I do, Mr. Chair, and I'm very happy to have that opportunity. I believe the members will have a copy of what I'm going to be saying as well. If they happen to want to follow along or refer back to it as we go along today, they'll be able to do that.
I want to say, first of all, that you've been very patient with us at the Mental Health Commission because you've invited us to come here, three of us. Mr. Préfontaine has worked very hard to try to get the three of us here. Judge Ted Ormston, who is the chair of one of our advisory committees, our chief operating officer, and I as secretary of the board were intending to come along. We haven't been able to find a date that you had and was possible for us. But I'll just say to you that if you have further interest after this meeting, Mr. Chair and members of the committee, in hearing more from us, I'm sure those other people will be able to make time for you individually, collectively, or however you'd like to do it. So thank you for inviting us.
I want to move right along, and I want to situate my remarks—as you would expect me to do, I think, since I'm from the Mental Health Commission—about mental health and addiction care for federally incarcerated offenders in the context of the work of the Mental Health Commission of Canada.
The MHCC, as I'll refer to it as a short form, had its origins in the report tabled by the Standing Committee on Social Affairs, Science and Technology. That report was tabled in May 2006 and was prepared under the leadership of someone many of you will know, the Honourable Michael Kirby, and his deputy chair for that committee, Dr. Wilbert Keon.
Appropriately titled “Out of the Shadows at Last”, this was the first ever—it's hard to believe for somebody like me who has worked in correctional services since 1960 and in the mental health field—comprehensive study of mental health, mental illness, and addiction services in Canada. Many of you may have seen that report. If you haven't, it's that thick. It's well worth referring to. It has a specific section referring to the federally incarcerated offender group and the work of the Correctional Service of Canada, which would be helpful.
Their process in that committee, the Senate committee, was to make proposals that would transform the systems and services provided for persons living with a mental illness and/or addictive behaviours in Canada. Some of you will know that about 60% of the people who have a mental illness also have a substance abuse problem. So the crossover is very high.
One of the 118 recommendations in that report proposed the creation of a Mental Health Commission. The purpose of this national, not federal, commission was to provide a body empowered to accelerate the development and implementation of effective solutions and to maintain a needed national focus on mental health issues. Again, if any of you know Michael Kirby, you'll know he makes it his business to keep a focus on whatever task he is given. In all of the activities of the commission, we strive to be a catalyst for change. So that's our byword. In the federal budget of March 2007, the federal government announced the creation and funding of a Mental Health Commission with Michael Kirby as its chair.
The commission was asked to focus on certain specific tasks. They are the development of a mental health strategy for Canada, the development of a knowledge exchange centre for this field, and the creation and implementation of a 10-year anti-stigma/anti-discrimination program. And then subsequently, the federal government asked the commission to establish a five-year research/demonstration project for homeless mentally ill persons situated in five cities in Canada. Some of you will be familiar with that activity, which is very much under way at the moment.
The commission itself has a 10-year life, so it will run on longer than do those demonstration projects in homelessness.
The commission has just published a phase one report concerning the mental health strategy. It is the product of an extensive consultation across Canada. All of you as members, I think, have received it. It's the product of an extensive consultation across Canada to determine what should be included in a national strategy.
Entitled Toward Recovery and Well-Being: A Framework for a Mental Health Strategy for Canada, this report provides a comprehensive, high-level platform for the next stage of development and consultation. This second phase will present the “how”--what should be in the strategy for Canada for mental health and justice, for example, the whole justice field. So this second phase is going to work on the “how” of the transformation, is expected to be completed by late 2011.
For example, it will include what are eight distinct advisory committees, such as the one chaired by Judge Ted Ormston. Judge Ted Ormston will provide what the public government bodies, our staff, and those various persons, perhaps you yourselves, believe should be in sections of the report. It's certainly going to deal with the widest possible range of mental health and addiction matters, from children and youth to seniors, to addicted persons, to those who fall into the criminal justice system.
I trust that committee members will have that report. Mr. Préfontaine indicates that you received it.
The Toward Recovery and Well-Being report could be useful to this committee as you perhaps consider the value of a national mental health and substance abuse strategy for the Correctional Service of Canada. We believe that such a strategy could be useful in providing a sound framework for determining funding priorities, program development, and change within the Correctional Service of Canada. We encourage that if they do, or you do, recommend that they undertake having a national strategy for corrections, it be integrated with the national strategy that the Mental Health Commission is developing. It makes sense to have sub-strategies, if I can put it that way, across Canada. The last thing we need in this poor old mental health and criminal justice field is more fragmentation. We've got plenty of that.
