Good morning, and thank you, Sandy. It's a pleasure to be invited here today.
My name is Wayne Skinner, and I work in the addictions program at the Centre for Addiction and Mental Health. I'm deputy clinical director there.
My work over the last while actually has been in the area of concurrent disorders--co-occurring addiction and mental health problems. We've done some substantial work in that area. We've also done some work in terms of trying to work with our partners in the system to be more aware that to be working with either addiction or mental health clients is to very likely be working with people who have both sets of problems. Historically, neither of those systems has been well set up to deal with those services.
In the addictions program, we started with a few select concurrent disorder programs, and now we've actually moved to a broader approach whereby we're challenging ourselves to make all of our programs able to include and work with people because of their complexity. Historically, many people with complex problems were excluded from treatment because of the requirement that the other set of problems be either dormant or absent as a condition of entry.
The reality for many people with addiction and mental health issues is that they do have these complex issues. In fact, an axiom I have come to believe in, based on experience and the literature, is that when we're working with people with addiction and mental health problems, severity predicts complexity. Wherever we see people with severe problems, I think we should be challenging ourselves to be seeing what other issues are there. The logic, in my view, shouldn't be to be surprised; we should be challenging ourselves to prove that they're not there. The assumption should be that the complexity is there.
Certainly that means significant change in how we work in systems. When you think of the three axes of corrections, addictions, and mental health, there's a tidy assumption that people who go into those systems have a primary problem. That's how they get sorted in. And if the other issues are there, they're not significant. Actually, what we know from the real lives of people in these systems is that there is huge overlap. We work in addictions with people who have serious mental health issues, criminal justice involvement, and other social problems.
I'm very impressed with the report you issued in December 2010, in which you describe the problem in the correctional system very well. I think it creates a foundation for moving ahead to working on solutions. We don't need to bring the argument to this committee, I think, about the reality of these problems. It's a great opportunity, actually, to be able to sit with you and talk about where some of the solutions might be.
I have personally had the chance over my career to work with people at the Correctional Service of Canada. I've been involved in the National Summer Institution on Addictions that CCSA has co-sponsored in Prince Edward Island over the last decade on a bi-annual basis. One of the things I know is that some very good models of care and products, if you will, have been developed. Some of my colleagues at CAMH and in the addictions and mental health systems across the country have contributed to making really good treatment programs for women and men who are federal inmates. I think that represents an important resource in the criminal justice system for finding solutions for people.
I support the recommendation you make in your report that when we're looking at a policy and at systems approaches, we need to think of these things comprehensively. We need to think about the opportunity to do intervention with people who are in the criminal justice system. But there are also prevention opportunities with these individuals, because they're at risk of having other problems in their lives because of what they're dealing with already. We know about the higher suicide rate and the risks that go along with this population, for example. We know about the domestic violence and the like. To use Dr. Simpson's notion, there is an opportunity for intervention here that we are not making an optimal response to right now. Thinking about how to make better responses is really very important.
The other thing is that these approaches need to be oriented so there are phases to them. How do we identify the individual with these issues? What interventions do we have available to them? How do we support people as we ready them to return to communities, and when they are back into community life? We need to have that kind of phased approach to the work we do to be really successful doing it.
Those are the comments I want to make at this point. I'll stop here. I look forward to your questions.