Public Safety Committee on Dec. 10th, 2009

[Phil McColeman, Conservative, Brant, ON]

Thank you very much, Mr. Thompson, for being here.

In some ways, if I might just say so on a personal level, you've assisted me in conceptualizing some of the things we've seen in terms of the sheer diversity. To my mind, how we will make recommendations coherently around that has been a little bit daunting. You've helped me see that conceptually, and you've outlined a number of very good initiatives.

One of the biggest things we have witnessed is connecting to the community. Some of the successes really revolve around the effectiveness of connection to the community.

One of those areas is connecting to higher-level educational institutions within communities, post-secondary institutions that have specific programming. Because of your vast knowledge and experience, I'd like to ask you this question: in our current curriculums for criminology or the various disciplines, do you think we are churning out--for lack of a better word--graduates with enough specialized education and skills who have an interest in taking these initiatives forward?

[Glenn Thompson]

Well, we certainly aren't, that's for sure. We're not turning out enough people.

I would look less at the training of people at the advanced level. Psychiatrists are getting very good training. Psychologists are getting terrific training. Social workers are getting better and better training. We need to look at the next layer down, I think. What about teachers and how diversified their training can be, or people in the schools who can help to intervene in these situations, doing the early intervention kind of stuff? It doesn't have to be a psychiatrist or even a social worker or psychologist. Lots of people can be trained at a basic level to be helpful.

The Mental Health Commission is probably going to take on a program that's been operating in Alberta called Mental Health First Aid. You may never have heard of it, but it's being widely used across the world these days. It was invented in Australia. It's a training program of a very basic sort. It's a kind of CPR for mental health, I'd say. So if you know how to help a person who's having heart difficulty and do mouth-to-mouth respiration, this is the equivalent in mental health terms.

We need to have many more people trained at that kind of simple level without any highfalutin kind of advanced training so they can refer people on and sort them out. There are all kinds of young people in high school. If you have teenagers in your house, you probably wonder some days if they aren't all mentally ill, and other days you think they're fine. It's a trauma for all of us to go through teenage years, and it's very difficult to know sometimes whether somebody's in serious difficulty or they're not. Somebody with a bit of training can begin to help sort that out for teachers and others in their school, so we need that kind of training as much as anything, I think.

We certainly need more people with advanced training. I know Correctional Services of Canada has difficulty getting enough psychologists, getting enough people who are trained in these various disciplines. Some of that has to do with whether they feel they're in an environment that can give them hope as a therapist, I guess, or as a helper. You have to change the environment of the institution to some extent to make it interesting to people, to make it attractive.

When I started in the Department of Reform Institutions in 1960 in Ontario, people at my social work school at the U of T said, “Well, there's one place not to work, and that's the Department of Reform Institutions. That's for sure.” So I was foolish enough to go there, and I stayed for 20 years. People have to be attracted into those kinds of difficult environments. Those of you who've worked in police work know the same thing. It isn't easy to be a police person. It certainly isn't easy to be a police person dealing with mentally ill people. That's for sure.

One of you asked where we are wasting our money. Those of you who are police officers will know that we're wasting a tremendous amount of money having two police officers sitting in an emergency ward of a hospital for hours and hours supervising someone who has a serious mental illness until somebody gets around to seeing them, and then they might be discharged. I see nodding heads, of course. That's a terrible waste of resources. So we need to do something about that, and we can do a better job in that kind of situation than we're doing now.

[Phil McColeman, Conservative, Brant, ON]

We had witnesses here on the addiction side--the drug courts and the mental health courts--which are developing.... I think the upfront streaming is an issue we would like to address in a proactive way. Do you see those institutions serving a major role in the future, in terms of further development and putting people into the right kinds of treatment?

[The Chair, Conservative, Garry Breitkreuz]

Let's take time for a brief response.

Go ahead.

[Glenn Thompson]

Are you thinking of the institutions in the community that deal with that kind of clientele?

[Phil McColeman, Conservative, Brant, ON]

Not so much. The person who is a first offender. They give them options in terms of going to those courts and being properly streamed instead of going into the wrong situation.