Just as the general mental health and addiction service system is poorly integrated and with many challenges as clients move through it--maybe you have relatives, as almost all of us do, who have moved through the mental health system--we know how fragmented it is, so also is the criminal justice system faced with similar obstacles, but ones that are often even more substantial. A mental health strategy for the Correctional Service of Canada could be a good start.
Stigma, and the discrimination that emanates from it, is a hurdle that Canadians must overcome if the mental health and addiction service is to function to best effect. The commission's Opening Minds program was recently launched, and the campaign that goes with it is absolutely essential in raising public awareness about stigma and its impacts. Most of us who work at the Mental Health Commission don't think that the changes we're involved in and helping to promote are going to get very far unless there is a reduction in the stigma and discrimination against people in corrections.
Just as stigma is a large issue to overcome with the general public, the stigma and fear that attaches to criminal behaviour when combined with mental illness is a much greater challenge. It's our view that any program to transform mental health and addictions care for the Correctional Service of Canada will need to be accompanied by an anti-stigma program directed at staff and other inmates, as well as the general public.
You might be interested to know that the stigma program, the general one that we're operating, is focusing first on the area of stigmatization of youth and also the stigmatization of mentally ill people within the health care system. Our vice-chair, Dr. David Goldbloom, a very well-known doctor in Canada, a psychiatrist, would be the first to say that patients who come to hospitals for general care face a tremendous amount of discrimination from all levels of staff within the system. All of us have grown up with this kind of sense of apprehension about what to do about the mentally ill, and physicians aren't any different. They get relatively little training. For general practitioners in this area, when someone appears who has a mental illness, it's very difficult to know what to do, and to do it in a short time. If you have a broken arm, they're much more adroit at handling that.
So training and retraining will be vital aspects of system and service delivery transformation for mental health and addictions in the criminal justice system. We believe that a robust knowledge transfer and exchange program should accompany this training for it to have the most widespread and highest impact.
I know from my past work in the mental health field that the Community Living agency in Ontario, a very large agency devoted to helping people who are developmentally challenged, has a marvellous and very expensive website that people who are staff in institutions can go to and refer to documents written by other staff who write in layperson's language so that people can understand it, whether it's in the middle of the night or in the middle of the day when they're trying to find something out.
There are literally thousands of people who work in correctional services and the criminal justice system in Canada. We need to give them easier access to information that will help them do their work. The Mental Health Commission is not a traditional service agency. Its central methodology is to establish research demonstration projects, often in partnership with other agencies, in a wide variety of sectors as we search, or help others search, for better ways to structure the system and to provide service.
My personal experience with correctional services over the years has been that the system has shifted from one set of programs and beliefs to another without ever having sufficient research to know what has had the best effect. I watched it for twenty years while I was in the correctional services department in Ontario, and we went from industrial farms to treatment to educational programs. It was whatever the government of the day or the staff of the day thought might work best, but it was very poorly researched. That's been the history of correctional services in Canada.
Your committee, I think, has an opportunity to suggest that research demonstration projects become a key component of any major changes that may be instituted within the Correctional Service of Canada. For those persons faced with a serious mental illness under the responsibility of CSC, there are regional treatment centres. I'm sure you know about them, and I think you visited one of them just recently. However, we think it would be helpful to have an intermediate-level mental health facility for persons who've responded to treatment in the RTCs, one or the other of them, so that they're not shunted directly back into the regular criminal justice population of correctional services.
There needs to be some intermediate level. A coherent strategy for those affected by mental health and addictions would afford an opportunity to build on the changes begun at the regional treatment centre in an intermediate environment with more support and with access to continued but less intensive treatment. Indeed, it might be beneficial for persons with a mental illness or a serious substance abuse issue to go to that kind of intermediate facility before discharge to the community, whether they come from the regional treatment centre or whether they come from a general correctional institution. It would provide a place to get people who have a mental health or substance abuse problem or both to be readied in a better way for the outside world.
If you look at it from a public safety point of view, it might very well make them less difficult, less dangerous, and less likely to reoffend, and certainly there would be an improvement in their care.
I think that kind of intermediate-level facility would provide an excellent opportunity as well for a demonstration project with rigorous research as a component of it, so we'd recommend that kind of facility, but we really wouldn't be strongly in favour of it unless it was heavily researched to see if it really does pay off. Between 2004 and 2008 in Ontario, the mental health services saw an increase of $220 million in their budgets. This still represented a decline in the proportion of the health care dollars spent on these vital services in Ontario.
In that same period, the spending on services for those with substance abuse issues in Ontario saw very little increase at all. While mental health systems have been studied exhaustively and in spite of thoughtful recommendations, governments have usually chosen to put their health care dollar elsewhere.
