifically is giving the deputy commissioner for women full and direct authority for all matters affecting female prisoners.

You heard the comments from the department officials with Correctional Services of Canada saying they don't agree with the correctional investigator. What would your response to that be? Do you agree that Madame Arbour's recommendations in that regard are important? What is your response to the department response today?

[Kim Pate]

Yes, we do agree with the recommendation of Madam Arbour. In fact we, the correctional investigator, and a number of other groups at the Arbour commission recommended a completely separate system because of the manner in which male corrections influences negatively what happens with women. In fact one of the challenges in Ashley's case and all of these other cases is that who is responsible, ultimately, is often a very difficult piece to pin down. It could be the warden, it could be someone in the community, it could be the regional deputy commissioner, it could be a policy decision that's being encouraged from national headquarters, and sometimes it's all of those. So it's very difficult to determine. It's easier then to defray responsibility, but it's very difficult to have the kind of accountability and sentence management that we need to have.

Thank you.

[The Chair, Conservative, Garry Breitkreuz]

Thank you very much.

Monsieur Ménard, you're giving your time to Ms. Mourani.

Ms. Mourani, please, go ahead.

[Maria Mourani, Bloc, Ahuntsic, QC]

Thank you, Mr. Chairman.

Good afternoon. Thank you for being here and for helping us with this study. I have a question for Ms. Pate.

I'll summarize what you said: the correctional institutions, the penitentiaries, are not really places where individuals with mental health problems can be managed. The Correctional Service, it has to be admitted, is really based on risk management.

In your opinion, are the psychiatric hospitals of the various provinces able to manage the risk that a person who has a mental health problem and who is a criminal may present? Do they very readily do that, currently, in the case of former inmates, perhaps? Ultimately, could the 20% who are in the correctional system and who are identified as very ill simply be managed in psychiatric hospitals?

[Kim Pate]

It would be my opinion, yes, that they could. The law currently, as it exists, the Corrections and Conditional Release Act, would allow that.

In fact, Corrections routinely sends individuals to psychiatric institutions in jurisdictions. The obvious one people know about and was discussed is the Phillippe Pinel Institute, which has a separate unit. In addition, though, in this region, St. Thomas has been used. Other hospitals have been used. Portions of Kingston General have been used. It depends on the institution, but most of the provinces and territories--not all the territories--have locked forensic units.

Although those sometimes aren't the greatest places, because of the limited resources, in my experience, the reality is that every single prisoner, to a person, who has gone from a prison segregation cell to a forensic unit, even if it's a locked forensic unit, even if it's the most secure forensic unit, even if it has essentially the same conditions of segregation, within 24 hours has shown improvement. Partly it's because of the more appropriate medication treatment or whatever. As well, they are treated, fundamentally, as individuals with a mental health issue whose behaviour is symptomatic of that mental health issue, not of bad behaviour, which is how they tend to be seen in prisons, not surprisingly. That's what prisons are.

As I mentioned, at the regional psychiatric centre most of the staff believe that security takes precedence over mental health, even though it's the business of this facility.

Another issue you should ask about, especially in the psychiatric centres you go to, is how many times committal proceedings are commenced. In my experience, the mental health legislation is often used to commence committal proceedings and to then do forced injections. It is then abandoned before the mechanisms for oversight kick in at a provincial mental health point.

My post-graduate work right now is in forensic mental health because of these issues. So if there's anything we can assist with, I'd be happy to. I know that we're limited in time.

[Maria Mourani, Bloc, Ahuntsic, QC]

Thank you, Madam.

You talked a lot about segregation. Bill C-47 sets out various measures for change at the Correctional Service, including measures designed to provide greater penalties for non-compliance and inappropriate behaviour in the penitentiaries.

In your view, can that bill be even more harmful for persons suffering from mental disorders and who do not necessarily have the same way of expression their emotions, their experience as someone who does not have mental health problems?

[Kim Pate]

The more limited access is to conditional release options. The more the statutory provisions allow, and in fact are supposed to ensure, that they happen, the more we'll see these individuals not being able to earn their way out. Right now, people have to earn their way out. I can tell you that the women I'm talking about, including women who go back and forth now from the community to Pinel, who used to go back and forth from psychiatric hospitals to segregation units--and there was a lot of intervention to break that cycle--are individuals who would continue to be in the system right now if we didn't have interventions like statutory release.

As we see some of the elimination of those options, we're going to see more individuals to warrant expiry, and then they'll be released into the community. We already see them at that stage now. Last year, there was a women who went straight from the management protocol described in the correctional investigator's report to the street. She went from being cuffed at the back, in a security gown, escorted by three to five staff through the institution whenever she was out of her cell, to the street, with no resources, or virtually no resources. Eventually we were able to get some resources for her.

That's what we're going to increasingly see. It's a set-up. It's a huge financial cost, but it's also a huge human and social cost for those individuals and for the community as a whole, because there aren't resources. Far better to invest those services now in community-based services, even locked forensic mental health services if we need them, than to put them into prisons, I would suggest. Our organization would support that.

[Maria Mourani, Bloc, Ahuntsic, QC]

Do you really think that, with regard to assessing the merits of parole, the Correctional Service has that expertise specific to the mental health field? Assessing the merits of a criminal inmate who belongs to a street gang, a criminal organization or any other form of criminal behaviour but who does not have mental health problems is one thing and that's part of the criminological side of the assessment of risk and merit.

However, how can anyone assess the merits of someone who is suffering from mental health problems, from psychotic disorders, who sees things behind you, who is in his officer's office and who tells him that he sees the devil with tentacles behind him. I've previously experienced that; that's why I'm asking you the question. How can anyone assess the merit of someone who is in the midst of a psychotic crisis?

