Public Safety Committee on Dec. 8th, 2011

[The Chair, Conservative, Kevin Sorenson]

Good morning, everyone, and welcome.

This is meeting number eighteen of the Standing Committee on Public Safety and National Security, Thursday, December 8, 2011. Although committees can always change their minds and extend meetings, this may very well be the last day of our study on drugs and alcohol in prisons.

In our first hour we will hear from our final witness. In terms of our second hour, we had asked a number of witnesses but all were unable to attend. So in the second hour we'll go in camera and discuss a little bit on the draft report, and there will possibly be more we can do with that on Tuesday.

We have appearing before us, from Correctional Service of Canada, Jan Looman, clinical manager of the regional treatment centre at Kingston, Ontario. This committee very much appreciates the large amount of input we have received from the Correctional Service of Canada. Certainly in your position as clinical manager at the regional treatment centre, I know we will have questions for you after your opening comments.

Mr. Looman, we look forward to your opening comments, and then we will move into a couple of rounds of questioning.

[Dr. Jan Looman, Clinical Manager, Regional Treatment Centre, Kingston, Ontario, Correctional Service of Canada]

Good morning, Mr. Chair and members of the committee.

My name is Dr. Jan Looman. I have worked at the Correctional Service of Canada as a psychologist for 18 years, all of that time spent at the regional treatment centre in the Ontario region.

For most of my career I was the clinical director of the high-intensity sex offender treatment program. This provides treatment for the highest-risk sex offenders in the Ontario region, many of whom suffer from major mental disorders.

In the summer of 2010 I assumed the responsibilities of chief psychologist at the regional treatment centre, overseeing a department of 14 mental health professionals: two occupational therapists, two social workers, five psychologists, and five behavioural counsellors. As of this week, I'm now the clinical manager at the RTC, responsible for overseeing the clinical process at our facility.

Mr. Chair, I'm pleased to be here today to share my insight and experiences with you as you study the issue of drugs and alcohol in the federal correctional environment.

By way of background, the RTC in Ontario is a 148-bed psychiatric hospital located in Kingston. It provides mental health services to federally sentenced offenders in the Ontario region. It's a multi-level facility that admits offenders from institutions across the region for assessment, stabilization, and in some cases longer-term treatment.

The most frequent diagnosis for offenders admitted to the facility is schizophrenia and mood disorders, such as major depression. Anxiety disorders are also common diagnoses. Most of these offenders at the RTC also have concurrent substance abuse disorders. That I'm sure is not a surprise to you, as I know you have already heard that between 70% and 80% of offenders suffer from substance abuse problems.

From the perspective of providing treatment to mentally disordered offenders, a concurrent substance abuse problem certainly complicates the clinical presentation. Most mental disorders are made worse by substance abuse, and much substance abuse is motivated by the desire to self-medicate.

Furthermore, when offenders with concurrent disorders are abusing substances, it becomes even more likely they will suffer an acute episode of their illness. This is further complicated by interactions between psychotropic medications and illicit substances, which may lead to accidental overdose or the prescribed medication being rendered ineffective.

Mr. Chair, at the RTC as well as at other institutions in Canada, mentally disordered offenders have a difficult time functioning at the best of times. Penitentiaries are stressful environments that make it difficult for these offenders to find and maintain any degree of stability. In addition, mentally disordered offenders can be victimized by higher-functioning offenders, which increases their stress.

Unfortunately, it is often difficult for offenders with mental illnesses to be admitted to NSAP, the national substance abuse program. Because of their mental disorder, many of the men who need the program do not get the opportunity to participate. These are offenders who end up in segregation at the institutions, or whose functioning in the program is too disruptive to be maintained.

To this end, the RTC in Ontario has an NSAP program that is delivered in a modified format to those men who meet the referral criteria. In 2012 the psychology department will also be offering a program for men who present more challenging substance abuse programming requirements due to a concurrent mental illness.

Leaving aside the issue of concurrent disorders, substance abuse in the general population has other impacts on the delivery of treatment services. First and most obviously, men who are abusing substances are not able to participate meaningfully in treatment programs. Their impairment diminishes their ability to benefit from the programs, and they're also maintaining their anti-social behaviours by being involved in the drug subculture.

Furthermore, inside penitentiaries the drug subculture is often associated with gang activity and violence. This destabilizes institutions and makes it difficult for offenders to focus on self-improvement when they fear for their own safety. Drug activity often leads to muscling behaviour and the use of weaker offenders to hold or transport drugs. All of this negatively impacts the institutional environment and therefore diminishes the ability of offenders to benefit from programming.

Mr. Chair, in closing I would like to say that I appreciate the attention of this committee to the issue of drugs and alcohol in the federal correctional system. As I hope I have conveyed to you today, it is certainly challenging to treat offenders who present with concurrent mental health issues.