[Glenn Thompson]

Absolutely. The Scarborough court in Toronto is a good example of good streaming, so if you're looking for a good example, talk to the gentleman who's a PhD now, who works in that court, who works for the Canadian Mental Health Association. He's an expert in early streaming for people who have mental health or substance abuse issues or both, and he's trying to help the court and the police and others decide which ones should be referred to community agencies.

Yes, there's quite a bit known about that now, and it's being applied.

[The Chair, Conservative, Garry Breitkreuz]

Thank you.

Ms. Mourani, please.

[Maria Mourani, Bloc, Ahuntsic, QC]

Thank you Mr. Chairman.

Mr. Thompson, I'd like you to tell me a little bit about the intermediate mental health facilities. What does this word intermediate actually mean? Would these facilities be under the authority of Corrections Canada, a community service, the provinces?

[Glenn Thompson]

I see them as a Correctional Service of Canada facility and I think they would be less intensive in the kind of care they would be trying to provide than the regional treatment centre you visited, or less intensive than the Brockville facility that I mentioned the province operates. It would be a step-down facility, but it's quite a crunch to go from any psychiatric hospital--forget about correctional services--right back into the community with absolutely no support. Imagine yourself in the Centre for Addiction and Mental Health in Toronto with a very advanced treatment program, and suddenly you're out in the community and you have no support or help. People who go from the regional treatment centre back into a regular penitentiary probably feel as though they've just hit a brick wall. They may well deteriorate, decompensate fairly quickly in that environment. They could be much better treated in a halfway house, if you want to call it that. That would be a correctional services institution with a less intensive kind of care, and that could very well be the avenue out into the community.

I think it's difficult for people with a serious mental illness to go from an RTC out into the community directly, and it's a waste of money to keep people in the RTC who could be handled in that less intensive environment. If that kind of facility were created, I'm sure you'd find people who could go there instead of to the RTC, to a somewhat less intensive program.

[Maria Mourani, Bloc, Ahuntsic, QC]

When you refer to "intermediate" do you mean, in concrete terms, a new type of facility or the halfway houses that already exist? For instance, halfway houses already exist within Corrections, they are the CCCs, which are created specifically for people with mental health problems, like the CCC Martineau in Montreal.

Is that what you mean by intermediate? If not, should Corrections develop another facility, which would be more similar to a hospital? I do not understand the word intermediate, I'm sorry.

[Glenn Thompson]

It would be the latter. It would be an institution, because there are those community facilities. These would be people who are not yet ready to go out into the community but who are somewhere in their mental health status between the general population and somebody who is severely psychotic, for example. If you were in a severe schizophrenic state, you ought to be in the RTC. Once you begin to respond to care, whether you're depressed or whatever your particular psychiatric problem, then you can move out into a less intensive kind of program.

It would be similar to, I suppose, a community resource centre, the one you mentioned in Quebec, but it would be within the institutional setting. There are many, many people who aren't yet ready, I'm sure, to go out into the community who could use that intermediate facility. But as I said in the remarks I made at first, I would definitely make it a research demonstration project. I wouldn't just build a facility and hope it's going to work. I would research what I'm doing there very carefully and try different methods.

[Maria Mourani, Bloc, Ahuntsic, QC]

Would these people be sent to these intermediate centres at the end of their term, in the middle or when the risk of danger to the public has decreased? Under what criteria would people be sent to an intermediate centre?

[Glenn Thompson]

The first use I'd recommend would be as a step-down in intensive care from an RTC. It would be persons who've been to a regional treatment centre, who have been very severely mentally ill, and who are now going to a less intensive facility but not back into the general population. Some of those people, if they're nearing the end of their sentence or able to be paroled, may very well go right out of the intermediate facility into the community. They're still mentally ill or have a serious substance abuse problem, and they probably then need to go out into the kind of facility you mentioned that's in Montreal.

[Maria Mourani, Bloc, Ahuntsic, QC]

I am done? Very well. Thank you.

