Public Safety Committee on Dec. 8th, 2011

[Dr. Jan Looman]

Yes.

[Candice Bergen, Conservative, Portage—Lisgar, MB]

Over the last two years, $21.5 million has been invested. I think you said you've been part of this process for 18 years; that's what your presentation said. Can you describe the difference you've seen—you said over ten years, but I'm wondering, even in the last five years? What are some of the gains we've made in helping people faster?

I wonder if you are able to compare it to treatments that people receive on the outside. If someone has a diagnosis of mental illness, how soon are they able to get treatment on the outside, versus how soon are inmates able to get treatment? If you could link that together with the recent investments....

[Dr. Jan Looman]

I'm not sure about wait times in the community for mental health treatment, so I can't comment on that. What I've seen in the past five years would be, as I said earlier, the establishment of the intermediate mental health units in the institutions. Some of the institutions have separate mental health units and others have.... Well, okay, I'll back up.

They all have an increase in the mental health staff. There are dedicated mental health teams in each of the institutions, and that's a new thing. There are psychiatric nurses, some of the institutions have social workers, and there are behavioural counsellors. Those were new positions set up specifically to address the mentally disordered population.

As I said, some of the institutions have dedicated mental health units and in the community there are also mental health teams that work with the mentally disordered offenders who have been released on supervision, and that's also new.

I can't remember what else you asked me.

[Candice Bergen, Conservative, Portage—Lisgar, MB]

Yes, that's good.

I probably have only two and a half minutes left. I'm going to bring it back to the issue of drugs and alcohol in prison, specifically inmates who are dealing with a mental illness.

What we need to understand is that there is a very different atmosphere in prisons as compared to where people are dealing with mental illness on the outside. Can you describe for us what the atmosphere is like in a prison? I believe it is inherently a dangerous atmosphere. Correct me if I'm wrong, but I would think most inmates, on average, wouldn't feel safe. They would probably feel they have to be on guard all the time.

For inmates who are dealing with mental illness, knowing that there are drugs—and you talked a bit about muscling—can you link it and describe for us the difference between trying to deal with a mental illness and maybe an addiction on the outside versus in the prison atmosphere and why that has to be dealt with in a different way and why legislators have to view it differently from the way we might for someone dealing with the same thing on the outside?

[Dr. Jan Looman]

As I said, the prison population is a very stressful place. There is a lot of risk for violence. Although most offenders aren't imminently violent, there is a risk for violence.

The institutions, because there are a bunch of men in the same place, tend to be controlled by the stronger, tougher guys, and gangs are in control of a lot of the institutions. The drug trade is a big part of that.

A lot of people actually develop substance abuse problems when they come into the prison as a way of coping with the stress. It's a way of sort of blocking out the environment they're dealing with and trying to deal with the stress. Before they came into prison they might have used pot or whatever, but when they come into prison, because of the stress, they move from pot to harder drugs as a way of coping.

In the community, people with mental illness can isolate themselves and remove themselves from the stress of dealing with people. If I don't want to leave my house, I don't need to. So if I have a mental illness and I find it difficult to function in the real world, I can isolate myself in my house. But in prison you don't have that luxury. You can try to isolate yourself in your cell, but you're still in that environment and it's very noisy and you have to go out to eat, so you're to some extent forced to go out into the prison environment. If you want medical care, you need to leave your cell to get it.

[Candice Bergen, Conservative, Portage—Lisgar, MB]

I'll just quickly ask you this. Would we be correct, then, as a committee, in recognizing the value of a zero tolerance policy towards drugs in prison because it would help those who are mentally ill? Again it's ideal, but if they knew there were very limited drugs and all of the negative activity that comes along with drugs in prisons.... I'm assuming you would support a zero tolerance policy in these penitentiaries.

[Dr. Jan Looman]

Yes, there is no question that it would improve the environment. I don't think it would solve all the problems, because you still have a bunch of anti-social guys living together, so it's going to be a stressful environment even without drugs. But it would certainly help.

[Candice Bergen, Conservative, Portage—Lisgar, MB]

Thank you.

[The Chair, Conservative, Kevin Sorenson]

Thank you very much, Mr. Looman.

We'll now go to Madame Morin.

There is one other thing I should maybe mention. I have asked Mr. Looman if he has a little extra time beyond just the one hour. I know we find this fascinating. He has complied and said he could stay a little longer, so I'm hoping that everyone who has questions will have ample opportunity to ask them. As I said, we had guests who weren't able to appear for our second hour.

Ms. Morin, you have five minutes.

[Marie-Claude Morin, NDP, Saint-Hyacinthe—Bagot, QC]

Thank you, Mr. Chair. First of all, I want to advise you that I will give the last minute of my time to Mr. Sandhu. I will share my time with him.

I would like to thank you. I found your testimony very interesting. Mental health is often neglected in our society. It is not always easy to understand it.

I have a few questions for you. First, I know that it would be important to treat people with mental health issues in prisons differently, given the repercussions on these people.

With regard to substance addiction, are there any programs or treatments specifically for these types of issues? Are these people treated the same way as so-called normal people in penitentiaries?

[Dr. Jan Looman]

The mainstream substance abuse program is designed for so-called normally functioning offenders. At the treatment centre we've adapted that program so that it can accommodate the mentally disordered population. It's still the national substance abuse program, which isn't designed to address mental illness. It's designed to address substance abuse. That's why I was saying that we are going to implement a program that's designed specifically to address the concurrent disorders. We're just researching that right now. We're hoping to get it going early in the new year.

