1. The Canadian Correctional Public Health Program Prison Health Expert Group Sixth Meeting Oslo, Norway September 30, 2008

2. 2 The Correctional Service of Canada (CSC) CSC is an agency within the Government of Canada’s Public Safety Portfolio, which also includes: Royal Canadian Mounted Police Canada Border Services Agency Canadian Security Intelligence Service National Parole Board CSC contributes to public safety by administering court-imposed sentences for offenders sentenced to two years or more by: Providing programs/interventions to prepare offenders for safe release back into communities Supervising offenders conditionally released into communities

3. 3 CSC Context 58 Institutions, 16 community correctional centres, 71 parole offices and 4 Healing Lodges All have health units except for community corrections centres (urban settings) 5 regional mental health treatment centres Approx. 13,200 incarcerated offenders Approx. 19% are Aboriginal Approx. 8,000 offenders in the community (Source: Report on Plans and Priorities 2008-09) Staff complement of approx. 16,000 employees – over 800 of which are nurses A budget of $1.9B

4. 4 Changing Offender Profile Over the last 10 years, upon admission, an increasing number of offenders have Extensive histories of violence and violent crimes Previous youth and adult convictions Affiliations with gangs and organized crime Serious substance abuse histories and problems First Nation, Métis and Inuit ancestries Serious mental health disorders

5. 5 Health Care of Inmates CSC is required to provide every inmate with: (a) essential health care; and (b) reasonable access to non-essential mental health care that will contribute to the inmate’s rehabilitation and successful reintegration into the community. (Section 85, Corrections and Conditional Release Act)

6. 6 CSC Health Services Vision: Improved offender health that contributes to the safety of Canadians. Mission: We provide offenders with efficient, effective health services that: Encourage individual responsibility; Promote health reintegration; and Contribute to safe communities.

7. 7 CSC’s Health Services Five Priorities: Improve the quality and consistency of essential health service delivery. Inform decision-making by collecting and analyzing key health information. Improve capacity to address the health needs of Aboriginal offenders, women offenders and offenders with mental health disorders. Build a sustainable Health Services’ workforce in a healthy workplace. Strengthen management practices with a focus on accountability, efficiency and effectiveness.

8. 8 Health Services Structure INSTITUTIONAL HEALTH UNITS REGIONAL DIRECTOR, HS PACIFICPRAIRIESONTARIOQUEBECATLANTIC NHQ STAFF AND REGIONAL HEALTH STAFF DG MENTAL HEALTH DG CLINICAL SERVICES DG POLICY PLANNING, QI DG PUBLIC HEALTH AC HEALTH SERVICES NHQ STAFF AND REGIONAL HEALTH STAFF REGIONAL DIRECTOR, HS

9. 9 CSC’s Mental Health Strategy Mental health services in institutions ($16M / year) Mental health services to prepare for release and in the community ($30M / 5 years)

10. 10 Elements of the Mental Health Strategy Mental health screening and assessment at admission Primary mental health care Intermediate mental health care Mental Health Treatment Centres (one in each Region) Mental health support in the community Provision of mental health training to both mental health professionals and correctional staff

11. 11 CSC’s Public Health Program Contributes to public health and a safe and healthy correctional environment through: Epidemiology and Surveillance Screening and Testing Prevention and Control Care, Treatment and Support Health Education Total budget (salary and operating) for 2008-09 - $16M Collaboration and cooperation with the Public Health Agency of Canada (PHAC) and community-based service organizations

12. 12 Epidemiology and Surveillance Information collected on: Numbers tested (HIV, viral Hepatitis, STIs, TB) Numbers on treatment Risk factors Periodic surveillance reports and infectious diseases newsletters provided to corrections staff, corrections stakeholders, and public health officials. An Inmate Risk Behaviours Survey in 2007 Results will help inform public health policy and programming

13. 13 Screening and Testing All inmates at admission are offered testing for infectious diseases and TB immunization against Hepatitis A and B All testing is voluntary and available to inmates throughout their incarceration

14. 14 Prevention and Control CSC policy requires that harm reduction measures be discreetly available in institutions: Condoms Dental dams Lubricant Policy also requires bleach and instructions on how to clean needles be offered Other infection control measures include: Infection Control Manual Promotion of effective hand hygiene by staff and inmates. Guidelines for the Management of Antibiotic Resistant Organisms. Commissioner's Directive 821.1 - Managing Exposure to Blood and Body Fluids. Staff and inmate national training package on the Cleaning Blood and/or Other Body Fluids.

15. 15 Care, Treatment and Support Methadone is universally available Treatment for HIV and other infectious diseases is provided through medical specialists from the community Continuity of care through Discharge Planning Guidelines and Regional Discharge Planners Strategies to better address the public health needs of “vulnerable populations” – women, Aboriginals – are being developed.

16. 16 Health Education On admission Reception Awareness Program is offered to all Ensures inmates have information on how to avoid infection and/or its transmission Covers available treatment and support services, including substance abuse programs During sentence Health education sessions – (National HIV/AIDS Peer Education and Counselling Program) Circle of Knowledge Keepers, Chee Mamuk – Aboriginal Peer Education Counselling Program Special Initiatives Program (inmate-developed programs)

17. 17 Prevalence of HIV and Hepatitis C (HCV) Rate of HIV/AIDS is 7 to 10 times higher in the inmate population than the general Canadian population. At year-end 2006, 1.64% (218) inmates in CSC institutions were known to be HIV-positive. Rate of HCV is 30 times higher in the inmate population than the general Canadian population. At year-end 2006, 27.6% (3661) inmates were known to be infected with HCV.

18. 18 For more information … Ann Marie Hume Director General, Public Health Correctional Service of Canada 340 Laurier Avenue West Ottawa, Ontario K1A 0P9 (613) 992-8792 humeam@csc-scc.gc.ca