[The Chair, Conservative, Garry Breitkreuz]

Yes, sorry. Thank you.

We'll go over to the government side now, with Ms. Glover, and then back to Mr. Oliphant.

[Shelly Glover, Conservative, Saint Boniface, MB]

Thank you, Mr. Chair.

I want to welcome you, as well, and wish you a merry Christmas.

I was very interested to hear what you had to say about the waste of time and money on the policing side. I'm glad to hear someone acknowledge that, because I spent a number of years policing, much like my colleagues on this side of the House. I'll tell you that situation you described, where two police offers sit—as I was sitting—for between five and ten hours, sometimes longer, in a hospital, only to have the patient, who is clearly exhibiting some kind of mental illness, be released because the criterion that has to be met by the psychiatrist is simply whether they are a danger immediately to themselves or others--that is very disappointing. And I feel we fail these people at that point. I strongly believe that's where the prevention Mr. Kania talks about comes in. That's one aspect of prevention that needs to be inserted at that point. We will have to work strongly with the provinces to encourage them to see about perhaps alleviating some of that wasteful time and money.

I also enjoyed what you said in your dissertation at the beginning, when you talked about developing a program similar to what you have for health care professionals. I note that you've passed out some pamphlets that refer to those all-important projects and programs that the Mental Health Commission is endeavouring to offer. I would like you to explain how you suggest we mirror these in the Correctional Service.

I understand when you talk about the anti-stigma program. Your Opening Minds program is very clear in your pamphlet, so I understand education. I don't quite get how we do the research demonstration project, the one you have for the health care professionals and the one that is being financed by the Government of Canada, where we're taking homeless people and putting them into housing and studying whether or not that has a positive impact on their receiving further relations or further treatment, as opposed to the placebo group who will not be receiving housing, and they're going to watch and see how they transition into treatment. How do you suggest we do that within a correctional facility? How do we research and do a demonstration project, as you're suggesting, within a secure facility?

I'm not sure how we do that, and I'd love to hear your suggestions on how it gets done.

[Glenn Thompson]

To go back to the intermediate facility idea, for instance, the correctional services have many people at the moment who go from RTCs back to the general population. Take a group of 300 people who are going to that population, divert 150 of them randomly to the intermediate facility, and find out which one works better for those two groups. That would be a research-type way to do it.

[Shelly Glover, Conservative, Saint Boniface, MB]

My only concern is that you don't have a population of 300 in one facility who are necessarily at that point in their recovery or treatment. That might involve having to pull people from all across the country to put them in this research demonstration project. That would be problematic, I believe, because they would want access to family and other supports they already have there. That's where I'm at a bit of a loss as to how we get this done while also taking into consideration their needs for support.

[Glenn Thompson]

I would bet that if the commissioner of corrections were here, he could find you 300 people in half an hour in the general population who would very well use an intermediate facility, plus people coming out of the RTC. I think people from both directions could use these kinds of facilities.

The Correctional Service of Canada has a lot of people who have mid-level mental illness, for sure. I don't think finding the number of people would be the problem; I think the difficulty is in the complexity of that kind of research. With the homelessness research we have going on, people who know about research—and I don't pretend to—tell us it's the biggest operational research on homelessness that's ever been done in the world. It's a very commendable project.

It's very expensive as well. These things are not something one can do without a significant piece of funding. That program, over five years, costs $110 million. I was deputy minister of housing in Ontario, and I know how much housing costs. Dividing $110 million by five doesn't give you a lot of housing dollars if you're putting people in rent geared to income accommodation. It costs a lot to live in our housing situations these days. Housing plus treatment is an expensive process.

Housing plus treatment plus research would be an expensive process, but it would very worth doing. It might very well alleviate a lot of the difficulties in the general correctional institutions federally that are caused by, if you can put it that way, people with a serious mental illness--people who are making the lives of correctional workers and their fellow inmates unbearable because they don't know what to do with them and they're very complex cases to deal with.

I think it would be doable to have that kind of research project. We have a lot of people who know a lot about research, and we can help the Correctional Service with that. We are running about 25 research projects now, plus these ones on homelessness.

