Prisons Overwhelmed by Mental Illness: Watchdog

TheTyee.com – News – Ombudsman Howard Sapers speaks Monday in Vancouver on alternatives to incarceration.
22 Feb 2014.   By Kristian Secher

Howard Sapers has spent the last 10 years probing Canada’s federal prison system, calling out malpractice and gaps in service and documenting them in more than dozen reports.

As the Correctional Investigator of Canada (currently in his third term), it’s his job to advocate for the rights of those inside the system. His most recent reports have slammed Correctional Service of Canada (CSC) for its lax approach to caring for elderly and chronically ill inmates, a growing segment of the prison population.

He’s also been highly critical of the impact of Tory crime legislation on issues of overcrowding in prisons — in particular the criminalization of mental illness.

On Monday, Feb. 24, he will be speaking at a free event in Vancouver hosted by Simon Fraser University about mental health and addiction amongst Canada’s federal offenders. The Tyee caught up with him ahead of time to get his perspective on the problems associated with treating mental illnesses in prison and alternatives to incarceration.

What’s the state of mental health in Canadian prisons today?

“We’ve seen a big increase in the number of men and women being sent to federal penitentiaries with a mental health issue and many of them end up with diagnosed mental illnesses such as schizophrenia.

“The screening and assessment has gotten much better in recent years and there is now a computerized process in place that tabulates and scores peoples’ answers and provides an assessment of their mental health.

“This has resulted in about a third of all admission into federal custody being referred for some kind of follow-up, and last year almost 50 per cent of offenders received at least one mental health service.

“But really all this does is underline the extent of the need of mental health services and again really leads to questions around if CSC has the capacity to meet that kind of demand.

“Just think about those two statistics together: a third require some kind of follow-up check and half of all inmates receive at least one kind of service — you just know what kind of pressure the system is under to provide mental health interventions.

“This growth in the numbers has increased the demands for mental health services and has really stretched the capacity of the Correctional Service of Canada.”

Why is it so hard to keep up?

“One of the biggest challenges the correctional service has is in the recruitment and retention of qualified mental health professionals. They have a particularly hard time hiring psychologists, psychiatric social workers and nurses.

“In fact, many of the psychology positions are currently filled with individuals who do not have the qualifications to be licensed psychologists and this really has a very negative impact on the treatment that offenders with mental health issues have in federal penitentiaries.

“Working in a prison environment is unique and many health care professionals would choose to work in a community before they would choose to work in a prison. The pay scales are often not as attractive in federal corrections as they are in other areas. There’s also the scope of practice and interprovincial licensing. CSC is a national organization and the positions are national but every province has its own licensing body for psychologists, registered nurses and physicians, which leads to some interesting situations where people may be licensed for Saskatchewan but the job that they’re being hired for is in Ontario, and then there may be issues with them getting a licence to another province.

“So there’s lots of hurdles for the correctional service to clear and in combination they all result in the difficulties with recruitment and retention.

“Then there’s also the conflict with providing health care in a predominantly security driven environment which means that responses in prison hospitals are very security focused.

“While it doesn’t necessarily mean treatment is withheld, it does present barriers to treatment. So what we’ll see is people who self-harm often being met with an emergency response team that involve the use of restraints, pepper spray and the use of segregation — so regardless of the extent of illness the patients continue to be treated more like inmates.

“Another problem is that prescription drugs quickly become contraband items inside a penitentiary. There’s a whole range of psychotropic medicines which are not considered appropriate in a prison setting. So even in terms of treating someone who is diagnosed there can be limitations on the kinds of medication that can be used.

“Of course there’s also the issue of how receptive offenders are to treatment because treatment is dependent upon consent, and here there are issues as well.”

One example of failure on the system’s behalf is the case of Ashley Smith. Why was her mental illness not spotted by the system?

“Well, Ashley Smith was incarcerated in 2006 and that meant she wasn’t screened by the new computerized process because it was not fully in place by then.

“But Ashley Smith was very unique. She was originally sentenced and incarcerated as a young offender but on her 18th birthday the province of New Brunswick applied to have her treated as an adult.

“That resulted in her being transferred to the federal system and when she came into the federal system she was immediately put into segregation status. She never got the benefit of a full mental health assessment and a mental health plan — partly because she was uncooperative on many occasions and partly because the system simply moved her around too much. So there were many, many failings of the system in how they dealt with Ashley Smith and how they failed to adjust their response to her behaviour.

“There were things about Ashley that made her very unique but sadly her treatment in the federal system was not unique: the overuse of incarceration, the security-focused response to self-harm, the lack of capacity in terms of mental health assessment — those things are not unique and those were the aspects of her circumstances that we investigated and made recommendations on.”

What steps have the government taken to meet these recommendations?

“We have not yet received a response to these recommendations.

“In fact, I just this morning received correspondence from the commissioner of corrections telling me to essentially be patient that the responsible recommendation is forthcoming.

“Two things we recommended was that CSC should place more people with significant mental illness into hospitals instead of sending them to prisons. If people are profoundly ill they need to be in a health-focused environment. Secondly, we recommended that a position of a patient advocate be created much as you would have it in a community hospital to ensure that the individuals are getting the services that they require. This is an experience that has served well in the community.

“I’m hoping it’s taking CSC so long because we’re going to see a very thoughtful integrated response that will take into account not only the investigative work from my office but also the recent recommendation from the Ontario coroner’s inquest on Ashley Smith.”

That’s your hope. What do you expect?

“Well let me say that my hope and expectations are aligned at this point. I’m always optimistic.”

Another issue you have covered is aboriginal offenders. How is the CSC handling them?

“We know that almost one in four men and women serving a federal sentence is of aboriginal ancestry. The number of aboriginal women serving federal sentences has grown by 90 per cent in the last decade and we know they are more likely to self-harm and more of them are being held proportionally in maximum security.

“For aboriginal men we know that they’re often considered to be higher risk for release and that they spend longer time in higher security even when serving similar sentences for similar crimes than non-aboriginal offenders.

“The question has to do with recognizing and applying our understanding of what it is that brought these men and women into conflict with the law. There are cultural issues, there are historical issues, and there are sociological issues and it’s very hard to address those in a prison setting — but that’s the reality.

“Imprisonment is a very blunt instrument, and when you’re dealing with complex needs of individuals, a blunt instrument sometimes is just the wrong instrument.”

Have you looked at how Canada stacks up against other nations?

“Canada has a good international representation but I think that part of this representation is at risk as we rely more and more on incarceration and fall further behind in terms of meeting the needs of those people that we incarcerate.

“I meet frequently with corrections officials from around the world and I can tell you that dealing with the mentally ill in conflict with the law is a shared concern and so is the overrepresentation of indigenous people in prisons.

“It’s important to remember that corrections is very complex business and CSC is a big organization. It employs about 20,000 people and incarcerates over 15,000 daily on an average count.

“There’s another 8,000 or 9,000 being supervised under parole so we’re dealing with over 20,000 men and women in the care custody of the service.

“There are 53 custody sites across the country so this is a big dispersed organization where there are literally thousands and thousands of interactions every day between the people that work for CSC and the people that are under their care and custody and the vast majority of those interactions result in good outcomes.

“But my office deals with the problems. When there are conflicts and when things don’t go well, and we’re busy.

“There are a lot of problems but I think that it’s also important to recognize that we don’t hear about any of the successes really and you have to keep in mind that CSC is considered to be one of the best correctional services in the world.

“But CSC has to work hard to maintain that reputation — because it is at risk.”

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