Rights Watch 2011 Conference Ivan Zinger, J.D., Ph.D. Executive Director and General Counsel Office of the Correctional Investigator October 21-22, 2011

Presentation Outline 1.The Office of the Correctional Investigator 2.Delivery of Heath Care in Canadian Federal Corrections 3.Prevalence of Mental Health Concerns 4.Offenders with Mental Health Concerns 5.Key Challenges 6.Concluding Remarks 2

The Office of the Correctional Investigator (OCI): Role and Mandate The Office of the Correctional Investigator (OCI) acts as an Ombudsman for offenders serving a sentence of two years or more. –Independent monitoring and oversight of federal corrections. –Accessible and timely investigation of offender complaints. –Determines whether the Correctional Service of Canada (CSC) has acted fairly, reasonably and in compliance with law and policy. –Makes recommendations to enhance accountability in corrections. Established in 1973, the Office was formally entrenched in legislation in November 1992 with the enactment of the Corrections and Conditional Release Act. The Act gives the OCI broad authority and the responsibility to investigate offender complaints related to “decisions, recommendations, acts or omissions” of CSC. 3

OCI Operations The Office has 32 staff, the majority of which are directly involved in the day- to-day addressing of inmate complaints. On average, the Office receives 6,000 offender complaints annually. In , investigators spent 375 days in federal penitentiaries and interviewed 2100 offenders. The Office received over 20,000 contacts on its toll- free number and conducted over 1,200 use of force reviews. 4 AREAS OF CONCERN MOST FREQUENTLY IDENTIFIED BY OFFENDERS ( )

CSC Obligations to Provide Physical Health and Mental Health Care Pursuant to s. 86 of the CCRA, CSC “…shall provide every inmate with essential health care and reasonable access to non-essential mental health care that will contribute to the inmate’s rehabilitation and successful reintegration into the community.” CSC is further obligated to consider an offender’s state of health and health care needs in all decisions, including placement, transfer, segregation, discipline and community release and supervision (s. 87, CCRA). 5

Prevalence of Mental Health Concerns Proportion of federal offenders with significant, identified mental health needs has more than doubled between 1997 and According to an evaluation of the CSC Computerized Mental Health Intake Screening System (ComHISS), implemented in FY 2009/10, 36% of offenders had a significant mental health diagnosis at admission requiring some level of psychological or psychiatric services. In 2009, the prevalence rate of mental health concerns the Pacific Region for women offenders was estimated at 70%. Incidents of serious self-harming behaviour in federal prisons (e.g. head banging, slashing, use of ligatures, self-mutilation) are rising (doubling between 2006 and 2008); one in four women offenders has a history of self-harm. On average, federal inmates commit suicide annually. The rate of suicide in federal custody is approximately 7 times higher than the national average. 6

Offenders with Mental Health Concerns Offenders with a diagnosed mental disorder are typically afflicted by more than one disorder (90%), often substance abuse (80%). Offenders with mental health problems are more often: –Victims of violence, intimidation and bullying. –Placed in administrative segregation. –Classified at higher security levels. –Unable to complete correctional programs. –Released later in their sentences. Offenders with mental health issues may exhibit symptoms of their illness through disruptive behaviour, aggression, violence, self- mutilation, suicidal ideation, withdrawal and refusal/inability to follow prison rules and routines. Symptoms of mental illness are too often considered to be maladaptive “acting out” behaviours and frequently subject to security or use of force interventions, and disciplinary measures. 7

Mental Illness and Prisons Managing offenders with MH issues in prison creates professional and operational dilemmas related to conflicting priorities and objectives: –Security vs. treatment –Inmate vs. patient –Assistance vs. control –Prison vs. hospital Correctional staff are ill-equipped to recognize and deal with offenders with significant MH issues. Confidentiality/privacy concerns – sharing information between correctional staff and health care professionals. 8

9 Challenges for Federal Corrections System is facing serious capacity, accessibility, quality of care and service delivery challenges: –Limited capacity and resources to address growing MH needs. –Lack of bed space at CSC regional psychiatric facilities. –Lack of “intermediate” mental health care capacity. –Segregation too often remains only alternative to house offenders with acute mental health symptoms or who self- harm. –Aging and inappropriate infrastructure. –Recruitment and retention of mental health care professionals. –Training for front-line staff in recognizing and dealing with mentally disordered offenders. –Limited capacity to address chronic self-harm. –Relief for stressed and fatigued staff.

Concluding Remarks The federal Canadian offender profile can be used as a barometer to gauge the successes and failures of key Canadian public policies (Zinger, CJCCJ, in press), including: –Access to community mental health services – 36% of prisoners have serious mental health issues requiring psychological or psychiatric services (Wilton 2010). –Aboriginal self-governance – 17.9% of prisoners are of Aboriginal ancestry but they comprise less than 4% in the Canadian general population (Public Safety Canada 2010; Statistics Canada 2008). –Diversity in Canadian society – 7.9% of prisoners are black Canadians but they only represent 2.5% in the Canadian general population (Public Safety Canada 2010; Statistics Canada 2009). –National drug strategy – 75% of prisoners have a history of substance abuse at admission, and substance abuse was directly linked with prisoners’ index offences in 66% of cases (Correctional Service Canada 2010; Weekes, Moser, Ternes and Kunic 2009). 10

Concluding Remarks (Con’t) –Education – prisoners have on average a grade 8 education upon admission to penitentiaries (Correctional Service Canada 2010); –Harm reduction – 31% of prisoners have Hepatitis C and 4.6% have HIV/AIDS (Zakaria 2010). –Women in Canadian society – the number of women prisoners have increased by 40% in the last 10 years, and the Aboriginal women offender population has increased by 90% (Correctional Service Canada 2010); and 68% of women offenders have been sexual abused and 86% have been physically abused (McConnell and Taylor 2010). 11

The Proportion of Federally Incarcerated Aboriginal Offenders is Increasing 12 Source: CSC Corporate Reporting System, as of

The Proportion of Federally Incarcerated African Canadian Offenders is Increasing 13 Source: CSC Corporate Reporting System, as of

The Proportion of Federally Incarcerated Caucasian Offenders is Decreasing 14 Source: CSC Corporate Reporting System, as of

Concluding Remarks (Con’t) Canada’s needs a National Strategy for Corrections and Mental Health. Canada must explore alternative models for the delivery of health care to federal offenders. The development of alternative models should include public consultations. Addressing the high prevalence of mental health concerns in Corrections is not only a public health issue, but a human rights issue. 15

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