[Marie-Claude Morin, NDP, Saint-Hyacinthe—Bagot, QC]

We know that people with mental health issues, be it schizophrenia, bipolar disease or anxiety issues, have an acute need for medication. Some of them take lithium and others take citalopram. I know that these medications could probably also be used as drugs.

However, since these people need the medication, how do you manage this problem within a prison? How do you ensure that an inmate has the medication he needs? How do you manage that situation?

[Dr. Jan Looman]

That's actually a fairly substantial problem. In a mainstream institution some of the prescribed drugs that are also drugs of abuse are handed out. There's a process. A lot of medication the guys get—we call them cards—are bubble packs. They're sort of like how you get a lot of gum in bubble packs. They get these cards of medication that they take to their cell. They are supposed to take it as prescribed.

Some of the medication that is more prone to abuse is handed out. The guy has to go to the health care centre in the institution and he is handed the pill. The nurse watches him taking the pill. We call that direct-observed therapy, or DOT. A lot of drugs that are prone to abuse are delivered on a DOT basis, as opposed to in the cards.

On the muscling I was talking about earlier, if people know that a certain offender is getting one of these medications, they might try to intimidate the guy into tonguing it. He would pretend to swallow it, but he doesn't actually swallow it. Then he goes away and spits it out, and he's forced to give it up to the guy who's muscling him. That does happen in mainstream institutions. One of the consequences of that is the guy isn't getting the medication he needs. So he tends to decompensate and he ends up having to come to the treatment centre, or whatever.

There are problems with that sort of thing in the mainstream institutions. They try to minimize it as much as possible. If I know that Joe is getting muscled for his medication, I might tell the nurse that Joe is getting muscled, so the nurse is more careful about the way she dispenses the medication to that guy. They might crush it and put it in applesauce or something like that so he can't spit it out. There are ways to get around those sorts of things. It does tend to be a problem.

In the treatment centre, because we have more direct observation of the offenders and we have more control over the medications and how medications are administered, practically everybody in the building is on DOT. We don't use cards. That problem is minimized.

[The Chair, Conservative, Kevin Sorenson]

All right. We'll come back to you. You'll get a whole subsequent different question here.

We'll go to Mr. Leef for five minutes.

[Ryan Leef, Conservative, Yukon, YT]

Thank you, Mr. Chair.

And thank you to Mr. Looman for coming.

I'll be going back to the discussion we were having about the environment and the creation of that environment, bigger group rooms, bigger interview rooms, and the related impact that limited space has on the time people get with offenders, as you said, and directly related to staff not being present because of the security needs and not being able to leave them alone, move on, which shortens that length of time.

You did mention that new buildings would be the reasonable solution. I think that is what you said. When you're talking about that, we recognize there is some need for an institutional setting and wanting to protect society. We talk about keeping drugs and alcohol out of the prisons, to tie this directly to what we're studying. But would you say that investment in newer, bigger, cleaner correctional centres or prisons—just by virtue of these new open-space concepts and the technology we have—also would help limit or help enhance the limiting of drugs and alcohol access in the prisons, which would then further your efforts?

[Dr. Jan Looman]

Are you asking if I think providing new buildings would help with controlling drugs?

[Ryan Leef, Conservative, Yukon, YT]

Yes--based on the design and the technological advancements that come with those nowadays.

[Dr. Jan Looman]

I don't know. That's not something I've ever thought of.

I think people are clever, and if they want to get drugs in, they'll get drugs in. I'm not sure giving us a new building would do that. I don't have the expertise to answer that question.

[Ryan Leef, Conservative, Yukon, YT]

From your experience, what would be the advantages of having new spaces to work with?

[Dr. Jan Looman]

You would have an environment that's conducive to delivering treatment. That's what I was talking about.

Right now at the treatment centre in Kingston, if we're trying to deliver a program, we don't have any place on the living units where we can deliver that program. We have to take people off the living units into another area to deliver the program. As soon as you have to do that, there are costs for security and costs for other space. You have limited security officers, and you're drawing a security officer from one place to another place to supervise the program. He's only there for a limited time, so you're limiting the amount of time when you have access to the offenders for treatment. When you're taking an officer from one place to another, whatever was going on in the place he was coming from is limited, so it has impacts on the whole institution when you don't have spaces on the unit where you can deliver the programs.

[Ryan Leef, Conservative, Yukon, YT]

Have you ever had any of your programs or opportunities to meet with offenders interrupted because of operational requirements, searches, and things that are taking precedence?

[Dr. Jan Looman]

Yes.

[Ryan Leef, Conservative, Yukon, YT]

It would stand to reason then if there were some additional investment, let's say—and I know this is perhaps outside your area of expertise in terms of commenting on the specific technology that's required—if we had improved technology, and we had improved systems of drug detection, which becomes a daily operational requirement of the front-line staff, if that technology were improved, thus reducing the absolute dependency on what I would see as very slow and methodical physical searches of things, then that would actually start to enhance the opportunity and time inmates would have in program and one-on-one with you.

[Dr. Jan Looman]

Sure.

[Ryan Leef, Conservative, Yukon, YT]

We've heard some testimony about the front-line officers saying they feel they're as much a part of a program as anybody else. They're with them 24/7 and have the ability to interact with positive behavioural change.

Do the officers involved have much opportunity or training to be involved in any of the mental disorder issues that do combine with substance abuse? I know some of the officers we heard took some substance abuse familiarity training, but are they receiving the same thing with the combination of mental illness and substance abuse?