Thank you once again for the opportunity to appear before you today, and I will be pleased to answer any questions you may have for me.

[The Chair, Conservative, Kevin Sorenson]

All right, thank you very much. I may add that this is a little different. Your being here, Doctor, provides a little different perspective from what we've seen in the past. We do appreciate your attendance here with us this morning.

We'll move into the first round of questioning and we will go to Mr. Norlock, please, for seven minutes.

[Rick Norlock, Conservative, Northumberland—Quinte West, ON]

Thank you very much, Mr. Chair, and I thank our witness for attending today.

I can say that in a previous Parliament I had the privilege of visiting Kingston Penitentiary, and I did go to an area where persons were treated for mental illness, because that was the purpose of the study: looking into mental illness and other aspects of our prison system. We know that one of the reasons we have people in our facilities—federal facilities as well as provincial, I suspect—is because during the.... This is a western hemispheric phenomenon that we closed, and rightly so, some of the institutions where we warehoused people with mental illness. Of course some fell through the cracks and ended up in our prisons primarily because of that, and that leads me into the question of the self-medicated with drugs.

You're a doctor. Can I ask if you are a clinical psychologist or a psychiatrist?

[Dr. Jan Looman]

I'm a clinical psychologist.

[Rick Norlock, Conservative, Northumberland—Quinte West, ON]

Thank you.

I am going to say, at the risk of the ire perhaps on my side, that I found the treatment facility in Kingston, where people were being treated, akin to somewhat of a dungeon. It was constructed prior to Confederation. I think folks will find our government is working very hard at replacing some of those older institutions with more modern institutions where we can really treat people in institutions that are properly designed to take care of people with mental illness.

You may feel free to respond to my comment, rather than my question. Specifically, I wonder if a clinical psychologist could create an atmosphere in a federal penitentiary that was conducive to removing people or helping people help themselves get off the terrible drugs many of them are on, including alcohol. Could you describe for me how the presence of drugs in an institution can affect your ability to properly bring those people with a drug problem to a healthier lifestyle—in other words, get off drugs and alcohol? Don't be afraid to give me sort of the nirvana part of where you'd like us to go.

Also because you mentioned it, I'd like you to explain a little further this program you're going to bring in, in 2012. I know it's a broad subject, but feel free to hit on some of those.... I'm sure there will be other people asking you to expand on it.

[The Chair, Conservative, Kevin Sorenson]

Thank you, Mr. Norlock.

Mr. Looman.

[Dr. Jan Looman]

You touched on a number of things there.

First of all, the treatment centre is old and outdated. If I were to design the perfect treatment environment, it wouldn't look at all like the treatment centre does. It would be a modern building, purpose-built for providing treatment. There would be treatment rooms on the units. There would be a much less prison-like environment, a more hospital-like environment.

One of the advantages, though, of having a treatment centre separate from the mainstream institutions is that you have much better control of what goes on inside the building. When I was heading up the sex offender program, every year or so we'd have a couple of guys who would actually quit the program prematurely because they couldn't get access to drugs. So if you have a treatment centre where you've got a sort of isolated population, you've got much better control over those sorts of things. They're less able to transport drugs. Drugs are more easily detected and removed from the population. So having a separate environment in which to provide treatment is the ideal situation.

The concurrent disorders program I was talking about is a program that's designed to treat the mental illness at the same time as you treat the substance abuse problem. Substance abuse actually is a diagnosable mental disorder. It's not a behaviour problem. It's a psychiatric problem, so to speak. So treating the two concurrently is much more effective than treating them separately, because the problems interact with each other. People use substances because of their mental illness, and the mental illness is made worse by the substance abuse. So treating them together, you have a much more effective intervention.

[Rick Norlock, Conservative, Northumberland—Quinte West, ON]

Thank you.

Is that the sort of regime that you would use for 2012, the anticipated new program?

[Dr. Jan Looman]

Yes.

[Rick Norlock, Conservative, Northumberland—Quinte West, ON]

If you could—in layman's terms—in the two minutes that I—

[The Chair, Conservative, Kevin Sorenson]

You have a minute and a half.

[Rick Norlock, Conservative, Northumberland—Quinte West, ON]

In the minute and a half that we have left, could you just give us a quick bird's-eye view of how the program starts, who you target, and what the goals and the treatment methods are?

[Dr. Jan Looman]

Like I said, it would be men who have a mental disorder as well as a substance abuse problem. So we'd be targeting people with schizophrenia, major depression, anxiety disorders, as well as a substance abuse problem, and it could be drugs or alcohol.