[The Chair, Conservative, Garry Breitkreuz]

Very briefly.

[Kim Pate]

Thank you.

You said more eloquently what I was just trying to say a minute ago in response to your previous question.

Again, one of the recommendations made by Louise Arbour and repeated by the correctional investigator in the most recent report is for a someone with mental health expertise to make an independent review of those who are currently in segregation.

We are seeing people spending longer and longer periods in those conditions and developing more mental health issues. We now have two cases where judges have actually found that prison is a risk factor for someone with a mental health issue committing a violent offence. It is not something inherent in that individual, but the fact that they have become habituated to an institutional environment that promotes that kind of response as a way to get attention in whatever way they can.

[The Chair, Conservative, Garry Breitkreuz]

Thank you very much. We'll have to end it there.

Mr. Davies, please, for seven minutes.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you, Mr. Chairman.

The first thing I want to do on behalf of all Canadians is thank you, Ms. Pate, and the Elizabeth Fry Society for providing such an essential and profoundly important service to women across this country.

I also want to thank Dr. Ford for all the work you have done in our prisons for the last 25 years. I can tell you must have started quite young.

There is so much to ask on the subject of mental health, and we only have seven minutes. I'll just get to some specific things.

I want to come back to the issue of segregation. I think all members of this committee would probably agree that we're dealing with mental health problems in our prisons by tossing people into segregation. The other thing I hope everybody agrees with at this point is that segregation is probably the worst place you can put someone who is having an acute problem with mental health.

Mr. Sapers puts it best. He says that prolonged periods of deprivation of human contact adversely affect mental health and are counterproductive to rehabilitation.

I do know there are models around the world that are using methods other than segregation. One of them is used at an institution in Britain called Styal Prison, where I understand they have a ten-bed unit. When someone self-harms or goes into some sort of behaviour indicating acute mental illness, the person is sent to that unit and one specific staff member is assigned to that person. Essentially that person is put within a health care setting within the institution.

Do you think that is something we should emulate in this country?

[Kim Pate]

Certainly the examples.... Bedford Hills Correctional Facility in New York has a similar model for mental health system services for prisoners. It is run by the psychiatric hospital in New York.

Some really important units once existed in the U.K. but they have since been shut down. Barlinnian shot units were in existence for those seen as the most problematic and who also likely had mental health issues. We often think of these sorts of therapeutic environments as essentially long gone.

There are examples of some institutions that worked very effectively to provide positive and effective intervention. Most have been shut down, much like the resources in the community are being shut down. I would encourage you to look at those.

I would also encourage you to look at and get some of the information that women have asked us to get about their cases but which we are unable to get. Unfortunately, so much is being focused on the fiscal aspect. I am more interested in the human and social cost of what's happening.

Just looking at some of these cases and the difference in costs to keep those women in community, I have a list of women who were classified as some of the most problematic when they were in prison and who are now in the community. They may go into hospital from time to time, but they are not out there creating mayhem. They are not a risk to the public. If they are a risk to anybody it is to themselves, and this is not on a regular basis but when they have flare-ups of mental health issues or--

[Don Davies, NDP, Vancouver Kingsway, BC]

On that score, are there sufficient resources in the community, particularly for women coming out of federal institutions--halfway houses or places of support--where they can continue accessing the programs they need?

[Kim Pate]

No, there are not. In fact, you may want to consult with another American, Jerome Miller, who was head of juvenile corrections in Massachusetts in the seventies and led a--

[Rob Oliphant, Liberal, Don Valley West, ON]

On a point of order, there are eleven conversations going on in this room with officials and with staff and with members of the committee. I can't hear the witness even with my earphones on.

[The Chair, Conservative, Garry Breitkreuz]

Respect the witnesses, please.

Thank you. Good point, Mr. Oliphant.

Go ahead, Ms. Pate.

[Kim Pate]

Jerome Miller talked about when they were decarcerating young people in juvenile corrections, one of the issues they didn't do sufficiently was transfer those resources into the community. So there are individuals who have had experience doing this and have learned from those experiences, and I would encourage we look at that. We could start with a decarceration strategy for a number of the individuals with mental health issues. Even if we took half of the resources that are currently being spent to keep them in custody and inject those into the community, we could see huge benefits for not only those individuals but also for many others with similar issues. I think we can do that and should do that.

[Don Davies, NDP, Vancouver Kingsway, BC]

The previous corrections officials I think did a wonderful job trying to defend their system at this point, about which there is much to be defended, but I think they were a little exuberant in that endeavour.

I'm reading from Mr. Sapers' report, where he says:

In the six-month period between April and September 2008, there were 184 self-harm incidents reported in SITREP, more than double the number recorded over the same period in 2006.

That tells me that if we have double the amount of self-harming incidents in a two-year period, that must be an indicator that we are failing to provide necessary programs, interventions in our prisons. Do you have any experience with the concept of self-harm in prisons and suicide attempts?

[Kim Pate]

In our experience with the individuals we're working with, and the regional advocates who go on our behalf into the institutions, the more desperate people feel and the less hope they have, the more likely it is.... Usually they'll first act out against themselves. Then they may start acting out against others—staff, other prisoners—and ultimately may commit suicide.

That is something that's well documented. Dr. Jan Heney, who worked at the Prison for Women, did a research piece for Corrections on suicide. Dr. Kathleen Kendall did an evaluation of the therapeutic programs and the difficulty of providing therapeutic programs in prisons. She actually worked for the Correctional Service of Canada. Most of those reports won't be brought forth willingly by Corrections, I would suggest, because they're highly critical. The very people, though, who are encouraging us to use them, in court or wherever, recognize that in fact there is a very real need to change direction.