[The Chair, Conservative, Garry Breitkreuz]

Thank you. We're going to have to leave it there for now.

Mr. Oliphant, please.

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

Thank you, Mr. Thompson. I want to do three things while you're here.

One is to thank you for your amazing public service, which has continued, frankly, long after I expected it would have. I think you are representative of the finest public servants in our country. In the line of Bob Carman and people I worked with, I'm glad you continue to do what you do. It's wonderful.

Second, I want to take an opportunity to push back a bit. I do this when people come to my office to lobby me about issues; I push back and lobby them. I'd like to take a minute to lobby the commission to keep a focus on incarcerated people, which has not really been in your work.

I think what we see in our work is that this segment of the population are the leftovers. I think the commission has a responsibility to broaden its work to include those who are some of the least likeable of the mentally ill because they have sometimes committed terrible crimes. I think our society needs your help at the commission to do that.

That's just a little plea. I always take that opportunity.

Third, one of our witnesses said, and I want your comment on this, that prisons have become a risk factor for addictions and mental health. You have a long history in corrections and in mental health, and I'd like some comments on that.

[Glenn Thompson]

I suppose any kind of incarceration is a risk for a mentally ill person. If a mentally ill person is placed in a secure setting that doesn't attend to their mental health needs, it's bound to be a risk. Perhaps that's what the person who was speaking to you was saying. A custodial environment is not likely to be good for a person with a mental health problem. On the other hand, society has to be protected, and we need to deter the general population from committing offences.

We always have these competing features with us when we consider the offender population. We're trying to deter. The poor judge is sitting there trying to encourage a general deterrence while dealing with the person's needs. It's difficult to handle these competing requirements. However, that doesn't mean it can't be done. I think we have to adjust our correctional environments to make that happen. I take your admonition that the Mental Health Commission needs to concern itself with people who are in custody.

Yesterday, in a document from the Canadian Criminal Justice Association, I read that we recently had about 38,000 people in custody in Canada. That's a lot of people, especially when you take into account the number who go through provincial institutions at a rapid rate. I can't remember how many thousands of people used to go through Toronto Jail when we had just the one facility in Toronto. Thousands of people went through there every year.

So we can affect them for better or worse.

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

Don't get me wrong; public safety is my first concern. We have to keep the public safe, so we incarcerate. I would put that over deterrence and punishment as the main reason for putting people in jail. It's for our safety. Are there a couple of things you have seen in your career that could mitigate this problem?

We were in the Kingston Penitentiary in the treatment centre, and the building did not physically lend itself to creating a healing environment. However, we were in other buildings that did. The physical architecture of buildings can actually promote healing. In your experience, is there anything else that you would want us to hear about?

[Glenn Thompson]

There's no doubt about the benefits of a good environment. I had someone the other day asking the commission, just because he thought we might know, about the design of a large new office. He wanted to know how to design it to promote mental health among his workers. So we did a bit of research on it.

Recently, I heard a physician on CBC Radio who discovered, through her own physical illness, the healing environment of place in which she received care. She's made it a career and has written books about it. I can give you that information, if you'd like. But there's absolutely no doubt about what you were saying.

Here's a vignette for you. Back in 1966, I was the superintendent of the Andrew Mercer Reformatory for Women. Can you imagine a guy doing that? They couldn't find a lady to do it, ladies. I was there for three or four years. We disposed of that institution and built the Vanier Centre for Women in Brampton. At the Mercer Reformatory for Women, people were carving their bodies in all sorts of grotesque ways. They were mostly teenage women cutting themselves as though to cut their wrists. They weren't really trying to kill themselves, but they were damaging their bodies and disturbing things terribly. When we moved to the new institution in Brampton, which had an entirely different physical facility, that behaviour stopped. It didn't occur after that. It was like pulling the blind up or down. It was the most amazing part of the change that we made. There were all sorts of other good things we were doing there—treatment programs, shop programs, and group therapy. But the change in environment stands out. It helped a lot.