The target is to help them manage both disorders once they have finished the program. So it would be addressing issues related to the mental illness: how they manage their symptoms, maintenance on medication, how to identify when they're moving from a stable to an acute phase of illness, and how to compensate for that and at the same time how to cope with urges to use substances, education about the negative effect that substance abuse has on their mental illness, and that rather than using substances they should use their prescribed medication, and use it as it's prescribed.

I lost track of my thinking, but it's sort of addressing the two issues together. The main focus would be on the interaction of the two problems; how they interact, how to identify when they're decompensating, and how to intervene in that for themselves.

[The Chair, Conservative, Kevin Sorenson]

Thank you very much, Doctor.

I should also make mention to the committee that with Dr. Looman's being here, he's really the first person we've heard from who is involved in a maximum security penitentiary as well.

Is that correct?

[Dr. Jan Looman]

Yes.

[The Chair, Conservative, Kevin Sorenson]

We've heard about medium and minimum security, and I think we should be aware of the fact that although his expertise is more on mental health, there may be questions in regard to maximum security.

We'll move over to the opposition side, and we'll go to Mr. Sandhu, please, for seven minutes.

[Jasbir Sandhu, NDP, Surrey North, BC]

Thank you, Mr. Chair.

Welcome, Dr. Looman.

Dr. Looman, I was actually perusing the papers just a couple of days ago, and I came across an article in The Globe and Mail. The headline was “Canada's prisons becoming warehouses for the mentally ill”. I want to mention a couple of things that were quoted by the Canadian Psychiatric Association. Basically, what they were saying is that prisons are becoming the institute of last resort for the mentally ill.

Also, the article talked about the CSC not being geared towards handling the vast population of the mentally ill who are in our prison systems. I would have to agree with Mr. Norlock when he pointed out—and this was also quoted in the paper by this psychiatric association spokesperson—that we live in a first-world country, yet the conditions in which the mentally ill are treated in the prison system are appalling.

Can you maybe talk about the relationship between mental illness and substance abuse, and how inadequate treatments are for the mentally ill housed in our prisons, and how it affects the severity of problems of drugs and alcohol in prisons?

[Dr. Jan Looman]

First, I think the statement that we're not geared toward mental illness and that the conditions are appalling is a bit of an over-generalization.

In the past ten years CSC has made quite a bit of movement in addressing the problem of the increased number of mentally disordered offenders who are coming in. We're trying to identify them early in their sentences. Some of the institutions have what we call intermediate mental health units, where mentally disordered offenders can be housed in a more protected environment away from the general population so that some of the stressors and difficulties they face in the general population are minimized.

At least two of the treatment centres—the one in the prairies and the one in the Pacific region—are modern, state-of-the-art psychiatric hospitals. So at least in some areas the conditions are far from appalling. At the same time, movement can still be made. I work in a building that was built in the 1860s, and it's probably not the ideal situation for a lot of mentally disordered offenders.

To address the substance abuse and mental health issues, we try to identify the offenders in the institutions who are having difficulty functioning. Quite often they end up in segregation. They end up in acute crisis because of the stressors they face in the general population. So we try to identify those people and either get them moved from wherever they are to one of the intermediate mental health units or into the treatment centre, where they can be restabilized and taken out of the stressful environment they're in.

A lot of the people who come to the treatment centres stay, because we've identified that they can't function in the mainstream institutions. They're too fragile, low-functioning, or whatever, to be maintained in that environment. When we bring them to the treatment centre we stabilize them and get them functioning at a level where they can be maintained. We keep them at the treatment centre for the duration of their sentence, or try to get them transferred to a less secure environment where they can function better.

[Jasbir Sandhu, NDP, Surrey North, BC]

Are there waiting times to get into treatment centres once somebody with a mental illness has been identified?

[Dr. Jan Looman]

I can only speak for ours; I'm not sure what happens in other regions.

If someone's in a crisis and needs to be brought in immediately, we are usually able to accommodate them, if not on the same day, then within a couple of days of their being identified. For people who are not in a crisis state, we can usually admit them within a couple of weeks. It depends on bed availability at the treatment centre.

[Jasbir Sandhu, NDP, Surrey North, BC]

On the treatment centres, would you say they're functioning under stress to only deal with crisis cases, or are there cases where once somebody has been identified with a mental illness they would get immediate treatment?

[Dr. Jan Looman]

You asked two questions that didn't really....

[Jasbir Sandhu, NDP, Surrey North, BC]

The first question is would it be too simplistic to say that the treatment centres only handle cases of severe distress?

[Dr. Jan Looman]

No. We have an acute unit, and if someone's in a crisis state we bring them to that unit and stabilize them. If we identify someone in an institution who is not in an acute state but is having difficulty functioning and would benefit from being taken out of that environment and put in a more structured and safe environment, we're able to bring that person to one of the other units and accommodate them in that way.